Écoles et pandémie : qu'avons-nous appris de la crise sanitaire ?

The COVID-19 pandemic led to unprecedented measures being taken to combat the spread of SARS-CoV-2. Due to its multiple social, educational, economic and health impacts, the almost universal closure of schools worldwide during the first lockdown was undoubtedly one of the most striking measures in the management of this pandemic. One year after the start of the COVID-19 pandemic, more than 800 million students, or more than half of the world's school population, are still facing major disruptions to their education, ranging from total school closures to reduced or part-time school hours. Drawing on the scientific data available, consideration of the varied responses proposed in different countries, and the experiences of professionals in the field worldwide, this article analyses the main issues involved in closing and reopening schools, from decision-making to practical implementation in the field. This approach allows us to draw out the first lessons from the crisis and to call for the emergence and sharing, well beyond the school environment, of an educational approach to health. On this basis, it is the production of relevant national frameworks for reflection and the empowerment of local actors that will make it possible to protect pupils, prevent the development of epidemics and maintain a quality educational process.

Déterminants de la participation des professionnels de l'éducation à la promotion de la santé en Nouvelle-Calédonie.

CONTEXT: Although there is strong evidence in the literature on the interest of the implementation of health policy and programs in schools, data on the determinants of the active participation of education professionals in health promotion programs remain scare. OBJECTIVE: Our study was conducted in 2018-2019 in New Caledonia, a South Pacific archipelago rich in cultural diversity but marked by major inequalities in health and education. It aimed to identify the factors that explain the involvement of teachers in an intersectoral health promotion program (development of a health education pathway led by an intersectoral team). It involved 40 schools, which corresponds to 20% of primary schools of the archipelago. RESULTS: Data show that of the 139 education professionals who were enrolled in the program by the education administration, 77 actively contributed. The work of these 60 teachers, 12 school principals and 5 district managers were studied in detail and categorized on the basis of the nature of their contribution. CONCLUSION: Analysis of the factors impacting active participation showed that two main parameters play a key role in teacher engagement: support and leadership at the school level. This work confirms, on the one hand, the stakes for primary schools to have local support in health promotion and, on the other hand, the need to strengthen the role of school principals in the field of health.

Implementation of health promotion programmes in schools: an approach to understand the influence of contextual factors on the process?

BACKGROUND: Implementing complex and multi-level public health programmes is challenging in school settings. Discrepancies between expected and actual programme outcomes are often reported. Such discrepancies are due to complex interactions between contextual factors. Contextual factors relate to the setting, the community, in which implementation occurs, the stakeholders involved, and the characteristics of the programme itself. This work uses realist evaluation to understand how contextual factors influence the implementation process, to result in variable programme outcomes. This study focuses on identifying contextual factors, pinpointing combinations of contextual factors, and understanding interactions and effects of such factors and combinations on programme outcomes on different levels of the implementation process. METHODS: Schools which had participated in a school-based health promotion programme between 2012 and 2015 were included. Two sets of qualitative data were collected: semi-structured interviews with school staff and programme coordinators; and written documents about the actions implemented in a selection of four schools. Quantitative data included 1553 questionnaires targeting pupils aged 8 to 11 in 14 schools to describe the different school contexts. RESULTS: The comparison between what was expected from the programme (programme theory) and the outcomes identified in the field data, showed that some of the mechanisms expected to support the implementation of the programme, did not operate as anticipated (e.g. inclusion of training, initiation by decision-maker). Key factors which influenced the implementation process included, amongst other factors, the mode of introduction of the programme, home/school relationship, leadership of the management team, and the level of delegated power. Five types of interactions between contextual factors were put forward: enabling, hindering, neutral, counterbalancing and moderating effects. Recurrent combinations of factors were identified. Implementation was more challenging in vulnerable schools where school climate was poor. CONCLUSION: A single programme cannot be suited or introduced in the same manner in every context. However, key recurrent combinations of contextual factors could contribute to the design of implementation patterns, which could provide guidelines and recommendation for grass-root programme implementation.

[Oral health inequalities: Determinants of access to prevention and care in France]. / Inégalités en santé orale : déterminants de l'accès à la prévention et aux soins en France.

