This qualitative case study examines how school-based health education within the Health-Promoting Schools framework influences children’s healthy snacking behaviour.
Data were collected through semi-structured interviews with teachers, parents, and food vendors, classroom and canteen observations, and document analysis in one public elementary school in Indonesia.
The findings reveal four interrelated factors shaping children’s snack-related behaviours: (1) institutional support through active school health committees and collaboration with local primary health centres; (2) the use of visual, digital, and interpersonal health education media to deliver nutrition messages; (3) parental engagement in reinforcing healthy eating practices at home; and (4) persistent environmental challenges posed by the presence of unhealthy street food vendors surrounding the school. Drawing on the Socio-Ecological Model and the Health Belief Model, this study demonstrates that effective health education in schools requires not only increasing children’s awareness but also strengthening supportive social and environmental structures. The study contributes empirical evidence from a low- and middle-income country context to international discussions on health education and Health-Promoting Schools, highlighting the importance of context-sensitive and collaborative approaches to promoting healthy eating behaviours among school-aged children.
This study has several limitations that should be considered when interpreting the findings. First, the research was conducted as a qualitative case study in a single public elementary school in Indonesia, which limits the generalisability of the results to other school settings or regions. While the in-depth qualitative approach provides rich contextual insights into the implementation of school-based health education, it does not allow for statistical measurement of behavioural change among students. Second, the study relied primarily on self-reported data from teachers, parents, and food vendors, which may be subject to social desirability bias. Third, children’s snack consumption was observed within the school environment, but dietary behaviours outside school hours were not systematically assessed. Future research could adopt mixed-method or longitudinal designs across multiple schools to examine the long-term impact of Health-Promoting Schools initiatives on children’s dietary behaviours and nutritional outcomes.
The findings offer several practical implications for schools and health education practitioners. Schools should strengthen the integration of health education into daily learning activities rather than limiting it to occasional campaigns. Teachers and school health coordinators can utilise simple visual and digital media, such as posters, videos, and messaging applications, to reinforce healthy snacking messages in age-appropriate ways. Strengthening collaboration with local primary health centres is also essential to support food safety monitoring and provide technical guidance on nutrition education. In addition, schools should actively engage parents through regular communication and participatory activities, as parental reinforcement at home plays a critical role in sustaining healthy eating behaviours among children.
From a broader social perspective, this study highlights the importance of schools as key settings for reducing health inequalities among children, particularly in low- and middle-income contexts. The persistence of unhealthy street food vendors around schools reflects wider structural and environmental challenges that cannot be addressed by schools alone. Effective health education therefore requires coordinated action involving local governments, health authorities, school communities, and food vendors. By fostering shared responsibility for children’s nutrition and food safety, school-based health promotion can contribute to the development of healthier community norms and support long-term improvements in children’s well-being.
This study provides original empirical evidence on the implementation of Health-Promoting Schools and school-based health education in an Indonesian context, which remains underrepresented in international health education literature. By applying the Socio-Ecological Model and the Health Belief Model, the research demonstrates how children’s healthy snacking behaviour is shaped by the interaction between educational strategies, institutional support, family involvement, and the surrounding food environment. The findings add value by highlighting the need for context-sensitive and collaborative approaches to health education in resource-constrained settings, thereby contributing to global discussions on the adaptation of Health-Promoting Schools frameworks in low- and middle-income countries.
