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Influence of key components of health-promoting schools and physician ratio on health insurance education: a cross-sectional study

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Abstract

Background

Health-Promoting Schools (HPS) have been implemented worldwide for years. However, the influence of healthcare resources, such as physician ratio, on the attitude of students towards healthcare services remains poorly studied. This study evaluated the influence of health information education (HIE) programs on the implementation of HPS key components across various school levels and physician ratios, and explored the relationship between these factors and healthcare attitudes of students.

Methods

This cross-sectional study used data from the Health Promoting Schools Performance Survey, which included 3,365 primary and secondary schools.

Result

HIE programs were implemented in 2,525 schools. Primary schools had a higher HIE adoption rate than did secondary schools. HPS key components, including health policy, health life skill, and community relation, were commonly promoted. Schools conducting HIE effectiveness analysis showed significantly better implementation of HPS key components. Physician ratio, personal health life skills of students, community relations, students’ lectures, and teacher empowerment were significantly influenced by HIE. Multiple regression analysis revealed that low physician ratio was associated with an emphasis on the promotion of school health services. In schools with medium and high physician ratios, enhancement of teacher empowerment activities improved HIE.

Conclusions

This study provides important insights on key components of HPS and shows that these can be customized according to physician ratio to enhance the effectiveness of HIE.

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Availability of data and materials

Every year from November to December, school staff in Taiwan are required to complete a survey on health promotion of the Ministry of Education over the past year through the database system. Any queries regarding these data may be directed to the corresponding authors. The datasets generated and/or analyzed during the current study are not publicly available because of the regulations stipulated by the Institutional Review Board of the National Taiwan Normal University’s Research Ethics Review Committee. However, the datasets are available from the corresponding author upon reasonable request.

Abbreviations

CR :

Community relations

HIE :

Health insurance education

HPS :

Health-promoting school

PHLS :

Personal health life skill

SSE :

School social environment

SHP :

School health policy

SHS :

School health services

SPE :

School physical environment

References

  • Anand T, Ingle GK, Meena GS, Kishore J, Yadav S (2015) Effect of life skills training on dietary behavior of school adolescents in Delhi: a nonrandomized interventional study. Asia Pacific J Public Health 27(2):NP1616-NP1626

  • Barnard M, Dehon E, Compretta C et al (2020) Development of a competency model and tailored assessment method for high school science teachers utilizing a flipped learning approach. Educ Tech Research Dev 68(5):2595–2614

    Article  Google Scholar 

  • Bennett L, Burns S (2020) Implementing health-promoting schools to prevent obesity. Health Educ 120(2):197–216

    Article  Google Scholar 

  • Benthroldo RS, Paravidino VB, Cunha DB, Mediano MFF, Sichieri R, Marques ES (2022) Environment modification at school to promote physical activity among adolescents: a cluster randomized controlled trial. Rev Bras Epidemiol 25:e220019

    Article  PubMed  Google Scholar 

  • Brivio F, Fagnani L, Pezzoli S et al (2021) School health promotion at the time of COVID-19: an exploratory investigation with school leaders and teachers. Eur J Investig Health Psychol Educ 11(4):1181–1204

    PubMed  PubMed Central  Google Scholar 

  • Chang CC, Shih SF, Tung CY, Liu CH, Yin YW, Dai RL (2016a) Analysis of Taiwan national health insurance education in elementary and junior high school textbooks for the grade 1–9 curriculum in the health and physical education field. J Res Educ Sci 61(1):139–167

    Google Scholar 

  • Chang LC, Wu PC, Niu YZ, Chen ML, Liao LL (2016b) Trajectory of myopia prevention in Taiwanese schools. Taiwan J Public Health 35(1):17

    Google Scholar 

  • Chang CC, Liu CC, Chung TS et al (2018) Effectiveness of education in teaching elementary students about the correct use of medication and Taiwan’s national health insurance. J Healthcare Qual 12(1):68–75

    Google Scholar 

  • Chang FC (2016) 2016 Health promotion school counselling plan final report. Ministry of education Republic of China (Taiwan)

  • Dossett ML, Hall JA, Kaptchuk TJ, Yeh GY (2021) Improved health outcomes in integrative medicine visits may reflect differences in physician and patient behaviors compared to standard medical visits. Patient Educ Couns 104(2):315–321

