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Table 3 Characteristics of included empirical UK studies and the programme theories (PT) for which they provided evidence

From: Implementing health promotion programmes in schools: a realist systematic review of research and experience in the United Kingdom

Programme details Study type How implementation assessed
Active primary school (pilot)   
Co-ordinators worked with schools to provide opportunities for physical activity within and outside of the curriculum.
  Physical activity
  Delivered to: pupils (5–11 years) (primary)
  Delivered by: co-ordinators
 Lowden et al. [42] BA Available resources
Process evaluation Adaptation
APPLES—the Active Programme Promoting Lifestyle Education in Schools   
Multi-disciplinary health promotion team worked with schools to develop school action plans tailored to each school’s perception of needs.
  Delivered to: pupils (8–10 years) (primary)
  Delivered by: health promotion team
 Sahota et al. [43] CRCT Engagement
Process evaluation
ASSIST—A Stop Smoking in Schools Trial   
Pupils nominated ‘influential peers’ who received training to become ‘peer supporters’ who aimed to reduce/stop smoking amongst their peers.
  Substance use (tobacco)
  Delivered to: pupils (12–13 years) (secondary)
  Delivered by: peers (12–13 years)
 Audrey et al. [44] NA Researchers’ reflections on programme implementation
 Audrey et al. [45] NA NA
 Audrey et al. [46] Process evaluation Adolescents’ perspectives
 Audrey et al. [43] Process evaluation Teachers perceptions
 Holliday et al. [47] Process evaluation Fidelity of delivery
15 lessons (‘normative’ focus) delivered over 2 years; parenting skill workshops; local media coverage, managed by media relations agency; education and training for local retailers; involvement of wider community of drug professionals and organisations.
  Substance use (legal and illegal substances)
  Delivered to: pupils (11–13 years) (secondary)
  Delivered by: teachers
 Stead et al. [48] CBA Teacher training
Process evaluation Curriculum
School drug advisor support for delivery in schools
 Stead et al. [49] Process evaluation Fidelity
Adaptation of content
Teaching confidence
 Blueprint Evaluation Team [50] Evaluation Materials
Student participation
Citizenship Safety Project   
Secondary school pupils trained to teach aspects of accident prevention and risk awareness
  Injury prevention
  Delivered to: pupils (6–7 years) (primary)
  Delivered by: peers (14–15 years)
 Frederick, Barlow [51] CBA Perceptions of project (teacher/year 10 students)
(pilot study)
Eat Smart Play Smart   
Behaviourally focused ‘lunchtime clubs’ of 25 min/week (for 20 weeks) to raise value of desired behaviour, tasting opportunities, incentives, and practical skills.
  Delivered to: pupils (5–7 years) (primary)
  Delivered by: researchers
 Warren et al. [52] RCT Practical tasks/participation
Incorporation of materials into curriculum
Family Smoking Education (Health Education Authority)   
Teachers’ guide, parents’ leaflet, and pupils’ booklet were provided and delivered within the curriculum in the way that teachers judged to be most suitable.
  Substance use (tobacco)
  Delivered to: pupils (11–13 years) (secondary)
  Delivered by: teachers
 Newman, Nutbeam [53] CBA Teachers’ feedback on programme delivery
GGHB Sexual Health Education   
One lesson per week (5-week duration, as part of PSE curriculum), emphasising pupils’ ownership of the issues and challenging misconceptions with factual information. Mainly single sex groups. Included whole group, small group, and individual work and video, reading material, and quizzes.
  Delivered to: pupils (11–16 years) (secondary)
  Delivered by: teachers
 Lowden, Powney [54] Process evaluation Student engagement
Teachers’ experiences
HeLP—Healthy Lifestyle Programme   
Over three terms (18 months), a range of activities intended to change behaviour at individual, family, and institutional levels—competitions, workshops, parents’ evening, PSHE lessons, drama activities, 1:1 goal-setting and assessment, newsletters.
  Delivered to: pupils (8–11 years) (primary)
  Delivered by: teachers, drama group, researchers
 Wyatt et al. [55] CRCT (pilot) Delivery
Process evaluation Resources
KAT—Kids, Adults Together   
Classroom activities, ‘fun evening’ for families, DVD for pupils to watch with parents.
  Substance use (alcohol)
  Delivered to: pupils (9–11 years) (primary)
  Delivered by: teachers
 Rothwell, Segrott [56] Process evaluation Engagement
NE Choices   
Drama workshop, ‘youth work projects’, outdoor activity programme for ‘high-risk’ youth, and drugs awareness sessions for parents, training for teachers, youth workers, and school governors.
  Substance use (legal and illegal drugs)
  Delivered to: pupils (13–16 years) (secondary)
  Delivered by: various (theatre company, teachers, youth workers)
 Stead et al. [57] CBA Project aims versus youth work aims
Process evaluation Concordance/adaptation to participants needs
PhunkyFoods Programme   
Lesson plans (1-h duration) to support delivery through art, drama, music, and play activities. Schools can adapt lesson plans. DVDs, books, and games provided.
