Conference Agenda

This contribution presents the findings of a qualitative study conducted as part of a monitoring process of the implementation of the Life Skills Training Programme (LSTP) in primary education, aimed at understanding how this validated and structured life skills intervention is translated into everyday school practice and which factors influence its effectiveness. LSTP is a preventive programme in the socio-health field, designed to reduce the use of substances such as alcohol, tobacco, and drugs and to prevent violent behaviours by addressing the main social and psychological factors that contribute to the initiation of substance use and other risk behaviours (Botvin et al., 1995; Botvin et al., 2003).

The programme aligns with international policies promoting the development of socio-emotional skills in school settings, recognised as essential for inclusion, equity, and student well-being (WHO, 1992; OECD, 2021). In this perspective, LSTP is structured around three main components: the development of personal self-regulation skills, the enhancement of social competencies, and the strengthening of resistance to substance use, including health education content and the promotion of pro-health attitudes. These components are organised into instructional units that can be implemented within the classroom context and integrated into the school curriculum (Botvin et al., 2015).

Originally developed by Gilbert J. Botvin, LSTP is grounded in Social Learning Theory (Bandura, 1977) and Problem Behaviour Theory (Jessor & Jessor, 1977), which conceptualise risk behaviours as shaped by social learning processes, group norms, and individual self-regulation skills. Extensive empirical evidence supports the programme’s international effectiveness in reducing substance use, violence, and other problematic behaviours, with both short- and long-term benefits (Botvin & Griffin, 2004; Griffin et al., 2023). The robustness of the model is further confirmed by its widespread adoption: LSTP has been implemented throughout the United States and in 39 countries worldwide.

The programme was first validated in the United States for lower secondary education and later adapted for primary education (Botvin et al., 1995; 2003). LSTP was introduced in Italy in 2010 in the Lombardy region as a preventive intervention in lower secondary schools, following an adaptation to the national context whose effectiveness has been empirically demonstrated (Velasco et al., 2015; 2017). Through a process of adaptation, the programme was later extended to primary schools to enhance its preventive potential within the vertical curriculum of comprehensive institutes, culminating in the development, from the 2021-22 school year, of the LSTP Primary, implemented from third to fifth grade. In this context, teachers implementing the LSTP in their classrooms participate in a preparatory training pathway combined with ongoing methodological support prior to programme delivery. This training is jointly conducted by regionally accredited health professionals and teacher-trainers, who are in turn trained by authorised health and socio-health professionals.

As mentioned above, this contribution forms part of the LSTP monitoring activities carried out in primary schools under an agreement between the Health Protection Agency (ATS) of the Metropolitan City of Milan and the University of Milano-Bicocca. This paper examines the implementation of the LSTP in Lombardy, Italy, and related training processes, highlighting the perspectives of teachers and teacher-trainers involved. Specifically, the research explores how the programme is translated into everyday school practice and the meanings, perceived changes, and critical issues that emerge from the experiences of those involved in its implementation and training. In this regard, the study contributes to ongoing international discussions on the promotion of life skills within educational systems.

According to Sørensen et al. (2012) health literacy /(HL) can be understood as the individual ability to find, understand, appraise and apply health information to restore, maintain or promote health in everyday life. International surveys conducted in recent years highlight the increasing importance of HL with the pooled prevalence of low HL in European Union Member States ranging from of 27% to 48% (Bacolini et al., 2021). Although numerous empirical findings on HL for adulthood are now available, research in childhood and adolescence is still less developed. Findings from the Health Behaviour in School-aged Children (HSBC) revealed low and moderate levels of HL among adolescents ranging from 62% and 87% (Paakkari et al., 2020). The growing interest in the concept has led to the development of so-called domain-specific concepts such as navigation HL. Its conceptual basis is strongly rooted in difficulties of navigating a complex health care information environment. However, navigation barriers also occur outside the healthcare system, e.g. in the wider community. Limited research shows that knowledge about the existence and availability of community health services, the ability to assess their quality and confidentiality, positive experiences with local service providers, and the perception that these services promote or maintain one's own health can be considered important determinants of young people's utilization (Dadaczynski et al., 2021).

Given the lack of interventions, a location-based game application named Nebolus was developed aiming to strengthen the navigation HL of adolescents aged 12 to 16 years at the intersection between schools and communities. neighborhood). This includes promoting the ability to (1) find information about local health service providers/professionals and their activities, (2) understand the services and activities
provided by local health stakeholders and professionals, (3) evaluate the quality of local health service providers/ professionals and their offerings, and (4) apply health information obtained through local health service providers. This paper focuses on evaluating the effectiveness of Nebolus.

Historically, the intersection of education and health has reflected evolving health paradigms themselves (e.g. Armstrong, 2025; Beckwith et al., 2024; Carlsson, 2024; Nash et al., 2024). After a period of almost no mutual connection, education, catalysed by the expansion of primary school enrolment, began to serve as a site for healthcare delivery, such as school-based vaccinations or check-ups. With the development of the idea of reciprocal relationship between health and education, schools became places for “maintaining health” and “teaching to be healthy,” introducing physical education, food delivery, and health-related issues in the curriculum. Concurrently, the rise of educational inclusivity expanded the school’s mandate to accommodate students regardless of health status. Growing acknowledgement of mental health issues and child-centred approaches further shifted the paradigm toward the school being a place for 'learning to be healthy' through a focus on wellbeing and active learning.

