School-based approaches to mitigate child health inequities in Canada: The Health Promoting Schools approach and equity, diversity, inclusion, and accessibility school practices
Creators: Honorato, Camila
Publisher: name: University of Alberta Library
Year: 2024

<p>Childhood exposure to neighbourhood deprivation has been consistently associated with poor health behaviours, including unhealthy diets, sedentary behaviours, and poor mental health and wellbeing. These may result in health inequities that could present challenges to public health, especially in light of the COVID-19 pandemic, which has contributed to widening health inequities among children. Since children spend a substantial portion of their time in schools, these environments are ideal settings for health promotion. The Health Promoting Schools (HPS) approach has been recognized as the most effective and cost-effective school-based health intervention. However, implementing such interventions across Canada’s vast landscape is a complex task due to the lack of comprehensive guidance for supporting an increasingly ethno-cultural and gender-diverse student population. In this context, the integration of equity, diversity, inclusion, and accessibility (EDIA) principles into school culture is essential for successfully implementing the HPS approach in Canadian settings.<br>
This thesis aimed to develop standards and indicators for implementing and sustaining HPS in Canada and to examine the role of school practices that promote EDIA in mitigating child health inequities within deprived neighbourhoods of a province in Western Canada. The specific objectives of the thesis were to (1) perform a literature review to derive a comprehensive inventory of statements related to the implementation and sustainment of HPS,  (2) conduct a consensus seeking process to establish a set of standards and indicators for HPS that are specific to Canada, and (3) determine whether the implementation of EDIA school practices modify the effects of school neighbourhood deprivation on students’ healthy eating, physical activity, screen time, and mental health and wellbeing. <br>
The first and second objectives were addressed by a study involving a comprehensive review of the literature and a consensus-seeking process. The literature review yielded 147 statements related to HPS implementation and sustainment, which were grouped into 42 standard components and 105 indicators. These were then evaluated by two expert panels comprising 53 education and policy experts from across Canada. Through three rounds of the Delphi survey, consensus was reached on 100% of standard components and 81% of indicators, which were then mapped into nine standards for HPS.<br>
To address the third objective, I used cross-sectional data from 1,970 grade 4-6 students (aged 9-12 years) in 28 elementary schools participating in the APPLE Schools initiative in Alberta, Canada, during the Spring of 2023 and Spring of 2024. The study revealed that schools in more deprived neighbourhoods were more likely to have greater implementation of EDIA school practices. While these practices were not sufficient to mitigate the negative effects of neighbourhood deprivation, full implementation of EDIA appeared to be beneficial for students’ diet quality.<br><br>
This thesis provided some contributions for school health promotion in Canada. The developed set of HPS standards and indicators offers a guide for implementing and sustaining health promotion initiatives in Canadian schools, accounting for the country’s unique educational, demographic, and ethno-cultural contexts. This work aligns with global efforts to advance school health promotion, supporting an international agenda that recognizes education&#39;s role in creating healthier, more equitable societies. The methodological approach used can serve as a model for other jurisdictions seeking to establish or update context-specific HPS guidelines. Additionally, this thesis contributes to understanding the relationship among school neighbourhood deprivation, EDIA practices, and child health behaviours in Canada. Future research should focus on developing user-friendly tools to track HPS implementation, conducting longitudinal studies to evaluate the long-term impact of EDIA practices, and creating objective instruments for assessing EDIA implementation in schools. These efforts will help to inform policies and practices to mitigate health inequities among Canadian children, especially in deprived communities.</p>