Developing standards and indicators to guide implementation and sustainment of health promoting schools in Canada: a Delphi study with education and policy experts

BACKGROUND: Health promoting schools (HPS) is an effective approach to promote children's health and development. Standards and indicators for HPS are essential to guide its implementation and sustainment but have not been established in Canada. We describe the methodological approach to develop standards and indicators for HPS that are up to date, achievable, acceptable, and feasible in the Canadian settings. METHODS: We conducted a rapid review of the literature to create a comprehensive inventory of statements related to existing standards and indicators for HPS. We identified and screened 490 relevant peer-reviewed and grey literature publications. From the 23 publications that were classified as 'high quality' and 4 classified as 'medium quality', in addition to 8 key reports for HPS, we extracted 1005 statements related to HPS standards and indicators. After de-duplication, 147 unique statements were retained and grouped into 42 standard components and 105 indicators. Two panels appraised, updated, split, merged, and reworded these standard components and indicators in three rounds of the Delphi survey. RESULTS: Overall, 53 experts completed the first round of the Delphi survey, 48 completed the second round, and 46 completed the final round. Consensus was reached on all standard components and 87 (83%) of indicators. After mapping to nine standards, categorized into four distinctive domains (i.e. the health promoting schools, enablers, Canadian values, and quality improvement), the final set included 37 standard components and 100 indicators. CONCLUSION: We provide the rationale and methodological underpinnings for establishing Canadian standards and indicators for HPS. These will guide policy and practice to promote equity and improve children's learning, health and wellbeing.