title: Providing context to the implementation of health promoting schools: A case study.
abstract: OBJECTIVE
  Issues related to program context are important components of population health interventions and particularly among complex, adaptive initiatives in schools. Health Promoting Schools (HPS) is a global approach to support early development of healthy behaviors among children and youth. The purpose of this study was to explicate the practical and contextual processes that influenced implementation of HPS in schools in Nova Scotia (Canada).
  
  
  METHODS
  Using a case-study approach, data was collected using interviews (n=14) with principals, teachers and parents, observations collected during school visits and document review in five diverse schools.
  
  
  RESULTS
  Case study schools reported a variety of HPS practices and three key themes emerged that provided context to the processes that facilitated their implementation. The results suggest that although school characteristics (theme 1), like staff allocation, physical location and resources, are important, these barriers can be mitigated by building organizational capacity (theme 2) and establishing a supportive school community culture (theme 3).
  
  
  CONCLUSIONS
  The study provided insight to the variability in implementation by describing how contextual barriers were experienced and mitigated by schools. Establishing a broad system to support HPS, with collaboration across health and education sectors, could help to progress adoption, implementation and sustainability of HPS.
authors: School of Health and Human Performance, Dalhousie University, 1318 Robie Street, PO BOX 15000, Halifax, NS, Canada B3H 4R2; School of Public Health, University of Alberta, 3-50 University Terrace, 8303, 112St, Edmonton, AB, Canada T6G 2T4. Electronic address: Jessie-Lee.McIsaac@dal.ca.
authors: Jessie-Lee D
authors: JL
authors: McIsaac
authors: School of Public Health, University of Alberta, 3-50 University Terrace, 8303, 112St, Edmonton, AB, Canada T6G 2T4. Electronic address: zmumtaz@ualberta.ca.
authors: Zubia
authors: Z
authors: Mumtaz
authors: School of Public Health, University of Alberta, 3-50 University Terrace, 8303, 112St, Edmonton, AB, Canada T6G 2T4. Electronic address: Paul.Veugelers@ualberta.ca.
authors: Paul J
authors: PJ
authors: Veugelers
authors: School of Health and Human Performance, Dalhousie University, 1318 Robie Street, PO BOX 15000, Halifax, NS, Canada B3H 4R2. Electronic address: Sara.Kirk@dal.ca.
authors: Sara F L
authors: SF
authors: Kirk
mesh_terms: D000293:Adolescent; D002648:Child; D002669:Child Welfare; D005260:Female; D006801:Humans; D008297:Male; D009674:Nova Scotia; D015397:Program Evaluation; D012572:School Health Services / Q000458:organization & administration*; D012574:Schools / Q000458:organization & administration; D013334:Students / Q000706:statistics & numerical data
keywords: Child and youth health; Health promotion; Program context; Program implementation; School health