Effects of a school-based health promotion strategy on capacity building: a quasi-experimental study

Background

A school-based health promotion strategy (“Weitblick”), adapted from the internationally established Communities That Care prevention system, is currently being implemented in Germany. Schools are key settings for population-level prevention but often lack structured, evidence-based approaches. “Weitblick” aims to strengthen schools’ capacity to adopt a science-based approach to prevention. This study assesses its effects on capacity-related outcomes at the school level.

Methods

The study employs a sequential longitudinal design using baseline data from subsequently recruited schools to construct a control group. Capacity-related outcomes were assessed through a biennial multiple-key-informant survey. Depending on school size, three to ten informants were surveyed per school, and responses were aggregated at the school level. The primary outcome is the adoption of science-based prevention. Secondary outcomes include intersectoral collaboration, integrated prevention strategy, support for prevention, and social norms. Changes over time were analyzed using paired t-tests.

Results

Between September 2023 and March 2026, 51 schools were recruited. Of these, 40 schools (n = 307 informants) were included in the control group (CG), and 11 schools (n = 49 informants) in the intervention group (IG). Improvements in the primary outcome were observed only in the IG (g = 0.82; 95% CI [0.15, 1.45]). Intersectoral collaboration also increased only in the IG (g = 0.66; 95% CI [−0.03, 1.45]). In contrast, social norms declined in the IG (g = −0.93; 95% CI [−1.91, −0.15]), with a comparable trend observed in the CG.

Conclusions

The findings suggest that school-based capacity-building supports the adoption of science-based prevention. Implementing structured approaches such as “Weitblick” could help schools to develop more coordinated and sustainable prevention strategies. However, the results should be interpreted with caution, given the non-randomized study design.

Key messages

• The “Weitblick” strategy was accompanied by improved adoption of science-based prevention and increased intersectoral collaboration at the school level.

• School-based capacity-building may strengthen prevention infrastructure, but its effects on broader outcomes such as social norms remain uncertain and require long-term evaluation.