Achieving health-promoting schools, the <i>Alliance for Health</i> experiment: setting up an interventional research protocol and evaluating a health-promotion program in primary schools

The early years in life are critical in many ways as they significantly impact future health outcomes. In line with the 2018-2022 National French Health Strategy, <i>Alliance for Health</i> is a complex intervention that deploys a health-promotion program based on a health determinants approach and oriented toward 8- to 11-year-olds. It aims to increase their psychosocial competencies and health literacy levels. The objective of the study was to understand and assess the outcomes and implementation process of an evidence-based health-promotion program targeting both primary schools and the children's local environment. To reach this goal, pupils were exposed to health-promoting actions carried out by their teachers and a health-promoting environment, both inside and outside the school. A multisite cluster trial involving a complex intervention in the population was performed with one experimental group and one control group during three academic years. The project took place in four districts of the Auvergne-Rhône-Alpes region and involved 101 schools (10,000 pupils: intervention group 5000 + control group 5000). This research intervention program gathered local policy makers, regional education authorities, the regional public health agency, and researchers (education and public health). The intervention's focus was on its sustainability, its integration in the everyday practices of the professionals, and its impact on the children's psychosocial competencies and health literacy. This paper describes the project's protocol, the research design, and the interventions deployed to improve health-promotion services provided in primary schools and the children's local environment.