INTRODUCTION: Oral diseases are unequally distributed according to a social gradient, which now constitutes a major public health problem. Acting against oral health inequalities requires a better understanding of the underlying mechanisms in order to identify the appropriate solutions to improve access to oral health promotion and dental care for deprived populations. METHODS: A patient-centered model of health care access, describing the ideal interactions between individuals and the health care system was applied to the field of oral health in the French context. This model defines access to health care as the result of interactions between individuals and the health care system, in which health needs are perceived, health care is sought, health care structures are accessed and effectively used. Analysis is based on quantitative and qualitative bibliographic data acquired through an explanatory sociological approach. RESULTS: Socially deprived populations face many barriers preventing their access to dental care: the need for dental care is not necessarily perceived, and, when perceived, dental care is not immediately sought, accessibility to dental care structures is difficult and dental attendance is erratic. CONCLUSION: This review provides information to decision-makers in order to support regional health policies and to help implement public health strategies according to the principle of proportionate universalism. Two axes for action were identified, namely to integrate oral health promotion interventions within health promotion programmes and to gradually reorganize the dental care system to make it more accessible to everyone.

The involvement of young people in school- and community-based noncommunicable disease prevention interventions: a scoping review of designs and outcomes.

BACKGROUND: Since stakeholders' active engagement is essential for public health strategies to be effective, this review is focused on intervention designs and outcomes of school- and community-based noncommunicable disease (NCD) prevention interventions involving children and young people. METHODS: The review process was based on the principles of scoping reviews. A systematic search was conducted in eight major databases in October 2015. Empirical studies published in English, French, Portuguese, and Spanish were considered. Five selection criteria were applied. Included in the review were (1) empirical studies describing (2) a health intervention focused on diet and/or physical activity, (3) based on children's and young people's involvement that included (4) a relationship between school and local community while (5) providing explicit information about the outcomes of the intervention. The search provided 3995 hits, of which 3253 were screened by title and abstract, leading to the full-text screening of 24 papers. Ultimately, 12 papers were included in the review. The included papers were analysed independently by at least two reviewers. RESULTS: Few relevant papers were identified because interventions are often either based on children's involvement or are multi-setting, but rarely both. Children were involved through participation in needs assessments, health committees and advocacy. School-community collaboration ranged from shared activities, to joint interventions with common goals and activities. Most often, collaboration was school-initiated. Most papers provided a limited description of the outcomes. Positive effects were identified at the organisational level (policy, action plans, and healthy environments), in adult stakeholders (empowerment, healthy eating) and in children (knowledge, social norms, critical thinking, and health behaviour). Limitations related to the search and analytical methods are discussed. CONCLUSION: There are very few published studies on the effectiveness of interventions based on children's involvement in school- and community-based NCD prevention programmes. However, interventions with these characteristics show potential benefits, and the merits of complex multi-setting approaches should be further explored through intervention-based studies assessing their effectiveness and identifying which components contribute to the observed outcomes.

Psychological distress and lifestyle of students: implications for health promotion.

Poor diet, physical inactivity, tobacco smoking and alcohol consumption are major risk factors for chronic disease and premature mortality. These behaviours are of concern among higher education students and may be linked to psychological distress which is problematic particularly for students on programmes with practicum components such as nursing and teaching. Understanding how risk behaviours aggregate and relate to psychological distress and coping among this population is important for health promotion. This research examined, via a comprehensive survey undergraduate nursing/midwifery and teacher education students' (n = 1557) lifestyle behaviour (Lifestyle Behaviour Questionnaire), self-reported psychological distress (General Health Questionnaire) and coping processes (Ways of Coping Questionnaire). The results showed that health- risk behaviours were common, including alcohol consumption (93.2%), unhealthy diet (26.3%), physical inactivity (26%), tobacco smoking (17%), cannabis use (11.6%) and high levels of stress (41.9%). Students tended to cluster into two groups: those with risk behaviours (n = 733) and those with positive health behaviours (n = 379). The group with risk behaviours had high psychological distress and used mostly passive coping strategies such as escape avoidance. The potential impact on student health and academic achievement is of concern and suggests the need for comprehensive health promotion programmes to tackle multiple behaviours. As these students are the nurses and teachers of the future, their risk behaviours, elevated psychological distress and poor coping also raise concerns regarding their roles as future health educators/promoters. Attention to promotion of health and well-being among this population is essential.

[SCHOOL HEALTH IN FRANCE]. / La santé des enfants en milieu scolaire en France.

