Objective To analyze the policy and methodological framework of monitoring and evaluation in the fields of World Health Organization (WHO) health service system, health-promoting schools, and physical activity, and to construct a policy framework and approach to monitor and evaluate the integration of physical activity into the health-promoting schools.
Methods Using the theory of WHO health service system components, the core policy documents of the WHO in the fields of health service, health-promoting schools, and physical activity were systematically analyzed, the relevant policy framework was constructed and the core elements were analyzed at macro, meso, and micro levels.
Results At the macro policy level, the policy framework, monitoring and evaluation framework, governance and monitoring capacity building were addressed. (1) Based on the theory of WHO's six building blocks of health services, the policy framework for monitoring and evaluation of physical activity integration into health-promoting schools was constructed to guide the development and application of information systems, monitoring indicator systems, and evaluation tools. (2) With reference to the generic monitoring and evaluation framework of the national health strategy (NHS), a monitoring and evaluation framework covering input and process indicators, output indicators, outcome indicators and impact indicators was constructed within framework of school health service system monitoring and physical activity monitoring. (3) School health governance and monitoring capacity should be enhanced, and national health-promoting school governance and monitoring capacity should be strengthened based on the National Health Service System monitoring platform strengthening strategy. At the meso level, it involved monitoring implementation programs, core content, and data platforms. (1) Building a national health-promoting school and physical activity monitoring system, and a monitoring and evaluation program emphasizing "health first", "student-centered", "whole-school participation", and "continuous improvement" as well as "school responsibility", "unified indicator system", and "multidimensional evaluation". (2) Referring to the health-promoting school, and incorporate physical activity into the health-promoting school monitoring system and the monitoring and evaluation data platform by referring to the global monitoring standards for health-promoting schools and physical activity. (3) Establishing a monitoring and evaluation mechanism that combines regular monitoring and periodic evaluation, online monitoring and fieldwork, quantitative analysis and qualitative analysis, and school evidence and expert evaluation to monitor and evaluate student physical activity policy-related implementation actions and student physical activity and health status from multiple levels and perspectives. (4) Strengthening the construction of school health information systems, strengthen school physical activity statistical surveys and research, strengthen physical education and health literacy monitoring, form a scientific database of exercise prescriptions, and adjust policy actions and service measures based on monitoring reports. (5) Establishing a synergistic mechanism for monitoring and evaluation. At the micro level, it involves monitoring and evaluation indicators, methods and tools. (1) Under the framework of WHO health service monitoring, health-promoting school monitoring and physical activity monitoring, developing monitoring and evaluation standards and indicator systems for physical activity integration into health-promoting schools and develop monitoring and evaluation tools and data platforms. (2) Constructing a scientific monitoring indicator system, including core indicators and extended indicators, and incorporate quality physical education and practice teaching monitoring. In the construction of the indicator system, input and process indicators include physical activity leadership and governance, financial resources, human resources, technology and equipment facilities, and information systems; output indicators focus on physical activity promotion-related indicators, including quality physical education and practice teaching, promotion and assurance of active travel, and physical activity interventions and services in the classroom, between classes, and after school; outcome indicators address physical activity coverage, levels, and effects; the impact indicators include health, functioning, well-being and quality of life, as well as environmental, social, economic, educational, sport and public health aspects. (3) In terms of monitoring and evaluation methods and tools, adopting the standardized tools recommended by WHO for monitoring and evaluation.
Conclusion Physical activity, as a health strategy, is important to build health-promoting schools and promoting students' physical development and health. This study constructed a policy framework and methodological system for monitoring and evaluation of physical activity integration into health-promoting schools based on the WHO health services framework. This monitoring and evaluation covered at the macro, meso and micro levels. At the macro level, the policy framework, monitoring and evaluation framework, and monitoring capacity were proposed; at the meso level, the implementation plan, core contents, and data platform were proposed; at the micro level, the monitoring framework and contents of physical activity integration into health-promoting schools were used as the basis to develop the related indicator system and implementation methods and tools.