Abstract:
The health promoting school programme has been adopted in public schools across South Africa. However, there has been a dearth of research evaluating the implementation of these programmes in the local context. The original intention of this study was to evaluate the implementation of the programme in health promoting schools in the study area and develop a conceptual framework to improve programme implementation and evaluation of health promoting schools in South Africa. The study followed a pragmatist mixed methods approach, comprised of three phases. In Phase 1, an audit of health promoting schools (n=11) was conducted using an audit tool, and descriptive statistics were used to present the data. The findings showed that compliance to the programme was generally disappointing, with implementation fidelity being very poor. School processes such as leadership by the principal; support from staff, parents/community, and the school governing body; high priority for policy implementation; and clear and structured team responsibilities were found to facilitate implementation. The Kruskal-Wallis chi-square showed no evidence of significant differences in school performance (p=0.44). The tool was found to have a high internal consistency, with a Cronbach’s alpha coefficient of 0.805. Two key performance areas—leadership, management, and communication; and curriculum provision and resources—were excluded from the tool, which compromised content validity. In Phase 2, data were collected from key participants through individual interviews (n=20) with principals, educators, and school governing body members. In addition, a focus group was held with health promoters. A grounded theory was developed which showed that lack of guidance and accountability resulted in poor implementation. This was evidenced in the poor training of implementers; poor leadership and collaboration; weak accountability structures; and lack of resources and communication. A draft conceptual framework was developed using grounded data. During Phase 3, the Delphi technique was employed to gain the opinions of local and international experts to refine the framework. A five-point Likert scale with seven questions was sent to experts in a series of two rounds. Findings were collated and used to refine the framework. This study added to the knowledge gap regarding HPS implementation in South Africa. It was concluded that further studies are needed in order improve implementation processes and evaluation and develop standardized tools and indicators for local schools.
