Eric Nsiah-Boateng, Patricia Akweongo, Justice Nonvignon, Moses Aikins
Effect of social capital on enrolment of informal sector occupational groups in the national health insurance scheme in Ghana: a cross-sectional survey
BMC health services research
background world health organizations whos health promoting schools hps framework holistic settingsbased approach promoting health educational attainment school effectiveness approach previously rigorously reviewed objectives assess effectiveness health promoting schools hps framework improving health wellbeing students academic achievement search methods searched following electronic databases january 2011 march april 2013 cochrane central register controlled trials central medline embase psycinfo cinahl campbell library assia bibliomap cab abstracts ibss social science citation index sociological abstracts trophi global health database sigle australian education index british education index education resources information centre database education research dissertation express index theses great britain ireland clinicaltrialsgov current controlled trials international clinical trials registry platform also searched relevant websites handsearched reference lists used citation tracking identify relevant articles selection criteria included clusterrandomised controlled trials randomisation took place level school district geographical area participants children young people aged four 18 years attending schools colleges review define hps interventions comprising following three elements input curriculum changes schools ethos environment engagement families communities compared intervention schools implemented either intervention continued usual practice programme included one two mentioned hps elements data collection analysis least two review authors identified relevant trials extracted data assessed risk bias trials grouped different types interventions according health topic targeted approach used data permitted performed randomeffects metaanalyses provide summary results across studies main results included 67 eligible cluster trials randomising 1443 schools districts made 1345 schools 98 districts studies tackled range health issues physical activity 4 nutrition 12 physical activity nutrition combined 18 bullying 7 tobacco 5 alcohol 2 sexual health 2 violence 2 mental health 2 handwashing 2 multiple risk behaviours 7 cyclehelmet use 1 eating disorders 1 sun protection 1 oral health 1 quality evidence overall low moderate determined grade approach risk bias assessments identified methodological limitations including heavy reliance selfreported data high attrition rates studies addition lack longterm followup data studies found positive effects interventions body mass index bmi physical activity physical fitness fruit vegetable intake tobacco use bullied intervention effects generally small potential produce public health benefits population level found little evidence effectiveness standardised body mass index zbmi evidence effectiveness fat intake alcohol use drug use mental health violence bullying others however small number studies focused latter outcomes possible metaanalyse data health outcomes due lack data studies provided details adverse events outcomes related interventions addition studies included academic attendance schoolrelated outcomes therefore cannot draw clear conclusions effectiveness approach improving academic achievement authors conclusions results review provide evidence effectiveness interventions based hps framework improving certain health outcomes others welldesigned research required establish effectiveness approach health topics academic achievement