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Development of the School Health Education Program from the perspective of

Comprehensive School Health Model: an example at a Higher Secondary
School of Karachi, Pakistan

Article  in  Taiwan Journal of Public Health · December 2017

DOI: 10.6288/TJPH201736105118

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 原　著

Development of the School Health Education Program from the

perspective of Comprehensive School Health Model: an example
at a Higher Secondary School of Karachi, Pakistan

Saleema A Gulzar1,*, Parvez Nayani2, Syed Shajee Husain3, Amna Khan4

Objectives: To assess need for school health program, common health issues, knowledge and
attitude towards health, perceived needs of students, teachers and parents. Thereafter apply Com-
prehensive School Health Model in a higher secondary school of Karachi; and gather outcome of
the program through anecdotal evidences from stakeholders. Methods: Baseline assessment was
conducted through focus group discussions and individual views from through interactive activi-
ties from 250 students; focus group discussions with 35 teachers and administered questionnaires
to 16 parents. We thematically analyzed the data. Based on the thematic analysis, assigned school
health nurse developed and implemented health education curriculum. We gathered anecdotal
evidence from stakeholders to gauge success of the program. Results: The responses of students
were more inclined towards physical aspects of health, and those of parents on issues related to
mental and social development. Teachers emphasized broad and important aspects of counseling
on psychosocial problems of students. After implementation of the curriculum, there were de-
velopments like establishment of a cafeteria committee to ensure healthy food availability and
extended counseling facilities to help students cope with daily life stressors. Conclusions: The
program was successful in terms of executing health promoting initiatives for school children.
The framework can act as a reference for other schools in developing countries that share similar
needs and want to administer and direct the concept of school health promotion for their students.
(Taiwan J Public Health. 2017;36(6):545-555)

Key words: school health, nurses’ roles and responsibilities, health promotion, school health program

1
School of Nursing and Midwifery, Aga Khan University,
Stadium Rd., P. O. Box 3500, Karachi, Pakistan. INTRODUCTIONS
2
Aga Khan University Program in Afghanistan, Aga
Khan University, Karachi, Pakistan. Unhealthy habits and behaviors play a
3
Department of Community and Family Medicine major role in hindering the performance level
Faculty of Medicine and Health Sciences, Univer- of students during their academic years. Their
siti Malaysia Sabah, Malaysia. physical and psychological well-being is at
4
Research Office, Department of Community Health stakes when it comes to execute important life
Sciences, School of Nursing, Aga Khan University, routines. Today, major health problems are
Karachi, Pakistan.
due to the behaviors and attitudes established
*
Correspondence author.
during youth [1]. Health education can play
E-mail: [Link]@[Link]
Received: Dec 1, 2016
a major role to recognize risk behaviors,
Accepted: Oct 25, 2017 factors and conditions which affect them. It
DOI:10.6288/TJPH201736105118 can facilitate voluntary actions conducive to

