health education research activities

Data Collections, Research Projects, and Funding Opportunities

Discover data collections, research projects, and funding opportunities related to nutrition, food insecurity, and physical inactivity in tribal communities. 

Data Collections

Centers for disease control and prevention (cdc): adult physical inactivity outside of work interactive maps.

CDC developed  interactive maps  showing differences in physical activity among U.S. adults by race and ethnicity and location in 2022. 27 states had a physical inactivity prevalence of 30 percent or higher among non-Hispanic AI/AN adults.

National Cancer Institute (NCI): Cancer Resources 

For information on AI/AN specific cancer surveillance and tumor registries, as well as the programs that support these efforts, visit this National Cancer Institute (NCI) webpage . 

Learn about AI colorectal screening programs and review cancer literature searches specific for Native American populations on NCI’s Native American Health webpage .

National Institutes of Health (NIH) Office of Aids Research (OAR): Data Hub

To learn about funding opportunities and ongoing research on HIV/AIDS within AI/AN populations, visit NIH’s  Office of Aids Research (OAR) Data Hub . 

Research Projects and Resources

Centers for diabetes translation research (cdtr).

The   Centers for American Indian and Alaska Native Diabetes Translation Research , funded under the Centers for Diabetes Translation Research (CDTR) program , has a mission to translate research of proven efficacy into practice in both clinical and community settings, with the goal of improving the diabetes-related health of Native people.  Learn more about this grant award .

CDC: Keys to Success Tip Sheet: Enrolling and Retaining American Indian Participants in the National Diabetes Prevention Program Lifestyle Change Program

Including traditional foods in type 2 diabetes prevention programs serving AI/AN communities can help program participants achieve their goals. This tip sheet provides lessons learned and insights on how staff can include traditional foods and make their program more culturally relevant for AI/AN participants. 

NIH: ADVANCE: Advancing Prevention Research for Health Equity

NIH provides funding support for a variety of research, training, infrastructure development, and outreach and information dissemination projects. The NIH Office of Disease Prevention is coordinating the NIH-wide research effort, ADVANCE: Advancing Prevention Research for Health Equity . As part of this initiative, this Notice of Special Interest (NOSI) focuses specifically on preventive interventions to address cardiometabolic risk factors in populations that experience health disparities, including AI/AN people. In the United States, AI/AN children experience disproportionate health disparities, including high rates of diabetes, obesity, and dental caries when compared to all other groups. Youth from AI/AN populations also face socio-cultural barriers in school and community settings that undermine the importance of their Native identity.

NIH: Exploring Food Insecurity as a Social Determinant of Health Among American Indian and Alaska Native Adolescents at Risk for Gestational Diabetes

Exploring Food Insecurity as a Social Determinant of Health Among American Indian and Alaska Native Adolescents at Risk for Gestational Diabetes   aims to explore how food insecurity impacts AI/AN females prior to pregnancy and will identify solutions to decrease food insecurity and diabetes health disparities in AI/AN communities. 

NIH: Native Collective Research Effort to Enhance Wellness (N CREW) 

The NIH supported program   Native Collective Research Effort to Enhance Wellness (N CREW) supports Tribes and Native American Serving Organizations (T/NASOs). T/NASOs participating in the program conduct research to address overdose, substance use, and pain, including related factors such as mental health and wellness. Phase I completed in November 2023 with the goal to support T/NASOs to plan, develop, pilot, and implement research and data improvement projects. Projects have received an initial review, and the process to award the projects has been initiated.

NIH: Osage Community Supported Agriculture Study (OCSA) 

The Osage Community Supported Agriculture Study (OCSA)   will test the efficacy of a CSA program combined with culturally tailored nutrition and cooking education among Osage adults, evaluate its cost-effectiveness, and develop a multimedia toolkit for disseminating findings .

NIH: Promoting Linguistic and Cultural Identity through Bilingual Children’s Stories to Address Nutrition and Health in Indigenous Communities

The Promoting Linguistic and Cultural Identity through Bilingual Children’s Stories to Address Nutrition and Health in Indigenous Communities project will develop a platform for the creation, distribution, and consumption of Native-authored, bilingual resources. The resources, tailored to AI/AN families, will relate to health, nutrition, and traditional foods. The goal is to create a library of dynamic, bilingual children’s eBooks in AI/AN languages and English, with accompanying interactive activities to promote parent-child dialogue and co-reading.

NIH/NHLBI: Strong Heart Study (SHS) 

The  Strong Heart Study (SHS) is a study of cardiovascular disease and its risk factors among American Indian men and women, and is one of the largest epidemiological studies of American Indians ever undertaken. 

NIH/National Institute of Environmental Health Sciences (NIEHS): Building Food Sovereignty, Sustainability, and Better Health in Environmentally impacted Native Americans

This National Institute of Environmental Health Sciences (NIEHS) project   will identify and implement safe and nutritious farming practices and restore food sovereignty through development of a farming system program supported by the Turtle Clan-founded Munsee Three Sisters Medicinal Farm. This innovative study will integrate a culturally centered, environmental road map created from community input for food sovereignty and sustainability that can be shared and disseminated to other environmentally impacted Nations. 

NIH/NIEHS: Native American Health and the Environment

NIH supports research to determine how environmental agents cause or exacerbate human diseases, including research to improve the environmental health of American Indians and Alaska Natives (AI/AN).  Learn more about these NIEHS-founded initiatives .

Research Funding Opportunities

Nih: intervention research to improve native american health (irinah) program.

The  Intervention Research to Improve Native American Health (IRINAH) Program supports research on interventions that aim to improve the health and well-being of Native American populations, including traditional nutrition and sports. IRINAH supports: 

• Etiologic research that will directly inform intervention development or adaptations
• Research that develops, adapts, or tests interventions for health promotion, prevention, treatment, or recovery
• Research on dissemination and implementation that develops and tests strategies to overcome barriers to the adoption, integration, scale-up, and sustainability of effective interventions

The IRINAH program includes 3 different funding opportunities:  R01 - PAR-23-298 ,  R21 - PAR-23-299 , and  R34 - PAR-23-285 .

NIH: Native American Research Centers for Health (NARCH) Program

The  Native American Research Centers for Health (NARCH) Program funds federally recognized American Indian/Alaska Native (AI/AN) Tribes and organizations for health research, research career enhancement, and research infrastructure enhancement activities. The NARCH program aims to support research directly linked to health concerns specifically identified, selected, and prioritized by tribal communities. 

The NARCH program includes 2 funding opportunities:   S06– PAR-23-166 and   R34 – PAR-24-041 . 

NIH: Notices of Special Interest

The  Determining the Tri-directional Relationship Among Oral History, Nutrition, and Comprehensive Health Notice of Special Interest Funding Opportunity supports research on the interplay of nutrition/food insecurity, oral diseases, and comprehensive health across the lifespan.

The  Stimulating Research to Understand and Address Hunger, Food and Nutrition Insecurity Notice of Special Interest Funding Opportunity encourages research on the efficacy of interventions and development of new measures for nutrition security and the mechanisms of food insecurity on a variety of health outcomes.

The Office of Disease Prevention and Health Promotion (ODPHP) cannot attest to the accuracy of a non-federal website.

Linking to a non-federal website does not constitute an endorsement by ODPHP or any of its employees of the sponsors or the information and products presented on the website.

You will be subject to the destination website's privacy policy when you follow the link.

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Health Education and Health Promotion: Key Concepts and Exemplary Evidence to Support Them

• First Online: 09 October 2018

Cite this chapter

• Hein de Vries 8 ,
• Stef P. J. Kremers 8 &
• Sonia Lippke 9  

3334 Accesses

12 Citations

Health is regarded as the result of an interaction between individual and environmental factors. While health education is the process of educating people about health and how they can influence their health, health promotion targets not only people but also their environments. Promoting health behavior can take place at the micro level (the personal level), the meso level (the organizational level, including e.g. families, schools and worksites) and at the macro level (the (inter)national level, including e.g. governments). Health education is one of the methods used in health promotion, with health promotion extending beyond just health education.

Models and theories that focus on understanding health and health behavior are of key importance for health education and health promotion. Different classes of models and theories can be distinguished, such as planning models, behavioral change models, and diffusion models. Within these models different topics and factors are relevant, ranging from health literacy, attitudes, social influences, self-efficacy, planning, and stages of change to evaluation, implementation, stakeholder involvement, and policy changes. Exemplary health promotion settings are schools, worksites, and healthcare, but also the domains that are involved with policy development. Main health promotion methods can involve a variety of different methods and approaches, such as counseling, brochures, eHealth, stakeholder involvement, consensus meetings, community ownership, panel discussions, and policy development. Because health education and health promotion should be theory- and evidence-based, personalized interventions are recommended to take empirical findings and proven theoretical assumptions into account.

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Theory and Fundamentals of Health Promotion for Children and Adolescents

Aarts, H., Paulussen, T., & Schaalma, H. (1997). Physical exercise habit: On the conceptualization and formation of habitual health behaviours. Health Education Research, 12 (3), 363.

Article   PubMed   Google Scholar  

Abraham, C., & Michie, S. (2008). A taxonomy of behavior change techniques used in interventions. Health Psychology, 27 (3), 379–387.

Abraham, C., & Sheeran, P. (2003). Acting on intentions: The role of anticipated regret. The British Journal of Social Psychology, 42 (Pt 4), 495–511.

Abraham, C., & Sheeran, P. (2005). The Health Belief Model. In M. Conner & P. Norman (Eds.), Predicting health behaviour (pp. 28–80). Berkshire: Open University Press.

Google Scholar  

Abroms, L. C., & Maibach, E. W. (2008). The effectiveness of mass communication to change public behavior. Annual Review of Public Health, 29 , 219–234.

Adams, J., & White, M. (2003). Are activity promotion interventions based on the transtheoretical model effective? A critical review. British Journal of Sports Medicine, 37 (2), 106–114.

Article   PubMed   PubMed Central   Google Scholar  

Ajzen, I. (1988). Attitudes, personality, and behavior . Chicago: Dorsey Press.

Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50 (2), 179–211.

Article   Google Scholar  

Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior . Englewood Cliffs: Prentice-Hall.

Aldana, S. G., Merrill, R. M., Price, K., Hardy, A., & Hager, R. (2005). Financial impact of a comprehensive multisite workplace health promotion program. Preventive Medicine, 40 (2), 131–137.

Alderman, M. H., & Schoenbaum, E. E. (1975). Detection and treatment of hypertension at the work site. The New England Journal of Medicine, 293 (2), 65–68.

Armitage, C. J. (2009). Is there utility in the transtheoretical model? British Journal of Health Psychology, 14 (2), 195–210.

Armitage, C. J. (2004). Evidence that implementation intentions reduce dietary fat intake: A randomized trial. Health Psychology, 23 (3), 319.

Armitage, C. J., & Conner, M. (2001). Efficacy of the theory of planned behaviour: A meta-analytic review. The British Journal of Social Psychology, 40 (Pt 4), 471–499.

Armstrong, N., & Powell, J. (2008). Preliminary test of an Internet-based diabetes self-management tool. Journal of Telemedicine and Telecare, 14 (3), 114–116.

Asch, S. E. (1956). Studies of independence and conformity: I. A minority of one against a unanimous majority. Psychological Monographs, 70 (9), 1.

Ashford, S., Edmunds, J., & French, D. P. (2010). What is the best way to change self-efficacy to promote lifestyle and recreational physical activity? A systematic review with meta-analysis. British Journal of Health Psychology, 15 (Pt 2), 265–288.

Ausems, M., Mesters, I., van Breukelen, G., & De Vries, H. (2004). Effects of in-school and tailored out-of-school smoking prevention among Dutch vocational school students. Health Education Research, 19 (1), 51–63.

Austin, J. T., & Vancouver, J. B. (1996). Goal constructs in psychology: Structure, process, and content. Psychological Bulletin, 120 (3), 338.

Aveyard, P., Massey, L., Parsons, A., Manaseki, S., & Griffin, C. (2009). The effect of Transtheoretical Model based interventions on smoking cessation. Social science and medicine, 68 (3), 397–403.

Babbin, S. F., Harrington, M., Burditt, C., Redding, C., Paiva, A., Meier, K., Oatley, K., McGee, H., & Velicer, W. F. (2011). Prevention of alcohol use in middle school students: Psychometric assessment of the decisional balance inventory. Addictive Behaviors, 36 (5), 543–546.

Bagozzi, R. P. (1992). The self-regulation of attitudes, intentions, and behavior. Social Psychology Quarterly, 55 (2), 178.

Bagozzi, R. P., & Dholakia, U. (1999). Goal setting and goal striving in consumer behavior. Journal of Marketing, 63 , 19–32.

Baker, D. W., Parker, R. M., Williams, M. V., & Clark, W. S. (1998). Health literacy and the risk of hospital admission. Journal of General Internal Medicine, 13 (12), 791–798.

Bandura, A. (1977). Social learning theory . New York: General Learning Press.

Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory . Englewood Cliffs: Prentice-Hall.

Bandura, A. (1989). Human agency in social cognitive theory. American Psychologist, 44 (9), 1175–1184.

Bandura, A. (1993). Perceived self-efficacy in cognitive development and functioning. Educational Psychologist, 28 (2), 117–148.

Bandura, A. (1997). Editorial. American Journal of Health Promotion, 12 (1), 8–10.

Bargh, J. A. (2005). Bypassing the will: Toward demystifying the nonconscious control of social behavior. In R. R. Hassin, J. S. Uleman, & J. A. Bargh (Eds.), The new unconscious (pp. 37–58). New York: Oxford University Press.

Bartholomew, L. K., Parcel, G. S., Kok, G., & Gottlieb, N. H. (2001). Intervention-mapping: Designing theory and evidence-based health promotion programs . Mountain View: Mayfield.

Bartholomew, L. K., Parcel, G. S., Kok, G., Gottlieb, N. H., & Fernández, M. E. (2011). Planning health promotion: An intervention mapping approach (3rd ed.). San Francisco: Jossey Bass.

Bentz, C. J., Bruce Bayley, K., Bonin, K. E., Fleming, L., Hollis, J. F., Hunt, J. S., LeBlanc, B., McAfee, T., Payne, N., & Siemienczuk, J. (2007). Provider feedback to improve 5A’s tobacco cessation in primary care: A cluster randomized clinical trial. Nicotine & Tobacco Research, 9 (3), 341–349.

Berkman, L. F., & Syme, S. L. (1979). Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents. American Journal of Epidemiology, 109 (2), 186–204.

Beyer, J. M., & Trice, H. M. (1978). Implementing change: Alcoholism policies in work organization . New York: Free Press.

Blissmer, B., & McAuley, E. (2002). Testing the requirements of stages of physical activity among adults: The comparative effectiveness of stage-matched, mismatched, standard care, and control interventions. Annals of Behavioral Medicine, 24 (3), 181–189.

Bodenheimer, T., Lorig, K., Holman, H., & Grumbach, K. (2002). Patient self-management of chronic disease in primary care. JAMA, 288 (19), 2469–2475.

Boer, H., & Seydel, E. R. (1996). Protection motivation theory. In M. Conner & P. Norman (Eds.), Predicting health behavior (pp. 95–120). Buckingham: Open University Press.

Bolman, C., Arwert, T. G., & Vollink, T. (2011). Adherence to prophylactic asthma medication: Habit strength and cognitions. Heart & Lung, 40 (1), 63–75.

Bonfadelli, H. (2002). Medieninhaltsforschung: Grundlagen, Methoden, Anwendungen . Konstanz: UVK.

Borland, R., Balmford, J., Segan, C., Livingston, P., & Owen, N. (2003). The effectiveness of personalized smoking cessation strategies for callers to a Quitline service. Addiction, 98 (6), 837–846.

Botvin, G. J., Eng, A., & Williams, C. L. (1980). Preventing the onset of cigarette smoking through life skills training. Preventive Medicine, 9 (1), 135–143.

Botvin, G. J., & Griffin, K. W. (2004). Life skills training: Empirical findings and future directions. The Journal of Primary Prevention, 25 (2), 211.

Bracht, N. (1990). Community organization principles in health promotion: A five-stage model. In N. Bracht & L. Kingsbury (Eds.), Health promotion at the community level . Thousand Oaks: Sage.

Bracht, N. (1999). Health promotion at the community level: New advances . Thousand Oaks: Sage.

Brewer, N. T., Weinstein, N. D., Cuite, C. L., & Herrington, J. E. (2004). Risk perceptions and their relation to risk behavior. Annals of Behavioral Medicine, 27 (2), 125.

Brewer, N. T., Brewer, N. T., & Fazekas, K. I. (2007). Predictors of HPV vaccine acceptability: A theory-informed, systematic review. Preventive Medicine: An International Journal Devoted to Practice and Theory, 45 (2–3), 107.

Brinn, M. P., Carson, K. V., Esterman, A. J., Chang, A. B., & Smith, B. J. (2010). Mass media interventions for preventing smoking in young people. Cochrane Database of Systematic Reviews, 11 , CD001006.

Britt, E., Hudson, S. M., & Blampied, N. M. (2004). Motivational interviewing in health settings: A review. Patient Education and Counseling, 53 (2), 147–155.

Brodie, M., Flournoy, R. E., Altman, D. E., Blendon, R. J., Benson, J. M., & Rosenbaum, M. D. (2000). Health information, the Internet, and the digital divide. Health Affairs (Millwood), 19 (6), 255–265.

Brouwer, W., Oenema, A., Raat, H., Crutzen, R., de Nooijer, J., de Vries, N. K., & Brug, J. (2010). Characteristics of visitors and revisitors to an Internet-delivered computer-tailored lifestyle intervention implemented for use by the general public. Health Education Research, 25 (4), 585–595.

Brown, T., & Summerbell, C. (2009). Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: An update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obesity Reviews, 10 (1), 110–141.

Brug, J., Lechner, L., & De Vries, H. (1995). Psychosocial determinants of fruit and vegetable consumption. Appetite, 25 (3), 285.

Brug, J., Steenhuis, I., van Assema, P., & de Vries, H. (1996). The impact of a computer-tailored nutrition intervention. Preventive Medicine, 25 (3), 236–242.

Brug, J., Steenhuis, I. H. M., Van Assema, P., Glanz, K., & De Vries, H. (1999). The impact of two computer tailored nutrition education interventions. Health Education Research, 14 , 249–256.

Brug, J., Conner, M., Harré, N., Kremers, S., McKellar, S., & Whitelaw, S. (2005). The transtheoretical model and stages of change: A critique. Observations by five commentators on the paper by Adams, J., & White, M. (2004). Why don’t stage-based activity promotion interventions work? Health Education Research, 20 (2), 244.

Bruvold, W. H. (1993). A meta-analysis of adolescent smoking prevention programs. American Journal of Public Health, 83 (6), 872.

Bryan, A., Fisher, J. D., & Fisher, W. A. (2002). Tests of the mediational role of preparatory safer sexual behavior in the context of the theory of planned behavior. Health Psychology, 21 (1), 71–80.

