Lessons learnt from school-based health promotion projects in low- and middle-income countries

Background: Non-communicable diseases (NCD) are now the leading cause of death worldwide. As habits and lifestyle are established in childhood and adolescence, targeting school children before they develop unhealthy habits offers a window of opportunity to halt and reverse the emerging NCD epidemic. However, few experiences from school interventions in low- and middle-income countries have been collected. Therefore, the aim of this study was to review experiences of implementing school-based health promotion interventions to identify barriers and recommendations for future interventions. Methods: A qualitative investigation of 17 school-based health promotion interventions in low- and middle-income countries was conducted. Data were collected through questionnaires (15 project leaders) and in-depth interviews with nine project leaders. The data from the questionnaires and interviews was triangulated and analysed using content analysis, where themes and categories emerging from the material were explored. Results: Three key themes emerged from the data: 1) policy environment and stakeholder engagement, 2) health education sessions, and 3) practical health promotion activities. The themes explored the experiences and lessons learned from 17 school-based health promotion projects in low- and middle-income countries. Stakeholders at different administrative levels were important for the projects; however, stakeholders close to implementation were seen to be more engaged. Most projects conducted traditional health education lectures, which formed the basis of their intervention. Promotion of physical activity and healthy eating through participatory approaches were identified; however, barriers such as lack of areas suitable for physical activity and lack of healthy food alternatives in schools can obstruct the successful implementation of interventions. Conclusions: This study has documented experiences with school-based health promotion in low- and middle-income countries, and has shown that schools can play an important role in facilitating NCD-related behavioural change in children. The study recommends increased emphasis on a whole-school approach where activities focusing on individual behavioural change are supported by interventions improving the structural environment.