however this appears nor to be the case as 14 of 22 interventions to change one or more at school behaviors were skill successful in a achieve behavioral change despite the absence of a healthy school environment. No interventions thus far have focused on including health services. These promising findings regarding the development of school-based health interventions should substantiated further studies.
Several studies mentioned that in complex, comprehensive interventions, such as many multi-health behavioral school-based program, it is crucial to incorporate process evaluation in the structure of the program, to enable adequate interpretation of quantitative data. Unless the trials illuminate processes and mechanisms they often fail to provide useful information. If the result is negative, we are left wondering whether the intervention is inherently ineffective, whether it was inadequately applied or applied in an inappropriate context, or whether the trial used an inappropriate design, comparison groups or outcomes. If there is a positive effect, it can be hard to judge how the results of the trial might be applied to a different context
For example, Bee were unable to draw conclusions about whether their physical activity and healthy eating intervention was effective because of a lack of process evaluation. Therefore, we suggest that complex multi-behavioral school-based health interventions should be studied via a comprehensive and context driven evaluation. Process evaluation potentially increases feasibility and provides for a better in context interpretation of quantitative results.
Con
Tacking multiple unhealthy adolescent behaviors simultaneously via school-based interventions and via a whole-school approach has become more popular in the last decade. Despite promising results regarding several individual aspects, such as involving parents and communities in school-based interventions, other aspects remain to be studied more thoroughly, such as the effects of creating a healthy school environment or introducing healthy behavior policies.
Two clusters of behaviors emerged as often being targeted simultaneously, namely, addiction and energy balance(nutrition, physical activity, and screen-time behaviors) ; however, there have been too few studies of adolescent and school health to be able to evaluate whether targeting these behaviors simultaneously has a synergistic effect. This remains to be investigated in future studies.
Implications
School-based interventions to promote healthy adolescent behavior are becoming increasingly comprehensive and complex. This review highlights the positive effect of involving parent and the community in health interventions and of targeting clusters of related behaviors. Other aspects of health promotion at schools, such as the introduction of behavioral policies for student or the creation of a healthy school environment , require further investigation as data on the effectiveness of these aspects are limited.
The review also identified several important points to be borne in mind when developing school-based health interventions, namely, that interventions should be organized through existing school infrastructure ; that they should be centrally organized within a school ; that they should to be fine-tuned to the target population and that they should be embedded in the family and neighborhood environment as well as in the school environment.