Campbell, M. K., Demark-Wahnefried, W., Symons, M., Kalsbeek, W. D., Dodds, J., Cowan, A., Jackson, B., Motsinger, B., Hoben, K., Lashley, J., Demissie, S., & McClelland, J. W. (1999). Fruit and vegetable consumption and prevention of cancer: The Black Churches United for Better Health project. American Journal of Public Health, 89 (9), 1390–1396.

Chaiken, S., Liberman, A., & Eagly, A. H. (1989). Heuristic and systematic information processing within and beyond the persuasion context. In J. S. Uleman & J. A. Bargh (Eds.), Unintended thought . New York: The Guilford Press.

Charles, C., Whelan, T., & Gafni, A. (1999). What do we mean by partnership in making decisions about treatment? BMJ, 319 (7212), 780–782.

Chinn, M. D., & Fairlie, R. W. (2007). The determinants of the global digital divide: A cross-country analysis of computer and internet penetration. Oxford Economic Papers, 16 , f-44.

Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98 (2), 310.

Collins, J. L. (1982, March). Self-efficacy and ability in achievement behavior. Paper presented at the annual meeting of the American Educational Research Association, New York.

Conner, M., & Norman, P. (2005). Predicting health behaviour: Research and practice with social cognition models . Maidenhead: Open University Press.

Conner, M., & Armitage, C. J. (1998). Extending the theory of planned behavior: A review and avenues for further research. Journal of Applied Social Psychology, 28 (15), 1429.

Conner, M., Godin, G., Sheeran, P., & Germain, M. (2013). Some feelings are more important: Cognitive attitudes, affective attitudes, anticipated affect, and blood donation. Health Psychology, 32 (3), 264.

Coster, S., & Norman, I. (2009). Cochrane reviews of educational and self-management interventions to guide nursing practice: A review. International Journal of Nursing Studies, 46 (4), 508–528.

Cramer, J. A. (2004). A systematic review of adherence with medications for diabetes. Diabetes Care, 27 (5), 1218–1224.

Cranney, M., Warren, E., Barton, S., Gardner, K., & Walley, T. (2001). Why do GPs not implement evidence-based guidelines? A descriptive study. Family Practice, 18 (4), 359–363.

Cutrona, S. L., Choudhry, N. K., Stedman, M., Servi, A., Liberman, J. N., Brennan, T., Fischer, M. A., Alan Brookhart, M., & Shrank, W. H. (2010). Physician effectiveness in interventions to improve cardiovascular medication adherence: A systematic review. Journal of General Internal Medicine, 25 (10), 1090–1096.

de Bruijn, G. J., Kremers, S. P., De Vries, H., Van Mechelen, W., & Brug, J. (2007). Associations of social-environmental and individual-level factors with adolescent soft drink consumption: Results from the SMILE study. Health Education Research, 22 (2), 227–237.

de Meij, J. S., Chinapaw, M. J., Kremers, S. P., Jurg, M. E., & Van Mechelen, W. (2010). Promoting physical activity in children: The stepwise development of the primary school-based JUMP-in intervention applying the RE-AIM evaluation framework. British Journal of Sports Medicine, 44 (12), 879–887.

de Nooijer, J., Lechner, L., & de Vries, H. (2002). Early detection of cancer: Knowledge and behavior among Dutch adults. Cancer Detection and Prevention, 26 (5), 362–369.

de Vet, E., de Nooijer, J., de Vries, N. K., & Brug, J. (2008a). Testing the transtheoretical model for fruit intake: Comparing web-based tailored stage-matched and stage-mismatched feedback. Health Education Research, 23 (2), 218–227.

de Vet, E., De Nooijer, J., De Vries, N. K., & Brug, J. (2008b). Do the transtheoretical processes of change predict transitions in stages of change for fruit intake? Health Education & Behavior, 35 (5), 603–618.

de Vet, E., Gebhardt, W. A., Sinnige, J., Van Puffelen, A., Van Lettow, B., & de Wit, J. B. (2011). Implementation intentions for buying, carrying, discussing and using condoms: The role of the quality of plans. Health Education Research, 26 (3), 443–455.

de Vries, H., & Backbier, E. (1994). Self-efficacy as an important determinant of quitting among pregnant women who smoke: The phi-pattern. Preventive Medicine, 23 (2), 167–174.

de Vries, H., & Brug, J. (1999). Computer-tailored interventions motivating people to adopt health promoting behaviours: Introduction to a new approach. Patient Education and Counseling, 36 (2), 99–105.

de Vries, H., & van Dillen, S. (2002). Prevention of Lyme disease in Dutch children: Analysis of determinants of tick inspection by parents. Preventive Medicine, 35 (2), 160–165.

de Vries, H., & van Dillen, S. (2007). I PLAN: Planning the prevention of Lyme disease, a health promotion approach. In P. van Nitch (Ed.), Research on Lyme disease . New York: Nova Science.

de Vries, H., Dijkstra, M., & Kuhlman, P. (1988). Self-efficacy: The third factor besides attitude and subjective norm as a predictor of behavioural intentions. Health Education Research, 3 (3), 273.

de Vries, H., Backbier, E., Kok, G., & Dijkstra, M. (1995). The impact of social influences in the context of attitude, self-efficacy, intention and previous behavior as predictors of smoking onset. Journal of Applied Social Psychology, 25 , 237–257.

de Vries, H., Mudde, A. N., Dijkstra, A., & Willemsen, M. C. (1998). Differential beliefs, perceived social influences, and self-efficacy expectations among smokers in various motivational phases. Preventive Medicine, 27 (5 Pt 1), 681–689.

de Vries, H., Mudde, A., Leijs, I., Charlton, A., Vartiainen, E., Buijs, G., Clemente, M. P., Storm, H., González Navarro, A., Nebot, M., Prins, T., & Kremers, S. (2003). The European Smoking Prevention Framework Approach (EFSA): An example of integral prevention. Health Education Research, 18 (5), 611–626.

de Vries, H., Lezwijn, J., Hol, M., & Honing, C. (2005). Skin cancer prevention: Behaviour and motives of Dutch adolescents. European Journal of Cancer Prevention, 14 (1), 39–50.

de Vries, H., Candel, M., Engels, R., & Mercken, L. (2006). Challenges to the peer influence paradigm: Results for 12–13 year olds from six European countries from the European Smoking Prevention Framework Approach study. Tobacco Control, 15 (2), 83–89.

de Vries, H., van’t Riet, J., Panday, S., & Reubsaet, A. (2007). Access point analysis in smoking and nonsmoking adolescents: Findings from the European Smoking Prevention Framework Approach study. European Journal of Cancer Prevention, 16 (3), 257–265.

de Vries, H., Kremers, S., Smeets, T., & Reubsaet, A. (2008a). Clustering of diet, physical activity and smoking and a general willingness to change. Psychology & Health, 23 (3), 265.

de Vries, H., van’t Riet, J., Spigt, M., Metsemakers, J., van den Akker, M., Vermunt, J. K., & Kremers, S. (2008b). Clusters of lifestyle behaviors: Results from the Dutch SMILE study. Preventive Medicine, 46 (3), 203–208.

de Vries, H., Kremers, S. P. J., Smeets, T., Brug, J., & Eijmael, K. (2008c). The effectiveness of tailored feedback and action plans in an intervention addressing multiple health behaviors. American Journal of Health Promotion, 22 (6), 417–425.

Dean, A. J., Walters, J., & Hall, A. (2010). A systematic review of interventions to enhance medication adherence in children and adolescents with chronic illness. Archives of Disease in Childhood, 95 (9), 717–723.

Della Mea, V. (2001). What is e-Health (2): The death of telemedicine? Journal of Medical Internet Research, 3 (2), e22.

Dempsey, A. R., Johnson, S. S., & Westhoff, C. L. (2011). Predicting oral contraceptive continuation using the transtheoretical model of health behavior change. Perspectives on Sexual and Reproductive Health, 43 (1), 23–29.

Dictionary, O. E. (2010). “Mass media, n.”, Oxford University Press.

Dijk, F., & de Vries, H. (2009). Smoke alert: A computer-tailored smoking-cessation intervention for Dutch adolescents. Documentation of a FCHE workshop held in Berlin, 18–19 September 2008. Research and Practice of Health Promotion, 14 , 34–46.

Dijkstra, A. (2005). Working mechanisms of computer-tailored health education: Evidence from smoking cessation. Health Education Research, 20 (5), 527–539.

Dijkstra, A., & De Vries, H. (1999). The development of computer-generated tailored interventions. Patient Education and Counseling, 36 (2), 193–203.

Dijkstra, A., & De Vries, H. (2000). Subtypes of precontemplating smokers defined by different long-term plans to change their smoking behavior. Health Education Research, 15 (4), 423–434.

Dijkstra, A., Bakker, M., & De Vries, H. (1997). Subtypes within a sample of precontemplating smokers: A preliminary extension of the stages of change. Addictive Behaviors, 22 (3), 327–337.

Dijkstra, A., De Vries, H., Roijackers, J., & van Breukelen, G. (1998). Tailored interventions to communicate stage-matched information to smokers in different motivational stages. Journal of Consulting and Clinical Psychology, 66 (3), 549–557.

Dijkstra, A., Conijn, B., & De Vries, H. (2006). A match–mismatch test of a stage model of behaviour change in tobacco smoking. Addiction, 101 (7), 1035–1043.

DiMatteo, M. R. (2004). Social support and patient adherence to medical treatment: A meta-analysis. Health Psychology, 23 (2), 207–218.

Dlamini, S., Taylor, M., Mkhize, N., Huver, R., Sathiparsad, R., de Vries, H., Naidoo, K., & Jinabhai, C. (2009). Gender factors associated with sexual abstinent behaviour of rural South African high school going youth in KwaZulu-Natal, South Africa. Health Education Research, 24 (3), 450–460.

Dunton, G. F., Lagloire, R., & Robertson, T. (2009). Using the RE-AIM framework to evaluate the statewide dissemination of a school-based physical activity and nutrition curriculum: “Exercise Your Options”. American Journal of Health Promotion, 23 (4), 229–232.

Dusenbury, L., Brannigan, R., Falco, M., & Hansen, W. B. (2003). A review of research on fidelity of implementation: Implications for drug abuse prevention in school settings. Health Education Research, 18 (2), 237–256.

Epstein, S. (1994). Integration of the cognitive and the psychodynamic unconscious. The American Psychologist, 49 (8), 709–724.

Etter, J. F. (2009). Comparing computer-tailored, internet-based smoking cessation counseling reports with generic, untailored reports: A randomized trial. Journal of Health Communication, 14 (7), 646–657.

Evans, R. I. (1976). Smoking in children: Developing a social psychological strategy of deterrence. Preventive Medicine, 5 (1), 122–127.

Evans-Whipp, T., Beyers, J. M., Lloyd, S., Lafazia, A. N., Toumbourou, J. W., Arthur, M. W., & Catalano, R. F. (2004). A review of school drug policies and their impact on youth substance use. Health Promotion International, 19 (2), 227.

Eysenbach, G. (2005). The law of attrition. Journal of Medical Internet Research, 7 (1), e11.

Faggiano, F., Vigna-Taglianti, F. D., Versino, E., Zambon, A., Borraccino, A., & Lemma, P. (2008). School-based prevention for illicit drugs use: A systematic review. Preventive Medicine, 46 (5), 385–396.

Farquhar, J. W., Fortmann, S. P., Flora, J. A., Taylor, C. B., Haskell, W. L., Williams, P. T., Maccoby, N., & Wood, P. D. (1990). Effects of communitywide education on cardiovascular disease risk factors. The Stanford Five-City Project. JAMA, 264 (3), 359–365.

Fazio, R. H. (1990). Multiple processes by which attitudes guide behaviour: The MODE model as an integrative framework. In M. P. Zanna (Ed.), Advances in experimental social psychology (pp. 75–109). San Diego: Academic Press.

Feifer, C., Ornstein, S. M., Jenkins, R. G., Wessell, A., Corley, S. T., Nemeth, L. S., Roylance, L., Nietert, P. J., & Liszka, H. (2006). The logic behind a multimethod intervention to improve adherence to clinical practice guidelines in a nationwide network of primary care practices. Evaluation & the Health Professions, 29 (1), 65–88.

Festinger, L. (1954). A theory of social comparison processes. Human Relations, 7 , 117.

Fishbein, M., & Ajzen, I. (1975). Belief, attitude, intention, and behavior: An introduction to theory and research . Reading: Addison-Wesley.

Fishbein, M., & Ajzen, I. (2010). Predicting and changing behavior: The reasoned action approach . New York: Taylor & Francis Group.

Fletcher, A., Bonell, C., & Hargreaves, J. (2008). School effects on young people’s drug use: A systematic review of intervention and observational studies. The Journal of Adolescent Health, 42 (3), 209–220.

Fleuren, M., Wiefferink, K., & Paulussen, T. (2004). Determinants of innovation within health care organizations: Literature review and Delphi study. International Journal for Quality in Health Care, 16 (2), 107–123.

Floyd, D. L., Prentice-Dunn, S., & Rogers, R. W. (2000). A meta-analysis of research on protection motivation theory. Journal of Applied Social Psychology, 30 (2), 407–429.

Fox, M. P. (2009). A systematic review of the literature reporting on studies that examined the impact of interactive, computer-based patient education programs. Patient Education and Counseling, 77 (1), 6–13.

Fransen, G. A. J., Mesters, I., Janssen, M. J. R., Knottnerus, J. A., & Muris, J. W. M. (2009). Which patient-related factors determine self-perceived patient adherence to prescribed dyspepsia medication? Health Education Research, 24 (5), 788–798.

Gaglio, B., Shoup, J. A., & Glasgow, R. E. (2013). The RE-AIM framework: A systematic review of use over time. American Journal of Public Health, 103 (6), e38–e46.

Gagne, C., & Godin, G. (2000). The theory of planned behavior: Some measurement issues concerning belief-based variables. Journal of Applied Social Psychology, 30 (10), 2173–2193.

Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health behavior and health education: Theory, research, and practice . San Francisco: Jossey-Bass.

Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89 (9), 1322–1327.

Glasgow, R. E., Lichtenstein, E., & Marcus, A. C. (2003). Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. American Journal of Public Health, 93 (8), 1261–1267.

Glynn, T. J. (1989). Essential elements of school-based smoking prevention programs. The Journal of School Health, 59 (5), 181–188.

Godin, G., & Conner, M. (2008). Intention-behavior relationship based on epidemiologic indices: An application to physical activity. American Journal of Health Promotion, 22 (3), 180–182.

Godin, G., & Kok, G. (1996). The theory of planned behavior: A review of its applications to health-related behaviors. American Journal of Health Promotion, 11 (2), 87–98.

Goebbels, A. F., Goebbels, A. F. G., Nicholson, J. M., Walsh, K., & De Vries, H. (2008). Teachers’ reporting of suspected child abuse and neglect: Behaviour and determinants. Health Education Research, 23 (6), 941–951.

Goetzel, R. Z., & Ozminkowski, R. J. (2008). The health and cost benefits of work site health-promotion programs. Annual Review of Public Health, 29 , 303–323.

Gollwitzer, P. M. (1990). Action phases and mind-sets. In E. T. Higgins & R. M. Sorrentino (Eds.), Handbook of motivation and cognition: Foundations of social behavior (Vol. 2, pp. 53–92). New York: Guilford Press.

Gollwitzer, P. M. (1999). Implementation intentions: Strong effects of simple plans. American Psychologist, 54 (7), 493.

Gollwitzer, P. M., & Sheeran, P. (2006). Implementation intentions and goal achievement: A Meta-analysis of effects and processes. Advances in Experimental Social Psychology, 38 , 69–119.

Grant, R. W., Wald, J. S., Poon, E. G., Schnipper, J. L., Gandhi, T. K., Volk, L. A., & Middleton, B. (2006). Design and implementation of a web-based patient portal linked to an ambulatory care electronic health record: Patient gateway for diabetes collaborative care. Diabetes Technology & Therapeutics, 8 (5), 576–586.

Green, L. W. (1980). Health education planning: A diagnostic approach . Palo Alto: Mayfield.

Green, L. W., & Kreuter, M. W. (1991). Health promotion planning: An educational and environmental approach . Mountain View: Mayfield.

Green, L. W., & Kreuter, M. (1999). Health promotion planning: An educational and ecological approach . Mountain View: Mayfield.

Green, L. W., & Kreuter, M. W. (2005). Health program planning: An educational and ecological approach . New York: McGraw-Hill.

Grilli, R., Ramsay, C., & Minozzi, S. (2002). Mass media interventions: Effects on health services utilisation. Cochrane Database of Systematic Reviews, 1 , CD000389.

Groeneveld, I. F., Proper, K. I., Van der Beek, A. J., & Van Mechelen, W. (2010). Sustained body weight reduction by an individual-based lifestyle intervention for workers in the construction industry at risk for cardiovascular disease: Results of a randomized controlled trial. Preventive Medicine, 51 (3-4), 240–246.

Grol, R., & Jones, R. (2000). Twenty years of implementation research. Family Practice, 17 (Suppl 1), S32–S35.

Grube, J. W., Morgan, M., & McGree, S. T. (1986). Attitudes and normative beliefs as predictors of smoking intentions and behaviours: A test of three models. The British Journal of Social Psychology, 25 (Pt 2), 81–93.

Hagger, M. S., Lonsdale, A. J., Hein, V., Koka, A., Lintunen, T., Pasi, H., Lindwall, M., Rudolfsson, L., & Chatzisarantis, N. L. D. (2011). Predicting alcohol consumption and binge drinking in company employees: An application of planned behaviour and self-determination theories. British Journal of Health Psychology, 17 (2), 379–407.

Hall, K. L., & Rossi, J. S. (2008). Meta-analytic examination of the strong and weak principles across 48 health behaviors. Preventive Medicine, 46 (3), 266–274.

Hallfors, D., & Godette, D. (2002). Will the ‘principles of effectiveness’ improve prevention practice? Early findings from a diffusion study. Health Education Research, 17 (4), 461–470.

Handley, M., MacGregor, K., Schillinger, D., Sharifi, C., Wong, S., & Bodenheimer, T. (2006). Using action plans to help primary care patients adopt healthy behaviors: A descriptive study. Journal of American Board of Family Medicine, 19 (3), 224–231.

Hansen, W. B. (1992). School-based substance abuse prevention: A review of the state of the art in curriculum, 1980–1990. Health Education Research, 7 (3), 403–430.

Harakeh, Z., Scholte, R. H., Vermulst, A. A., de Vries, H., & Engels, R. C. (2004). Parental factors and adolescents’ smoking behavior: An extension of the theory of planned behavior. Preventive Medicine, 39 (5), 951–961.

Harden, A., Peersman, G., Oliver, S., Mauthner, M., & Oakley, A. (1999). A systematic review of the effectiveness of health promotion interventions in the workplace. Occupational Medicine (London), 49 (8), 540–548.

