Critical Analysis of a Health Promoting School Intervention Report

This report critically analyzes a health promotion intervention implemented in Diamond level health promoting schools (DLHPS) in Thailand to manage childhood obesity, as described by Phaitrakoon et al. (2014). The intervention involved activities like promoting healthy eating habits and encouraging physical activity among students. The analysis evaluates the intervention's effectiveness in relation to the Ottawa Charter principles, focusing on developing personal skills, creating supportive environments, reorienting health services, strengthening community actions, and building healthy public policy. It also assesses the intervention against equity principles, highlighting both strengths and weaknesses. The report concludes with recommendations to improve the intervention by addressing social disadvantages, cultural barriers, and ensuring the availability of healthy foods for all children. The study highlights the importance of collaboration between various stakeholders like school directors, teachers, cooks, and parents to reduce the prevalence of overweight and obesity in students. Furthermore, the report emphasizes the need to consider the long-term benefits of healthy eating habits at home as well.

Running head: HEALTH PROMOTION
Health promotion
Name of the student:
Name of the University:
Author’s note

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Introduction:
The prevalence of obesity and overweight is a major global health concern and the
burden of obesity is increasing in children too. The report is focused on evaluating a health
promoting school intervention that engages in management of obesity in school children. The
main purpose of this paper is to analyse the article by Phaitrakoon et al. (2014) in relation to the
Ottawa principles and the equity principles. The critical analysis of the paper will be done by
first giving description of the intervention and then analysing the intervention in relation the five
principles of the Ottawa charter and the equity principles.
Description of intervention:
The study Phaitrakoon et al. (2014) included Diamond level health promoting schools
(DLHPS) in Thailand, which includes the schools that receive highest reward (Diamond) for
performing well according to health promotion policy. 60 DLHPS were taken in the study and
the participants included four school directors, eight teachers, six cooks, and 36 students who
had earlier taken part in obesity management programs in schools. The average age of school
directors, teachers and cook were 55.2, 39.0 and 38.5 years respectively. The average age of the
students was 10.7 years and majority of them were 12 years old in grade 6. In each school,
several activities were carried out such as developing worksheets of nutrient content of school
foods, planting vegetables in schools, organizing health activity days for students and monitoring
of nutritional status of students. In-depth interview was conducted with all groups regarding key
role in school management programs. The content analysis of the focus group discussions
revealed that three activities related to health and nutrition learning, exercise for health and
provision of health food was most values by students. However, some challenges encountered

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included confusion related to DLHPS status and resistance towards consumption of vegetables
and healthy foods. Most important outcome was that after the interventions, students were able to
maintain good weight which resulted in good weight and mood too.
Analysis of intervention in relation to Ottawa principles:
The DHLPS program was effective in developing personal skills of students related to
consuming healthy diet and engaging in physical activity. This is understood from the review of
program activities as students consumed vegetables that were planted by them in schools and
they were encouraged to engage in aerobic dance in the morning and sports in the afternoon.
Hence, these activities give clue to students regarding how to promote their development by
education and life enhancing skills. The strength of suggesting activities at school is that it is
giving students new clues to engage in physical activity. In addition, by encouraging children to
plant and eat vegetables, the program gave students the opportunity to eat more vegetables.
Dhandevi and Jeewon (2015) give the evidence that nutrition education interventions are
effective in increasing fruit and vegetable intake and promote body weight management.
The DHLPS program established a supportive environment for promoting physical
activity among students. This is understood from the fact that health activity days were organized
once a semester and as reported by school directors, exercises like shoulder and knee rotation
was implemented every morning. Hence, student got access to an environment, where they could
engage in exercise behaviours and physical activity. The strength of this action is that one of the
cause of obesity is lack of appropriate environment for engaging in physical activity. Hence,
creating healthy environment and increasing opportunity for physical activity is effective in
meeting recommended physical activity needs (Committee on Accelerating Progress in Obesity

