Skip to main content

Table 4 Programme theories tested in the review

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

Theme Context-mechanism-outcome Area and sources Full synth.a
Programme theory 1—preparing for implementation
Preparation for the introduction of a health promotion programme to a school is more likely to be successful when systematically planned in conjunction with other school responsibilities. This involves
Pre-delivery consultation Well-established, uncontentious programmes are perceived as credible and ‘workable’ by teachers and require only basic pre-delivery consultation to be viewed as acceptable; However If a programme contains novel topic or delivery components, then staff’s unfamiliarity with these elements risks them being viewed as unacceptable. In these cases, more extensive pre-delivery consultation is required. Also If a programme’s topic or approach is contentious for some stakeholders, then consultation needs to be inclusive of these stakeholders. Drug [50]; SRE [45] [54] [63] [70]; Tob [44] [45] p.1–4; 8–11
Pupil engagement Whatever the topic of a programme, pupils are engaged if the relevance and multiple benefits (personal, social, academic) of a programme are made clear. Also Novelty can be a strong way of initially engaging pupils’ attention, but novelty alone is insufficient for maintaining engagement. Ob [58] [55]; SRE
[54] [69] [72]; Tob [53] [77] [44] [45]; WB [79]
p.5–6
Reciprocity For all programmes, successful preparation for delivery hinges on teachers’ and pupils’ judgement that they will receive the support they deem to be necessary to achieve multiple goals. Ob [58]; PA [42] [66]; SRE [54] [70] [71] [75]; Tob [77] [44] [45] [47]; WB [79] p.5–10
Current practice and interests Programmes can ‘work with’ current practice and interests in a number of ways (e.g. by meeting an unmet need, by complementing, or by driving change), but the contexts in which these processes occur remains unclear. Ob [58] [55]; PA [42]; SRE [68]; Tob [45] p.9–10
Identifying clear aims and priorities, including intended outcomes   None identified Not applicable
Programme theory 2—introducing a programme within a school
The introduction of a health promotion programme to a school is more likely to be successful when it is incorporated into school activities through
Integrating a programme into the life of a school (senior support) Across a wide range of programmes, it is necessary for the actions of seniors to be tangible so that teachers feel confident in playing their role in programme delivery. However The extent of senior support is less important where pupil groups are more stable (e.g. in primary schools) and less contentious health issues are addressed. Ob [43]; PA [42]; SRE [69] [63]; Tob [47]; WB [79] p.12–13
Integrating a programme into the life of a school (leadership skills) If a named co-ordinator is willing, able, and has the support and capacity to take responsibility, then programme delivery is improved. The success of this role depends on a person’s credibility and influence rather than his/her level of seniority. Ob [58]; PA [42] [81]; SRE [62]; Tob [47] p.13–14
Engaging those who deliver and participate in health promotion programmes (training and professional development) If teachers perceive that training for a programme addresses relevant skill or knowledge deficits, then they are more likely to be motivated to engage with that training. However If a programme’s approach is discordant with teachers’ personal values, then engagement can be problematic. Drug [57] [48]; Ob [58]; PA [42]; SRE [69] [61] [75]; Tob [46]; WB [79] p.15–17
Engaging those who deliver and participate in health promotion programmes (pupils) At both primary and secondary school levels, programme flexibility to accommodate pupils’ different rates of physical, psychological, and social development facilitates engagement. At primary school, pupils experiencing a programme as fun is the main way to engage pupils. At secondary school, pupils’ engagement pivots on a perception that a programme is both fun to take part in and addresses a perceived knowledge or skill deficit. Also Where a programme addresses controversial behaviours, teacher-pupil confidentiality is key to pupil engagement. Alc [78] [48]; Drug [66]; Ob [58] [52] [55]; PA [62] [63]; SRE [54] [60] [72] [73]; Tob [56] [82] p.17–22
Programme theory 3—embedding a programme into routine practice
The routine delivery (‘embedding’) of a programme takes time and motivation. It is likely to involve changes in the school environment and the development of new relationships between stakeholders that require pro-active management so that
Different stakeholders’ goals are reconciled   None identified Not applicable
Organisational decisions in other areas of school life are made taking into account how they impact onprogramme delivery No additional insight to that in programme theory 2 (‘integrating a programme’) Tob [47]; WB [80] p.22
School staff’s existing relationships with pupils are built upon   None identified Not applicable
Stakeholders’ enthusiasm, knowledge, and experience are harnessed   None identified Not applicable
Knowledge of ‘core’ and ‘peripheral’ elements and minimum resources, skills, and informational content is retained   None identified Not applicable
Responsibility for programme delivery becomes rooted in the school Insufficient evidence to express context-mechanism-outcome PA [55]; WB [74] p.23
Expectations about implementation are fed back No additional insight to that in programme theory 2 (‘integrating a programme’) Drug [78]; Ob [58] [52]; Tob [46] p.23–24
Programme theory 4—fidelity of implementation and programme adaptation
The preparation for, introduction, initial delivery, and ongoing sustainability of a health promotion programme in a school is more likely to be successful when there is
Specificity about essential, optional, and adaptable programme elements Insufficient evidence to express context-mechanism-outcome Drug [57] [48] [49]; Ob [59]; [58]; SRE [54]; Tob [44] [47] p.24–26
Scope for ‘mutual adaptation’ between the programme and the people delivering it Insufficient evidence to express context-mechanism-outcome Drug [48]; Ob [58]; PA/WB [81]; SRE [71]; Tob [77]; WB [80] p.24–26
  1. Key (type of health promotion programme): Alc alcohol, Drug legal and illegal drugs, Ob obesity, PA physical activity, SRE sex and relationship education, Tob tobacco, WB well-being
  2. aFor full synthesis, see Additional file 11