Harting, J., Rutten, G. M., Rutten, S. T., & Kremers, S. P. (2009). A qualitative application of the diffusion of innovations theory to examine determinants of guideline adherence among physical therapists. Physical Therapy, 89 (3), 221–232.

Hawkins, R. P., Kreuter, M., Resnicow, K., Fishbein, M., & Dijkstra, A. (2008). Understanding tailoring in communicating about health. Health Education Research, 23 (3), 454–466.

US Department of Health and Human Services. (1991). Healthy people 2000: National health promotion and disease prevention objectives and healthy schools. Journal of School Health, 61 (7), 298–328.

Heckhausen, H. (1991). Motivation and action . New York: Springer.

Book   Google Scholar  

Helmink, J. H., Meis, J. J., de Weerdt, I., Visser, F. N., de Vries, N. K., & Kremers, S. P. (2010). Development and implementation of a lifestyle intervention to promote physical activity and healthy diet in the Dutch general practice setting: The BeweegKuur programme. International Journal of Behavioral Nutrition and Physical Activity, 7 , 49.

Henderson, V. (1966). The nature of nursing . New York: Macmillan.

Hendriksen, E. S., Pettifor, A., Lee, S. J., Coates, T. J., & Rees, H. V. (2007). Predictors of condom use among young adults in South Africa: The Reproductive Health and HIV Research Unit National Youth Survey. American Journal of Public Health, 97 (7), 1241–1248.

Herzog, T. A., & Blagg, C. O. (2007). Are most precontemplators contemplating smoking cessation? Assessing the validity of the stages of change. Health Psychology, 26 (2), 222.

Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1 , 91–111.

Hochbaum, G. M. (1971). Measurement of effectiveness of health education activites. International Journal of Health Education, 2 , 54–59.

Hoffman, D. L., & Novak, T. P. (1998). Bridging the racial divide on the Internet. Science, 280 , 390–391.

Hofmann, W., Friese, M., & Wiers, R. W. (2008). Impulsive versus reflective influences on health behavior: A theoretical framework and empirical review. Health Psychology Review, 2 , 111–137.

Holm, K., Kremers, S. P., & de Vries, H. (2003). Why do Danish adolescents take up smoking? European Journal of Public Health, 13 (1), 67–74.

Horowitz, S. M. (2003). Applying the transtheoretical model to pregnancy and STD prevention: A review of the literature. American Journal of Health Promotion, 17 (5), 304–328.

Hoving, E. F., Mudde, A. N., & de Vries, H. (2006). Smoking and the O pattern; predictors of transitions through the stages of change. Health Education Research, 21 (3), 305–314.

Hovland, C. I., Janis, I. L., & Kelley, H. H. (1953). Communication and persuasion: Psychological studies of opinion change . New Haven: Yale UP.

Huver, R. M. E., Engels, R. C. M. E., & de Vries, H. (2006). Are anti-smoking parenting practices related to adolescent smoking cognitions and behavior? Health Education Research, 21 (1), 66–77.

Huver, R. M., Engels, R. C. M. E., Vermulst, A. A., & de Vries, H. (2007). Is parenting style a context for smoking-specific parenting practices? Drug and Alcohol Dependence, 89 (2-3), 116–125.

Hyman, H. H., & Sheatsley, P. B. (1947). Some reasons why information campaigns fail. Public Opinion Quarterly, 11 , 412–423.

Ito, K. E., & Brown, J. D. (2010). To friend or not to friend: Using new media for adolescent health promotion. North Carolina Medical Journal, 71 (4), 367–372.

PubMed   Google Scholar  

Jackson, C., Lawton, R., Knapp, P., Raynor, D. K., Conner, M., Lowe, C., & Closs, S. J. (2005). Beyond intention: Do specific plans increase health behaviours in patients in primary care? A study of fruit and vegetable consumption. Social Science & Medicine, 60 (10), 2383.

James, S., Reddy, P., Ruiter, R. A., McCauley, A., & Borne, B. V. D. (2006). The impact of an HIV and AIDS life skills program on secondary school students in KwaZulu-Natal, South Africa. AIDS Educ Prev, 18 (4), 281–294.

Janis, I. L., & Mann, L. (1977). Decision making: A psychological analysis of conflict, choice, and commitment . New York: Free Press.

Janssen, E., van Osch, L., de Vries, H., & Lechner, L. (2011). Measuring risk perceptions of skin cancer: Reliability and validity of different operationalizations. British Journal of Health Psychology, 16 (Pt 1), 92–112.

Janssen, E., van Osch, L., Lechner, L., Candel, M., & de Vries, H. (2012). Thinking versus feeling: Differentiating between cognitive and affective components of perceived cancer risk. Psychology & Health, 27 (7), 767–783.

Janssen, E., van Osch, L., de Vries, H., & Lechner, L. (2013). Examining direct and indirect pathways to health behaviour: The influence of cognitive and affective probability beliefs. Psychology & Health, 28 (5), 546–560.

Janz, N. K., & Becker, M. H. (1984). The Health Belief Model: A decade later. Health Education Quarterly, 11 (1), 1–47.

Johnson, C. E., Mues, K. E., Mayne, S. L., & Kiblawi, A. N. (2008). Cervical cancer screening among immigrants and ethnic minorities: A systematic review using the Health Belief Model. Journal of Lower Genital Tract Disease, 12 (3), 232–241.

Joosten, E. A., DeFuentes-Merillas, L., De Weert, G. H., Sensky, T., Van Der Staak, C. P. F., & de Jong, C. A. (2008). Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychotherapy and Psychosomatics, 77 (4), 219–226.

Jurg, M. E., Kremers, S. P., Candel, M. J., Van der Wal, M. F., & Meij, J. S. D. (2006). A controlled trial of a school-based environmental intervention to improve physical activity in Dutch children: JUMP-in, kids in motion. Health Promotion International, 21 (4), 320.

Kamarck, T. W., Manuck, S. B., & Jennings, J. R. (1990). Social support reduces cardiovascular reactivity to psychological challenge: A laboratory model. Psychosomatic Medicine, 52 (1), 42.

Kemp, R., Kirov, G., Everitt, B., Hayward, P., & David, A. (1998). Randomised controlled trial of compliance therapy. 18-month follow-up. The British Journal of Psychiatry, 172 , 413–419.

King, E. S., Rimer, B. K., Seay, J., Balshem, A., & Engstrom, P. F. (1994). Promoting mammography use through progressive interventions: Is it effective? American Journal of Public Health, 84 (1), 104–106.

Kirby, D. B., Laris, B. A., & Rolleri, L. A. (2007). Sex and HIV education programs: Their impact on sexual behaviors of young people throughout the world. The Journal of Adolescent Health, 40 (3), 206–217.

Knai, C., Pomerleau, J., Lock, K., & McKee, M. (2006). Getting children to eat more fruit and vegetables: A systematic review. Preventive Medicine: An International Journal Devoted to Practice and Theory, 42 (2), 85.

Kok, G., Lo, S. H., Peters, G. J. Y., & Ruiter, R. A. (2011). Changing energy-related behavior: An intervention mapping approach. Energy Policy, 39 , 5280–5286.

Kolbe, L. J. (1985). Why school health education? An empirical point of view. Health Education, 16 (2), 116–120.

Kremers, S. P. (2010). Theory and practice in the study of influences on energy balance-related behaviors. Patient Education and Counseling, 79 (3), 291–298.

Kremers, S. P., & Brug, J. (2008). Habit strength of physical activity and sedentary behavior among children and adolescents. Pediatric Exercise Science, 20 (1), 5–14. Discussion 14-7.

Kremers, S. P. J., Mudde, A. N., & de Vries, H. (2001). Subtypes within the precontemplation stage of adolescent smoking acquisition. Addictive Behaviors, 26 (2), 237.

Kremers, S. P., De Bruijn, G. J., Visscher, T. L., Van Mechelen, W., De Vries, N. K., & Brug, J. (2006). Environmental influences on energy balance-related behaviors: A dual-process view. International Journal of Behavioral Nutrition and Physical Activity, 3 , 9.

Kreuter, M. W., & Strecher, V. J. (1996). Do tailored behavior change messages enhance the effectiveness of health risk appraisal? Results from a randomized trial. Health Education Research, 11 (1), 97–105.

Kreuter, M. W., Farrell, D. W., Olevitch, L. R., & Brennan, L. K. (2000). Tailoring health messages: Customizing communication with computer technology . Mahwah: Lawrence Erlbaum Associates.

Kroeze, W., Werkman, A., & Brug, J. (2006). A systematic review of randomized trials on the effectiveness of computer-tailored education on physical activity and dietary behaviors. Annals of Behavioral Medicine, 31 (3), 205–223.

Kruger, S. (1991). The patient educator role in nursing. Applied Nursing Research, 4 (1), 19–24.

Kwak, L., Kremers, S. P., van Baak, M. A., & Brug, J. (2007). Formation of implementation intentions promotes stair use. American Journal of Preventive Medicine, 32 (3), 254.

Latham, G. P., & Locke, E. A. (2006). Enhancing the benefits and overcoming the pitfalls of goal setting. Organizational Dynamics, 35 (4), 332–340.

Lazarus, R. S. (1966). Psychological stress and the coping process . New York: McGraw-Hill.

Leung, L. (2008). Internet embeddedness: Links with online health information seeking, expectancy value/quality of health information websites, and Internet usage patterns. Cyberpsychology & Behavior, 11 (5), 565–569.

Leventhal, H. (1970). Findings and theory in the study of fear communications. In L. Berkowitz (Ed.), Advances in experimental social psychology . New York: Academic Press.

Leventhal, H., & Cameron, L. (1987). Behavioral theories and the problem of compliance. Patient Education and Counseling, 10 (2), 117.

Leventhal, H., Nerenz, D. R., & Steele, D. J. (1984). Illness representation and coping with health threats . In A. Baum, S. E. Taylor, & J. E. Singer (Eds.), Handbook of psychology and health (pp. 219–252). Hillsdale: Lawrence Erlbaum Associates.

Lewis, B. A., Williams, D. M., Neighbors, C. J., Jakicic, J. M., & Marcus, B. H. (2010). Cost analysis of Internet vs. print interventions for physical activity promotion. Psychology of Sport and Exercise, 11 (3), 246–249.

Lippke, S., & Plotnikoff, R. C. (2012). Testing two principles of the health action process approach in individuals with type 2 diabetes. Health Psychology .

Lippke, S., & Ziegelmann, J. P. (2008). Theory-based health behavior change: Developing, testing, and applying theories for evidence-based interventions. Applied Psychology, 57 (4), 698–716.

Lippke, S., Ziegelmann, J. P., & Schwarzer, R. (2004). Initiation and maintenance of physical exercise: Stage-specific effects of a planning intervention. Research in Sports Medicine, 12 (3), 221.

Lippke, S., Ziegelmann, J. P., & Schwarzer, R. (2005). Stage-specific adoption and maintenance of physical activity: Testing a three-stage model. Psychology of Sport and Exercise, 6 , 585–603.

Lippke, S., Schwarzer, R., Ziegelmann, J. P., Scholz, U., & Schüz, B. (2010). Testing stage-specific effects of a stage-matched intervention: A randomized controlled trial targeting physical exercise and its predictors. Health Education & Behavior, 37 (4), 533–546.

Liu, L. L., & Park, D. C. (2004). Aging and medical adherence: The use of automatic processes to achieve effortful things. Psychology and Aging, 19 (2), 318–325.

Locke, E. A., & Latham, G. P. (2002). Building a practically useful theory of goal setting and task motivation. A 35-year odyssey. The American Psychologist, 57 (9), 705–717.

Lotrean, L. M., Dijk, F., Mesters, I., Ionut, C., & De Vries, H. (2010). Evaluation of a peer-led smoking prevention programme for Romanian adolescents. Health Education Research, 25 (5), 803.

Luszczynska, A., & Schwarzer, R. (2003). Planning and self-efficacy in the adoption and maintenance of breast self-examination: A longitudinal study on self-regulatory cognitions. Psychology & Health, 18 (1), 93–108.

MacGregor, K., Handley, M., Wong, S., Sharifi, C., Gjeltema, K., Schillinger, D., & Bodenheimer, T. (2006). Behavior-change action plans in primary care: A feasibility study of clinicians. The Journal of the American Board of Family Medicine, 19 , 215–223.

Marks, R., Allegrante, J. P., & Lorig, K. (2005). A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: Implications for health education practice (part II). Health Promotion Practice, 6 (2), 148–156.

Marlatt, G. A., & George, W. H. (1984). Relapse prevention: Introduction and overview of the model. British Journal of Addiction, 79 (3), 261–273.

Marshall, S. J., & Biddle, S. J. (2001). The transtheoretical model of behavior change: A meta-analysis of applications to physical activity and exercise. Annals of Behavioral Medicine, 23 (4), 229–246.

Martinez, M. (2008). High attrition rates in e-learning: Challenges, predictors, and solutions (p. 15). Santa Rosa: The E-Learning Developers’ Journal.

Mays, D., Streisand, R., Walker, L. R., Prokhorov, A. V., & Tercyak, K. P. (2012). Cigarette smoking among adolescents with type 1 diabetes: Strategies for behavioral prevention and intervention. Journal of Diabetes and its Complications, 26 (2), 148–153.

McGuire, W. J. (1985). Attitudes and attitude change. In G. Lindzey & E. Aronson (Eds.), Handbook of social psychology (Vol. II). New York: Lawrence Erlbaum Associates.

McKenzie, J. F., & Smeltzer, J. L. (2001). Planning, implementing and evaluating health promotion programs . Boston: Allyn and Bacon.

McLean, S. M., Burton, M., Bradley, L., & Littlewood, C. (2010). Interventions for enhancing adherence with physiotherapy: A systematic review. Manual Therapy, 15 (6), 514–521.

McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15 (4), 351–377.

Mercken, L., Snijders, T. A., Steglich, C., & de Vries, H. (2009). Dynamics of adolescent friendship networks and smoking behavior: Social network analyses in six European countries. Social Science & Medicine, 69 (10), 1506.

Mercken, L., Candel, M., Van Osch, L., & De Vries, H. (2010). No smoke without fire: The impact of future friends on adolescent smoking behaviour. British Journal of Health Psychology, 16 (Pt 1), 170–188.

Milgram, S. (1963). Behavioral study of obedience. Journal of Abnormal Psychology, 67 , 371–378.

Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people to change (2nd ed.). New York: Guilford Press.

Milne, S., Sheeran, P., & Orbell, S. (2000). Prediction and intervention in health-related behavior: A meta-analytic review of protection motivation theory. Journal of Applied Social Psychology, 30 (1), 106.

Milne, S., Orbell, S., & Sheeran, P. (2002). Combining motivational and volitional interventions to promote exercise participation: Protection motivation theory and implementation intentions. British Journal of Health Psychology, 7 (Pt 2), 163–184.

Montaño, D. E., & Kasprzyk, D. (2008). Theory of reasoned action, theory of planned behavior and the integrated behavioral model. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior and health education (4th ed.). San Francisco: Jossey-Bass.

Moritz, S. E., Feltz, D. L., Fahrbach, K. R., & Mack, D. E. (2000). The relation of self-efficacy measures to sport performance: A meta-analytic review. Research Quarterly for Exercise and Sport, 71 (3), 280–294.

Morrison, V., & Bennett, P. (2008). An introduction to health psychology (2nd ed.). London: Pearson Publishing.

Mulvaney, S. A., Rothman, R. L., Wallston, K. A., Lybarger, C., & Dietrich, M. S. (2010). An internet-based program to improve self-management in adolescents with type 1 diabetes. Diabetes Care, 33 (3), 602–604.

Newman, I. M., Martin, G. L., & Ang, J. (1982). The role of attitudes and social norms in adolescent cigarette smoking. The New Zealand Medical Journal, 95 (715), 618–621.

Ni Mhurchu, C., Aston, L. M., & Jebb, S. A. (2010). Effects of worksite health promotion interventions on employee diets: A systematic review. BMC Public Health, 10 (62), 1.

Nichols, J., Schutte, N. S., Brown, R. F., Dennis, C. L., & Price, I. (2009). The impact of a self-efficacy intervention on short-term breast-feeding outcomes. Health Education & Behavior, 36 (2), 250–258.

Nigg, C. R., Albright, C., Williams, R., Nichols, C., Renda, G., Stevens, V. J., & Vogt, T. M. (2010). Are physical activity and nutrition indicators of the checklist of health promotion environments at worksites (CHEW) associated with employee obesity among hotel workers? Journal of Occupational and Environmental Medicine, 52 (Suppl. 1), S4–S7.

Noar, S. M., & Harrington, N. G. (2012). eHealth applications . New York: Routledge.

Noar, S. M., Benac, C. N., & Harris, M. S. (2007). Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychological Bulletin, 133 (4), 673–693.

Noar, S. M., Black, H. G., & Pierce, L. B. (2009). Efficacy of computer technology-based HIV prevention interventions: A meta-analysis. AIDS, 23 (1), 107.

Noar, S. M., Webb, E. M., Van Stee, S. K., Redding, C. A., Feist-Price, S., Crosby, R., & Troutman, A. (2011). Using computer technology for HIV prevention among African-Americans: Development of a tailored information program for safer sex (TIPSS). Health Education Research, 26 (3), 393–406.

Norman, G. J., Velicer, W. F., Fava, J. L., & Prochaska, J. O. (2000). Cluster subtypes within stage of change in a representative sample of smokers. Addictive Behaviors, 25 (2), 183.

Norman, P., Boer, H., & Seydel, E. R. (2005). Protection motivation theory. In M. Conner & P. Norman (Eds.), Predicting health behavior (pp. 81–126). London: Open University Press.

Norris, S. L., Engelgau, M. M., & Narayan, K. V. (2001). Effectiveness of self-management training in type 2 diabetes a systematic review of randomized controlled trials. Diabetes Care, 24 (3), 561–587.

Norris, S. L., Lau, J., Smith, S. J., Schmid, C. H., & Engelgau, M. M. (2002). Self-management education for adults with type 2 diabetes a meta-analysis of the effect on glycemic control. Diabetes Care, 25 (7), 1159–1171.

O’Leary, A. (1985). Self-efficacy and health. Behaviour Research and Therapy, 23 (4), 437.

Oei, T. P., & Burrow, T. (2000). Alcohol expectancy and drinking refusal self-efficacy: A test of specificity theory. Addictive Behaviors, 25 (4), 499–507.

Oenema, A., Brug, J., & Lechner, L. (2001). Web-based tailored nutrition education: Results of a randomized controlled trial. Health Education Research, 16 (6), 647–660.

Oostveen, T., Knibbe, R., & de Vries, H. (1996). Social influences on young adults’ alcohol consumption: Norms, modeling, pressure, socializing, and conformity. Addictive Behaviors, 21 (2), 187–197.