On average, French children spend 18.5 years n schools. Improving the effectiveness of interventions in school setting aiming at promoting children's health and reducing health inequities is critical in public health. Evidence shows that a whole school approach, where there is coherence between the school's policies and practices that promote social inclusion and commitment to education, actually facilitates improved learning outcomes, increases emotional wellbeing and reduces health risk behaviours. Many factors govern the ways in which school health education is implemented and within these factors, staff commitment and partnership with local health professionals play a crucial role. The effectiveness of health promotion in schools is directly linked to the way in which school environment is supportive. There is a need to improve school organisation, ethos and environment as well as to invest in partnerships with local organisations and services especially the health professionals who are in charge of children's health.

[A health education program based on training and support of stakeholders in the field]. / Un dispositif d'éducation pour la santé fondé sur la formation et l'accompagnement des acteurs à l'échelle du territoire.

Education Santé Territoire (EST) is a health education programme for children and adolescents. It was developed on the basis of the international literature and the results of interventional studies conducted in France. It is based on local resources and develops a territorial approach centered on the school as the reference site of the "perceived territory" of children and adolescents. It therefore comprises a local environment approach (school and college) and a territorial approach, as it is centered on participation and is designed to mobilize local stakeholders involved in the education of young people. It concerns educational activities (in the schoolroom, in the institution, in the context of extracurricular activities, in leisure centres, in sports clubs); the school-community relationship; the quality of life of children and adolescents. The available results show major changes in practices and a wide range of modalities of participation. Factors that determine participation are essentially related to individual determinants (adhesion to the underlying values of the programme, compatibility of representations, perception of the relevance of the content) and contextual factors (numbers, school environment, social environment). Training and the history of involvement in the programme appear to be key elements determining participation.

[Community health: where do we stand after forty years?]. / Quarante ans après, où en est la santé communautaire ?

At the end of the 1970s, the term "community health" was hugely popular in the field of health and welfare in many countries throughout the world. Mainly inspired by American and Latin American sources, the concept was based on a participatory and multidisciplinary approach to preventive and curative health services. What is the current state of community health? The objective of this study was to examine the socio-historical development of community health over the last 40 years. The paper begins by presenting a conceptual framework defining community health and public health as two distinct domains in the field of health and welfare. The study found that depending on the setting, the historical period and the ability of actors to promote their views, the space occupied by the two domains and the relationships between them tend to vary, as shown by a comparative analysis between France and Québec from the 1970s to the 2010s. Based on the results of this study, the expression ?doing community health' appears to refer to a precise set of?practices based on certain approaches and methods implemented by actors in specific areas of intervention. Depending on the time and place, the actions and practices of the?concerned actors will determine the extent to which they are incorporated into the institutional context of public interventions.

Occupational Health of Education Personnel-The Role of Job Crafting and Other Control Strategies on Healthy Ageing at Work.

This article looks at the strategies that influence healthy ageing at work from the motivational theory of life span development (MTD). It aims to better understand the influence of job crafting as a selective primary control, help-seeking as a compensatory primary control, positive reappraisal as a selective secondary control, and downward social comparison and downgrading expectation as a compensatory secondary control on healthy ageing at work (work engagement, health, and motivation to continue working after retirement). A total of 386 educational personnel participated in the study. This study used hierarchical regression analysis to test incremental validity, supplemented with confirmatory factor analysis and structural equation modelling as a solution to solve the potential error problems caused. The results show that job crafting is positively correlated with healthy ageing at work. Positive reappraisal and downward social comparison showed incremental validity in predicting healthy ageing at work beyond job crafting among the middle-aged group (45-65-years-old); in particular, positive reappraisal was the determinant of healthy ageing at work among the middle-aged group. However, both help-seeking and downgrading expectation did not show incremental validity. This study can contribute to the evolution of career development interventions and human resource management focused on supporting older people at work.

Gender implications of the teaching of relationships and sexuality education for health-promoting schools.

Relationships and sexuality education (RSE) was introduced in Irish schools in 1995 to address pressures on young people specific to relationships and sexuality. RSE is part of a whole school health promotion project. Emphasis is put on personal and social development of students, cross-curricular dimensions, school ethos, school climate and partnership with families and community. However, RSE has become the preserve of female teachers with fewer male teachers attending in-service. This research explored the attitudes, beliefs and needs of male post-primary teachers with regard to RSE in their school. A qualitative design was employed utilizing focus groups. A total of 25 male post-primary teachers took part in five focus groups. Two of the groups consisted of men who had participated in RSE training; the other three groups were with men who had not. The analysis of the data suggested that there was reluctance on the part of male teachers to teach RSE, and that they feel under threat about their personal and professional identity. They felt under threat both from internal personal forces, in the form of mental models assimilated through personal history and upbringing, and from external organisational forces, communicated through the local school and wider social culture. The data indicate the need for professional development and support that is tailored specifically for male teachers. In order to support male teachers to become more involved in school health promotion and in the teaching of health curricula, pre-service education needs to prioritize key issues such as gender roles and identity.

