Background Society is experiencing increasing rates of non-communicable diseases (NCDs) and environmental degradation related to climate change. Links between behaviours that exacerbate both poor health and carbon emissions such as food and transport choices are related to individual and collective behaviours. As many behaviours are shaped in early life, schools might be important settings in which to address these issues. To explore this further, we examined the global evidence base for integrated strategies for promoting healthy and environmentally aware behaviours within the school context.
Methods A systematic scoping review was undertaken to identify literature on integrated health and environmental agendas in schools over the last 20 years. Search strings were applied across 10 databases covering relevant disciplines. In total, 3051 titles and abstracts were screened and 228 papers underwent a full-text screen by two independent reviewers, verified by a third. Two texts were found via additional citation searches. 87 texts were eligible, 75 journal articles and 12 additional sources including books and grey literature. Texts were included if they explicitly explored combining health and environmental agendas in any school context. No restrictions in terms of study design, aspect of health or population within the school context were applied.
Results Evidence of whether integrating health and environmental agendas in the school context could improve behaviours related to NCDs and climate change has grown since 2004, particularly in the North American, Australasian and Scandinavian context. Out of the 87 included texts, 55 were based on empirical data: primary qualitative (21), quantitative research (6), mixed method (16) or secondary analysis (12), such as systematic reviews (3). A range of disciplinary fields, most notably Education, Public Health and Geography were found to have explored integration. Only 2/55 studies were found to have follow up longitudinal data. Thirteen of the included texts focused on theories or frameworks associated with integration. A further 8 texts presented logic models to explain the components involved in integration. Predominant theories and concepts included: participation pedagogies, action competencies and socio-ecological frameworks.
Conclusion This review found little consistent evidence to support the implementation of integrated strategies; there seems to be a need for developing an interdisciplinary theoretical framework to guide future research, and strengthening the evidence base could translate research and guide future-focused policy and practice. To inform this, a follow up in-depth evidence synthesis will focus on the subset of conceptual texts.
Funding This work was conducted as part of a PhD project funded by the University of Exeter College of Medicine and Health. Partial funding also provided by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC South West Peninsula). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
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