Orbell, S., & Sheeran, P. (1998). ‘Inclined abstainers’: A problem for predicting health-related behaviour. The British Journal of Social Psychology, 37 (Pt 2), 151–165.

Panday, S., Reddy, S. P., Ruiter, R. A., Bergström, E., & de Vries, H. (2005). Determinants of smoking cessation among adolescents in South Africa. Health Education Research, 20 (5), 586–599.

Parcel, G. S., Eriksen, M. P., Lovato, C. Y., Gottlieb, N. H., Brink, S. G., & Green, L. W. (1989). The diffusion of school-based tobacco-use prevention programs: Project description and baseline data. Health Education Research, 4 (1), 111.

Parker, R. M., & Jacobson, T. A. (2000). The role of health literacy in narrowing the treatment gap for hypercholesterolemia. The American Journal of Managed Care, 6 (12), 1340–1342.

Pelletier, K. R. (2009). A review and analysis of the clinical and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: Update VII 2004–2008. Journal of Occupational and Environmental Medicine, 51 (7), 822–837.

Perry, C. L., Kelder, S. H., & Klepp, K. I. (1994). Community-wide cardiovascular disease prevention in young people: Long-term outcomes of the class of 1989 study. European Journal of Public Health, 4 (3), 188–194.

Perry, C. L., Williams, C. L., Veblen-Mortenson, S., Toomey, T. L., Komro, K. A., Anstine, P. S., McGovern, P. G., Finnegan, J. R., Forster, J. L., Wagenaar, A. C., & Wolfson, M. (1996). Project Northland: Outcomes of a communitywide alcohol use prevention program during early adolescence. American Journal of Public Health, 86 (7), 956–965.

Peters, L. W., Wiefferink, C. H., Hoekstra, F., Buijs, G. J., ten Dam, G. T., & Paulussen, T. G. (2009). A review of similarities between domain-specific determinants of four health behaviors among adolescents. Health Education Research, 24 (2), 198–223.

Peterson, A. V., Jr., Kealey, K. A., Mann, S. L., Marek, P. M., & Sarason, I. G. (2000). Hutchinson Smoking Prevention Project: Long-term randomized trial in school-based tobacco use prevention – Results on smoking. Journal of the National Cancer Institute, 92 (24), 1979–1991.

Petty, R. E., & Cacioppo, J. T. (1986). Communication and persuasion, central and peripheral routes to attitude change . New York: Springer.

Pinto, A. M., Heinberg, L. J., Coughlin, J. W., Fava, J. L., & Guarda, A. S. (2008). The Eating Disorder Recovery Self-Efficacy Questionnaire (EDRSQ): Change with treatment and prediction of outcome. Eating Behaviors, 9 (2), 143.

Plotnikoff, R. C., Lippke, S., Courneya, K. S., Birkett, N., & Sigal, R. J. (2008). Physical activity and social cognitive theory: A test in a population sample of adults with type 1 or type 2 diabetes. Applied Psychology, 57 (4), 628–643.

Plotnikoff, R. C., Lippke, S., Johnson, S. T., & Courneya, K. S. (2010a). Physical activity and stages of change: A longitudinal test in types 1 and 2 diabetes samples. Annals of Behavioral Medicine, 40 (2), 138–149.

Plotnikoff, R. C., Lippke, S., Trinh, L., Courneya, K. S., Birkett, N., & Sigal, R. J. (2010b). Protection motivation theory and the prediction of physical activity among adults with type 1 or type 2 diabetes in a large population sample. British Journal of Health Psychology, 15 (Pt 3), 643–661.

Pomp, S., Lippke, S., Fleig, L., & Schwarzer, R. (2010). Synergistic effects of intention and depression on action control: Longitudinal predictors of exercise after rehabilitation. Mental Health and Physical Activity, 2 , 78–84.

Presson, C. C., Chassin, L., Sherman, S. J., Olshavsky, R., Bensenberg, M., & Corty, E. (1984). Predictors of adolescents’ intentions to smoke: Age, sex, race, and regional differences. The International Journal of the Addictions, 19 (5), 503–519.

Elders, M. J. (1994). Preventing tobacco use among young people. A report of the Surgeon General. Executive summary. MMWR – Recommendations and Reports, 43 (RR-4), 1–10.

Price, V., & Zaller, J. (1993). Who gets the news? Alternative measures of news reception and their implications for research. Public Opinion Quarterly, 57 (2), 133.

Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51 (3), 390–395.

Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12 (1), 38–48.

Prochaska, J. O., Velicer, W. F., Rossi, J. S., Goldstein, M. G., Marcus, B. H., Rakowski, W., Fiore, C., Harlow, L. L., Redding, C. A., Rosenbloom, D., & Rossi, S. R. (1994). Stages of change and decisional balance for 12 problem behaviors. Health Psychology, 13 (1), 39–46.

Prochaska, J. O., Velicer, W. F., Redding, C., Rossi, J. S., Goldstein, M., DePue, J., Greene, G. W., Rossi, S. R., Sun, X., & Fava, J. L. (2005). Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer, and receive regular mammograms. Preventive Medicine, 41 (2), 406–416.

Prochaska, J. J., Spring, B., & Nigg, C. R. (2008). Multiple health behavior change research: An introduction and overview. Preventive Medicine, 46 (3), 181–188.

Puska, P. M., Puska, P. M. J., Barrueco, M., Roussos, C., Hider, A., & Hogue, S. (2005). The participation of health professionals in a smoking-cessation programme positively influences the smoking cessation advice given to patients. International Journal of Clinical Practice, 59 (4), 447–452.

Quinlan, K. B., & McCaul, K. D. (2000). Matched and mismatched interventions with young adult smokers: Testing a stage theory. Health Psychology, 19 (2), 165.

Rahimi, B., Timpka, T., Vimarlund, V., Uppugunduri, S., & Svensson, M. (2009). Organization-wide adoption of computerized provider order entry systems: A study based on diffusion of innovations theory. BMC Medical Informatics and Decision Making, 9 (1), 52.

Rakowski, W., Ehrich, B., Goldstein, M. G., Rimer, B. K., Pearlman, D. N., Clark, M. A., Velicer, W. F., & Woolverton III, H. (1998). Increasing mammography among women aged 40–74 by use of a stage-matched, tailored intervention. Preventive Medicine, 27 (5 Pt 1), 748–756.

Renner, B., Kwon, S., Yang, B.-H., Paik, K.-C., Kim, S. H., Roh, S., Song, J., & Schwarzer, R. (2008). Social-cognitive predictors of dietary behaviors in South Korean men and women. International Journal of Behavioral Medicine, 15 (1), 4–13.

Resnicow, K., & Vaughan, R. (2006). A chaotic view of behavior change: A quantum leap for health promotion. International Journal of Behavioral Nutrition and Physical Activity, 3 , 25.

Resnicow, K., DiIorio, C., Soet, J. E., Borrelli, B., Hecht, J., & Ernst, D. (2002). Motivational interviewing in health promotion: It sounds like something is changing. Health Psychology, 21 (5), 444.

Rigotti, N. A., Munafo, M. R., & Stead, L. F. (2008). Smoking cessation interventions for hospitalized smokers: A systematic review. Archives of Internal Medicine, 168 (18), 1950–1960.

Riper, H., Kramer, J., Smit, F., Conijn, B., Schippers, G., & Cuijpers, P. (2008). Web-based self-help for problem drinkers: A pragmatic randomized trial. Addiction, 103 (2), 218.

Rivis, A., & Sheeran, P. (2003). Descriptive norms as an additional predictor in the theory of planned behaviour: A meta-analysis. Current Psychology: Developmental, Learning, Personality, Social, 22 , 218–233.

Rogers, R. W. (1975). A protection motivation theory of fear appeals and attitude change. Journal of Psychology: Interdisciplinary and Applied, 91 (1), 93.

Rogers, R. W. (1983). Cognitive and physiological processes in fear appeals and attitude change: A revised theory of protection motivation. In J. T. Cacioppo & R. E. Petty (Eds.), Social psychophysiology . New York: Guilford Press.

Rogers, R. W. (2003). Diffusion of innovations (5th ed.). New York: Free Press.

Rohrbach, L. A., Grana, R., Sussman, S., & Valente, T. W. (2006). Type II translation: Transporting prevention interventions from research to real-world settings. Evaluation & the Health Professions, 29 (3), 302–333.

Rosenstock, I. (1974). Historical origins of the Health Belief Model. Health Education Monographs, 2 (4), 336.

Rosseel, J. P., Hilberink, S. R., Jacobs, J. E., Maassen, I. M., Plasschaert, A. J. M., & Grol, R. P. T. M. (2010). Are oral health complaints related to smoking cessation intentions? Community Dentistry and Oral Epidemiology, 38 (5), 470–478.

Ruiter, R. A., Kessels, L. T., Jansma, B. M., & Brug, J. (2006). Increased attention for computer-tailored health communications: An event-related potential study. Health Psychology, 25 (3), 300–306.

Rutter, D. R., Steadman, L., & Quine, L. (2006). An implementation intentions intervention to increase uptake of mammography. Annals of Behavioral Medicine, 32 (2), 127–134.

Salpeter, S. R., Buckley, N. S., Ormiston, T. M., & Salpeter, E. E. (2006). Meta-analysis: Effect of long-acting beta-agonists on severe asthma exacerbations and asthma-related deaths. Annals of Internal Medicine, 144 (12), 904–912.

Sarafino, E. P. (1994). Health psychology: Biopsychosocial interactions (2nd ed.). New York: Wiley.

Sarkar, U., Karter, A. J., Liu, J. Y., Adler, N. E., Nguyen, R., López, A., & Schillinger, D. (2011). Social disparities in internet patient portal use in diabetes: Evidence that the digital divide extends beyond access. Journal of the American Medical Informatics Association, 18 (3), 318–321.

Say, R. E., & Thomson, R. (2003). The importance of patient preferences in treatment decisions – Challenges for doctors. BMJ, 327 (7414), 542–545.

Schaalma, H., Kok, G., & Peters, L. (1993). Determinants of consistent condom use by adolescents: The impact of experience of sexual intercourse. Health Education Research, 8 (2), 255.

Schoenmakers, T., Wiers, R. W., & Field, M. (2008). Effects of a low dose of alcohol on cognitive biases and craving in heavy drinkers. Psychopharmacology, 197 (1), 169–178.

Schwarzer, R. (Ed.). (1992). Self-efficacy: Thought control of action . Washington, DC: Hemisphere.

Schwarzer, R. (2008a). Modeling health behavior change: The Health Action Process Approach (HAPA) . Available from: http://www.hapa-model.de/

Schwarzer, R. (2008b). Modeling health behavior change: How to predict and modify the adoption and maintenance of health behaviors. Applied Psychology. An International Review, 57 (1), 1.

Schwarzer, R., Schüz, B., Ziegelmann, J. P., Lippke, S., Luszczynska, A., & Scholz, U. (2007). Adoption and maintenance of four health behaviors: Theory-guided longitudinal studies on dental flossing, seat belt use, dietary behavior, and physical activity. Annals of Behavioral Medicine, 33 (2), 156.

Schwarzer, R., Luszczynska, A., Ziegelmann, J. P., Scholz, U., & Lippke, S. (2008). Social-cognitive predictors of physical exercise adherence: Three longitudinal studies in rehabilitation. Health Psychology, 27 (Suppl. 1), S54.

Schwarzer, R., Lippke, S., & Luszczynska, A. (2011). Mechanisms of health behavior change in persons with chronic illness or disability: The Health Action Process Approach (HAPA). Rehabilitation Psychology, 56 (3), 161.

Segaar, D., Willemsen, M. C., Bolman, C., & De Vries, H. (2007a). Nurse adherence to a minimal-contact smoking cessation intervention on cardiac wards. Research in Nursing & Health, 30 (4), 429–444.

Segaar, D., Bolman, C., Willemsen, M. C., & De Vries, H. (2007b). Identifying determinants of protocol adoption by midwives: A comprehensive approach. Health Education Research, 22 (1), 14–26.

Senge, P. (1990). The fifth discipline: The art and practice of the learning organization . New York: Currency Doubleday.

Sheeran, P., & Orbell, S. (2000). Using implementation intentions to increase attendance for cervical cancer screening. Health Psychology, 19 (3), 283–289.

Sheeran, P., Webb, T. L., & Gollwitzer, P. M. (2005). The interplay between goal intentions and implementation intentions. Personality and Social Psychology Bulletin, 31 (1), 87–98.

Sherif, M. (1935). A study of some social factors in perception. Archives of Psychology, 187 .

Simonds, S. K. (1978). Health education: Facing issues of policy, ethics, and social justice. Health Education Monographs, 6 (Suppl. 1), 18–27.

Skår, S., Sniehotta, F. F., Molloy, G. J., Prestwich, A., & Araujo-Soares, V. (2011). Do brief online planning interventions increase physical activity amongst university students? A randomised controlled trial. Psychology & Health, 26 (4), 399–417.

Skinner, C. S., Sykes, R. K., Monsees, B. S., Andriole, D. A., Arfken, C. L., & Fisher, E. B. (1998). Learn, share, and live: Breast cancer education for older, urban minority women. Health Education & Behavior, 25 (1), 60–78.

Slovic, P. (1987). Perception of risk. Science, 236 (4799), 280–285.

Slovic, P., & Peters, E. (2006). Risk perception and affect. Current Directions in Psychological Science, 15 (6), 322–325.

Smeets, T., Brug, J., & de Vries, H. (2008). Effects of tailoring health messages on physical activity. Health Education Research, 23 (3), 402–413.

Smerecnik, C., Quaak, M., van Schayck, C. P., van Schooten, F. J., & de Vries, H. (2011). Are smokers interested in genetic testing for smoking addiction? A socio-cognitive approach. Psychology & Health, 26 (8), 1099–1112.

Sniehotta, F. F. (2009). Towards a theory of intentional behaviour change: Plans, planning, and self-regulation. British Journal of Health Psychology, 14 (2), 261.

Sniehotta, F. F., Scholz, U., Schwarzer, R., Fuhrmann, B., Kiwus, U., & Völler, H. (2005). Long-term effects of two psychological interventions on physical exercise and self-regulation following coronary rehabilitation. International Journal of Behavioral Medicine, 12 (4), 244–255.

Sniehotta, F. F., Scholz, U., & Schwarzer, R. (2006). Action plans and coping plans for physical exercise: A longitudinal intervention study in cardiac rehabilitation. British Journal of Health Psychology, 11 (Pt 1), 23–37.

Snyder, L. B., Hamilton, M. A., Mitchell, E. W., Kiwanuka-Tondo, J., Fleming-Milici, F., & Proctor, D. (2004). A meta-analysis of the effect of mediated health communication campaigns on behavior change in the United States. Journal of Health Communication, 9 (Suppl. 1), 71–96.

Soler, R. E., Leeks, K. D., Razi, S., Hopkins, D. P., Griffith, M., Aten, A., Chattopadhyay, S. K., Smith, S. C., Habarta, N., & Goetzel, R. Z. (2010). A systematic review of selected interventions for worksite health promotion. The assessment of health risks with feedback. American Journal of Preventive Medicine, 38 (2 Suppl), S237–S262.

Stock, J., & Cervone, D. (1990). Proximal goal-setting and self-regulatory processes. Cognitive Therapy and Research, 14 (5), 483–498.

Strack, F., & Deutsch, R. (2004). Reflective and impulsive determinants of social behavior. Personality and Social Psychology Review, 8 (3), 220.

Strecher, V. J. (1999). Computer-tailored smoking cessation materials: A review and discussion. Patient Education and Counseling, 36 (2), 107–117.

Strecher, V. J., & Rosenstock, I. M. (1997). The Health Belief Model. In A. Baum et al. (Eds.), Cambridge handbook of psychology, health and medicine . Cambridge: Cambridge University Press.

Strecher, V. J., McEvoy DeVellis, B., Becker, M. H., & Rosenstock, I. M. (1986). The role of self-efficacy in achieving health behavior change. Health Education Quarterly, 13 (1), 73–92.

Strecher, V. J., Kreuter, M., Den Boer, D. J., Kobrin, S., Hospers, H. J., & Skinner, C. S. (1994). The effects of computer-tailored smoking cessation messages in family practice settings. The Journal of Family Practice, 39 (3), 262–270.

Strecher, V. J., Shiffman, S., & West, R. (2005). Randomized controlled trial of a web-based computer-tailored smoking cessation program as a supplement to nicotine patch therapy. Addiction, 100 (5), 682–688.

Strecher, V. J., McClure, J. B., Alexander, G. L., Chakraborty, B., Nair, V. N., Konkel, J. M., Greene, S. M., Collins, L. M., Carlier, C. C., & Wiese, C. J. (2008). Web-based smoking-cessation programs: Results of a randomized trial. American Journal of Preventive Medicine, 34 (5), 373–381.

Suissa, S., & Ernst, P. (2001). Inhaled corticosteroids: Impact on asthma morbidity and mortality. The Journal of Allergy and Clinical Immunology, 107 (6), 937–944.

Sutton, S. (2000). Interpreting cross-sectional data on stages of change. Psychology and Health, 15 (2), 163–171.

Swinburn, B., Egger, G., & Raza, F. (1999). Dissecting obesogenic environments: The development and application of a framework for identifying and prioritizing environmental interventions for obesity. Preventive Medicine, 29 (6 Pt 1), 563–570.

Taylor, S. E., Falke, R. L., Shoptaw, S. J., & Lichtman, R. R. (1986). Social support, support groups, and the cancer patient. Journal of Consulting and Clinical Psychology, 54 (5), 608–615.

Te Poel, F., Bolman, C., Reubsaet, A., & de Vries, H. (2009). Efficacy of a single computer-tailored e-mail for smoking cessation: Results after 6 months. Health Education Research, 24 (6), 930–940.

Thomas, R. (2002). School-based programmes for preventing smoking. Cochrane Database of Systematic Reviews, 4 , CD001293.

Thomas, R., & Perera, R. (2013). School-based programmes for preventing smoking. Cochrane Database of Systematic Reviews, 4 , CD001293.

Thurstone, L. L. (1931). Measurement of social attitudes. Journal of Abnormal and Social Psychology, 26 , 249–269.

Tichenor, P. J., Donohue, G. A., & Olien, C. N. (1970). Mass media flow and differential growth in knowledge. Public Opinion Quarterly, 34 .

Tu, H. T., & Cohen, G. R. (2008). Striking jump in consumers seeking health care information. Tracking Report, 20 , 1–8.

Turner, J. C. (1991). Social influence . Belmont: Wadsworth Publishing.

Tyler-Smith, K. (2006). Early attrition among first time eLearners: A review of factors that contribute to drop-out, withdrawal and non-completion rates of adult learners undertaking eLearning programmes. Journal of Online Learning and Teaching, 2 , 73–85.

Uchino, B. N. (2006). Social support and health: A review of physiological processes potentially underlying links to disease outcomes. Journal of Behavioral Medicine, 29 (4), 377.

