This study describes in detail the processes, interventions, challenges, and selfreported changes associated with implementing the Health-Promoting Schools (HPS) project in Zhejiang Province, China. It is a descriptive study, based on a case study model, using illustrative examples from nine schools.; Grounded theory analysis revealed detailed pre-implementation, implementation, and monitoring and evaluation processes; classroom-based, school-wide and outreach activities; and modifications to the physical and psycho-social school environment. Schools faced a number of challenges related to understanding and integrating the HPS concept and a lack of professional development and support. Yet, participants reported many health-conducive changes in their attitudes, conceptual knowledge, and behaviors associated with this project.; Theoretical analysis confirmed the applicability of a 3-part framework: key factors for changing policy and practice, the comprehensive HPS framework, and success factors of school health programs.
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