健康服务视域下健康促进学校及身体活动监测与评估研究

Monitoring and evaluation of health-promoting schools and physical activity from the perspective of health services

目的分析世界卫生组织(WHO)健康服务体系、健康促进学校、身体活动领域的监测与评估的政策与方法体系,构建身体活动融入健康促进学校的监测与评估政策架构以及方法体系。方法运用WHO健康服务体系构成要素的理论,在宏观、中观和微观3个层面,对WHO健康服务体系、健康促进学校和身体活动相关领域的核心政策文件进行系统内容分析,构建相关的政策架构并且分析核心内容。结果在宏观政策层面,涉及政策架构、监测与评估架构、治理与监测能力建设。①根据WHO健康服务构成6要素的理论,构建身体活动融入健康促进学校监测与评估的政策架构,指导信息系统建设、监测指标体系、评估工具等开发与应用。②参照国家健康战略通用监测与评估架构,在学校健康服务体系监测架构和身体活动监测架构下,构建涵盖投入和过程指标、产出指标、结果指标和影响指标的监测与评估体系。③提升学校健康治理与监测能力,根据国家健康服务体系监测平台强化策略,加强国家健康促进学校治理与监测能力。在中观层面,涉及监测实施方案、核心内容以及数据平台。①构建国家的健康促进学校和身体活动监测体系以及监测与评估方案,坚持“健康第一”“学生中心”“全校参与”“持续改进”基本理念以及“学校主责”“统一指标体系”“多维评估”基本原则。②参考健康促进学校和身体活动全球监测标准,将身体活动纳入健康促进学校监测体系以及监测与评估数据平台。③建立监测与评估机制,采取常态监测和周期性评估相结合、在线监测和实地考察相结合、定量分析和定性判断相结合、学校举证和专家查证相结合等多种方法,多维度、多视角监测评估学生身体活动政策相关的实施行动以及学生身体活动和健康状况。④加强学校健康信息系统建设,加强学校身体活动调查统计和研究,加强体育和健康素养监测,形成科学的运动处方库,根据监测报告调整政策行动和服务措施。⑤建立监测与评估的协同机制。在微观层面,涉及监测与评估指标、方法和工具。①在WHO健康服务监测、健康促进学校监测以及身体活动监测架构下,制定身体活动融入健康促进学校的监测与评估标准、指标体系并且开发监测与评估工具和数据平台。②构建科学的监测指标体系,包含核心指标和扩展指标,纳入优质体育教学和实践教学监测。在指标体系构建上,投入和过程指标涉及身体活动领导力与治理、筹资、人力资源、技术和设备设施、信息系统;产出指标主要为身体活动促进相关指标,包括优质体育教学和实践教学、推动和保障积极出行以及课堂、课间、课后的身体活动干预和服务;结果指标涉及身体活动覆盖、水平和效果;影响指标涉及健康、功能、福祉和生活质量以及环境、社会、经济、教育、体育和公共卫生等方面。③在监测与评估方法和工具上,采用WHO推荐的监测与评估标准化工具。结论身体活动作为一项健康战略,对于构建健康促进学校,促进学生的身体发展和健康具有重要意义。本研究基于WHO健康服务视域,构建身体活动融入健康促进学校的监测与评估政策架构以及方法体系,该监测与评估涉及宏观、中观和微观3个层面。在宏观层面上,构建相关政策架构、监测与评估架构并且提升监测能力;中观层面上,构建监测与评估实施方案、核心内容及数据平台;微观层面上,以身体活动融入健康促进学校监测架构和内容为依据,开发相关的指标体系及实施方法与工具。

Objective To analyze the policy and methodological framework of monitoring and evaluation in the fields of World Health Organization(WHO)health service system,health-promoting schools,and physical activity,and to construct a policy framework and approach to monitor and evaluate the integration of physical activity into the health-promoting schools.Methods Using the theory of WHO health service system components,the core policy documents of the WHO in the fields of health service,health-promoting schools,and physical activity were systematically analyzed,the relevant policy framework was constructed and the core elements were analyzed at macro,meso,and micro levels.Results At the macro policy level,the policy framework,monitoring and evaluation framework,governance and monitoring capacity building were addressed.(1)Based on the theory of WHO’s six building blocks of health services,the policy framework for monitoring and evaluation of physical activity integration into health-promoting schools was constructed to guide the development and application of information systems,monitoring indicator systems,and evaluation tools.(2)With reference to the generic monitoring and evaluation framework of the national health strategy(NHS),a monitoring and evaluation framework covering input and process indicators,output indicators,outcome indicators and impact indicators was constructed within framework of school health service system monitoring and physical activity monitoring.(3)School health governance and monitoring capacity should be enhanced,and national health-promoting school governance and monitoring capacity should be strengthened based on the National Health Service System monitoring platform strengthening strategy.At the meso level,it involved monitoring implementation programs,core content,and data platforms.(1)Building a national health-promoting school and physical activity monitoring system,and a monitoring and evaluation program emphasizing"health first","student-centered","whole-school participation",and"continuous improvement"as well as"school responsibility","unified indicator system",and"multidimensional evaluation".(2)Referring to the health-promoting school,and incorporate physical activity into the health-promoting school monitoring system and the monitoring and evaluation data platform by referring to the global monitoring standards for healthpromoting schools and physical activity.(3)Establishing a monitoring and evaluation mechanism that combines regular monitoring and periodic evaluation,online monitoring and fieldwork,quantitative analysis and qualitative analysis,and school evidence and expert evaluation to monitor and evaluate student physical activity policy-related implementation actions and student physical activity and health status from multiple levels and perspectives.(4)Strengthening the construction of school health information systems,strengthen school physical activity statistical surveys and research,strengthen physical education and health literacy monitoring,form a scientific database of exercise prescriptions,and adjust policy actions and service measures based on monitoring reports.(5)Establishing a synergistic mechanism for monitoring and evaluation.At the micro level,it involves monitoring and evaluation indicators,methods and tools.(1)Under the framework of WHO health service monitoring,healthpromoting school monitoring and physical activity monitoring,developing monitoring and evaluation standards and indicator systems for physical activity integration into health-promoting schools and develop monitoring and evaluation tools and data platforms.(2)Constructing a scientific monitoring indicator system,including core indicators and extended indicators,and incorporate quality physical education and practice teaching monitoring.In the construction of the indicator system,input and process indicators include physical activity leadership and governance,financial resources,human resources,technology and equipment facilities,and information systems;output indicators focus on physical activity promotion-related indicators,including quality physical education and practice teaching,promotion and assurance of active travel,and physical activity interventions and services in the classroom,between classes,and after school;outcome indicators address physical activity coverage,levels,and effects;the impact indicators include health,functioning,well-being and quality of life,as well as environmental,social,economic,educational,sport and public health aspects.(3)In terms of monitoring and evaluation methods and tools,adopting the standardized tools recommended by WHO for monitoring and evaluation.Conclusion Physical activity,as a health strategy,is important to build health-promoting schools and promoting students’physical development and health.This study constructed a policy framework and methodological system for monitoring and evaluation of physical activity integration into health-promoting schools based on the WHO health services framework.This monitoring and evaluation covered at the macro,meso and micro levels.At the macro level,the policy framework,monitoring and evaluation framework,and monitoring capacity were proposed;at the meso level,the implementation plan,core contents,and data platform were proposed;at the micro level,the monitoring framework and contents of physical activity integration into health-promoting schools were used as the basis to develop the related indicator system and implementation methods and tools.