Health promotion research has come of age! Structuring the field based on the practices of health promotion researchers.

Health promotion is mostly framed as a discourse and practices based on a set of values and principles that promote changes at various levels (individual, community and global). There is no well-defined knowledge base and no widely agreed knowledge development methods. During the past decades, health promotion knowledge has developed following a potluck model. Researchers from various disciplinary backgrounds attracted to the values and transformative vision of health promotion have used their disciplinary-based research methods and theories to conduct studies about the various practices that are associated with health promotion. Although health promotion research has acquired many attributes of a distinct field, researching practices from various disciplinary perspectives is not sufficient to create a coherent knowledge base for health promotion. We propose three dimensions to further structure health promotion research. The first relates to the object for which knowledge is produced. For health promotion research this relates to health social practices. The second dimension relates to the purpose and ethics of research. In the case of health promotion research it pursues the dual purpose of producing knowledge (epistemic aim) and contributing to social changes (transformative aim). The third dimension concerns the knowledge produced and the conditions for valid knowledge. In the case of health promotion research, the condition of knowledge production should include a recognition of the complexity of social practice and the necessary dialogue between scientific. True to health promotion principles, we propose a bottom-up process for structuring the field through the creation of a 'Global Handbook of Health Promotion Research' that would draw on the research practices of those involved in health promotion research.

The Impact of School Closure on Adolescents' Wellbeing, and Steps towards to a New Normal: The Need for an Assessment Tool Update?

Close to 200 countries have implemented school closures to decrease the spread of the COVID-19 coronavirus. Though the closures have seemed necessary, their effects on the wellbeing of children and adolescents have raised serious concerns. To truly understand the impact of such disruption on young people's wellbeing, and their views on how to move towards a new normal, we must adopt different approaches to gather the data to secure children's and adolescents' rights to be heard in the issues that concern their lives. Current ways to examine the impacts of school closure have been dominated by gathering information concerning the children and adolescents, using mainly existing wellbeing indicators and related questionnaire surveys. Although such sources of information are important, they provide limited understanding of how children and adolescents have experienced school closures, especially if they have been produced using measures developed purely by adults. There is a need for information produced by children and adolescents themselves, which may require going beyond existing and pre-COVID theoretical wellbeing frameworks. By capturing information produced by children and adolescents, we can more effectively guide the development and evaluation of public health policies and identify solutions to mitigate the negative impacts of school closure, or to acknowledge the possible positive effects, and respond accordingly.

Supporting every school to become a foundation for healthy lives.

As a setting where children and adolescents live and learn, linked to the family and embedded within the wider community, schools have an important influence on every student's health. Many health interventions have used schools as a platform, often for standalone programmatic initiatives to reduce health risks, and sometimes for more comprehensive approaches, but the interventions, uptake, and sustainability are generally disappointing. Evidence shows that, to improve health and to reduce inequality, all students must attend school from a young age and for as long as possible, and their educational success therein must be maximised. Thus, beyond educational benefits, schools are also important for health. Coherence between each school's policies, structures and systems, human resources, and practices is required to advance both academic and health outcomes. Beyond simply implementing ready-made programmes into schools, health professionals can position themselves as catalysts for structural change as they have many opportunities to advocate for, and participate in, the intersectoral implementation of reforms and innovations in school systems to promote the health of all students.

Practices and representations of health education among primary school teachers.

