With the numerous programs, interventions, and policy changes being implemented in schools, it is important that they be evaluated and that those found to be effective be disseminated to other schools.
As noted earlier, the SHI is a self-assessment and planning tool designed to provide schools with a systematic means of assessing progress and planning for changes. Several elementary schools in Rhode Island used the SHI to assess their physical activity and nutrition environments and to evaluate the outcomes of a school-based intervention. The outcome measures included changes in the SHI module scores from the baseline point (October 2002) to the end of the school year (June 2003) and changes in the number of relevant policies that had been developed and implemented (Pearlman et al., 2005). A study of the use of the SHI in schools in Arizona with a high predominance of Hispanic/Latino students from low-income families found that external factors were often associated with changing policies and implementing recommendations (Austin et al., 2006; Staten et al., 2005). Both studies found similar perceived barriers to implementing nutrition and physical activity changes, including pressures to focus on reading and math test scores, low staff morale, budgetary concerns, and inconsistent support from the school administrators (Pearlman et al., 2005).
A recent study by Brener and colleagues (2006) matched school and classroom-level data from the SHPPS 2000 with comparable questions in the SHI to examine the percentage of schools meeting the SHI recommendations in four areas: school health and safety policies and environment; health education; physical education and other physical activity programs; and nutrition services. The study found that most schools are addressing school health issues to some extent, but few schools are providing a comprehensive approach. For example, the analysis of elementary school responses in SHPPS found that 38.2 percent had credentialed physical education teachers, 20.2 percent had a teacher-student ratio for physical education comparable to the ratio for classroom instruction, and only 8.0 percent met the SHI levels of 150 minutes of physical education per week (Brener et al., 2006). Data set linkages of this sort are useful in providing progress assessments.
It will be important for research and evaluation efforts to assess whether process and policy outcomes, such as those included in the School Health Index, lead to associated improvements in dietary and physical activity outcomes. A 2006 initiative of CDC, in partnership with the American School Health Association and corporate sponsors, will provide small grants to schools to support physical activity- or nutrition-related activities that are part of action plans developed through the use of the SHI (CDC, 2006a).