台灣衛誌 2017, Vol.36, No.6 545

Saleema A Gulzar, Parvez Nayani, Syed Shajee Husain, Amna Khan

health [2]. During the 20th century education, school health education can be dated back to
skills and other knowledge have become period of recognition (1850-1880) when people
vital determinants of and individual’s and a started to recognize that schools could be used
nation’s efficiency. The primitive determinant to educate and screen for diseases. It was until
of a country’s standard of living depends on the 1980s, when more sophisticated school
its success in developing and utilizing skills, health education programs were developed
knowledge, health, and habits of its population and global guidelines and recommendations
[3]. One major reason given for the dramatic were suggested to be developed to provide the
differences in economic development between foundation and standards for global school
East Asia and Africa is the significantly health initiative. An expert committee was
higher level of investment that East Asia has constituted by WHO for comprehensive school
made in the education and healthcare of its health education and promotion in Geneva
citizens. Thus, investments in interactive health [8]. In addition, published background papers,
education can have both short and long – teaching materials and over heads materials,
term benefits to an individual’s health and the fact sheets, press releases and background
productivity of nations. speech notes, and a bibliography of all
In 1986 the World Health Organization references cited in expert committee documents
(WHO) [4], initiated the concept of Health were also developed [9,10]. Center for Disease
Promoting School through the Ottawa Charter Control, USA has developed a comprehensive
for Health Promotion [5]. According to the curriculum for health education in schools [11].
WHO health promoting school has members Also, the ministries of education and health
from the school and community who work in a number of Asian and Pacific countries
together to provide students with integrated like India, Malaysia, Indonesia, Philippines,
and positive experiences and structures to Sri Lanka and Thailand have jointly revised
promote and protect their health. Health comprehensive health curricula for different
promotion always plays the holistic role to age groups and teachers [12].
execute the approaches of Health Education in The general picture inferred from the
terms of behavior change on willful grounds, literature explains the global importance of
it also include the personally organized and imparting health education to young adults.
independent participation [6], Research Focus is given on the content and process
conducted by Karina et. al has shown a strong through which they can be educated. Secondly,
and progressive relationship between health the health promotion frame work suggested
and learning. Students who report good by WHO is based on successful practice
health also perform better in school. In this evidenced internationally [13]. Inter sector
way by creating health promoting schools, and collaborative approach is also highlighted
school leaders could promote learning in an in literature for health promotion purpose.
active manner. Furthermore, schools could The existing literature shows that the need for
indeed provide efficient means of educating health promotions at a school level is existent,
young pupils [7]. Researchers highlighted but some strong interventions are required
that schools could further promote the better for more improvements and these demands
understanding of what health means, how to experimentations and development of model
achieve it, and how it contributes towards interventions to address present and future
social and economic development. History of needs.

546 台灣衛誌 2017, Vol.36, No.6

 Development of school health model Karachi

To address the need of school health, a malaria are major cause of childhood morbidity
professional school health nurse is required. and mortality in Pakistan [3]. Other infectious
R e c e n t l y i n t h e y e a r 2007, c o u n c i l o n diseases such as polio, tuberculosis, measles,
school health also supported this notion that hepatitis and dengue are also prevalent in the
positioning a school health nurse in school country. Among noncommunicable diseases,
setting, does not only serve the purpose of cardiovascular problems, mental disorder,
promoting health through health education and diabetes are on the rise [8].
screening services but also helps in imparting A committee on school health has clearly
coordinated health care in school setting by stated that school health nurse works as
providing individualized need based health care leader in coordination of parents, teachers and
to student [14]. Pakistan Ministry of Education children to address the health issues amongst
data of 2008-2009 shows that approximately school children and promote their health [17].
79% of children are availing school education. The success of this model was piloted in a
This data show that a large number of our higher secondary school of Karachi, Pakistan. It
children are now getting access to education in is worth mentioning that this type of framework
schools, which provides huge opportunities for can act as a reference for other schools in
health education program for them who would developing countries who want to administer
then be enabled to enhance its productivity and direct the concept of health education for
economically and socially [15]. their students.
School health programs in Pakistan are A Comprehensive School Health Model
being experimented in the form of school applied and conducted a qualitative assurance
projects with the collaboration of the Private project in a higher secondary school in Karachi
and Government sector. However, there is still for making it a health promoting school.
a need of a standard health education program
1. The primary objectives of this project were:
which is developed according to the needs of
To assess the views of students, teachers
the local population. One may question the
and parents about the need for school health
process through which schools can develop
program; their role; common health issues;
a comprehensive school health education
knowledge and attitude towards health; and
program that schools can provide an ideal,
their perceived needs.
though largely underused, setting for tackling
2. To develop a health education curriculum
the health problems of students, their families,
according as one of the critical component of
and communities [16]. For this purpose, the
the Comprehensive School health Model.
Comprehensive School Health model (see
3. The secondary objectives were: To apply
appendix) designed to protect and promote
Comprehensive School Health Model in a
health and safety of students and school staff
higher secondary school in Karachi.
has been accepted and administered in many
4. To assess the outcome of the program through
schools worldwide [1].
anecdotal evidences from stakeholders such
I n P a k i s t a n, i n f a n t a n d u n d e r f i v e
as school health nurse, teachers, parents and
mortality rates are 74 and 89 deaths per 1000
students.
live births in last five years respectively [3].
Maternal Mortality Ratio is 276 deaths per 100,
MATERIALS AND METHODS
000 live births [3]. Infectious diseases such
as diarrhea, Acute Respiratory Infections and This project was conducted at a non-

