Contexte : Les interventions de promotion de la santé (IPS) en milieu scolaire visent à soutenir le développement des jeunes et promouvoir l'adoption de modes de vie sains. Une culture scolaire promotrice de santé a été identifiée comme un facteur facilitant l’adoption, la mise en œuvre et l’efficacité des interventions. Toutefois, la culture scolaire peut varier d'une école à l'autre, particulièrement dans celles accueillant des élèves issus de milieux défavorisés, et des inégalités dans l’offre d’IPS risqueraient d’exacerber les inégalités de santé existantes. Un écart de connaissances persiste sur les inégalités sociales dans la culture scolaire et l’offre d’IPS dans les écoles desservant des élèves de statut socio-économique différent.
Objectifs : L'objectif était d'étudier les associations entre le niveau de défavorisation de l’école, la culture scolaire et la disponibilité d’IPS. Nous avons cherché à: (1) quantifier l'association entre la défavorisation de l’école, l'importance de problématiques de santé et la disponibilité d’IPS; (2) quantifier l'association entre la défavorisation de l’école et la culture scolaire promotrice de santé. Les résultats de l'objectif 1 ayant montré un gradient social dans la disponibilité d’IPS en matière de santé mentale, nous avons approfondi pour: (3) quantifier l'association entre des variables du contexte scolaire et la présence d’IPS de santé mentale; (4) les caractériser par rapport aux meilleures pratiques (ex. approche globale, optimisation de la culture scolaire).
Méthodes : Les données sont tirées de PromeSS, une étude transversale comprenant 171 écoles primaires du Québec, Canada (2017-2019). Quatre mesures d'une culture scolaire promotrice de santé ont été développées à partir du modèle théorique «Health Promoting Schools». Des modèles de régression logistique, ANOVA unidirectionnelle et tests de Tukey ont servi à estimer les associations entre les variables d’intérêt. Des données approfondies sur un échantillon de 25 IPS
de santé mentale ont été analysées dans le cadre d'une analyse de cas croisés.
Résultats : Les écoles défavorisées ont signalé plus de problématiques de santé que les écoles favorisées. Les proportions d’IPS disponibles étaient similaires, sauf pour les IPS de santé mentale offertes en plus grande proportion dans les écoles favorisées. Les écoles favorisées avaient une culture scolaire plus promotrice de la santé que les écoles défavorisées, principalement en termes d'engagement avec les familles et la communauté. Les écoles plus susceptibles de mettre en œuvre des IPS de santé mentale étaient les écoles favorisées, ayant une culture scolaire plus promotrice de santé et où les problématiques de santé mentale étaient considérées comme importantes. Bien que généralement bien adaptées à leur contexte, peu d’IPS de santé mentale étaient alignées avec les meilleures pratiques.
Conclusions : Cette thèse illustre l’importance du contexte dans lequel les IPS sont mis en œuvre, incluant la culture scolaire comme caractéristique essentielle pour des IPS efficaces et les conditions socioéconomiques des élèves. La capacité des écoles à établir une culture scolaire promotrice de santé et à mettre en œuvre des interventions fondées sur les données probantes devrait être renforcée, en particulier pour les écoles défavorisées, afin d'améliorer la santé des élèves et de réduire les inégalités. / Background: School-based health-promoting interventions (HPIs) are key components of public health strategies that aim to support youth development and promote the adoption of healthy lifestyles. A health-promoting school culture, which represents the school’s context for HPI implementation, has been identified as a facilitator of HPI adoption, implementation, and effectiveness. However, school culture may vary across schools and in particular, schools serving students from disadvantaged backgrounds which face known challenges for HPI implementation. Inequalities in school culture and HPI programming may exacerbate existing health inequalities across disadvantaged versus advantaged settings. Yet little is known about social inequalities in school culture or HPI availability across schools serving student populations of varying socio-
economic status.
Objectives: The aim of this dissertation was to investigate the associations among school deprivation, school culture and HPI availability. Specifically we aimed: (1) to quantify the association between school deprivation and each of perceived importance of health issues and HPI availability; (2) to quantify the association between school deprivation and health-promoting school culture. Because results from objective 1 showed a social gradient in the availability of mental health HPIs, we delved deeper: (3) to quantify the association between school context variables and the availability of mental health HPIs; and (4) to characterize them according to their alignment with best practices for effective school-based mental health promotion.
Methods: Data were drawn from the PromeSS study, a cross-sectional survey of school principals including 171 elementary schools across Québec, Canada (2017-2019). Four measures of a health- promoting school culture were developed drawing from the Health Promoting Schools theoretical
model. Logistic regression models, one-way ANOVA and post-hoc Tukey tests were used to estimate associations between school deprivation, health-promoting school culture, importance of health issues, and HPI availability. In-depth data on a sample of 25 mental health HPIs implemented in study schools were analyzed in cross-case analysis.
Results: The three articles that comprise this thesis show that: (1) disadvantaged schools reported more health issues as important than advantaged schools, but similar proportions of HPIs, except for mental health HPIs (a higher proportion of advantaged schools reported offering one in the past year); (2) advantaged schools had a more health-promoting school culture than disadvantaged schools, primarily in terms of engagement with families and the wider school community; (3) in the case of mental health promotion, advantaged schools, schools with a more health-promoting school culture, and schools where mental health issues were seen as important were more likely to implement mental health HPIs; and (4) although schools generally implemented interventions that were highly tailored to their context, few mental health HPIs were aligned with best practices for effective mental health promotion (e.g., whole-school approach, optimization of school culture). Conclusion: This thesis suggests that the context in which school-based HPIs are implemented matters, including student socioeconomic conditions. It strengthens empirical support for health- promoting school culture as a crucial feature for effective HPIs. School capacity for establishing a health-promoting school culture and implementing evidence-based interventions should be reinforced, especially for disadvantaged schools to improve student health and reduce inequalities.estimate associations between school deprivation, health-promoting school culture, importance of health issues, and HPI availability. In-depth data on a sample of 25 mental health HPIs implemented in study schools were analyzed in cross-case analysis.
Results: The three articles that comprise this thesis show that: (1) disadvantaged schools reported more health issues as important than advantaged schools, but similar proportions of HPIs, except for mental health HPIs (a higher proportion of advantaged schools reported offering one in the past year); (2) advantaged schools had a more health-promoting school culture than disadvantaged schools, primarily in terms of engagement with families and the wider school community; (3) in the case of mental health promotion, advantaged schools, schools with a more health-promoting school culture, and schools where mental health issues were seen as important were more likely to implement mental health HPIs; and (4) although schools generally implemented interventions that were highly tailored to their context, few mental health HPIs were aligned with best practices for effective mental health promotion (e.g., whole-school approach, optimization of school culture).
Conclusion: This thesis suggests that the context in which school-based HPIs are implemented matters, including student socioeconomic conditions. It strengthens empirical support for health- promoting school culture as a crucial feature for effective HPIs. School capacity for establishing a health-promoting school culture and implementing evidence-based interventions should be reinforced, especially for disadvantaged schools to improve student health and reduce inequalities.
| Identifer | oai:union.ndltd.org:umontreal.ca/oai:papyrus.bib.umontreal.ca:1866/32431 |
| Date | 03 1900 |
| Creators | Kalubi-Lukusa, Jodi Cécile |
| Contributors | O'Loughlin, Jennifer, Potvin, Louise |
| Source Sets | Université de Montréal |
| Language | English |
| Detected Language | English |
| Type | thesis, thèse |
| Format | application/pdf |
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