From School to Community: Understanding the Broad Reach and Impact of the Comprehensive School Health Approach
Creators: Klassen, Danielle J.
Publisher: name: University of Alberta Library
Year: 2024

<p>Children’s health is influenced significantly by the settings where they live learn and play. Due to the influence of the social determinants of health, children’s health outcomes differ. Consequently, all children are not afforded equal opportunity to thrive physically, mentally, socially, spiritually, and emotionally. Schools are an increasingly desirable setting to address the health of children as the school environment is a setting that supports development and learning. Moreover, health and education are interrelated, and it has been shown that healthy students learn better. Comprehensive School Health (CSH) is an internationally recognized, evidence-based approach to promote health wholistically in schools. Implementation of CSH addresses the school culture and environment and works in each school community based on the strengths and needs of the school and surrounding context. The whole school approach of CSH relies heavily on the interconnection between the school, home, and community environments, which are highly influential to one another. There is a need to better understand what changes in environments entail and resulting impacts of this interconnection.<br>
To fully understand the school and community connection, this research was done in partnership with the CSH intervention, APPLE Schools (A Project Promoting healthy Living for Everyone in Schools). The purpose of this research was to understand if and how the CSH approach of APPLE Schools impacts school and community environments and if and how this multi-setting approach endures throughout adverse events. This qualitative research study addressed the following objectives: (1) to explore the influence of APPLE Schools on the school and community environments from the perspectives of school staff, (2) to understand if and how the intervention, APPLE Schools, has impacted the community environment, and (3) to understand if and how schools that take a CSH approach have sustained and adapted their efforts in the face of adversity.<br><br>
Objective 1 used a case study approach guided by focused ethnography. Data generation included walking interviews and field notes. School staff (n=22) from five schools in northern Alberta, Canada were interviewed as the school environment was toured. Thematic analysis occurred concurrently to data generation. Four themes were identified: 1) APPLE schools look different, 2) APPLE Schools build champions, 3) APPLE Schools builds community partnerships, and 4) APPLE Schools honours community culture. The results showed the ways in which school-based health promotion influences environments both within and beyond school walls.<br>
Objective 2 used an instrumental case study approach. This objective used focused ethnography as a guiding method and semi-structured interviews and document analysis as data generation strategies. Community partners (n=17) were recruited from one community in Alberta, Canada. Reflexive thematic analysis was used to analyze data. Findings were represented in a stepped approach: 1) Foundation: establishes a healthy school culture; 2) Action: tying the work of schools and communities together; and 3) Impact: changes in school practices ripple out to promote health in the community. From this research, it was shown CSH can have impacts on community practices in ways that support the health of children. <br>
Objective 3 used a qualitative descriptive method and semi-structured interviews and focus groups as data generation strategies. School staff (n=22) in health champions roles during the COVID-19 pandemic were recruited from Alberta, British Columbia, Manitoba, and the Northwest Territories. Content analysis was used to identify three themes that represent how schools promoted healthy school communities during the pandemic: 1) wellness was already a priority; 2) purposeful efforts to continue health promotion; and 3) recognition that (a culture of) wellness extends beyond the school. The foundations of CSH were evident throughout each theme.<br>
This thesis demonstrated school staff and community partners supported CSH efforts and has shown the influential nature of schools taking a CSH approach upon their surrounding communities. APPLE Schools changed practices and spaces in the school environment, which eventually led to health promoting impacts seen in community organizations outside of the schools. This highlights the importance of partnerships between schools, families, and community members. Further, embedded cultures of health and wellness were shown to endure upheavals in the school environment through committed, collaborative efforts of the school community. This indicates CSH as a potential pathway to resiliency of health promotion in schools. </p>