台灣衛誌 2017, Vol.36, No.6 547

Saleema A Gulzar, Parvez Nayani, Syed Shajee Husain, Amna Khan

government Higher Secondary School in as school health nurse, teachers and students,
Karachi, Pakistan. The school has grade XI by interviewing them and observing class
and XII, aged 12-13 including girls and boys room sessions on health awareness, physical
with around 500 students enrolled of either education classes and school cafeteria
gender. Carrying out focus group discussions
w i t h t e a c h e r s, d i s c u s s i o n s a n d w r i t t e n RESULTS
suggestions from students and administration
of questionnaire to parents. The results have been organized under
The Baseline assessment was done two heads, ‘Need Assessment’ and ‘Outcome
through focus group discussions with teachers, of the Program’.
discussions and written suggestions from
students and administration of questionnaire A. Need Assessment
to the parents. The assessment included The responses from all the stakeholders
participants’ views about the need for school strongly suggested the need for health education
health program, its role, common health issues curriculum. The findings of assessment were
and participants’ knowledge and attitudes organized into three themes: Physical, Mental
towards health of adolescents through school and Social Health, from which a health
health promotion and their perceived needs. education curriculum was developed.
Through purposive sampling, 35 teachers, 250 Responses from students were more
students and 16 parents agreed to participate inclined towards physical aspects of health
after getting their informed consent. The such as, cardiac problems, eczema, jaundice,
confidentiality ensured by using anonymous headache, which should be prevented by a
questionnaires without identifying the healthy physical environment and balanced
individuals. Thematic analysis was performed diet. Parents focused more on issues related
on the baseline data to develop health education to mental and social development, such as,
curriculum by broadly categorizing responses self esteem and confidence building, healthy
into three themes which were ‘physical’, ‘social’ relationships, personality development,
and ‘mental’ aspects of health. personal grooming and stress management. On
Subsequently a school health nurse the other hand, teachers emphasized broad and
planned and implemented the curriculum and important aspect of counseling on psychosocial
other components of the comprehensive school problems of students.
health model. She developed specific lesson All the stakeholders suggested topics such
plans and prepared class room sessions which as intellectual skills, positive thinking, problem
were included in the regular teaching program. solving, decision making, critical thinking,
Students evaluated each session for further art and aesthetics and enhancing reading
modifications. The Health Promotion and and writing skills. Topics focusing on social
Resource Center of a health NGO in Pakistan aspects included ethics, mannerism, social
provided technical support throughout the psychology, time management, organization
process. The school management participated at skills, confidence building, networking,
every stage in deliberations and for planning the unity, friendship, and career orientation.
next steps. Although formal evaluation of the These topics could be included in the school
program was not conducted however, anecdotal curriculum with the technical support of Health
evidences gathered from stakeholders, such Promotion Resource Center. While describing

548 台灣衛誌 2017, Vol.36, No.6

 Table 1. Themes extracted as per the opinions expressed by the stake holders
S. no. Physical Mental Social
1 Parents Parents focused more on issues related to mental and While describing their role, parents suggested
social development, such as, self-esteem and confidence that they should participate more actively in
building, healthy relationships, personality development, school activities, such as meetings, seminars and
personal grooming and stress management. related events.
2 Teachers • On the other hand, teachers emphasized broad and

台灣衛誌 2017, Vol.36, No.6

important aspect of counseling on psychosocial
problems of students.
• Parents also felt that they could serve as motivators to
encourage healthy practices at home and monitoring
the mental and physical development of children.
• The teachers also supported establishment of parents-
teachers association and suggested strengthening the
position of school health nurse through empowering
her.
• The school health committee was formed during the
implementation phase, clearly stated that school health
nurse works as leader in coordination of parents,
teachers and children to address the health issues
amongst school children and promote their health.
3 Students Responses from students were more Students also suggested interactive activities
inclined towards physical aspects in the health education curriculum over formal
of health which includes Cardiac activities.
p r o b l e m s, e c z e m a, j a u n d i c e,
headache (migraine), which should
be prevented by a healthy physical
environment and balanced diet.
4 All the stakeholders suggested topics such as intellectual skills, positive thinking, problem solving, decision making, critical thinking, art and aesthetics
5 Everyone from the groups was of the opinion that there should be enhancement of reading and writing skills.