    Article  PubMed  Google Scholar 

  • Eggert LK, Blood-Siegfried J, Champagne M, Al-Jumaily M, Biederman DJ (2015) Coalition building for health: a community garden pilot project with apartment dwelling refugees. J Community Health Nurs 32(3):141–150

    Article  PubMed  Google Scholar 

  • Eschenbeck H, Lehner L, Hofmann H et al (2019) School-based mental health promotion in children and adolescents with StresSOS using online or face-to-face interventions: study protocol for a randomized controlled trial within the ProHEAD consortium. Trials 20(1):64

    Article  PubMed  PubMed Central  Google Scholar 

  • Garmy P, Clausson EK, Berg A, Steen Carlsson K, Jakobsson U (2019) Evaluation of a school-based cognitive-behavioral depression prevention program. Scand J Public Health 47(2):182–189

    Article  PubMed  Google Scholar 

  • Giannotta F, Weichold K (2016) Evaluation of a life skills program to prevent adolescent alcohol use in two European Countries: One-year follow-up. Child Youth Care Forum 45(4):607–624

    Article  Google Scholar 

  • González RCL (2013) Indicator name: professionals in health sector (Map 4.15). :163

  • Ickovics JR, Duffany KO, Shebl FM et al (2019) Implementing school-based policies to prevent obesity: cluster randomized trial. Am J Prev Med 56(1):e1–e11

    Article  PubMed  PubMed Central  Google Scholar 

  • Khanna RC, Murthy G (2017) Importance of integrating eye health into school health initiatives. Community Eye Health 30(98):S3-s5

    PubMed  PubMed Central  Google Scholar 

  • Kjønniksen L, Wiium N, Fjørtoft I (2022) Affordances of school ground environments for physical activity: a case study on 10-and 12-year-old children in a Norwegian primary school. Front Public Health 10:773323

    Article  PubMed  PubMed Central  Google Scholar 

  • Lee CH, Chang FC, Chi HY, Huang LJ (2018) Evaluating the effects of school-pharmacist partnerships to improve medication knowledge, efficacy and behavior. Taiwan J Public Health 37(2):196

    Google Scholar 

  • Lee A, Lo A, Li Q, Keung V, Kwong A (2020) Health promoting schools: an update. Appl Health Econ Health Policy 18(5):605–623

    Article  PubMed  PubMed Central  Google Scholar 

  • Lee SC, Lee CM, Chang FC, Miao NF (2017) "Effects of the training programs for adolescent smoking cessation education seed teachers." Chinese J school health(70): 1–30.

  • Lewallen TC, Hunt H, Potts-Datema W, Zaza S, Giles W (2015) The whole school, whole community, whole child model: a new approach for improving educational attainment and healthy development for students. J Sch Health 85(11):729–739

    Article  PubMed  PubMed Central  Google Scholar 

  • Liu J, Liu S, Yan J, Lee E, Mayes L (2016) The impact of life skills training on behavior problems in left-behind children in rural China: a pilot study. Sch Psychol Int 37(1):73–84

    Article  Google Scholar 

  • McIsaac JD, Penney TL, Ata N et al (2017) Evaluation of a health promoting schools program in a school board in Nova Scotia, Canada. Preventive Medicine Reports 5:279–284

    Article  PubMed  PubMed Central  Google Scholar 

  • Narayan V, Thomas S, Gomez MSS, Bhaskar BV, Rao AK (2023) Auxiliary delivered school based oral health promotion among 12–14-year-old children from a low resource setting-A cluster randomized trial. J Public Health Dent 83(2):177–184

    Article  PubMed  Google Scholar 

  • Pinto MB, Silva KL, de Andrade LDF (2017) School and community relationship in the perspective of Health Promotion. Int Arch Med 10

  • Sekhar DL, Schaefer EW, Waxmonsky JG, et al (2021) Screening in high schools to identify, evaluate, and lower depression among adolescents: a randomized clinical trial" JAMA Netw Open 4(11): e2131836.

  • Sheu JT, Han HW, Lien HM, Lo KT (2011) How did the increase in NHI copayments in 2005 affect the use of health care? Taiwan J Public Health 30(4):326–336

    Google Scholar 

  • Srikala B, Kishore KKV (2010) Empowering adolescents with life skills education in schools - school mental health program: does it work? Indian J Psychiat 52(4):344–349

    Article  Google Scholar 

  • Taiwan ministry of health and welfare (2018a) Urban and regional development statistics compiled.