USDHHS. (1980). Promoting health/preventing disease: Objectives for the nation . Washington, DC: US Government Printing Office.

USDHHS. (1990). The health benefits of smoking cessation. A report of the Surgeon General’s Office on Smoking and Health . Rockville: U.S. Govt. Printing Office.

Valente, T. W. (2002). Evaluating health promotion programs . New York: Oxford University Press.

van der Velde, F. W., Hooykaas, C., & van der Pligt, J. (1996). Conditional versus unconditional risk estimates in models of AIDS-related risk behaviour. Psychology & Health, 12 (1), 87.

van Keulen, H. M., Mesters, I., Ausems, M., Van Breukelen, G., Campbell, M., Resnicow, K., Brug, J., & De Vries, H. (2011). Tailored print communication and telephone motivational interviewing are equally successful in improving multiple lifestyle behaviors in a randomized controlled trial. Annals of Behavioral Medicine, 41 (1), 104–118.

van Osch, L., Reubsaet, A., Lechner, L., & de Vries, H. (2008a). The formation of specific action plans can enhance sun protection behavior in motivated parents. Preventive Medicine, 47 (1), 127–132.

van Osch, L., Reubsaet, A., Lechner, L., Candel, M., Mercken, L., & De Vries, H. (2008b). Predicting parental sunscreen use: Disentangling the role of action planning in the intention-behavior relationship. Psychology and Health, 23 (7), 829–846.

van Osch, L., Lechner, L., Reubsaet, A., & De Vries, H. (2010). From theory to practice: An explorative study into the instrumentality and specificity of implementation intentions. Psychology & Health, 25 (3), 351–364.

van Stralen, M. M., Kok, G., de Vries, H., Mudde, A. N., Bolman, C., & Lechner, L. (2008). The Active plus protocol: Systematic development of two theory-and evidence-based tailored physical activity interventions for the over-fifties. BMC Public Health, 8 (1), 399.

Vartiainen, E., Puska, P., Koskela, K., Nissinen, A., & Toumilehto, J. (1986). Ten-year results of a community-based anti-smoking program (as part of the North Karelia Project in Finland). Health Education Research, 1 (3), 175–184.

Vassallo, M., Saba, A., Arvola, A., Dean, M., Messina, F., Winkelmann, M., Claupein, E., Lähteenmäki, L., & Shepherd, R. (2009). Willingness to use functional breads. Applying the Health Belief Model across four European countries. Appetite, 52 (2), 452.

Velicer, W. F., Diclemente, C. C., Rossi, J. S., & Prochaska, J. O. (1990). Relapse situations and self-efficacy: An integrative model. Addictive Behaviors, 15 (3), 271–283.

Velicer, W. F., Prochaska, J. O., Bellis, J. M., DiClemente, C. C., Rossi, J. S., Fava, J. L., & Steiger, J. H. (1993). An expert system intervention for smoking cessation. Addictive Behaviors, 18 (3), 269–290.

Velicer, W. F., Prochaska, J. O., & Redding, C. A. (2006). Tailored communications for smoking cessation: Past successes and future directions. Drug and Alcohol Review, 25 (1), 49–57.

Vernon, S. W. (1999). Risk perception and risk communication for cancer screening behaviors: A review. Journal of the National Cancer Institute. Monographs, 25 , 101–119.

Verplanken, B., & Faes, S. (1999). Good intentions, bad habits, and effects of forming implementation intentions on healthy eating. European Journal of Social Psychology, 29 (5-6), 591.

Vries, H. D., & Mudde, A. N. (1998). Predicting stage transitions for smoking cessation applying the attitude-social influence-efficacy model. Psychology and Health, 13 (2), 369–385.

Wagner, T. H., Bundorf, M. K., Singer, S. J., & Baker, L. C. (2005). Free internet access, the digital divide, and health information. Medical Care, 43 (4), 415–420.

Webb, T. L., & Sheeran, P. (2006). Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychological Bulletin, 132 (2), 249–268.

Webb, T. L., Joseph, J., Yardley, L., & Michie, S. (2010). Using the internet to promote health behavior change: A systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. Journal of Medical Internet Research, 12 (1), e4.

Weinstein, N. D. (1988). The precaution adoption process. Health Psychology, 7 (4), 355–386.

Weinstein, N. D., & Sandman, P. M. (1992). A model of the precaution adoption process: Evidence from home radon testing. Health Psychology, 11 (3), 170–180.

Weinstein, N. D., Lyon, J. E., Sandman, P. M., & Cuite, C. L. (1998). Experimental evidence for stages of health behavior change: The precaution adoption process model applied to home radon testing. Health Psychology, 17 (5), 445.

WHO. (1978). Declaration of Alma-Ata . International conference on Primary Health Care, Alma-Ata, USSR, 6–12 September. Geneva: WHO.

WHO. (1985). Prerequisites for health. In WHO Regional Office of Europe (Ed.), Targets for all: Targets in support of the European regional strategy for health for all . Copenhagen: WHO Regional Office of Europe.

WHO. (1986). Ottawa charter of health promotion . In Health promotion I , Ottawa.

U.S. Department of Health and Human Services. (2000). Healthy people 2010: Understanding and improving health (2nd ed.). Washington, DC: U.S. Government Printing Office.

WHO. (2013). In J. M. Pelikan, I. Kickbusch, F. Apfel, & A. D. Tsouros (Eds.), Health literacy; solid facts .

WHO, [WHO definition of Health]. (1946). Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference , New York, 19–22 June 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

Wielm, A. G. (2004). Digital Nation: Towards an inclusive information society (pp. 133–134). Cambridge, MA: MIT Press.

Wiers, R. W., Bartholow, B. D., van den Wildenberg, E., Thush, C., Engels, R. C. M. E., Sher, K. J., Grenard, J., Ames, S. L., & Stacy, A. W. (2007). Automatic and controlled processes and the development of addictive behaviors in adolescents: A review and a model. Pharmacology, Biochemistry, and Behavior, 86 (2), 263–283.

Wiers, R. W., Rinck, M., Kordts, R., Houben, K., & Strack, F. (2009). Retraining automatic action-tendencies to approach alcohol in hazardous drinkers. Addiction, 105 (2), 279–287.

Wilde, M. H., & Garvin, S. (2007). A concept analysis of self-monitoring. Journal of Advanced Nursing, 57 (3), 339–350.

Wilson, M. G., Holman, P. B., & Hammock, A. (1996). A comprehensive review of the effects of worksite health promotion on health-related outcomes. American Journal of Health Promotion, 10 (6), 429–435.

Winett, L. B., & Wallack, L. (1996). Advancing public health goals through the mass media. Journal of Health Communication, 1 (2), 173–196.

Ziegelmann, J. P., Lippke, S., & Schwarzer, R. (2006). Adoption and maintenance of physical activity: Planning interventions in young, middle-aged, and older adults. Psychology & Health, 21 (2), 145–163.

Ziegelmann, J. P., Luszczynska, A., Lippke, S., & Schwarzer, R. (2007). Are goal intentions or implementation intentions better predictors of health behavior? A longitudinal study in orthopedic rehabilitation. Rehabilitation Psychology, 52 (1), 97.

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Hein de Vries & Stef P. J. Kremers

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Ulrike Ehlert

School of Public Health, Peking University Health Science Center, Beijing, China

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de Vries, H., Kremers, S.P.J., Lippke, S. (2018). Health Education and Health Promotion: Key Concepts and Exemplary Evidence to Support Them. In: Fisher, E., et al. Principles and Concepts of Behavioral Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-93826-4_17

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12 Grab & Go Projects for Health

• June 11, 2016

https://thehealthteacher.com/the-blue-zones-project/ * this post originally appeared on Choices.Scholastic.com

Many schools are shifting their curriculum to include project-based learning (PBL), but in the life of a teacher, project planning time is always tight.

As a head start, use any of these 12 ready-to-go projects and adapt them to your class as needed. Just click on the project title for a step-by-step outline.

1. The Blue Zones Project: Cultivating Healthier, Happier Student Lifestyles

Students research The Blue Zones, five areas of the world where people are most likely to live to be over 100. After learning about the healthy behaviors that lead to longevity, students set “Blue Zone” goals to implement within their homes and communities.

2. The Energy Bar Project: Part 1  &  Part 2

Students analyze food packaging health claims by making a trip to the grocery store, taste-testing energy bars, then creating and marketing their own healthy bars, complete with product boxes and a commercial. (This is a new project I tried this year, and my students absolutely loved it!)

3.  Exploring Dietary Guidelines Around the World (and at Home)

Let’s be real: The FDA’s new dietary guidelines are more confusing than ever. To learn to love real food, rather than fear food data, students will research dietary guidelines from around the world and create a set of guidelines for your school, using journalist  Michael Pollan’s Food Rules as an aid.

4.  A Nutrition PBL That Can Lead to Healthier School Lunch

After watching an inspirational documentary about a group of kids who bettered the lunch options in their school’s cafeteria, students work to make change in their own school with the help of an awesome advocacy kit from  DoSomething.org .

5. The Family Values Project

Family values play a key role in the decision-making process, and as teens gain more freedom, sticking to those values will help keep them safe from high-risk behaviors. In this project, students have a conversation with their parents to create a list of core values and a mission statement for their family.

6. The Alcohol Research Lab

Research on the impact of alcohol and the teenage brain is updated almost constantly. Rather than give the students the facts, let them find out for themselves as they dig up the latest details on the risks of underage drinking.

7. Teaching Kids About E-Cigarettes

Using resources provided as a launching point, students will create their own inquiry-based project to learn more about e-cigarettes.

8. An Advocacy Project to Help Kids Learn About the Benefits of Sleep

Today’s teens are horribly sleep deprived, and many of them don’t understand all of the ways that it’s negatively impacting their health. In this project, they’ll research the benefits of sleep and create an advocacy campaign to convince their classmates to get more shut-eye.

9. Stress Management for Teens

This unit plan ends on a positive note, with students making videos of their favorite healthy coping skills and stress busters. (This one is always a highlight for my sixth grade students.)

10. Positive Peer Pressure to Help Stop Bullying

Rather than take the anti-bullying angle, this project has students use a medium of their choice to encourage and support others via positive prevention methods.

11. Advocacy Through Art

In this cross-curricular project, health classes and art classes team up to create a public service announcement and a logo for an advocacy campaign of their conception.

12. Using Social Media to Teach Advocacy

So often we focus on the negative when talking to kids about social media, but in reality, they’re using social media to do amazing things to bring about positive social change. In this project, students find an advocacy group on social media that inspires them and present what they learned to the class.

Don’t have enough time to fit in a full project with your class? Team up with a colleague from another subject and check out these ideas for cross-curricular learning .

New Blog Posts

Health activities for the last few days of school, alcohol & drug research lab- 2022, resources for home learning during coronavirus, vaping advocacy activity, the latest on vaping and e-cigarettes…., evaluating websites, earcos etc 2019, great video to show teens about juuls, 8th grade tech balance, health sites web quest, npr podcast- the reading brain in the digital world, analyzing the scientific evidence behind health news, more hints and tips in the classroom....

Hi friends! Below you’ll find a link to the pages for all of our workshops this weekend. Google Doc folder containing all of the slide shows throughout

Time Management

Procrastination and time management are huge issues for all of us, not just the kids. Here’s a great digital workshop on multi-tasking that can be

Evaluating Health Websites

Hey 6th graders! Did you know that online health searches are now the third most popular activity on the web? While googling information about our

Health Ed- PHASE- Mar. 2022

Click on the session title to access the slides and resources Saturday, Feb. 26th, 2022 Part 1: Health Education for International Schools: Feb. 26, 2022 Saturday,

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Evidence-based practice in health education and promotion: a review and introduction to resources

Affiliation.

• 1 Kootenai Medical Center, Coeur dAlene, Idaho, USA. [email protected]
• PMID: 19141692
• DOI: 10.1177/1524839908328993

This review examines evidence-based practice (EBP) in health education and promotion with a focus on how academically trained health educators develop EBP skills and how health education and promotion practitioners access the literature to inform their activities. Competencies and credentialing in health education related to evidence-based practice are outlined and sources for evidence-based practice literature in health education and promotion are described. An exploratory questionnaire to consider teaching and resources in evidence-based practice was distributed to faculty and librarians from the top 10 ranked health education doctoral programs. Findings highlighted the integral value of EBP instruction to the curriculum. Growth opportunities in evidence-based health education and health promotion for instructors, practitioners, and librarians include promotion and expansion of online evidence-based public health resources to close the evidence-practice gap.

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What Works In Schools : Quality Health Education

CDC’s  What Works In Schools  Program improves the health and well-being of middle and high school students by:

• Improving health education,
• Connecting young people to the health services they need, and
• Making school environments safer and more supportive.

Health education is part of the primary mission of schools. It provides young people with the knowledge and skills they need to become successful learners and healthy adults. 1

Health education is a fundamental part of an overall school health program and helps youth acquire functional health knowledge, strengthens attitudes and beliefs, and builds skills needed to adopt and maintain healthy behaviors throughout their lives. 1

Health education is effective at addressing adolescent behaviors and experiences

Youth behaviors and experiences set the stage for healthy adulthood. 2-4 In particular, health behaviors and experiences related to early sexual initiation, violence, and substance use are consistently linked to poor grades and test scores and lower educational attainment, as well as other negative health outcomes. 5-14

Research suggests that well-designed and well-implemented school health programs can influence multiple health outcomes, including reducing risk behaviors related to sexually transmitted infections (STIs), including HIV, and unintended pregnancy, decreasing substance and tobacco use, and improving academic performance. 5,6,15,16

Providing health education as early as possible can help youth develop positive well-being, academic success, and healthy outcomes into adulthood. 17

See CDC’s  Characteristics of an Effective Health Education Curriculum  to learn more about research on effective curricula in school health education.

Health Education Curriculum and Standards

Quality health education starts with a quality curriculum and student learning standards. CDC provides guidance and tools to help schools use curricula that meets their specific needs.

District and school staff can use CDC’s Health Education Curriculum Analysis Tool (HECAT)  to analyze, select, or develop curriculum based on meeting adolescent health needs and community priorities. 1

Health education curriculum should include:

• A set of learning outcomes or objectives that focus on students gaining health-related knowledge, attitudes, and skills.
• A planned progression of lessons or learning experiences that are developmentally appropriate, build on one another over time, and lead to achieving learning and health objectives.
• Lessons or learning experiences connect to each other and reinforce important health-enhancing behaviors.
• Content or materials follow a planned order and help teachers and students meet the learning objectives.
• Assessment strategies to measure whether students have gained health-related knowledge, attitudes, and skills.

Health Education Standards

Health education standards are designed to establish, promote, and support health-enhancing behaviors for students in all grade levels. 1  These learning standards have been updated or are currently being revised by multiple professional organizations in school health. Versions of these standards are available here and here .

Sexual health is a critical component of health education

School-based sexual health education provides youth with the knowledge and skills they need to protect themselves from STIs/HIV,  and unintended pregnancy.

Click here to learn more about sexual health education .

National Sex Education Standards

The National Sex Education Standards outline foundational knowledge and skills students need to navigate sexual development and grow into sexually healthy adults. The standards are designed to help schools focus on what is most essential for students to learn by the end of a grade level or grade span and can be used to create lessons and curricula with aligned learning objectives. 18

Educator and Staff Professional Development and Training

Quality health education uses qualified teachers, connects students to health services, engages parents and community partners, and fosters positive relationships between adolescents and adults who are important to them. 19-21 Successful in-service professional development programs can improve both the amount of time teachers spend on health topics and their confidence to provide health education. 22-23

You can find professional development tool and resources here:

• Health Education Tools and Trainings
• Health Education Curriculum Analysis Tool (HECAT) . This tool helps school and community leaders conduct clear, complete, and consistent analyses of health education curricula across a wide variety of topics (e.g., nutrition, tobacco, mental/emotional health).
• HECAT Webinars . A series of six videos introducing HECAT and featured health topic modules.
• HECAT Online . A free, interactive tool that allows you to work collaboratively in teams to complete projects related to curriculum analyses, comparing strengths and weaknesses of multiple curricula, and developing a scope and sequence (S&S) for health education.
• HECAT Online Instructional Guides . A series of four guides detailing how to use HECAT Online for curriculum analyses or scope and sequence development.
• Centers for Disease Control and Prevention. Health Education Curriculum Analysis Tool, 2021 , Atlanta: CDC; 2021.
• Eisen M, Pallitto C, Bradner C, Bolshun N.  Teen Risk-Taking: Promising Prevention Programs and Approaches . Washington, DC: Urban Institute; 2000.
• Lohrmann DK, Wooley SF. Comprehensive School Health Education. In: Marx E, Wooley S, Northrop D, editors. Health Is Academic: A Guide to Coordinated School Health Programs. New York: Teachers College Press; 1998:43–45.
• Nation M, Crusto C, Wandersman A, Kumpfer KL, Seybolt D, Morrissey-Kane, E, Davino K.  What works: principles of effective prevention programs .  American Psychologist  2003;58(6/7):449–456.
• Coyle, K., Anderson, P., Laris, B. A., Barrett, M., Unti, T., & Baumler, E. (2021). A group randomized trial evaluating high school FLASH, a comprehensive sexual health curriculum.  Journal of Adolescent Health ,  68 (4), 686-695.
• Goldfarb, E. S., & Lieberman, L. D. (2021). Three decades of research: The case for comprehensive sex education. Journal of Adolescent Health, 68(1), 13-27.
• Marseille, E., Mirzazadeh, A., Biggs, M. A., Miller, A. P., Horvath, H., Lightfoot, M., & Kahn, J. G. (2018). Effectiveness of school-based teen pregnancy prevention programs in the USA: A systematic review and meta-analysis. Prevention Science, 19(4), 468-489.
• Denford, S., Abraham, C., Campbell, R., & Busse, H. (2017). A comprehensive review of reviews of school-based interventions to improve sexual-health. Health psychology review, 11(1), 33-52.
• Evans, C. B., Fraser, M. W., & Cotter, K. L. (2014). The effectiveness of school-based bullying prevention programs: A systematic review. Aggression and Violent Behavior, 19(5), 532-544.
• Faggiano F, Minozzi S, Versino E, Buscemi D. Universal school-based prevention for illicit drug use. Cochrane Database Syst Rev 2014(12):CD003020
• Onrust SA, Otten R, Lammers J, Smit F. School-based programmes to reduce and prevent substance use in different age groups: What works for whom? Systematic review and meta-regression analysis. Clin Psychol Rev 2016;44:45-5
• Hodder, R. K., Freund, M., Wolfenden, L., Bowman, J., Nepal, S., Dray, J., … & Wiggers, J. (2017). Systematic review of universal school-based ‘resilience’ interventions targeting adolescent tobacco, alcohol or illicit substance use: A meta-analysis. Preventive medicine, 100, 248-268.
• Rasberry CN, Tiu GF, Kann L, et al.  Health-Related Behaviors and Academic Achievement Among High School Students— United States, 2015 .  MMWR Morb Mortal Wkly Rep 2017 ;66:921–927
• Basch CE.  Healthier students are better learners: high-quality, strategically planned, and effectively coordinated school health programs must be a fundamental mission of schools to help close the achievement gap .  J Sch Health . 2011 Oct;81(10):650-62.
• Chin HB, Sipe TA, Elder R. The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: Two systematic reviews for the guide to community preventive services. Am J Prev Med 2012;42(3):272–94.
• Mavedzenge SN, Luecke E, Ross DA. Effective approaches for programming to reduce adolescent vulnerability to HIV infection, HIV risk, and HIV-related morbidity and mortality: A systematic review of systematic reviews. J Acquir Immune Defic Syndr 2014;66:S154–69.
• World Health Organization. Skills for health: Skills-based health education including life skills: An important component of a child-friendly/health-promoting school . World Health Organization, 2003.
• Future of Sex Education (2020) . National Sex Education Standards (Second Edition) .
• Murray, C. C., Sheremenko, G., Rose, I. D., Osuji, T. A., Rasberry, C. N., Lesesne, C. A., & Roberts, G. The influence of health education teacher characteristics on students’ health‐related knowledge gains. J Sch Health 2019; 89(7): 560-568.
• Centers for Disease Control and Prevention. PS18-1807 program guidance: Guidance for school-based HIV/STD prevention (component 2) recipients of PS18-1807 . Atlanta, GA: U.S. Department of Health and Human Services; 2019.
• Centers for Disease Control and Prevention (2016). Characteristics of an Effective Health Education Curriculum .
• Telljohann SK, Everett SA, Durgin J, Price JH.  Effects of an in-service workshop on the health teaching self-efficacy of elementary school teachers .  J Sch Health . 1996;66(7):261-265.
• Clayton HB, Brener ND, Barrios LC, Jayne PE, Everett Jones S. Professional development on sexual health education is associated with coverage of sexual health topics.  Pedagogy Health Promot . 2018;4(2):115-124. doi: 10.1177/2373379917718562.