549
Development of school health model Karachi
Saleema A Gulzar, Parvez Nayani, Syed Shajee Husain, Amna Khan

their role, parents suggested that they should B. Outcome of the Program:
participate more actively in school activities,
After implementation of the curriculum,
such as meetings, seminars and related events.
we noted anecdotal evidences to determine
Parents also felt that they could serve as
the program outcome. We have divided these
motivators to encourage healthy practices at
anecdotes in three thematic areas, ‘Physical
home and monitoring the mental and physical
Health’, ‘Mental Health’ and ‘Social Health’.
development of children. These responses
suggest a well defined active role for parents
and a stronger need for parents- teachers
association. The teachers also supported
establishment of parents-teachers association
and suggested strengthening the position of
school health nurse through empowering her.
Strategies and activities for health education:
Focus of students was more towards
participatory teaching strategies and health Physical Health: The school management
related activities. Students suggested activities constituted a committee for promoting healthy
which included seminars, health campaigns, dietary behavior for students to ensure provision
social gatherings, walks, educational visits, of healthy food available at the school cafeteria
awareness programs, research assignments, in a hygienic environment. The committee
supportive and fund raising campaigns for the comprised of students, teachers and parents.
needy, and also for indoor and outdoor sports. Moreover, students started taking interest in
Some other interesting suggestions included regular physical exercises and fitness programs
introducing health magazines and pamphlets including aerobics at school level. The school
and inter-college networking for sharing also started a first aid training course during
of knowledge and resources. Teachers also summer holidays to create awareness among
suggested broadening the scope of school health students about preventive measures for some
by focusing on mental health and counseling for everyday accidents and injuries. These session
students and the use of audiovisual aids. It was and activities conducted by a school health
emphasized on them to approach your teacher nurse.
of concerned health personnel to address any Mental Health: The school management
health related issues. They were taught that it is to initiate counseling facilities for students to
not a taboo to seek help for either for your own help them cope up with the daily life stresses,
self or for a fellow student if they feel a need such as meeting deadlines for assignments or
of it. Students were also encouraged to enhance preparation for examinations. Sessions on stress
their awareness on health by becoming a part prevention and management for students and
of teaching and learning practices pertaining teachers were also organized.
t o h e a l t h e d u c a t i o n p r o g r a m m e s. T h e y They found these sessions were very
were advised to act as an agent of change to useful and helped them enhance their
disseminate the importance of health education productivity. In addition, a workshop on
and its proper practices especially to those who ‘Adolescents’ Psychosocial Problems and
neglect and suffer drastically. Counseling’ was arranged for teachers. This

550 台灣衛誌 2017, Vol.36, No.6

 Development of school health model Karachi

enabled them to identify students more prone these dimensions. According to one study
to mental health issues and helped in prompt a p p r o x i m a t e l y 18% s t u d e n t s g e t h e a l t h
referral to the students’ counselor. education from a full time nurse during their
Social Health: The third aspect of the school stay. This approach would have better
program outcome is related to social health. health outcomes, as indicated by one of
Topics such as interpersonal skills and healthy the study [18,19]. Our project findings also
relationships were included in health education corroborate with this approach, where the
sessions for students. program focused on physical, social and mental
After the program implementation at health of school children.
higher secondary school, other schools of I n o u r s t u d y, a l l t h e s t a k e h o l d e r s
the system also became interested in the suggested topics related to mental and social
program. Therefore, a two days workshop was health. Cunningham et al also received similar
arranged for four schools on ‘School Health suggestions by their stakeholders. These
Promotion’ in which school health nurses, included addressing stigmas, implementing
physical education instructors and health culturally competent care, providing mental
coordinators participated. The objectives of health training to school staff, and increasing
this workshop were to enable each school to collaboration between community care
plan and implement health promoting activities providers. These topics can be included in the
in their schools and to empower participants, school curriculum with the technical support of
particularly school health nurses to work in Health Promotion Resource Center.
leadership positions. Another important finding was the
It is worth mentioning here that as a result suggestions from parents that they should
of implementing this program, the school participate more actively in health promotion
system created a position of a school health related activities. They should be involved
researcher. An experienced school health in monitoring the mental and physical
nurse was appointed at the management level. development of children. Involvement of
She developed a framework for school health parents in children’s education at school has
curriculum for the entire school system as a been shown to have positive educational
guide to facilitate school health nurses and outcomes. These responses suggest a well-
teachers to impart health education in their defined active role for parents and a stronger
respective schools. The health researcher need of parent teacher associations. The
conducted a cross sectional study on ‘prevalence development of school curriculum suggests that
of common health problems of school the school management has been supportive of
children’. She shared the results at school’s the initiative, indicating a milestone towards
leaders’ forum for further planning of strategies the sustainability of the program. Students also
to combat these health problems. suggested participatory activities over formal
activities, which show their enthusiasm in such
DISCUSSIONS activities. School health nurse on the other hand
encouraged students to initiate health promoting
Health as a concept includes physical, activities like community based health projects
mental and social wellbeing. Any health which enhanced awareness among people;
promotion program should have a holistic examples of which included projects on
approach to health encompassing all ‘balanced diet’ and ‘anemia’. The interviews