AIMS: School is one of the key settings for health education (HE). The objectives of this study are to assess primary school teachers' self-reported teaching practices in HE and to describe their representation concerning their role in HE. METHODS: A quantitative study was conducted on a sample of primary school teachers (n = 626) in two French regions in order to analyze their practices and representations in HE. A hierarchical clustering dendogram was performed on questions exploring representations of HE. Multiple linear regression analysis helped explain the motivation and self-perceived competency score. RESULTS: Three quarters of the teachers declare they work in HE. Only one third of them declare they work in a comprehensive HE perspective. The HE approach is often considered in terms of specific unique curriculum intervention. Two thirds of the teachers say they work alone in HE, the other third associate other partners and choose mainly school health services. Parents are rarely (12%) involved in HE initiatives. It is essentially the practice of HE, teacher training and teachers' representation of HE that condition their motivation to develop HE. CONCLUSIONS: Teachers can take different approaches to HE. Teachers' representation of HE plays an important role in the development of HE activities: some teachers consider that HE is the mission of the health professionals and the parents. Our expectations of teacher involvement should be realistic, should take into account the representations of their role, the difficulties they encounter, and should be sustained by specific training.

Evaluation of health promotion in schools: a realistic evaluation approach using mixed methods.

BACKGROUND: Schools are key settings for health promotion (HP) but the development of suitable approaches for evaluating HP in schools is still a major topic of discussion. This article presents a research protocol of a program developed to evaluate HP. After reviewing HP evaluation issues, the various possible approaches are analyzed and the importance of a realistic evaluation framework and a mixed methods (MM) design are demonstrated. METHODS/DESIGN: The design is based on a systemic approach to evaluation, taking into account the mechanisms, context and outcomes, as defined in realistic evaluation, adjusted to our own French context using an MM approach. The characteristics of the design are illustrated through the evaluation of a nationwide HP program in French primary schools designed to enhance children's social, emotional and physical health by improving teachers' HP practices and promoting a healthy school environment. An embedded MM design is used in which a qualitative data set plays a supportive, secondary role in a study based primarily on a different quantitative data set. The way the qualitative and quantitative approaches are combined through the entire evaluation framework is detailed. DISCUSSION: This study is a contribution towards the development of suitable approaches for evaluating HP programs in schools. The systemic approach of the evaluation carried out in this research is appropriate since it takes account of the limitations of traditional evaluation approaches and considers suggestions made by the HP research community.

School health promotion: organization of services and roles of health professionals in seven European countries.

BACKGROUND: This comparative study is intended to provide a better understanding of how health promotion services are organized in school settings in Europe and to show how health professionals involved outside or within the school setting help to improve young people's health. METHODS: This study was based on an analysis of school health policies and the organization of school health services, where these existed, as well as on interviews with health and education professionals. The countries concerned were Belgium (French-speaking community), Denmark, France, Spain (Catalonia), Switzerland (Jura), Poland and Portugal. RESULTS: Although the provision of health services for children and adolescents varied considerably, the health services available were very similar in each of the countries. The emphasis put on particular aspects of these services varied depending on the political and institutional culture in each country. Three different types of school health service provision were identified: community-based, school-based or health needs-focused. CONCLUSION: All countries had health education and health promotion services but the provision of these services varied considerably from country to country. They were provided either by a specific category of professionals (health personnel or teachers) or considered to be the responsibility of the educational community as a whole.

Factors influencing the contribution of staff to health education in schools.

Understanding the contribution of the whole-school staff to health education (HE) is an important goal in HE research. This study aimed to identify the views of staff (principals; teachers; school nurses and doctors; counsellors and administrative, maintenance, canteen and cleaning staff) regarding the nature of their contribution to HE. The research is based on 207 semi-structured interviews of staff in a sample of five French middle schools (grade 6-9). Content analysis was performed using Bardin's method. The results showed that staff members have different views of their role, three main roles were identified: (i) as an educator in everyday life issues (72%); (ii) individual support, listening (14%) and (iii) taking part in collective projects and facilitation (14%). Professional status has a significant influence on the view they have of their contribution to HE. These results show that in order to facilitate consistent implementation of HE, schools need to be supported to build HE policy (need analysis, definition of priorities and partnerships) and also to develop the means by which an inclusive and real sharing of common culture among all staff can happen; this is not limited to teaching staff but includes non-teaching staff also.

Enhancing the efficacy of health promotion interventions: A focus on the context.

•Health promotion programmes in various settings are effective means to improve the health of the population.•Despite substantial research, results from programme implementation remain unclear and challenging to evaluate.•A shift from 'one size fits all' evidence-based fidelity to anchoring and tailoring interventions to their contexts is needed.•Recurrences in combinations of contextual factors (namely Typical Contextual Equations) occur in a given type of context.•TCEs focus on a selection of the key critical factors that have drastic impact on implementation.