Implementation of the health promoting school program in Poland: results from a national cross-sectional study.

BACKGROUND: The Health Promoting School (HPS) approach is widely recognised as a promising avenue for supporting the health and wellbeing of pupils, teachers and non-teaching staff at the intersection of schools and communities. Although Poland has a long tradition of establishing a national HPS Network, empirical evidence on the level and determinants of implementation remains limited. This study aims to assess the level of implementation of health promotion in Polish schools belonging to the national HPS network and to examine differences in terms of school type, National HPS Certification, and length of network membership. METHODS: A cross-sectional survey was conducted between March and June 2023 among health promotion coordinators from public Polish schools participating in the HPS network (N = 500, completed questionnaires = 426, i.e., 85.2%). The HPS Implementation Questionnaire was used to measure seven dimensions of implementation (e.g., fidelity, adaptation, integration). Differences between groups were analysed using t-tests and one-way ANOVA. RESULTS: Overall implementation of the HPS approach was moderate-to-high (M = 3.05, SD = 0.62). The highest scores were found for Integration (M = 3.53, SD = 0.74) and Adaptation (M = 3.40, SD = 0.88), while Adherence (M = 2.09, SD = 0.70) and Participant responsiveness (M = 2.71, SD = 0.84) scored lowest. Group comparisons revealed higher implementation levels across most dimensions for primary schools, schools holding a National HPS Certificate and those with longer network members. CONCLUSIONS: The findings indicate that sustained participation in the HPS network is associated with higher implementation of school health promotion. Schools holding the National HPS Certificate scored higher on all implementation dimensions, a pattern consistent with the rigorous requirements of the certification process. The results highlight the importance of long-term capacity building, supportive structures, and contextual adaptation in achieving effective and sustainable HPS.