A scoping review of instruments measuring the implementation of the Health-Promoting School approach

The Health-Promoting School (HPS) is a holistic approach that addresses not only the curriculum but also policies, the physical and social school environment, and the school's external environment. Given its complexity in implementation, evidence on effectiveness is mixed. Adequately measuring the implementation of the approach is therefore essential for research and practice. This paper presents the results of a scoping review of instruments that measure the implementation of the HPS approach at the school level. The review was conducted using databases (Scopus, Web of Science, and EBSCO Global Health) and a survey targeting experts and stakeholders in school health promotion to collect unpublished instruments. The instruments were analysed with respect to the HPS components and health topics addressed, and implementation indicators. In total, 28 instruments were retrieved. Heterogeneity in instrument length, recipients, data collection methods, theoretical orientations, and methodological quality in the development and validation was observed. In relation to the HPS model, 'Healthy school policies' was the most frequent component, while 'School Social Environment' was the least addressed. Implementation indicators (implementation outcomes and steps in the implementation process) were present but were mostly not grounded in theoretical frameworks. Among the health topics, 'nutrition' and 'physical activity' were most frequently addressed for students, while 'relationships' was most often found for school staff. For the first time, the study provides an overview of existing instruments to capture the implementation of different components/indicators of HPS. Its results offer room for consolidation and further development of this emerging field.