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Educational Programs for the Promotion of Health at School: A Systematic Review

David pérez-jorge.

1 Department of Didactics and Educational Research, Faculty of Education, University of La Laguna, San Cristóbal de La Laguna, 38200 Santa Cruz de Tenerife, Spain; moc.liamg@9siulzelaznogardnajela (M.A.G.-L.); se.ude.llu@emijorcm (M.d.C.R.-J.)

María Alejandra González-Luis

María del carmen rodríguez-jiménez, eva ariño-mateo.

2 Department of Psychology, European University of Valencia, 46010 Valencia, Spain; [email protected]

Associated Data

Information and queries on the data used can be obtained from this article.

Context: Health promotion programs generate healthy changes in the educational community. However, not all of them meet the expected objectives due to multiple factors that affect their development, such as the teachers overload work, the lack of specific training, the lack of time to carry out health promotion activities, the lack of flexibility of the programs, and their non-inclusion in the training programs of the centers. Objective: To know the scope of the strategies and programs that promote healthy habits among students in compulsory educational stages. Data sources: a systematic review of articles in English, using the Web of Science (WOS), Medline, and PsycINFO databases.

1. Introduction

Health Promoting Schools (HpS) are resources for training, which are currently becoming a fundamental element for improving the comprehensive education of students, especially in the field of health. These schools favor the acquisition of knowledge and skills so that students are able to reflect and make decisions, in order to improve their health. These centers acquire a commitment to the development of training actions and to the implementation of programs for the promotion of healthy habits, creating a related awareness shared by all members of the educational community.

1.1. The Concept of Health

This work involves making a prior reflection on what is understood by health within the framework of the competencies that must be promoted from a school for its achievement. We start from the concept most agreed on and shared by the educational community, taking as a reference the definition from [ 1 ], which understands that health is the state of physical, mental, and social well-being of each individual and that it is a fundamental right of all citizens, without distinction of race, religion, political ideology, or economic or social conditions.

There are several approaches that have guided intervention in the field of health, as highlighted by [ 2 ]: (a) the preventive model, focused on early intervention; (b) the sanitary model, centered on the control of biophysical environmental conditions and; (c) the socio-medical model, focused on intervention in social and relational contexts. From our point of view, it is important to focus on the latter, since, as [ 3 ], this model relates the social, economic, and political context with the lifestyles of individuals. In this sense, it is considered essential to focus actions on health promotion, disease prevention, healing, and rehabilitation of people.

In this sense, [ 4 ] confirms that health forms a style and philosophy of life typical of each person and that it implies the promotion of autonomy that favors the configuration of one’s own personality. In this way, the individual is able to make their own decisions through a process of responsible reflection that helps them to adopt the habits and customs in solidarity with other citizens and with themselves, which has a positive impact on the enjoyment and improvement of their quality of life.

1.2. Health Promotion and Health Promoting Schools

In 1978, WHO, UNESCO, and UNICEF proposed various initiatives to introduce health promotion in schools. Years later, in 1986, the Ottawa Charter was drawn up, which recognized the importance of health education in achieving the wellbeing of all individuals [ 5 ]. Gradually, the promotion of health and healthy lifestyles has been promoted, in order to prevent diseases and improve people’s quality of life, which is why schools have taken a leading role in the promotion of health [ 6 ]. Reference [ 7 ] defines health promotion strategies in the school environment as a set of activities focused on improving the health of the entire educational community, and alludes to the need to influence the physical and social environments and policies of health promotion through the use of appropriate methodologies and school programs that promote their development. It is essential that the entire educational community be part of the health promotion process [ 8 ], therefore the need for health literacy arises, with the intention that people acquire knowledge and skills that allow them to promote health appropriately [ 9 ].

From the importance attributed to centers in the promotion of health, Health Promoting Schools (HpS) emerged, which oversee achieving social, economic, and environmental changes in the population in which they intervene. The essential function of HE is to develop the capacity of the entire educational community to achieve healthier lifestyles. These schools are in charge of carrying out activities that improve the health of the entire educational community, providing them with knowledge and habits for comprehensive care of people’s health. Reference [ 7 ] argues that the improvement of health states leads to an improvement in the academic results of the students.

Authors of [ 10 ] believe that it is essential to create policies that promote healthy lifestyles and prevent diseases, which should be promoted from educational centers as considered by the Ministry of Education, Culture, and Sports of the Government of Spain. Educational centers have direct access to students and the entire educational community, and therefore can directly influence the development of healthy habits and lifestyles. Educational centers are essential for the comprehensive development of students and the promotion of healthy lifestyles both physically, mentally, and socially.

As [ 7 ] underlines, HE aims to improve both the health of their students and their academic level through teaching and learning experiences and focused on actions related to well-being and healthy lifestyles. These actions are focused on elements that can affect health states, specifically referring to healthy eating, physical activity, emotional wellbeing, the consumption of drugs, tobacco, or alcohol, as well as the irresponsible use of Technology of Information and Communication (ICT), and the environment of the center.

1.3. Programs That Promote Health

An educational program is a set of activities that provides knowledge, skills, abilities, and competencies to students. Programs that promote health also have the objective of developing health in the educational community [ 11 ]. It is a teaching–learning process in which health is worked on and the quality of life of people is promoted, allowing critical thinking, affectivity, problem-solving, and social relationships develop [ 12 ]. According to [ 13 ], it is common for health risk behaviors to be seen in students, therefore, their prevention is essential through school programs that train and educate students. Reference [ 14 ] adds that educational centers are responsible for promoting health through programs, since through them healthy behaviors and habits are learned, thus avoiding risky behaviors. They state that health must be worked on throughout life, from childhood to adulthood, if a healthy culture and lifestyle is to be consolidated. The early approach and the consolidation of habits due to the influence effect are two of the reasons why educational centers are considered the most appropriate spaces to promote health [ 12 ].

The contribution of [ 15 ] affirms that for a health program to work, it is necessary that it be adapted to the context in which it is going to be implemented, moreover, they consider that this aspect is key if educational centers are to be a true HpS. The programs should not be implemented as something specific that is developed in certain circumstances, since health promotion must be part of the ideology and culture of the center, it must be a priority that must be addressed daily in the classroom, either as a specific subject [ 16 ] or in a transversal way [ 17 ]. Its value and relevance should prioritize its approach, giving time and opportunities for its internalization [ 16 ]. An example of the limited effects of specific actions in the field of health education is the study of [ 18 ], whose changes, despite being significant, were not maintained over time. The changes were observed with regard to healthy behaviors and knowledge about health, however, there were no changes in eating habits, nor in physical activity.

The main objective of this study is to know the scope of the strategies and programs that promote healthy habits among students in compulsory educational stages, using a systematic review methodology. We are unaware of the existence of previous systematic reviews, and this is a topic of great importance and relevance. For this reason, we consider it useful to identify the effectiveness of health promotion in HE.

Analyzing the existing theoretical framework, the research questions are:

• What programs do health-promoting schools develop and promote?
• Are educational programs effective in promoting healthy habits in students?
• What are the difficulties and limitations for the development of programs that promote health in educational centers?

2. Materials and Methods

The programs that promote health in educational centers tend to focus on different areas, therefore, studies that address specific areas of health promotion and not only those that speak on health promotion in a generic way were accepted. In addition, all those who are part of the educational community (students, teachers, principals, families) were considered as participants. Studies on health promotion programs had to provide data on the benefits and/or limitations of the implementation of these programs, whether of a preventive or specific interventional nature. Therefore, at the beginning of this research, a series of criteria were established for the inclusion and exclusion of documents.

In this way, the criteria considered are shown in Table 1 :

Estimated inclusion and exclusion criteria.

2.1. Literature Review

A systematic review of the scientific literature focusing on health promotion programs in schools was carried out for this study. This type of study aims to know, through the systematization of the search for sources and studies, the state of research in relation to a topic or question of research [ 19 ] This study was developed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) declaration model for meta-analysis and systematic review studies [ 20 ]. The PRISMA statement guides the conceptual and methodological aspects considered during the development of systematic review studies [ 21 ]. It is a type of study that analyzes the scientific literature on a topic with the aim of constructing valid and objective conclusions [ 22 ]. This is not only a study that provides knowledge on how health promotion is carried out in schools, but also poses challenges that will open the way for new studies and research.

The search of the sources was carried out on the databases of the Web of Science (WOS), which compiles the most important articles in the educational field, in addition, the search was carried out on Medline and PsycINFO, as they collect studies most prominent in the field of health. The search for sources lasted approximately 4 weeks, beginning on 24 April 2021, and ending on 26 May of the same year.

The following terms were used to search the indicated databases: “Health promotion program” together with a combination of educational terms (“Early childhood education”, “Primary school”, “Secondary school”, “Compulsory education”, “obligatory education”, “primary education”, “secondary education”, “basic education”, “elementary school”, “early education” and “high school”). It should be noted that the search was limited to research articles in English.

2.2. Characteristics of the Included Studies

Initially, the search strategy used was too general and non-specific, obtaining too many documents that were not related to the objective of the work. This search strategy was used: (School OR “obligatory education”) AND “health promotion program”.

In order to refine and focus the search, the search terms were broken down and replaced with synonyms. On the one hand, “health promotion program” was maintained as it is the main focus of this search and, in turn, all other terms were selected and debugged. The terms “Early childhood education”, “Primary school” and “Secondary school” were alternated between. With these combinations of topics and Boolean operators, the search offered a number of suitable articles to start selection and subsequent analysis. However, it was considered necessary to add the synonyms of the primary topics. As a result, after determining the final selection and alternating different combinations with Boolean operators, the final search was established with: (“Early childhood education” OR “Primary school” OR “Secondary school” OR “Compulsory education” OR “obligatory education” OR “primary education” OR “secondary education” OR “basic education” OR “elementary school” OR “early education” OR “high school”) AND “health promotion program”.

2.3. Procedure

The eligibility assessment was carried out independently and standardized. To do this, we began by searching the three databases mentioned above and, using the Mendeley bibliographic manager, all documents that were duplicated were eliminated. After this, the inclusion criteria, indicated above, were applied, eliminating those documents that did not meet the requirements, for which it was necessary to read the titles and summaries of all the documents. Finally, a complete reading of the remaining documents was made to confirm that they met the objectives of the study.

To extract the necessary information from the reports, the Atlas.ti V. 7 (Qualitative analysis program, originated at the Berlin University of Technology, Berlin, Germany in a project called ATLAS, between 1989 and 1992. The acronym stands for Archiv für Technik, Lebenswelt und Alltagssprache) program was used, with which all the important information was selected and encoded to be accessed quickly and easily. The information extracted refers to the main characteristics of each health promotion program, the sample, and the country in which the program was carried out, as well as the educational level at which it was put into practice. Likewise, the study methodology (qualitative or quantitative) and the main results were extracted, in order to know its limitations and benefits.

3.1. Study Selection

We began by searching the databases, where 29 documents were identified in WOS, 26 articles in Medline, and 6 in PsycINFO. Therefore, the search resulted in a total of 61 documents. At this point, duplicates were eliminated using the Mendeley bibliometric manager, excluding a total of 22 articles. After this, the inclusion criteria were applied, eliminating 25 documents that were not written in the last 5 years (2016–2021) and 3 articles that were not in English. The titles and abstracts of the documents were then read, eliminating one that did not specifically deal with health promotion programs. Finally, there were a total of 10 documents that were read completely, after the complete reading, 3 that were not research studies on the application of programs were discarded. Finally, as can be seen in Figure 1 , the total number of documents to be analyzed was seven.

Flow chart document.

3.2. Characteristics of the Included Studies

The seven articles selected for the review were research studies published in English and between the years 2016 and 2021, thus ensuring an analysis of the results on the application of programs for health promotion was updated. All the studies were international, carried out mainly in European countries (Ireland, Austria, Scotland, and Germany) and also in Australia, the United States of America, and Iran. According to the methodology used to approach the study, it was confirmed that two used qualitative methodology (28.57%; N = 2), another two quantitative (28.57%; N = 2), and three were mixed studies (42.85%; N = 3).

The evaluation instruments used were diverse, with more than one instrument in each of the studies, including: individual interviews (17.39%), questionnaires (43.47%), observations (4.34%), specific tests (skills and physical performance) (17.39%), focus groups (4.34%), electronic devices for routine and habit control (4.34%), and control scales (8.69%). As can be seen in Figure 2 , the most widely used were questionnaires, interviews, and tests.

Evaluation instruments used in the different publications.

In most of the studies, the selected samples were students from educational centers; only one study focused solely on the views of teachers on the importance of health promotion in schools. This shows a significant weakness in the approaches of the interventions that are developed in schools. These are usually one-off actions carried out by health professionals in which teachers are hardly involved (e.g., vaccination campaigns, oral hygiene campaigns…).

Regarding the results, it should be noted that there are disparities, as some programs did meet the objectives that had been set while others did not meet expectations, and their application was not very effective. Likewise, three studies focused on the primary education stage (42.85%), three on compulsory secondary education (42.85%), and one on both stages (14.28%). As can be seen from the distribution of studies at the educational stage, these studies mainly focused on the stages of primary and secondary education. All the information can be seen in Table 2 , where the author or authors, year of publication, purpose, design, sample, evaluation instrument, type of program, and main results are also listed.

Primary outcomes of the reviewed articles.

3.3. Identification of Health Promotion Programs

Each of the selected studies worked on different types of programs to promote health in educational centers. The programs mainly focused on five areas of health promotion; as seen in Table 3 , these areas coincided with those proposed by [ 7 ].

Areas of health promotion.

The first study was conducted by [ 15 ] and focuses on the ACE program (Activity, Confidence, and Eating). This program promotes healthy eating, physical activity, and dental and mental health and was developed within the framework of the Schools for Health in Europe (SHE) network, and its objective was to improve the implementation of health promotion programs in educational centers. This program promoted the participation of families, students, and teachers through different activities, such as cooking courses, books, dietician support, etc.

The second study focused on the “Classes in Motion” program, evaluated by [ 27 ]. The author approached health through physical activity from an integrated approach, without modification of the curricular program. Prior to the implementation of the program, teachers were trained through specific workshops, to provide them with adequate knowledge about health and active teaching methodologies to improve the motivation and safety of their students.

The third study integrated an iron (Fe) deficiency control program, evaluated by [ 24 ]. It was a national health promotion program, focused on nutrition and increasing the consumption of Fe supplementation. The importance of this study lies in the fact that the prevalence of Fe deficiency anemia is very high at the global level and, specifically, in Iran affects 35% of the child population, 33% of non-pregnant women, and 40% of pregnant women. Thus, the program focused on a women’s center and was developed in three phases; weekly administration of Fe, monitoring and control, and nutritional information on foods rich in Fe.

The fourth program called the “A Stop Smoking in Schools Trial” (ASSIST) focused on tobacco prevention, as evaluated by [ 25 ], and was intended to extend, through the students themselves, information and knowledge on the prevention of tobacco use in all contexts, both school and family. The students received training from health experts and became a trainer and promoter of healthy behaviors and preventive smoking.

The fifth program called “Join the Healthy Boat”, evaluated by [ 26 ], focused on the promotion of non-sedentary habits and the responsible use and consumption of ICT. It focused on the importance of training teaching staff in physical activity, healthy diet, and active free time, as well as motivating families to take part in the project. Through the collaboration of families at home, they controlled exercises and activities for the development of healthy habits, especially relevant to preventing sedentary lifestyles in the pandemic period.

The sixth program, called “Active Teen Leaders Avoiding Screen-time” (ATLAS), studied by [ 27 ], aimed to improve the frequency of physical activity, reduce the intake of sugary drinks, and reduce the time and consumption of ICT. This program considered that these objectives were achievable by motivating, improving, and reinforcing the individual responsibility of each student in maintaining healthy habits. The intervention was based on the use of multiple resources (physical activity sessions, telephone app, and website for self-monitoring of physical activity).

The last program, called “Hopeful Minds”, evaluated by [ 28 ], focused on the mental well-being of students. It proposed the promotion of mental health through social and emotional learning experiences provided by teachers. The study plan was carried out in two phases. In the first, skills such as meditation or managing a journal for self-reflection were taught; in the second, exercise and improvement of these practices.

3.4. Effectiveness and Main Difficulties in the Development of Programs That Promote Health

The analysis of the results of the programs has confirmed that not all the programs were effective and not all of them achieved their expected results, as seen in Table 4 .

Effectiveness of health promotion programs.

In the study [ 15 ], focusing on the primary education stage, the main results showed that teachers considered that schools have a fundamental role in health promotion, they saw work on this issue as incompatible to due to their overload of daily work. For this reason, they suggested that the program should consider the study plan of the center so that it could be implemented without creating more workload for the teaching staff. In addition, due to the lack of training in health, teaching staff considered it very important to have professional support to promote health in an appropriate way. In addition, they stated that one of the most important points was to create and reinforce the bond between the school and family so that students acquire healthy habits.

