JMIR Publications

ABSTRACT

Background:

Health Promoting School (HPS) interventions have the potential to improve adolescent health and well-being, but evidence regarding implementation and system-level impact in real-world school settings remains limited. “My Life – I Decide” (My Life) is a systems-oriented HPS intervention developed to strengthen positive mental and physical health, school well-being, and health-promoting school practices among 10th-grade students in Denmark.

Objective:

This paper describes the intervention, study design, and evaluation framework of the My Life intervention and its pragmatic controlled trial, including effectiveness, process, and system-level evaluations.

Methods:

The intervention builds on the HPS approach, action-oriented teaching, the life-psychological method, and education outside the classroom. It comprises four main phases: (1) Preparation, establishing collaboration between the health and education sectors (2) Planning, adapting the program to school contexts; (3) Health education program: classroom and community-based activities; and (4) Anchoring: sustaining health promoting work at the school. Effectiveness will be assessed in a pragmatic controlled waiting list trial design. Four intervention schools (11 classes) were matched with four control schools (15 classes) (n=416). Primary outcomes include social - and emotional competencies, self-efficacy, mental well-being, health literacy, positive student interpersonal relations, positive student-teacher relations, and school connectedness. Multilevel mixed models will be conducted to evaluate effectiveness at the individual student level. System-level impacts are evaluated using a mixed-method design. Pre- and post-school staff surveys at interventions and control schools will assess changes in school health promotion capacity. Semi-structured interviews with school and municipality representatives (n≈16 participants) and student focus groups (n≈8) will be used to explore collaborative and unexpected outcomes. The process evaluation applies a realist-informed multi-method design to explore implementation, mechanisms, and contextual factors across intervention schools. Data include short interviews with health consultants, post-session surveys with health consultants after each teaching session (n≈250 responses), student registration, health education observations (n=24), student focus groups (n≈8), and interviews with teachers, health consultants, and school and municipal managers (n≈16 participants).

Results:

The study will generate quantitative and qualitative data on student outcomes, implementation processes, intersectoral collaboration, and development of health-promoting practices within schools. Findings from the effectiveness, process, and system-level evaluations will be triangulated to test and refine the initial program theory of the intervention.

Conclusions:

The My Life study will contribute knowledge on the implementation and evaluation of complex HPS interventions in real-world educational settings. The findings may inform future HPS initiatives and provide methodological insights into combining effectiveness, process, and system-level evaluations in adolescent health promotion research. Clinical Trial: ClinicalTrials.gov, NCT07411677