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Open Access Highly Accessed Study protocol

Evaluation of health promotion in schools: a realistic evaluation approach using mixed methods

Jeanine Pommier12, Marie-Renée Guével12* and Didier Jourdan2

Author Affiliations

1 EHESP School of Public Health (Ecole des Hautes Etudes en Santé Publique), Av. du Professeur Léon Bernard, 35043 Rennes CEDEX, France

2 Laboratoire PAEDI, School Health Education research unit and IUFM d'Auvergne (Auvergne Teacher Training College), Université Blaise Pascal, 36, avenue Jean Jaurès CS 20001, 63407 CHAMALIERES CEDEX, France

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BMC Public Health 2010, 10:43  doi:10.1186/1471-2458-10-43

Published: 28 January 2010



Schools are key settings for health promotion (HP) but the development of suitable approaches for evaluating HP in schools is still a major topic of discussion. This article presents a research protocol of a program developed to evaluate HP. After reviewing HP evaluation issues, the various possible approaches are analyzed and the importance of a realistic evaluation framework and a mixed methods (MM) design are demonstrated.


The design is based on a systemic approach to evaluation, taking into account the mechanisms, context and outcomes, as defined in realistic evaluation, adjusted to our own French context using an MM approach. The characteristics of the design are illustrated through the evaluation of a nationwide HP program in French primary schools designed to enhance children's social, emotional and physical health by improving teachers' HP practices and promoting a healthy school environment. An embedded MM design is used in which a qualitative data set plays a supportive, secondary role in a study based primarily on a different quantitative data set. The way the qualitative and quantitative approaches are combined through the entire evaluation framework is detailed.


This study is a contribution towards the development of suitable approaches for evaluating HP programs in schools. The systemic approach of the evaluation carried out in this research is appropriate since it takes account of the limitations of traditional evaluation approaches and considers suggestions made by the HP research community.