Between knowledge, theory and practice: How Health-Promoting Schools “happened” in China

In this chapter, we examine the extent to which processes and factors we think are important are consistent with the processes and factors expressed in a successful effort to scale up the development of Health-Promoting Schools in Zhejiang Province, China. In doing so, we: (1) Review theoretical frameworks associated with the planning, implementation and success of school health programs, including the Health-Promoting School (HPS) framework put forth by the World Health Organization (WHO); Key Factors in Changing Policy and Practice, a framework developed by Cheryl Vince Whitman of Health and Human Development Programs at Education Development Center, Inc., Newton, Massachusetts, U.S.A. and a framework of success factors for health education programs from WHO’s publication, Skills for Health. (2) Present new research, based on grounded theory analyses, designed to discover and describe how Health-Promoting Schools “happened” in schools in Zhejiang Province, China. Qualitative data gathered in interviews with and written responses from school administrators, teachers, students, and parents are presented to illustrate key processes through which schools became Health-Promoting Schools, including processes to engage participants; promote conceptual understanding; plan, implement and evaluate overall program activities; conduct interventions at the classroom, school and community-levels; and overcome challenges. Self-reported changes in individual lives, including knowledge, attitudes and behaviours are also presented. (3) Identify and discuss consistencies and differences between the processes and factors cited in the theoretical frameworks and those found through the grounded theory analyses of the Zhejiang effort. (4) Conclude by suggesting how the findings of consistencies and differences can be useful to persons striving to strengthen theoretical frameworks and those striving to implement Health-Promoting Schools. This includes the identification of processes and factors cited in theoretical frameworks that are validated or supported by processes and factors discovered through the grounded theory analyses, and identification of processes and factors discovered through the grounded theory analyses that are not cited in the theoretical frameworks, and should be considered in the further development of theoretical frameworks.