  Healthy eating and physical activity
  Delivered to: pupils (5–11 years) (primary)
  Delivered by: school staff
 Teeman et al. [58] BA Teachers’ experiences
Process evaluation
Project Tomato   
Manual and 12 curriculum-related lesson plans formed ‘core elements’; other elements were ‘customisable’—cooking lessons, growing club information, team set-up information. Support materials (kit bags, newsletters, parent handouts) provided.
  Delivered to: pupils (8–9 years) (primary)
  Delivered by: teachers
 Christian [59] CRCT Fidelity
Process evaluation ‘Appreciation’ of programme
RIPPLE—Randomised Intervention of Pupil Peer Led Sex Education   
Peer educators trained by an external team to prepare classroom sessions (3 × 1 h), which were delivered without teacher supervision. Sessions used participatory learning methods and activities, covering relationships, STIs, and contraception.
  Delivered to: pupils (13–14 years) (secondary)
  Delivered by: peers (16–17 years)
 Forrest et al. [60] Process evaluation Participation in programme
Student engagement
Sex educator characteristics
 Strange et al. [61] Process evaluation Engagement with the programme
Perceived benefits beyond health promotion
 Strange et al. [62] Process evaluation Engagement with the programme
 Oakley et al. [63] Process evaluation Engagement with the programme
 Stephenson et al. [64] CRCT Programme participation
Process evaluation Student satisfaction with programme
 Strange et al. [65] CRCT Student engagement
Schools on the Move   
Teacher training covering embedding physical activity into the curriculum; distribution of pedometers to pupils, with instructions on how to use and record their activity levels on a website.
  Physical activity
  Delivered to: pupils (4–11 years) (primary and secondary)
  Delivered by: teachers
 Stathi et al. [66] BA Programme participation
Process evaluation Schools ethos
Programme support
SHARE—Sexual Health and Relationships: Safe, Happy and Responsible   
5-day teacher training, to deliver 20 classroom sessions (piloted and developed over 2 years). Sessions included small group work and games, information leaflets, and skill development through interactive video and role play.
  Delivered to: pupils (13–15 years) (secondary)
  Delivered by: teachers
 Wight et al. [67] CRCT School attitudes (PSE, context)
Process evaluation Teachers’ attitudes/teaching styles
(preliminary baseline) Teachers’ relations to pupils
Teaching elements
 Wight, Abraham [68] Programme development NA
 Buston, Hart [69] Process evaluation Student attitudes
Teacher confidence
 Buston et al. [70] Process evaluation ‘Fit’ with school organisation
Teachers’ explanations and reflections
 Buston et al. [71] CRCT Fidelity
Process evaluation
 Buston et al. [72] Process evaluation Student engagement (discomfort, gender, teacher, trust, fun)
 Buston, Wight [73] Process evaluation Young women
Group discussions
Timing, skill-based lessons
 Wight et al. [74] CRCT Organisational factors (i.e. timetabling)
Process evaluation Skill-based delivery
 Wight, Buston [75] Process evaluation Teacher training,
Developing confidence
Familiarisation of programme
 Buston, Wight [76] Process evaluation Student engagement (understanding variation between classes)
Teachers’ explanations and reflections
Smoking and Me   
1-day teacher training and teachers’ guide—five lesson outlines and guidance for choosing group leaders and managing groups. Lessons predominantly small group work—discussion, role play, and decision-making activities.
  Substance use (tobacco)
  Delivered to: pupils (12–13 years) (secondary)
  Delivered by: teachers, peers
 Newman et al. [77] CBA Pupil engagement
SPICED—Schools Partnership in Children’s Education on Drugs   
2-day training for professionals delivering programme. Seven classroom sessions, using participative learning, role play, and group discussion—covering facts about legal and illegal drugs, develop understanding of risk, and promote confidence and decision-making skills.
  Substance use (legal and illegal drugs)
  Delivered to: pupils (9–11 years) (primary)
  Delivered by: teacher, police officer, school nurse
 Crosswaite et al. [78] Process evaluation Classroom setting
Training provided
Issues around involvement of professional groups
UK Resilience Programme   
Professionals delivering the programme attended 10-day training course in USA. Manualised intervention (18 × 1 h workshops) teaching cognitive behavioural and social problem-solving skills.
 Delivered to: pupils (11–12 years) (secondary)
  Delivered by: trained facilitators
 Challen et al. [79] CBA Pupils’ and teachers’ experiences
 Challen et al. [80] Process evaluation
Various physical activities—breakfast club, physical education, lunchtime fitness classes, after-school play club, after-school sports. A ‘small fee’ was charged for breakfast and after-school activities (opt-in only).
  Physical activity and well-being
  Delivered to: pupils (9–11 years) (primary)
  Delivered by: YMCA sports coaches/play workers
 Stathi, Sebire [81] Process evaluation Project staff’s experiences
  1. BA before and after study, CBA controlled before and after study, CRCT cluster randomised controlled trial, NRCT non-randomised controlled trial, SRE sex and relationship education, SES socio-economic status, NC non-comparative, NR not reported, NA not applicable