The study [ 23 ] focused on primary school students between the ages of eight and nine. Even though volunteer teachers participated in the study, a fact that guaranteed greater commitment and motivation towards the program, the results were not as expected. Some positive changes were observed in motor skills that led to an improvement in coordination and spatial orientation skills, without other notable results regarding the acquisition of habits.

The results of the study carried out with women in secondary education [ 24 ] showed that the three main aspects of the program were not carried out efficiently, since the consumption of the pill due to Fe deficiency (food supplement) was very low and, among the consequences, was a lack of knowledge about health and, specifically, on nutrition, due to the fact that the training sessions were very scarce. Therefore, the program did not achieve its expected objectives.

The research [ 25 ], conducted in secondary education, highlighted the importance of peer support in relational activities and social interaction, with support partners benefiting the most. It must be kept in mind that the peer conversations did not penetrate as expected from the students. However, the program still achieved benefits for students, with improvements in self-esteem, communication skills, and group social cohesion.

The third and last study carried out in primary education [ 26 ], showed improvements in development and motivation towards physical activity or sports practice, however, this did not reduce the time dedicated to ICT consumption. In general terms, the program showed some changes, but it was not effective due to the scant participation and collaboration of families in controlling inappropriate habits.

The latest study [ 27 ], conducted in secondary education, showed the satisfaction of users with the activities of the program and the place where it was carried out. However, the program was very routine, causing a lack of motivation and interest in the proposed content. The motivation and support of the teachers were key to achieving the proposed objectives. The students became aware of the importance of daily exercise and sedentary behaviors were reduced, the consumption of sugary drinks was reduced, and their diet improved by introducing healthy food. From the empowerment of autonomy in decision-making, it was intended that the students become aware of their role in improving their health.

The study [ 28 ], in the stages of primary and secondary education on the effects on the emotional and mental health of students, showed that in the primary stage it was able to reduce anxiety and improve negative emotions, and an improvement in autonomy was evidenced in the management and control of emotions. However, in secondary education no improvements were observed in anxiety levels, although a resilient behavior of students with self-care habits and improved self-confidence was noted.

4. Discussion

The main purpose of this systematic review was to determine the effects of programs that promote health in educational centers. This review provides evidence that not all educational programs work, and, in many cases, the expected results are not achieved. However, those that work show positive effects regarding the development of skills, competencies, habits, well-being, etc. The articles reviewed were published between 2016 and 2021, and reflected the importance of educational centers in promoting healthy habits and lifestyles, considering the most effective context for their implementation. The number of studies carried out on programs that promote health has been scarce in recent years. That is why we believe that the development of training programs for the promotion of healthy habits should be promoted; in this sense, we believe that students should be taught to assume a proactive attitude towards the care and maintenance of healthy lifestyles. This is a commitment that requires the involvement of all social agents if we are to consolidate healthy and perpetual lifestyles. Even so, of the studies reviewed, it was found that: (a) the study samples varied and focused mainly on students, with studies focused on teachers and their training in health being especially scarce; (b) there is no clear and concise evaluation method to study health promotion in educational centers; and (c) the results obtained in the studies show variability in the effectiveness of the programs.

In general, not all programs work or generate behaviors that are compatible with the development of healthy habits in students and the rest of the educational community. The results of the systematic review carried out evidenced this fact. Only three of the seven programs obtained expected results, generating positive effects in students towards the development of healthy habits. From the programs presented above, results have been extracted that agree with the study carried out by [ 17 ], programs for the promotion of healthy habits have been found to take account of the school’s programming so that they can be carried out effectively, without overloading teachers. The planning and inclusion of health education in the school curriculum give it the continuous and integrated character that any knowledge requires to be acquired and integrated. Programs should tend to move away from isolated interventions in the form of ad hoc campaigns whose effect is insignificant (e.g., oral hygiene day, world sports day…).

Teachers demand the presence of experts to support the implementation of the programs, considering that they do not have sufficient qualifications for this task, and emphasize the importance of families being integrated into the school to achieve real change [ 15 ].

The participation of the entire educational community is essential for the success of these programs. As seen in the study [ 23 ], motivation of the teaching staff is not enough to achieve beneficial changes with the programs. Similarly, it was observed in the study [ 26 ], whose program did not work due to the low participation of families from home. Low family participation conditions the results [ 29 ]. When there is involvement and commitment on the part of families in the development of the programs, achievement of the results and goals of the program is favored [ 30 , 31 ].

Programs must be properly structured, focused on health promotion objectives, ensuring sufficient, adequate, and adapted training for students [ 24 ]. Specific or isolated interventions not adequately integrated into the training plan and educational programming of the centers do not guarantee the development of habits or the consolidation of self-care behaviors compatible with the health of the students [ 16 ]. It is essential that necessary time is dedicated to health promotion, to generate stable changes [ 18 ].

The findings of this study have highlighted the importance of having qualified and motivated teachers towards the promotion of health in schools, as well as having the spaces, resources, and materials for its promotion and consolidation [ 27 ]. Another study [ 30 ] corroborates the value of motivation and interest of the students towards the promotional health programs. The development of this type of program favored peer training, as well as the development of creative, critical, interpersonal thinking, and self-awareness skills that are fundamental for life [ 25 ]. Students learn in this way and by putting these skills into practice, to face health-related problems responsibly [ 31 ]. Peer learning has been established as a basic strategy for the promotion and consolidation of healthy habits and behaviors [ 25 ].

In the study [ 28 ], the relevance of training in the success of Health Education Programs was evidenced. Their experience properly developed and achieved optimal changes in the students, greater resilience, improved self-care, and decreased anxiety and negative thoughts were evidenced. Another study [ 29 ] valued the importance of the adequate development of health promotion programs, this type of action must be presented in the curricular framework of teaching and their actions must obey a strategic plan of actions focused on the improvement of the health of the students and the educational community. Specific or incomplete actions limiting the phase of action and change that must be carried out by the students and end up being actions without effect.

5. Conclusions

The main conclusions reached with this study are:

• Education and health promotion programs in schools must link families with the educational center.
• Improving the training of teachers in health matters is a requirement.
• Health promotion is a social commitment that requires the participation of all its members.
• Health education is not an exclusive commitment of schools, it must involve families and health professionals.
• Health education must be a fundamental objective in the annual programming of schools.
• Programs have to be well structured to work.
• Peer training is beneficial and makes programs work.
• The teacher must be a fundamental support point in the success of health promotion, they must lead the change by encouraging and motivating students towards the adoption of healthy habits.
• An improvement in the qualification and training of teachers in the field of health is required.
• Health promotion programs must be, above all, programs for the training of the entire educational community.

Author Contributions

Conceptualization, D.P.-J., M.A.G.-L. and E.A.-M.; methodology, D.P.-J. and M.d.C.R.-J.; formal analysis, D.P.-J. and M.A.G.-L.; investigation, D.P.-J., M.A.G.-L. and M.d.C.R.-J.; resources, D.P.-J. and E.A.-M.; writing—original draft preparation, D.P.-J. and M.d.C.R.-J.; writing—review, all authors; visualization, all authors; supervision, E.A.-M.; project administration, D.P.-J., M.A.G.-L. and E.A.-M. All authors have read and agreed to the published version of the manuscript.

This research was funded by the CajaCanarias Foundation and La Caixa Foundation Reference of the project IECVAD-COVID19.

Institutional Review Board Statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of CEIBA (protocol code 2021-0462 approval date: 13 April 2021).

Informed Consent Statement

Not applicable.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

• Open access
• Published: 08 September 2023

Integrating research in health professions education: a scoping review

• Kirsti Riiser 1 ,
• Runa Kalleson 1 ,
• Heidi Holmen 2 , 3 &
• Astrid Torbjørnsen 2  

BMC Medical Education volume  23 , Article number:  653 ( 2023 ) Cite this article

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Integrating teaching and research may boost students’ learning and improve future clinical practice when incorporated into education. Explorations of health professions students’ involvement in the research processes and their learning outcomes are sparse. Thus, the purpose of this scoping review is to explore the existing scientific literature on courses involving students from health professions education in research activities. The research questions are: Which parts of the research process are the health professions students involved in, and what are the students’ main learning outcomes related to the research process reported to be?

A scoping review following the six-step approach of Arksey and O’Malley was undertaken. We searched four electronic databases to identify studies focusing on research-based teaching in health professions education. Inspired by content analysis, we identified key concepts relating to the research process and learning outcomes.

We screened 1084 abstracts, reviewed 95 full-text reports, and included 24 for analysis. Overall, the students were more involved in conducting and disseminating research than in the planning phases. Learning outcomes were most frequently reported as specific research skills, such as conducting literature reviews, writing academically, and presenting results, but also as improved understanding of research in general as well as improved motivation and confidence in conducting research.

Conclusions

The heterogeneity of educational programs, study designs, and measures makes it difficult to draw conclusions across the studies included in the review. More research is needed to conclude whether health professions students who actively engage in research gain a better understanding of the research process, become more likely to pursue research in their practice, or are more motivated to choose an academic career.

Peer Review reports

The interplay between research and teaching in higher education is often referred to as a “nexus,” suggesting that the linkage is close, essential, and undeniable [ 1 ]. The much-referenced model of Healey [ 2 ] differentiates between research-led, research-oriented, research-tutored, and research-based teaching. Research-led and research-oriented teaching are both categorized as teacher-focused, with teaching structured around subject content and methods for knowledge production, respectively. Research-tutored and research-based teaching are presented as student-focused strategies, where the former involves students’ writing and discussions about research, and the latter actively involves the students in doing research [ 2 ]. According to Healey [ 3 ], a research-based curriculum is preferred because it treats learning as problems that remain to be solved through inquiry and research. Another way of illustrating the variations in linkages between teaching and research is to focus on relationships between the two and on student involvement, presented as a continuum from no relationship between teaching and research and students acting as consumers at one end, and complete integration with students as producers of research at the other [ 4 ]. Active student involvement is proposed as fundamental for learning [ 5 ]. Student participation in research corresponds with Healey’s description of research-based teaching and is thus recommended for implementation in higher education [ 6 ]. Arguments have been made to extend the term “teaching–research nexus” to “the teaching–learning–research nexus” or “the research–education nexus,” including not just the activities of the staff and students but also organizational, institutional, and cultural aspects [ 6 ]. In the present scoping review, we maintain the traditional term, as this is commonly used in the literature [ 7 ], but with the intention of investigating how health professions students are actively involved in research activities in their educational programs.

The linkage between research and teaching has been shown across disciplines, educational levels, academic orientations of study programs, and characteristics of students [ 5 ]. Traditionally, while the teaching–research nexus has been related to study disciplines such as medicine, the concept is increasingly included in programs for applied health studies [ 1 , 8 ]. There has been a call for more creative and interactive strategies to make research relevant to the practice of nursing [ 9 ] as well as occupational therapy and physiotherapy [ 10 , 11 ]. Many applied programs are at the bachelor level, such as nursing and physiotherapy, and among students in such programs, attitudes toward bringing research into teaching and learning activities have been reported as varied and ambiguous [ 12 ]. One issue raised by students is that time spent on research can be at the expense of practical training in profession-specific skills [ 13 ]. However, it has been argued that the ability to understand and be involved in research is of great importance to prepare students for a professional career in a rapidly changing, increasingly complex society [ 14 ].

Investigations of the relationship between teaching and research are longstanding and have been increasing over the last few decades [ 15 ]. However, our preliminary searches revealed a lack of scoping or systematic reviews and a paucity of studies that describe research-based teaching strategies or programs in the breath of health professions educations. Explorations and discussions of the students’ involvement in research processes and their learning outcomes of specific courses were sparse. Thus, we present a scoping review to map and identify available studies and obtain an overview of the topic. The overall purpose of this scoping review is to explore the existing scientific literature on courses involving students from health professions education in research activities.

This scoping review applies the approaches promoted by Arksey and O’Malley [ 16 ], which consist of six stages: (1) identify the research question, (2) identify relevant studies, (3) select the studies, (4) chart the data, (5) summarize and report the results, and (6) consult with stakeholders [ 16 ]. The decision was founded on the purpose of examining the extent, range, and nature of the research activity for our topic, to summarize and disseminate research findings, and to identify research gaps in the existing literature [ 16 , 17 ]. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR) [ 18 ] criteria guided the reporting of the review.

Identifying the research question

Based on the previous research presented in the introduction and our curiosity as scholars in the field of health education and research, we aimed to answer the following research questions: Which parts of the research process are the health professions students involved in, and what are the students’ main learning outcomes related to the research process reported to be?

Identifying relevant studies

To identify literature relevant to our research questions, key concepts and terms were developed from the literature relating to the research–learning or teaching nexus. The Norwegian Act for Health Personnel, which corresponds with other European countries on the recognition of professional qualifications, was searched to identify relevant health professions [ 19 ]. Health professions were combined with versions of the research–teaching concept. A search string was built and tailored to each database, searching for terms in titles, abstracts, keywords, and MeSH terms. To cover both education and health literature, we searched MEDLINE, Education Resources Information Center (ERIC), and SCOPUS. The first 300 papers listed in a Google Scholar search were also included. Table  1 provides the full search strategy for one of the databases.

We included studies reporting on health professions students and research-based teaching as main concepts and excluded studies reporting on evidence-based practice or problem-based learning only. We searched for studies focusing on research activities connected to a specific course or subject excluding studies reporting solely on students’ experiences related to their individual bachelor’s or master’s thesis. All professions not requiring higher education and professions requiring specialization or further education beyond qualification were excluded. A full list of the inclusion and exclusion criteria is outlined in Table  2 . Studies after 2000 were searched to include reports published after the initiation of major university reforms in the Nordic countries [ 20 ]. The first search was completed in April 2020, with a supplementary search in November 2022.

Study selection

Identified records were imported into the Covidence systematic review software [ 21 ], and duplicates were removed. Random pairs of two independent reviewers screened titles and abstracts for eligibility. Relevant reports were retrieved and assessed in full text against the inclusion criteria. Full-text reports that did not meet the inclusion criteria were excluded, and the reasons for exclusion were registered. Disagreements between the two reviewers were resolved through discussions with a third reviewer. The reference lists of the initially retained reports were hand searched. The selection procedure for the reference reports was the same as described above.

Charting the data

A data form was developed in Microsoft Excel to extract the data. The following key items of information were obtained from the studies: author, year of publication, location, student sample, aim of the study, methodology, outcome measure, and key results. The included studies were divided equally between the authors, and the data charting was conducted individually before all the authors agreed on the design and content of the final form.

All studies included in the final review were uploaded in full to NVivo [ 22 ], facilitating the analysis. Inspired by a directed content analysis approach [ 23 ], we identified key concepts related to the research process. We coded text from complete reports pertaining to the main steps of research: planning the research (choosing the topic, aims, and/or objective, conducting a literature review, designing the study), doing the research (collecting and analyzing the data), and disseminating the research (reporting and presenting the results). The coded text was extracted and organized in a table. Furthermore, we extracted all text relating to the students’ main learning outcomes, and using content analysis, we identified the following themes: knowledge and skills and engagement and satisfaction.

Consulting with stakeholders

According to Arksey and O’Malley’s sixth stage [ 16 ], we presented our review and findings with two stakeholders, both of whom were health care professionals (nurse and physiotherapist), and researchers and teachers with extensive pedagogical and didactical expertise. The stakeholders read through the entire manuscript, provided written feedback on the presentation of the main findings, and suggested relevant issues for discussion. The comments were included in the authors´ deliberations of the presentation of the results and in the discussion of the results.

Summary of the studies

Using the key search descriptors, we identified 1078 records. Through hand searches of the reference lists of the initially retained records, 60 additional records were found and assessed adding up to 1138 identified records in total. Among the records from the search, 54 were duplicates. We screened 1084 records of which 989 were deemed irrelevant. Altogether 95 reports were retrieved and assessed in full text including the 60 records identified through reference searching, and finally 24 reports were included. Figure  1 illustrates the process of article selection.

PRISMA flow diagram for study selection

The eligible studies represented 12 countries (Additional file 1 ), with the majority (n = 7) being from the United States. The studies covered six different health professions (medicine, nursing, dentistry, pharmacy, psychology, and physiotherapy) in addition interdisciplinary health education programs. Medicine was the most frequently studied health profession (n = 10, 42%). The majority of the studies reported on research-based teaching projects implemented in existing courses, most of which were public health or community health courses. Most studies had a quantitative design (n = 15, 63%), only two (8%) had a qualitative design, and the remaining seven studies (29%) used a multi- or mixed-methods design with both quantitative and qualitative methods. The majority of the studies (n = 21, 86%) included some kind of survey to assess outcomes, of which all but one [ 24 ] were designed to fit the specific study context. The surveys asked questions relating to the students’ learning outcomes, perceived involvement, and experience with research participation. There were also examples of studies reporting on achievements (e.g., awards, scholarships, and grants) and scientific production [ 25 , 26 , 27 ]. The qualitative studies included interviews, observations, narratives, and text and document analysis [ 28 , 29 , 30 , 31 ].

Summary of the students’ involvement in the research process

In all the studies, the students were actively engaged in conducting research, either by participating in data collection or interpreting it, or both (Table  3 ). In all but one of the studies [ 29 ], the students were involved in disseminating the research through the presentation of their results with a written report, poster, or oral presentation. The students were less engaged in planning the research than they were in later phases of the research process. The topics for the students’ projects were mostly predetermined; however, there were examples of studies in which the students themselves chose a research topic [ 26 ], chose or voted on a topic within an overarching theme [ 24 , 28 , 32 , 33 ], or were given the opportunity to choose between several predefined topics [ 34 ]. Arguments for letting the students participate in the choice of research topic were to increase enthusiasm and interest [ 24 , 28 ]. In 11 of the studies, the students were involved in drafting an aim or objective or a research question for their research project, and in 12 studies, students performed a literature review either prior to or after the identification of a research question. In almost half of the studies, the students were involved in the choice of study design.

Summary of the learning outcomes

The majority of the studies measured the students’ self-reported learning outcomes, but there are examples of studies that included assessments of the students’ research skills and knowledge of research methods as well as their academic success (Additional file 1 ). Students reported increased knowledge and skills , such as team skills [ 33 , 40 , 44 ], reading and writing skills, and research and presentation skills [ 24 , 31 , 32 , 40 , 41 , 42 , 45 ]. Positive outcomes were associated with learning how to make long-term plans and to work systematically [ 37 ], to engage in the scientific and creative process of designing, conducting, and implementing research [ 38 ], and to conduct literature reviews, write academically, and publish reports [ 26 ]. Two studies reported that research-based sessions encouraged critical thinking and reflective practice to support deep learning [ 29 , 46 ]. Research-based teaching was also reported to increase students’ awareness of the research culture of the faculty and their understanding of academic life [ 44 ]. Several of the studies included poster presentations, conference participation, and papers published by students as objective measures of academic output (e.g., 26, 27, 33). One study described how students found it more useful to write and present posters than to write a paper [ 40 ]. Factors related to poorer learning outcomes were, for example, unsuitable timing of the course in the program [ 36 ] and insufficient preparation for using statistical analysis software [ 38 ]. Courses with tight deadlines, that were too time consuming, or had overly complicated instructions were regarded as less useful [ 26 , 37 ].