However, this longstanding reality was challenged by the COVID-19 pandemic, underscoring the role of education beyond academic achievement. School closures necessitated a balance between remote teaching and safeguarding the physical and mental health of students and teachers, forcing educational systems to integrate health concerns more centrally into their coping strategies (Carlsson, 2024; Shadmi et al., 2023). Additionally, two trends have significantly reshaped the interplay of education and health. First, health is increasingly integrated into the core curriculum through an expanded definition of scientific and information literacy. This aligns with the growing positioning of students as active agents in their own health-related decision-making, linking personal health to community wellbeing and local environments (Dahan et al., 2025; McLellan et al., 2022). Second, the recognition of mental health and commitment to inclusivity increasingly require school personnel to act as "medical agents," not only adapting teaching practices but also contributing to early diagnosis for students with diverse health needs (Plotkin-Amrami et al., 2024).

Currently, we are witnessing a contradictory picture. On one hand, education is regarded as a primary partner for overall health and wellbeing, appearing as side-by-side Sustainable Development Goals and holistic health conceptions, such as One Health, Circular health, etc. (Capua, 2020; Winkler et al., 2025). This vision is supported by health-promoting and sustainable schools programs, all advocating for whole-child approaches and genuine integration of health and learning (Jourdan et al., 2021; Pulimeno et al., 2020). On the other hand, even acknowledging its importance, schools are still viewed as instrumental partners for health promotion. Most health-promoting initiatives follow a model of external intervention addressing a specific issue and targeting the student body but largely neglecting the complex interplay of health within daily school routines (Carlsson, 2026; O’Toole & Simovska, 2022). As a result, schools encounter fragmented exogenous demands, often lacking the systematic mechanism necessary for their effective and equal integration into the educational environment and, crucially, to take an agentic, rather than reactive position.

Currently, a clear gap exists: there is no systematic investigation of conceptions of youth health, nor analysis of the coherence and dissonance across governance levels, policy domains, and stakeholder groups (Dahan et al., 2025). This fragmented understanding often impedes effective cross-sectoral communication and co-production. To address this fragmentation, we propose Health-Based Education (HBE), a framework acknowledging the inherent embeddedness of health within pedagogy. Just as Place-Based Education conceptualises "place" as an intersection of various commons (Ardoin et al., 2012; Yemini et al., 2023), HBE posits that health is a foundational element of the educational arena rather than a temporary visitor with specific objectives. This model suggests health and education are mutually reinforcing. The present study aims to observe the possible axes underlying the HBE framework to better understand the foundational dimensions required for its systemic implementation.

Schools play a central role in shaping children’s future trajectories, including their health, well-being, and long-term lifestyle habits (Kolbe, 2019). In response to growing public health challenges, the concept of health-promoting schools has gained increasing relevance, emphasizing the integration of health education into everyday pedagogical practice in order to support both students’ learning and health outcomes (Lee et al., 2020). Within this framework, numerous school-based programs have been implemented internationally to reduce physical inactivity and promote regular physical activity among young people (van de Kop et al., 2019).

Despite these efforts, recent evidence indicates that a substantial proportion of Hungarian adolescents still fail to meet the World Health Organization’s physical activity recommendations (Gudelj Rakić et al., 2024). This gap is particularly concerning given that physical inactivity during adolescence is associated with adverse health outcomes and tends to persist into adulthood. Moreover, research consistently shows that individuals from socioeconomically disadvantaged backgrounds are more likely to engage in sedentary behaviors and face additional barriers to health-promoting resources, including limited access to healthcare services (Nikitara et al., 2021). These findings underscore the need to critically examine how school-based health education is conceptualized, implemented, and evaluated, especially in regions facing structural disadvantages.

Beyond the mere presence of health education initiatives, their effectiveness depends largely on the pedagogical frameworks, methodological approaches, and evaluation mechanisms applied in schools. Evidence-based analyses of educational theories, regulatory documents, and best practices are therefore essential for improving the quality and impact of health promotion programs (Merzel, 2021; Sendall, 2021). Previous research has emphasized that interventions aimed at increasing physical activity among adolescents must be systematically planned, context-sensitive, and rigorously evaluated in order to produce sustainable behavioral change (Barnes et al., 2021). However, relatively little is known about how these principles are reflected in everyday school practice, particularly from the perspectives of both students and teachers.

This study is guided by socioecological models of health behavior and the social determinants of health framework, which conceptualize physical activity as the result of interacting individual, social, and structural influences rather than individual choice alone. Against this background, the present study addresses a critical gap by providing a comprehensive, multi-perspective analysis of school-based health education in secondary schools in the Northern Hungary region, with a specific focus on physical activity promotion. The research seeks to identify the dominant health education topics, methods, and actors in schools; examine the alignment between regulatory documents and school-level health promotion programs; and explore students’ subjective health status, fitness, and satisfaction with health education. By integrating document analysis with large-scale questionnaire data from both students and teachers, the study aims to generate evidence that not only describes current practices but also highlights key inconsistencies and development needs relevant to improving physical activity-related health education in disadvantaged regions.