title: Health-promoting educational settings in Taiwan: development and evaluation of the Health-Promoting School Accreditation System.
abstract: BACKGROUND
  The Taiwan Ministry of Health and Welfare and Ministry of Education launched the Health-Promoting School (HPS) program in 2002. One of the most significant barriers to evaluating HPS is the absence of adequate instruments. The main aim of this study is to develop the Taiwan Health-Promoting School Accreditation System (HPSAS) framework and then evaluate its accreditation effectiveness.
  
  
  METHODS
  The HPSAS accreditation standards were derived mainly from the World Health Organization (WHO) publication, WHO Health Promoting Schools: A Framework for Action in 2008 and the Taiwan School Health Act. Delphi technique and pilot test were used to confirm the availability and acceptability of the standards and procedures for HPSAS in 2011. After that, two rounds of school evaluations were completed in 2012 (214 participant schools) and 2014 (182 participant schools). The accreditation operation process included documentary reviews, national and international accredited commissioners conducted on-site visits. Descriptive analyses were used to indicate HPS award level distribution.
  
  
  RESULTS
  The study established six key HPSAS standards. Each standard had at least two components; overall, there were 21 components and 47 scoring elements. Of the participating schools evaluated in 2012, four were at the gold, 14 silver, and 120 bronze levels, compared with five, 20, and 31, respectively, of schools evaluated in 2014. The study showed that schools at different award levels had different full-score rates in six standards. The schools at the gold level performed exceptionally well. The worst performance among the six standards at each award level was in the skill-based health curriculum.
  
  
  CONCLUSIONS
  The HPSAS is an objective instrument used to evaluate the process and outcomes of the HPS program. In the future, combinations of different types of data (e.g. students' health behaviors, school climate, or teachers' health-teaching innovations) will enable further validation of the HPS effectiveness.
authors.affiliation: Department of Public Health, Fu-Jen Catholic University, New Taipei City, Taiwan 026644@mail.fju.edu.tw.
authors.forename: Fu-Li
authors.initials: FL
authors.lastname: Chen
authors.affiliation: School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Albert
authors.initials: A
authors.lastname: Lee
mesh_terms: D000068:Accreditation; D006266:Health Education / Q000379:methods*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D015397:Program Evaluation; D012572:School Health Services / Q000458:organization & administration*; D012574:Schools / Q000458:organization & administration*; D013624:Taiwan; D014944:World Health Organization
keywords: Taiwan; evaluation; health promoting schools; health promotion