Integrated Whole-School Health and Physical Education: Implementation Fidelity, Daily Physical Activity, and Wellbeing in Primary Schools
Keywords:
physical education, whole-school health, moderate-to-vigorous physical activity, student wellbeing, physical literacy, implementation fidelity, primary schoolAbstract
School health programmes are often separated into physical education, health teaching, student support, and environmental initiatives even though students experience these elements within the same school day. This study evaluated a coordinated whole-school approach linking physical literacy and activity, health knowledge and behaviour, social-emotional wellbeing, and supportive school conditions. A 12-month, two-arm quasi-experimental study involved 18 primary schools, including 9 intervention schools and 9 matched comparison schools, with 2,310 students aged 8--11 years and 148 teachers. Moderate-to-vigorous physical activity (MVPA) was assessed by accelerometry, student wellbeing was measured with KIDSCREEN-27, and implementation was assessed with a fidelity checklist. Difference-in-differences analysis incorporated school-level clustering, and intervention schools were examined by high-, medium-, and low-fidelity tertiles. High-fidelity schools increased MVPA by 8.3 minutes/day compared with 1.1 minutes/day in comparison schools, giving a net difference of 7.2 minutes/day. Medium-fidelity schools increased by 3.6 minutes/day and low-fidelity schools by 0.4 minutes/day. Wellbeing increased by 2.4 points in high-fidelity schools, 1.1 points in medium-fidelity schools, 0.2 points in low-fidelity schools, and 0.3 points in comparison schools. The corresponding effect-size values were 0.31, 0.14, 0.03, and 0.04. The graded pattern across implementation levels shows that participation in a school-wide programme is not sufficient by itself; stronger and more consistent delivery is associated with larger changes in both daily activity and wellbeing. The findings support closer coordination of physical education, health learning, student wellbeing, and school conditions throughout the primary-school day.
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