台灣衛誌 2017, Vol.36, No.6 551

Saleema A Gulzar, Parvez Nayani, Syed Shajee Husain, Amna Khan

with school health nurse, teachers and students initiating prototype of school health promotion.
were indicative of the program’s success. The According to a study “young aged 12-22 years
school health nurse and the school management are in a transitional period of life with stresses
modified the school health curriculum for in choosing career, learning to interact with
higher secondary school. This was to be opposite gender, developing their own identity
followed by curriculum development for and achieving independence [22]. They are
secondary and primary schools. Cunningham, also striving to achieve intellectual, economic,
et, al. suggests that majority of the school and emotional autonomy. Therefore, it was
health promotion programs are based on considered that the program would greatly
holistic approach targeting a specific objective. benefit this age group as the students were
For the successful implementation, research already in the process of learning and further
suggests that the project should be ingrained in develop their personality during their transition
the school setting and not considered as another phase. Apart from developmental importance,
project isolated from the actual setting in which some other factors included changing the
it is going to be implemented. For the effective philosophy of the school by supporting the
school health program, the need of interactive intellectual, physical, socio-cultural and
content is evident [20]. moral development of students rather than
According to the 8th Five-year plan just concentrating on the traditional way of
of Pakistan there was no program for youth strengthening their education [22].
in general. Although some directions were The important step was to develop a
pointed out including the use of different more focused, integrated and student driven
c o m m u n i c a t i o n c h a n n e l s, i n n o v a t i v e program, which would bring parents and
approaches, use of media and targeting teachers at one platform for planning. Thus,
messages for particular age groups of people delegating leadership to students and making
but there was hardly any implementation. Being them the ambassadors of health in their
a developing country with scarce resources, school and community. Such models are
it is important to use the captive audience of seen in practice internationally. Their aim is
students and teachers with available resources focused at achieving healthy life style of total
and collaborative approach; an approach which school population, supportive and conducive
would make everybody responsible for health environment for health and healthy physical
promotion. The health promotion project at and social environment. Taking inspiration
higher secondary school was also an attempt to from such models, health promotion program
prove the possibility of such an effort. During at higher secondary school level was designed.
the 20th century, “education, skills and other Over all, the lessons learnt from this initiative
knowledge have become crucial determinants clearly elaborated that it is a high time to
of a person’s and a nation’s productivity. The address the health needs of young adults.
primary determinant of a country’s standard Considering our limited health resources, it
of living is how well it succeeds in developing is feasible to adopt health promotion model
and utilizing the skills, knowledge, health, and which aims at achieving health for all through
habits of its population [21]. a united, intersectoral and sincere efforts of
It is important and worth mentioning all including; health professionals, teachers,
to recognize factors which facilitated us in students and others involved in the process of
choosing the higher secondary school level for healthcare delivery.

