The settings approach to health promotion in schools: examining the role of school policies in fostering student health literacy.

This study explores the settings approach to health promotion, which seeks to create supportive environments by addressing multiple health determinants within specific contexts. In schools, this involves not only policy and management but also the organization of the environment, pedagogy, engagement with families and communities, and the provision of health and social services. In this quantitative study, health literacy was selected as the dependent variable to examine the influence of environmental and personal determinants on students' health. The sample comprised 46 primary schools (2325 students, 552 teachers, and 46 principals). The comprehensiveness of each school's health promotion policy over the years preceding the study was assessed using the Health Promoting Schools (HPSs) framework. Comprehensiveness of the HPS policy refers to the extent to which the school's health promotion policy addresses multiple and interacting determinants of health across the whole setting, including school organization, teaching and learning, the physical and social environment, family and community partnerships, and access to health and social services, in line with the settings approach to health promotion. Multivariate analyses showed that the breadth of HPS policies, collaborative practices with parents, teacher resources (training and well-being), and socio-economic context (mother's education level and proportion of free meal subsidies at school level) significantly affected students' health literacy. This study offers a key baseline for future research on how school health promotion policies affect students' health literacy.