Facilitating change in school health: a qualitative study of schools' experiences using the School Health Index.
BACKGROUND
As school-based efforts increase to address the epidemic of childhood obesity, a priority for health professionals and educators will be to identify effective tools appropriate for use in schools to help guide health promotion programs and policies. This article describes the results of a qualitative research study examining school staff and community members' experiences working with the Centers for Disease Control and Prevention's School Health Index, a self-assessment and planning tool that addresses nutrition and physical activity.


METHODS
In-depth interviews were carried out with faculty, staff, and community collaborators in nine public schools that were using the School Health Index to develop nutrition and physical activity initiatives for students. Interviews were conducted twice: once after a school had completed the School Health Index and once approximately 1 year later. Transcript data from interviews with 34 participants were analyzed using thematic analysis.


RESULTS
Findings indicated that school experiences differed markedly depending on whether they received help from an outside facilitator to work with the School Health Index. Unlike staff in schools working on their own, school staff working with outside facilitators described completing the School Health Index in a collaborative way, creating action plans, and working as a team to implement health promotion initiatives. In addition, the involvement of an outside facilitator supported schools in undertaking more complex tasks with a greater degree of collaboration across the school and local communities in order to achieve goals.


CONCLUSIONS
Outside facilitators may significantly enhance schools' efforts to work with the School Health Index and influence the organizational strategies they use to implement health promotion initiatives.
Division of Adolescent Medicine, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA. bryn.austin@childrens.harvard.edu
S Bryn
SB
Austin
Teresa
T
Fung
Adena
A
Cohen-Bearak
Kacey
K
Wardle
Lilian W Y
LW
Cheung
D002487:Centers for Disease Control and Prevention, U.S.; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D003159:Community-Institutional Relations; D005178:Faculty; D017408:Guidelines as Topic; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007407:Interviews as Topic; D009765:Obesity / Q000517:prevention & control; D010806:Physical Education and Training; D012572:School Health Services / Q000458:organization & administration*; D012574:Schools; D014481:United States