552 台灣衛誌 2017, Vol.36, No.6

 Development of school health model Karachi

It is evident that strategies suggested school representing the private sector is a

hold strong basis for participation, mutual aid major limitation of this study, nevertheless the
and strengthening student community action. results are sufficient enough to conclude, that
These are constituents of health promotion health education program for adolescents using
mechanisms and strategies which ultimately Comprehensive School Health Model results
lead to healthy environment and healthy public in positive outcomes. We recommend other
policy. All the analysis and results provide the schools to develop and implement school health
base for future plan of action for the health programs by applying comprehensive school
promotion in schools in Pakistan. health model. Still there is a need to acquire
more in depth knowledge to test the model at a
Conclusion large scale in public schools set up as well.
The program implemented in only one

ANNEXURE

Description of the Comprehensive School Health Model

This program initially included three components: health education, a healthful school environment,
and health services. Allensworth and Kolbe expanded this model in 1987 to include physical education,
nutrition services, counseling services, community and family involvement, and health promotion for staff.
The Coordinated School Health Program has described Comprehensive School Health Model comprising of
eight components.
1. Health Education – This component suggests a planned health curriculum for students delivered through
classroom instructions. Designed to encourage and assist students to maintain and improve their health,
prevent disease, and reduce health-related risk behaviors.
2. Healthful school environment – This component deals with the physical, emotional, and social climate
of the school. It includes issues regarding safety, school security, a school’s emotional and social
atmosphere, the physical environment, and sexual harassment. Designed to provide a safe, healthy and
supportive environment that promotes learning.
3. School Health Services - Encourages promoting and protecting the health of every child. It includes
Preventive services, education, emergency care, referral, and management of acute and chronic health
conditions.
4. School nutrition services – Promotes nutrition education and an environment that promotes healthy
eating behaviors for all children. Provides access to nutritious, affordable, and appealing meals.
5. School Physical Education- Promotes physical activity at school to develop basic movement skills,
sports skills, and physical fitness as well as to enhance mental, social, and emotional abilities.
6. Counseling/Psychological services - Activities that support evaluations and counseling for students
to resolve their cognitive, emotional, behavioral and social problems. Designed to prevent and address
problems and enhance healthy development.
7. Parent/ community involvement in schools – Encourages the involvement of parents and communities
in school activities.
8. School-site health promotion for staff - Assessment, education, and fitness activities for school faculty
and staff. Designed to maintain and improve the health and well-being of school staff.