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Prevention., 2012). However, one weakness is that the healthy activity was organized once a
semester. The duration for this could have been increased.
One of the strength of the DHLPS program is that it has taken an attempt to reorient
health services by sharing the responsibility for obesity prevention among school teachers,
parents, cooks and students. School directors were involved in implementing exercise activities
and cooks were educated regarding the standards guidelines for preparing healthy food. By the
cooperation of all parties, healthy activities were promoted in school children and positive
outcomes related to reduction in prevalence rate of overweight and obesity students was
achieving. Okely and Hammersley (2018) give the evidence that school-home partnership and
engagement of parents is critical for improving obesity related behaviour of children.
The intervention implemented by Phaitrakoon et al. (2014) is in relevant with
strengthening community actions as the intervention used existing human resources and material
resource in school to provide support to school children with obesity. Parents, teachers, cooks
and school directors made efforts to reduce risk factors of obesity. However, one weakness was
that there was a need for involvement of school nurse too who could monitor changes in body
weight. But this was not done suggesting further improvement in the program.
Another uniqueness of the DHLPS program is that it extended support to build healthy
public policy by improving the HPS (Health promoting school) policy in Thailand and using the
policy guidelines to set up the programs in school. The strength of the article is that it recognized
obstacles to the adaption of the HPS policy and implementing monitoring process for successful
delivery of the program. Lyn et al. (2013) supports that accelerating progress on policy changes
is critical to improve obesity related outcomes in community.

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Analysis of the intervention in relation to equity principles:
Equity principle is an approach to strengthen economic, social, educational, physical and
cultural aspects of a community. On review of the DHLPS intervention, it has been found that it
does not address equity principles because only few aspects of the equity principle has been
addressed in the intervention. For example, education, physical and social aspects were
considered by providing education, creating environment for physical activity and including
parents to manage obesity respectively. However, the program failed to take steps to address
economic barriers such as regulating cost of healthy foods to ensure that students could consume
healthy fruits even outside schools. In addition, cultural barriers to food eating pattern were not
addressed too. Kumanyika (2017) supports that as social disadvantage intensify obesity
promoting behaviour, focusing on health equity is important.
Recommendations
The health promotion intervention in the study by Phaitrakoon et al. (2014) can be
improved by taking the following steps:
 Making efforts to address social disadvantage and cultural barrier that contribute to
obesity (related to equity principle)
 To collaborate with policy makers to ensure that healthy food are easily available for all
group of children (related to Ottawa Charter principle.
 The program should focus on achieving long term benefits by ensuring that children
adhere to healthy foods in home too.

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References:
Committee on Accelerating Progress in Obesity Prevention. (2012). Accelerating progress in
obesity prevention: solving the weight of the nation. National Academies Press. Retrieved
from: http://www.healthynashville.org/content/sites/nashville/IOM_weight_of_nation.pdf
Dhandevi, P. E. M., & Jeewon, R. (2015). Fruit and vegetable intake: Benefits and progress of
nutrition education interventions-narrative review article. Iranian journal of public
health, 44(10), 1309. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4644575/pdf/IJPH-44-1309.pdf
Kumanyika, S. (2017). Getting to equity in obesity prevention: A new framework. NAM
Perspectives. Retrieved from: https://nam.edu/wp-content/uploads/2017/01/Getting-to-
Equity-in-Obesity-Prevention-A-New-Framework.pdf
Lyn, R., Aytur, S., Davis, T. A., Eyler, A. A., Evenson, K. R., Chriqui, J. F., ... & Brownson, R.
C. (2013). Policy, systems, and environmental approaches for obesity prevention: a
framework to inform local and state action. Journal of public health management and
practice: JPHMP, 19(3 Suppl 1), S23. doi:10.1097/PHH.0b013e3182841709.
Okely, A. D., & Hammersley, M. L. (2018). School–home partnerships: the missing piece in
obesity prevention?. The Lancet Child & Adolescent Health, 2(1), 5-6.
DOI:https://doi.org/10.1016/S2352-4642(17)30154-2
Phaitrakoon, J., Powwattana, A., Lagampan, S., & Klaewkla, J. (2014). The diamond level health
promoting schools (DLHPS) program for reduced child obesity in Thailand: lessons

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learned from interviews and focus groups. Asia Pacific journal of clinical nutrition. doi:
10.6133/apjcn.2014.23.2.17