Contemporary health-education intervention programs are increasingly used as a tool for improving health of school children [1-4]. Since 1992 a Network of 13 elementary Health Promoting Schools established in Yugoslavia (though not yet admitted to the European Network) has been operational. The Project was approved by the Ministries of Health, Education and Ecology from the very beginning, and financially supported by the Government of Serbia since 1995. The team of up to 40 health professionals, school principals and school project managers worked together for four years to change the working conditions in schools knowledge, attitudes and behaviour of school children and staff in order to improve their health [5]. The goal of this paper is to present results of health education intervention in changing of hygienic conditions in schools, as well as some of the attitudes, behaviour and knowledge of pupils and their parents.
Method: The study took place before and after the intervention--at two points in time--during 1993 and 1996. The tri-angular approach including (1) pupils, (2) schools (teachers, school environment), and (3) parents, was used. A random pretest and post-test study design with control group (12 experimental and two control schools) has been implemented. The multiphase cluster sample was employed in order to represent all of the country typical regions. Six types of especially designed questionnaires were used to provide comparable variables in the sample of pupils, their parents and teachers. Exception were 1st-graders and 4th-graders for whom information were gathered by means of a "draw-and-write" investigation technique [6]. The response rate was 88.70% before and 98.28% after intervention. Data were analyzed by descriptive and inferential statistics using SPSS/PC software.
Results: Schools are somewhat less overcrowded, much cleaner and better maintained after the four-year intervention. Toilets are in a better condition, but there is still much more to be done. The 1st- and 4th-graders, surveyed by the draw-and-write method, mentioned numerous ways of keeping and improving health, which were summarized as fifteen health-improvement measures (Graph 1). The most frequently mentioned measures were nutrition, physical activity, general hygiene, oral and dental hygiene, sleeping and fresh air. Each of these measures was mentioned by over 20% of the surveyed pupils. Eleven of 15 variables showed significant increase in frequencies (at the level of at least p < 0.01) after the intervention. As an indicator of a nutrition behaviour, the regularity of main meals is analyzed (Graph 2). The majority of children eat regularly and the difference before and after intervention is significant only for the school meal (c2 = 30.715, p < 0.001). Although over 70% of children learn that general hygiene is good for health in junior graders, only about little more than 30% of senior graders have a bath or shower every day, while others only once or twice a week. The differences are significant before and after the intervention (c2 = 10.648, p < 0.05) only for everyday practice. More than 90% of senior-grade pupils brush their teeth at least once or several times a day. Over 60% of children in our survey go in for sport, whereas about 20% never do so. It seems that the intervention contributed symbolically to this practice important for health, though before-after difference is significant (c2 = 6.673, p < 0.05). However, in the control group schools children have much less physical activity in 1996, and this difference is significant (c2 = 14.070, p < 0.010). The psycho-emotional status of Yugoslav young people is strongly influenced by the situation in the country the war, the economic disaster and the impact of international sanctions. Consequently, more than one-fourth of the children complained of frequent exhaustion and concentration problems, which their parents also noticed. (ABSTRACT TRUNCATED)