Reliability and validity of a scale for health-promoting schools

Despite a growing body of research regarding the health-promoting schools (HPS) concept from the World Health Organization (WHO), research on measuring of the HPS is limited. This study aims to develop a scale for assessing the status of the HPS based on the WHO guidelines and to evaluate the reliability and validity of the scale. After completing the translation and back-translation process, the content validity of the 50-item scale for HPS (SHPS) was assessed by an expert committee review and pretested with 17 teachers. A stratified, random sampling design was used. A total of 728 teachers from 94 schools completed a self-administered questionnaire. The total sample was randomly divided into three groups for exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and cross-validation. The EFA suggested seven factors, including 37 items, and the CFA confirmed these factors. In a second-order factor analysis, the second-order seven-factor model had acceptable fit indices (root mean square error of approximation 0.07, comparative fit index 0.98) with stability over validation sample and whole sample. Thus, the first-order seven factors (school nutrition services [three-item, alpha = 0.87], healthy school policies [six-item, alpha = 0.87], school's physical environment [10-item, alpha = 0.91], school's social environment [four-item, alpha = 0.88], community links [six-item, alpha = 0.91], individual health skills and action competencies [three-item, alpha = 0.89], and health services [five-item, alpha = 0.86]) loaded significantly onto the second-order factor (HPS [37-item, alpha = 0.97]). In conclusion, the SHPS is a reliable and valid measurement tool for assessing the states of the HPS in the Korean school context. It will be useful for comprehensively assessing schools' needs and monitoring the progress of school health interventions.