台灣衛誌 2017, Vol.36, No.6 553

Saleema A Gulzar, Parvez Nayani, Syed Shajee Husain, Amna Khan

REFERENCES 13. Friedman DJ, Starfield B. Models of population

health: their value for US public health practice, pol-
1. Kolbe LJ. An essential strategy to improve the health icy, and research. Am J Public Health 2003;93:366-9.
and education of Americans. Prev Med. 1993;22:544- doi:10.2105/AJPH.93.3.366.
60. doi:10.1006/pmed.1993.1047. 14. National Association of School Nurses. Position state-
2. Green LW, Kreuter MW. Health Promotion Planning: ment: caseload assignments. Available at: [Link]
An Educational and Environmental Approach. Moun- org/[Link]?tabid_209. Accessed April 16, 2007.
tain View, CA: Mayfield Publish Company, 2005. 15. Ministry of Finance, Government of Pakistan. Paki-
3. Pevlik Z. Human capital from the demographic point stan economic survey (2008-09), Available at: http://
of view. Reprodukce Lidského Kapitálu 2014;24:358- [Link]/survey_0809.html. Accessed
63. April 16, 2007.
4. WHO. Ottawa Charter for Health Promotion. Geneva: 16. Henderson AT. The Evidence Continues to Grow:
WHO, 1986. Parent Involvement Improves Student Achievement.
5. WHO. WHO Expert Committee on Comprehensive An Annotated Bibliography. National Committee for
School Health Education and Promotion. Geneva: Citizens in Education Special Report. Columbia, MD:
WHO, 2003. National Committee for Citizens in Education, 1987.
6. Meeks L, Heit P, Page R. Comprehensive School 17. Becker GS. Human Capital and Poverty Alleviation.
Health Education. 2nd ed., Blacklick, OH: Meeks HRO Working Papers Number 52. Washington, DC:
Heit, 1996. World Bank, 1995.
7. Sabinsky MS. Healthy eating at schools: how does a 18. Inchley J, Muldoon J, Currie C. Becoming a health
school food programme affect the quality of dietary promoting school: evaluating the process of effective
intake at lunch among children aged 7-13 years? [The- implementation. Health Promot Int 2006;22:65-71.
sis]. Denmark: Division of Nutrition, National Food doi:10.1093/heapro/dal059.
Institute, Technical University of Denmark, 2013. 19. Schainker E, O’Brien MJ, Fox D, Bauchner H. School
8. WHO. The Status of School Health. Geneva: WHO, nursing services: use in an urban public school sys-
1996. tem. Arch Pediatr Adolesc Med. 2005;159:83-7.
9. Allensworth DD, Kolbe LJ. The comprehensive doi:10.1001/archpedi.159.1.83.
school health program: exploring an expanded con- 20. Cunningham D, Stephan SH, Paternite C, et al. Stake-
cept. J S ch H e a l t h 1987;5 7:409-12. d o i:10.1111/ holders’ perspectives on the recommendations of
j.1746-1561.1987.tb03183.x. the president’s new freedom commission on mental
10. Freudenberg N, Ruglis J. reframing school dropout as health. Psychiatr Serv 2007;58:1344-7. doi:10.1176/
a public health issue. Prev Chronic Dis 2007;4:A107. [Link].58.10.1344.
11. Centers for Disease Control and Prevention (CDC). 21. Planning Commission, Government of Pakistan.
Guidelines for school and community programs to Eighth Five Year Plan (1993-98) Approach Paper.
promote lifelong physical activity among young peo- Islamabad, Pakistan: Planning Commission, Govern-
ple. MMWR Recomm Rep 1997;46:1-36. ment of Pakistan, 1992.
12. Maurer FA, Smith C. Community / Public Health 22. Dhillon SH, Philip L. Health in education for all:
Nursing Practice: Health or Families and Populations. enabling school age children and adults for healthy
3rd ed., New York, NY: Mosby, 2012. living. Hygie 1992;11:17-28.

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 Development of school health model Karachi

從綜合性學校衛生計畫看學校健康教育的發展：
以巴基斯坦卡拉奇一所高中為例

Saleema A Gulzar1,*, Parvez Nayani2,

Syed Shajee Husain3, Amna Khan4

目標：透過將綜合性學校衛生計畫應用在巴基斯坦卡拉奇的一所高中，藉以評估學校健康
教育計劃的需求、常見的健康議題、對健康的知識和態度，以及學生、教師與家長的自覺需
求。方法：採焦點團體法與250位學生、35位教師進行訪談，以及對16名家長進行問卷調查，
將收集到的資料進行主題分析，並依據主題，由一位學校保健室的護理人員制定並實施健康教
育課程。結果：學生們傾向於注重身體健康，而父母則傾向於心理和社會發展的相關層面，教
師則強調輔導學生的社會心理問題。在課程實施後，帶來一些新的影響，例如：食堂委員會的
成立以確保供應健康的食物，以及增設輔導設施，協助學生應付日常生活壓力。結論：此計畫
在執行學生健康促進方面來說是成功的，且此架構可作為發展中國家其他有相似需求，並希冀
經營和指導學生有關學校健康促進之概念的參考。（台灣衛誌 2017；36(6)：545-555）

關鍵詞： 學校衛生、護士的角色和責任、健康促進、學校衛生計劃

1
School of Nursing and Midwifery, Aga Khan University, Stadium Rd., P. O. Box 3500, Karachi, Pakistan.
2
Aga Khan University Program in Afghanistan, Aga Khan University, Karachi, Pakistan.
3
Department of Community and Family Medicine Faculty of Medicine and Health Sciences, Universiti Malaysia
Sabah, Malaysia.
4
Research Office, Department of Community Health Sciences, School of Nursing, Aga Khan University, Karachi,
Pakistan.
*
通訊作者：Saleema A Gulzar
E-mail: [Link]@[Link]
投稿日期：2016年12月1日
接受日期：2017年10月25日
DOI:10.6288/TJPH201736105118

台灣衛誌 2017, Vol.36, No.6 555

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