The Healthy School Network (HSN) was a Danish school-based health initiative. HSN was initiated by the ROCKWOOL Foundation in 2008 in an effort to communicate knowledge about health and to support health-promoting projects for Danish students in primary and lower secondary schools. By 2013, 193 schools were registered as HSN members.
The programme included establishing a school health committee at each school which was responsible for initiating health-promoting activities at the schools. Each school was also responsible for yearly health measurements of the students’ height, weight, waist circumference, fitness rating and vertical jump height. The measurements were collected in a shared HSN database with the intention of monitoring the students’ state of health – both over time and in comparison with other schools.
The purpose of these initiatives was to make students and their parents and teachers more aware of the students’ health status and thereby induce behavioural change towards increased physical activity and improvement in diet. In order to assess the programme’s effect on the students’ health, the ROCKWOOL Foundation initiated an evaluation of HSN in 2013.
HSN was evaluated through four separate evaluations with four different objectives.
1) Qualitative evaluation of HSN
The main purpose of the qualitative evaluation was to assess the relevance, quality, effectiveness and sustainability of the HSN. The results are primarily based upon qualitative data collected among different stakeholders such as school principals, teachers and parents. The evaluation was conducted by Als Research. (The evaluation only exists in Danish.)
2) Randomized effect evaluation
The main purpose of this evaluation was to examine the impact of HSN on the students’ physical health (measured by BMI and waist circumference). The evaluation was solely conducted among schools in the municipality of Odense where half of the schools were randomly selected to be HSN member schools, and the remainder served as a control group. The evaluation was conducted by Jane Greve and Eskil Heinesen from the ROCKWOOL Foundation Research Unit.
3) Comparative trend study
The primary objective of this study was to describe the intervention in terms of change in students’ anthropometry (height, weight and waist circumference) and physical fitness. A second objective was to evaluate secular trends in anthropometry and physical fitness by comparing results from the HSN intervention with four other studies. The study was conducted by John Singhammer and Lars Bo Andersen from the department of Exercise Epidemiology at the University of Southern Denmark.
4) Validation study
The main purpose of the validation study was to assess the reliability of the school-based measurements collected in the HSN database. The study was conducted by John Singhammer and Lars Bo Andersen from the department of Exercise Epidemiology at the University of Southern Denmark.
The evaluation of HSN finds that the participating schools found the intervention relevant and both teachers and parents agreed that HSN was helpful in terms of obtaining an improved and sustained focus on health. The school health committees in particular turned out to be key contributors – both in terms of initiating health-promoting activities and in terms of sustaining an increased focus on health.
The health measurements however, did not seem to contribute to an improved focus on health at the HSN schools. This was partly due to the fact that the teachers did not seem to understand their purpose and rarely used the measurements as a pedagogical tool, which was one of the original intentions of recording them. The evaluation also finds that some teachers had problems with measurement and entry procedures. The validation study concludes that schoolteachers can provide reliable measurements of children’s height, weight, and waist circumference but need additional training in measuring vertical jump height and cardiorespiratory fitness.
In terms of the impact of HSN on the students’ physical health – measured by BMI and waist circumference – the evaluation finds no consistent effect of the programme. The comparative trend study also shows no significant change in the students’ anthropometry and physical fitness from 2010 to 2012. These results might be due to the fact, that the intervention did not in itself include extra physical activity, but was rather aimed at obtaining an improved focus on health through health committees and yearly health measurements. In sum, it can thus be concluded that a large-scale low-intensity intervention such as the HSN initiative, is not effective enough to generate any significant quantitative results on children’s physical health.