  • Taiwan Ministry of Health and Welfare (2018b) Universal health insurance will grow by 4.217% through total 108 years of medicare, with an estimated total medical expenditure of about 713.978 billion yuan. https://www.mohw.gov.tw/fp-3800-44142-1.html

  • Tseng CC, Huang JJ, Yeh GL et al (2015) Exploring the relationships between high school students’ sexual knowledge, sexual attitude and sources of sexual knowledge in Taiwan. Health Prom Health Educ J 39:1–17

    Google Scholar 

  • Tung CY, Chang CC (2022) The effect of empowerment program on health education teachers with health insurance education. Int J Educ Methodol 8(2):313–320

    Article  Google Scholar 

  • Tung CY, Chang CC, Chang C et al (2016) The analysis of elementary students’ national health insurance knowledge and behavior: Yunlin County as an example. Chin J School Health 69:1–19

    Google Scholar 

  • Tung CY, Shih SF (2015) Report on the results of the project on promoting the sustainable development of public health care in primary and secondary schools. Ministry of Education Republic of China (Taiwan)

  • Turunen H, Sormunen M, Jourdan D, von Seelen J, Buijs G (2017) Health promoting schools-a complex approach and a major means to health improvement. Health Promot Int 32(2):177–184

    Article  CAS  PubMed  Google Scholar 

  • Velasco V, Celata C, Griffin KW (2021) Multiple health behavior programs in school settings: strategies to promote transfer-of-learning through life skills education. Front Public Health 9:716399

    Article  PubMed  PubMed Central  Google Scholar 

  • Wang YW (2018) Health promotion policies for all in Taiwan. J Nurs 65(5):5–12. https://doi.org/10.6224/JN.201810_65(5).02

    Article  Google Scholar 

  • World Health Organization (1986) World health statistics annual, World Health Organization. https://www.who.int/data/gho/publications/world-health-statistics

  • World Health Organization (2020) Life skills education school handbook: prevention of noncommunicable diseases: approaches for schools. W. H. Organization:Geneva. Switzerland. https://www.who.int/publications/i/item/9789240005020

  • World Health Organization (2023) Physicians ratio. https://www.who.int/data/gho/indicator-metadata-registry/imr-details/1208

  • Yang CY, Lo HL, Niu YZ (2019) Oral health in schools and the process of school nursing care. J Nurs 66(1):5–13

    Google Scholar 

  • You Y, Li X, Jiang S et al (2023) Can primary care physician recommendation improve influenza vaccine uptake among older adults? a community health centre-based experimental study in China. BMC Prim Care 24(1):16

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We appreciate the support of the Ministry of Education and National Health Insurance Administration in Taiwan in providing financial assistance and administrative support. We thank all the schools who participated in this study in 2018. We also express our gratitude to the reviewing committee for their valuable insights, which contributed to presenting our findings more comprehensively and clearly.

Funding

This study was funded by Ministry of Education, Taiwan.

Author information

Authors and Affiliations

  1. Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan

    Chia-Chen Chang & Chen-Yin Tung

  2. Department of Early Childhood Care and Education, Kang Ning University, New Taipei City, Taiwan

    Li-Chu Chen

  3. Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan

    Ping-Hsiu Tsai

  4. Department of General Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan

    Su-Hao Fan

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  1. Chia-Chen Chang
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  2. Li-Chu Chen
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  4. Su-Hao Fan
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Contributions

Conceptualization, CCC; data curation, LCC; formal analysis, PHT; funding acquisition, CYT; investigation, CYT; methodology, CCC; project administration, CCC; resources, LCC; software, PHT; supervision, CYT; validation, SHF; visualization, PHT; writing – original draft, PHT; writing – review and editing, CCC.

Corresponding author

Correspondence to Chen-Yin Tung.

Ethics declarations

Ethics approval and consent to participate

This study has been approved by the Research Ethics Committee (No. 202006HS010, Research Ethics Committee, National Taiwan Normal University).

Ethics statement

This study was reviewed and approved by the Institutional Review Board of the Research Ethics Review Committee of the National Taiwan Normal University (case number 202006HS010). The entire study was conducted according to the appropriate guidelines and regulations of the country in which it took place.

Conflict of interest statement

The authors declare that they have no competing interests.

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Chang, CC., Chen, LC., Tsai, PH. et al. Influence of key components of health-promoting schools and physician ratio on health insurance education: a cross-sectional study. J Public Health (Berl.) (2024). https://doi.org/10.1007/s10389-024-02251-w

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