Most studies included some kind of measure of students’ engagement and satisfaction with research-based teaching. In one study, students reported that it felt purposeful to conduct real research and be able to transfer their findings to practice [ 34 ]. Participating in a research project positively affected the students’ confidence in and understanding of research, and the students found it rewarding to be taken seriously as researchers [ 33 , 34 , 41 ]. One study showed that students who knew more about research at the beginning of the course had marginally more positive attitudes initially, but the pre-course differences disappeared by the end of the course [ 24 ]. Here, the students’ attitudes toward research were positively related to their overall number of skill-based experiences [ 24 ]. Several studies found that research-based teaching increased students’ motivation to participate in research in the future [ 24 , 31 , 36 , 40 ]. However, one study showed that even though research might be seen as important for future careers by students, a more research-based curriculum did not affect their beliefs about the value of research [ 45 ]. Less engagement in research was grounded in a belief that participation was not contributory for postgraduate courses [ 36 ], or was not experienced as sufficiently relevant [ 30 ]. In some studies, the students reported that they valued learning about the topic and interacting with the patients in the project more than participating in the research process [ 30 , 47 ].

The present scoping review aimed to explore scientific literature reporting on specific courses in health professions education in which students were actively engaged in research activities, that is, research-based teaching. We identified and summarized which parts of the research process students were involved in, and what their learning research-related outcomes were reported to be. Overall, the students were notably more involved in conducting and disseminating research and less involved in the planning phases. In some studies, the learning outcomes were reported as improved knowledge and understanding of the research process in general, but most frequently, the studies reported on how participating in research-based courses or programs increased specific research skills. How involvement in research contributed to learning about specific topics was less extensively discussed in the studies and is not within the scope of the present review.

During the screening process, we excluded many studies that reported on courses in evidence-based practice or programs engaging students in learning activities that can be characterized as problem-based learning. Although evidence-based practice and problem-based learning use research evidence and allow extensive student activity, compared to research-based teaching, they do not include activities in which the students take an active part in the research process and learn as researchers [ 2 , 3 , 8 ]. The inclusion/exclusion process confirmed our presupposition that studies on using research far outnumbered studies on doing research in health professions education. The relevance of evidence-based practice and problem-based learning skills for health professionals is highly acknowledged, and it is established that all health professions graduates should be able to gain, assess, and apply research-based knowledge in practice [ 48 , 49 ]. Knowing about the research process is important for students in their health professions education and beyond. However, knowledge and experiences acquired through actual training in planning, doing, and disseminating research may add greater value, even if the students´ acquired learning of research is limited to one project.

To a large extent, the research projects included in our review were minor student projects defined and limited by the topic of the course. The results show that students were actively involved in data collection, interpretation of data, and dissemination of research results. It is interesting that some of the courses also managed to involve the students in the initial research phases of deciding on the topic, objective, and design. Providing students with choices and opportunities for self-initiation might support their autonomous motivation and perceived competence [ 50 ]. Research has shown that adopting an autonomy-supportive teaching style, for example by issuing a meaningful rationale for the learning activities, and providing choice and involving the students in the course design, may increase their motivation [ 51 ]. Several of the included studies reported on motivational outcomes such as satisfaction, engagement, attitudes, or perception of relevance. However, the wide variation in designs across the studies makes it impossible to compare the impact of self-determination on student engagement and learning outcomes. Investigating the motivational effect of autonomy support in research-based courses is an intriguing issue that could be explored in future research.

The included studies typically aimed to measure the impact of a research-based course by comparing perceptions of knowledge and skills or research engagement before and after course participation. With one exception [ 24 ], all of the studies designed their own surveys, but included limited information on how the surveys were developed and evaluated. Without proper evaluation of reliability and validity, we cannot ensure that the instruments used were measuring what they were supposed to measure. Moreover, the use of tailored surveys designed to report on the impact of one specific program or course makes it impossible to compare improvements in knowledge of or motivation for research across studies. Thus, in future studies, systematically developed and validated instruments to measure constructs such as students’ attitudes toward research should be applied. The revised Attitudes Towards Research Scale [ 52 ], applied in Hardway and Stroud [ 24 ] and developed to measure perceptions of usefulness, anxiety toward, and positive feelings regarding research courses, is one, if not the only, instrument designed for this purpose. The scale contains factors measuring attitudes investigated in several of the studies in the present review, such as the value of doing research for its own sake, for practicing for a future research career, or to support practice. The latter conception of research as useful for practice may be of particular importance. Several of the included studies described that students were concerned that research engagement would take time away from learning about a topic and practicing skills, findings that are in line with previous literature [ 13 ].

The great majority of courses in the included studies were public health and community health courses. This demonstrates that public and community health are more versatile, relevant, and easy to access for student research than hospitals. In the public health courses described, the students were given the opportunity to engage in research to improve population health outcomes and minimize risks, thereby contributing to reducing health inequities. Rimer [ 53 ] argued that to help students focus on achieving a positive impact on health threats, they must be provided with the necessary research skills and tools to identify evidence gaps and be involved in meaningful practice-based research projects. There may also be practical and ethical reasons why research-based teaching is implemented in public health courses and, to a lesser degree, in clinical courses. Particularly in an educational context, investigating population strategies to promote health and prevent disease is less sensitive and ethically demanding than approaching vulnerable patients undergoing treatment.

This scoping review has some limitations. We searched only for studies in peer-reviewed journals and not gray literature. Thus, it is not possible to determine whether our findings are representative of research-based approaches in higher health education. We have reported on studies focusing on research activities connected to a specific course or subject. and did not include studies solely reporting on students’ experiences of doing research related to their bachelor’s or master’s theses. The choice was taken to narrow the scope of our review, but we acknowledge that we may have missed relevant information on how students‘ acquire research experiences from their thesis work. Even though the time span of our scope was more than 20 years and included a wide range of health professions, we found only 24 studies that matched our criteria. The updated search revealed no new articles published during the two years from the first to the updated search. This is likely a consequence of a demanding teaching situation during the Covid-19 pandemic. Research-based courses that require extra resources, as well as access to patients and communities, have been deprioritized [ 54 , 55 ]. A scoping review does not include a quality assessment of the research included. However, we are left with the impression that the validity of several of the studies was compromised by using unvalidated measures, no control groups, small samples, and limited follow-up times. During the selection process, a large body of research was excluded due to the lack of a clear description of methods or measures to report on the learning outcomes. It is a paradox that articles reporting on research-based higher education courses have extensive methodological shortcomings.

The present scoping review cannot make statements about the overall impact of research-based teaching on students’ knowledge of doing research nor future engagement in research activity. Thus, more research is needed to investigate whether health professions students who actively engage in research have a better understanding of how to conduct evidence-based work, are more motivated to choose an academic career or are more likely to pursue research in their practice. The latter is particularly important as evidence suggests that there is an association between individuals’ and healthcare organizations’ research engagement and improvements in healthcare performance [ 56 ]. A recent review found that clinical academic activity may have positive impacts for patients, beneficial impacts to the individual clinical academic, impacts for service provision and workforce, and the organization’s research profile, culture, and capacity, as well as economic impact and impacts on staff recruitment and retention [ 57 ].

In this scoping review, we identified scientific literature on research integration in health professions education. We aimed to investigate students´ participation in different phases of the research process and the learning outcomes reported. We found that in most studies, the students were involved in a range of research activities, but more often in conducting and disseminating the research than planning it. Reported learning outcomes included improved research skills, such as conducting literature reviews, writing academically, and presenting results, as well as increased motivation, confidence, and understanding of research. However, the heterogeneity of educational programs, study designs, and measures makes it difficult to summarize the outcomes. Understanding how students can be involved in research and exploring learning outcomes related to such research-based strategies appears to be crucial in enabling the development of educational programs for health professions students.

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Not applicable. All data were drawn from published manuscripts.

Tight M. Examining the research/teaching nexus. Eur J High Educ. 2016;6(4):293–311.

Google Scholar  

Healey M. Linking research and teaching to benefit student learning. J Geogr Higher Educ. 2005;29(2):183–201.

Healey M. Developing research-based curricula in college-based higher education. Heslington, York: The Higher Education Academy; 2014.

Dekker H, Wolff S. Re-inventing research-based teaching and learning. European Forum for enhanced collaboration in teaching. Brussels: Center for Education and Learning; 2016.

Elken M, Wollscheid S. The relationship between research and education: typologies and indicators. A literature review. Oslo: Nordic Institute for Studies in Innovation, Research and Education. 2016;8.

Gros B, Viader M, Cornet A, Martínez M, Palés J, Sancho M. The Research-Teaching Nexus and its influence on Student Learning. Int J High Educ. 2020;9(3):109–19.

Uaciquete AS, Valcke M. Strengthening the teaching and research Nexus (TRN) in higher education (HE): systematic review of reviews. Sustainability. 2022;14(22):15317.

Kyvik S, Vågan A. Forskningsbasert utdaning -en litteraturgjennomgang. In: Kyvik S, Vågan A, editors. Forskningsbasert utdanning? Oslo: Abstrakt forlag; 2014. p. 25–53.

Christie J, Hamill C, Power J. How can we maximize nursing students’ learning about research evidence and utilization in undergraduate, preregistration programmes? A discussion paper. J Adv Nurs. 2012;68(12):2789 – 801.

Helgøy KV, Smeby JC, Bonsaksen T, Rydland Olsen N. Research-based occupational therapy education: an exploration of students’ and faculty members’ experiences and perceptions. PLoS ONE. 2020;15(12):e0243544.

Helgøy KV, Bonsaksen T, Røykenes K. Research-based education in undergraduate occupational therapy and physiotherapy education programmes: a scoping review. BMC Med Educ. 2022;22(1):358.

Kyvik S, Vågan A. Forskningsbasert utdanning -noen kritiske spørsmål. Forskningsbasert utdanning? Oslo: Abstrakt forlag; 2014.

Kyvik S, Vågan A, Prøitz T, Aamodt P. Research-based education in undergraduate professional programmes. In: Smeby J, Sutphen M, editors. From vocational to Professional Education. New York: Routledge; 2015.

Jenkins A, Healey M, Zetter R. Linking teaching and research in disciplines and departments. York: The Higher Education Academy; 2007.

Malcolm M. A critical evaluation of recent progress in understanding the role of the research-teaching link in higher education. High Educ. 2014;67(3):289–301.

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.

Colquhoun HL, Levac D, O’Brien KK, Straus S, Tricco AC, Perrier L, et al. Scoping reviews: time for clarity in definition, methods, and reporting. J Clin Epidemiol. 2014;67(12):1291–4.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PRISMA for Scoping Reviews [Available from: http://www.prisma-statement.org/Extensions/ScopingReviews .

The Norwegian Ministry of Health and Care Services. Act relating to Health Personnel 1999.

Pinheiro R, Aarrevaara T, Berg LN, Fumasoli T, Geschwind L, Hansen HF, et al. Nordic Higher Education in Flux: System Evolution and Reform Trajectories. In: Pinheiro R, Geschwind L, Foss Hansen H, Pulkkinen K, editors. Reforms, Organizational Change and Performance in Higher Education: a comparative account from the nordic Countries. Cham: Springer International Publishing; 2019. pp. 69–108.

Babineau J. Product review: Covidence (systematic Review Software). The Journal of the canadian health libraries association = Journal de l’Association des Bibliothèques de la Santé. du Can. 2014;35(2):68–71.

QRS International Pty Ltd. NVivo qualitative data analysis software 2012.

Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.

Hardway CL, Stroud MJ. Using Student Choice to increase students knowledge of Research Methodology, improve their attitudes toward Research, and promote Acquisition of Professional Skills. Int J Teach Learn High Educ. 2014;26:381–92.

Eley DS, Wilkinson D. Building a teaching-research nexus in a research intensive university: rejuvenating the recruitment and training of the clinician scientist. Med Teach. 2015;37(2):174–80.

Smith FG, Harasym PH, Mandin H, Lorscheider FL. Development and evaluation of a research project program for medical students at the University of Calgary Faculty of Medicine. Acad Med. 2001;76(2):189–94.

Tamariz L, Vasquez D, Loor C, Palacio A. Successful adaptation of a research methods course in South America. Med Educ Online. 2017;22(1):1336418.

Hassan SL. Applying research-based learning in medical education through the route of special study modules: Notes from the UK. 2013.

Jutlla K, Lillyman S. An Action Research Study Engaging in the Use of Storyboarding as Research-based Approach to Teaching to identify issues faced when working with people with dementia from minority ethnic Communities. Worcest J Learn Teach. 2014(9).

Oakes CE, Sheehan NW. Students’ perceptions of a community-based service-learning project related to aging in place. Gerontol Geriatr Educ. 2014;35(3):285–96.

Dongre A, Kalaiselvan G, Mahalakshmy T. The benefits to medical undergraduates of exposure to community-based survey research. Educ Health. 2011;24(3):591.

Mullan JR, Weston KM, Rich WC, McLennan PL. Investigating the impact of a research-based integrated curriculum on self-perceived research experiences of medical students in community placements: a pre-and post-test analysis of three student cohorts. BMC Med Educ. 2014;14(1):1–9.

Bertrand FE, Slovensky DJ. Crafting a Team-Based, Interprofessional Undergraduate Research Honors Curriculum in the Health Professions. J Allied Health. 2020;49(1):e57–e62.

Balakas K, Sparks L. Teaching research and evidence-based practice using a service-learning approach. J Nurs Educ. 2010;49(12):691–5.

Bouhaimed M, Thalib L, Doi SA. Outcomes associated with community-based research projects in teaching undergraduate public health. Med Teach. 2008;30(4):384–8.

Chaturvedi S, Aggarwal OP. Training interns in population-based research: learners’ feedback from 13 consecutive batches from a medical school in India. Med Educ. 2001;35(6):585–9.

Choeisuwan V. Effects of Research-based instruction in Health System subject of nursing students, the Royal Thai Navy College of nursing. Procedia - Social and Behavioral Sciences. 2015;191:948–52.

Dehaven MJ, Chen L. Teaching medical students research while reaching the underserved. Fam Med. 2005;37(5):315–7.

Dehaven MJ, Gimpel NE, Dallo FJ, Billmeier TM. Reaching the underserved through community-based participatory research and service learning: description and evaluation of a unique medical student training program. J Public Health Manag Pract. 2011;17(4):363–8.

Deonandan R, Gomes J, Lavigne E, Dinh T, Blanchard R. A pilot study: research poster presentations as an educational tool for undergraduate epidemiology students. Adv Med Educ Pract. 2013;4:183–8.

George CL, Wood-Kanupka J, Oriel KN. Impact of participation in Community-Based Research among Undergraduate and Graduate students. J Allied Health. 2017;46(1):e15–e24.

Kongkaew C, Scholfield CN, Supapaan T, Mann C, Mongkhon P, Chanunun S. Impact of research-based learning on student knowledge and assessment in Pharmacoepidemiology: a one group pretest-posttest experimental study. Thai J Pharm Sci (TJPS). 2020;43(4):236–41

Millar E, Baker MG, Howden-Chapman P, Wilson N, Dickson N. Involving students in real-world research: a pilot study for teaching public health and research skills. BMC Med Educ. 2009;9(1):45.

Naug HL, Colson NJ, Donner DG. The Research Encounter: an innovative course inclusion that facilitates Student Engagement. Innov High Educ. 2012;37(4):335–45.

Vereijken MWC, van der Rijst RM, van Driel JH, Dekker FW. Student learning outcomes, perceptions and beliefs in the context of strengthening research integration into the first year of medical school. Adv Health Sci Educ Theory Pract. 2018;23(2):371–85.

Veses V, Del Mar Jovani-Sancho M, González-Martínez R, Cortell-Ballester I, Sheth CC. Raising awareness about microbial antibiotic resistance in undergraduate dental students: a research-based strategy for teaching non-laboratory elements of a microbiology curriculum. BMC Med Educ. 2020;20(1):47.

Wesselborg B, Hoenen M, Adam-Paffrath R, Kuske S, Schendel L, Grünewald M, et al. Interprofessional nutrition management - implementation and evaluation of a course for medical and nursing students using research-based learning method. GMS J Med Educ. 2019;36(6):Doc68.

Bala MM, Poklepović Peričić T, Zajac J, Rohwer A, Klugarova J, Välimäki M, et al. What are the effects of teaching evidence-based Health Care (EBHC) at different levels of health professions education? An updated overview of systematic reviews. PLoS ONE. 2021;16(7):e0254191.

Yew EHJ, Goh K. Problem-based learning: an overview of its process and impact on learning. Health Professions Education. 2016;2(2):75–9.

Ryan RM, Deci EL. Self-determination theory: basic psychological needs in motivation, development, and wellness. Guilford Publications; 2017.

Jeno LM, Nylehn J, Hole TN, Raaheim A, Velle G, Vandvik V. Motivational determinants of students’ academic functioning: the role of Autonomy-support, Autonomous Motivation, and perceived competence. Scand J Educ Res. 2021:1–18.

Papanastasiou EC. Revised-attitudes toward Research Scale (R-ATR); a First look at its Psychometric Properties. J Res Educ. 2014;24:146–59.

Rimer BK. Preparing students to Engage in Public Health Research of Consequence. Am J Public Health. 2016;106(9):1546–7.

Althwanay A, Ahsan F, Oliveri F, Goud HK, Mehkari Z, Mohammed L, et al. Medical Education, pre- and post-pandemic era: a review article. Cureus. 2020;12(10):e10775.

Sohrabi C, Mathew G, Franchi T, Kerwan A, Griffin M, Soleil CDMJ, et al. Impact of the coronavirus (COVID-19) pandemic on scientific research and implications for clinical academic training - A review. Int J Surg. 2021;86:57–63.

Boaz A, Hanney S, Jones T, Soper B. Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review. BMJ Open. 2015;5(12):e009415.

Newington L, Wells M, Adonis A, Bolton L, Bolton Saghdaoui L, Coffey M, et al. A qualitative systematic review and thematic synthesis exploring the impacts of clinical academic activity by healthcare professionals outside medicine. BMC Health Serv Res. 2021;21(1):400.

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We would like to thank associate professor Peter Frode Hougaard and associate professor Yngve Røe, both at the Faculty of Health Science, OsloMet, for their insightful comments on our manuscript in the consultation phase.

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Summary of included studies

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Riiser, K., Kalleson, R., Holmen, H. et al. Integrating research in health professions education: a scoping review. BMC Med Educ 23 , 653 (2023). https://doi.org/10.1186/s12909-023-04615-4

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