ArticleJMIR research protocols2026
Evaluation of School Health Policies and Practices in Brazil and Portugal: Protocol for Mixed Methods Research.
Article in JMIR research protocols, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: School health policies and practices are key components of health promotion for children and adolescents and play a central role in shaping healthy school environments, reducing health inequities, and fostering intersectoral collaboration between education and health systems. Despite their relevance, systematic and comparable assessments of how these policies and practices are implemented across different national contexts remain limited, particularly in low- and middle-income countries. Internationally comparable data are essential to identify strengths, gaps, and priorities for investment in school health. Objective: The aim of this study is to describe the protocol of a mixed methods study evaluating and comparing school health policies and practices in Brazil and Portugal. Methods: An explanatory sequential mixed methods design (QUAN → qual → [qual] → [qual]) will be adopted. The quantitative phase (phase I) consists of a cross-sectional survey conducted with school administrators using the Global School Health Policies and Practices Survey, which assesses multiple domains of school health policies, coordination, services, and practices. Quantitative findings will inform the subsequent qualitative phases. Phase II involves semistructured interviews with school principals or head teachers to explore institutional decision-making and policy implementation. Phase III includes interviews with school nurses to examine health service organization, intersectoral collaboration, and professional practices. Phase IV comprises participatory research with adolescents using the photovoice technique to capture youths' perspectives on school health environments and practices. The study will be conducted in elementary and secondary schools and related health services in selected cities in Brazil and Portugal. Data integration will occur sequentially through connected analyses and joint displays, enabling the development of meta-inferences that link quantitative patterns with qualitative explanations. Results: The study has secured funding from 2 funding agencies, with project activities initiated in 2025. Quantitative data collection and analysis began in October 2025 in the city of Cuiabá, Brazil. The expansion of data collection to additional Brazilian and Portuguese cities is planned for the first half of 2026. The qualitative phases, including interviews and photovoice activities, are scheduled to take place throughout 2026. The final integrated mixed methods analysis and manuscript preparation are planned for 2027, with dissemination of findings through peer-reviewed journals and national and international scientific conferences by the end of the project cycle. Conclusions: This study is expected to generate context-sensitive and comparative evidence to support intersectoral actions and inform the development and strengthening of school health promotion policies and practices in different national settings.
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