Strategies to facilitate the transfer of learning to different health behaviors and a ranking of their importance. The strategies identified above were evaluated by participants, and then ranked by importance. The results are reported in Table 4. All strategies were considered important, with a minimum mean of 8.
However, the ranking confirmed what was already found during the classification task. In school health promotion, interventions and programs implemented often focus on single behavior domains. Typically, each health topic is addressed separately, potentially resulting in overlapping interventions. Furthermore, new health behavior problems often arise among students from year to year, requiring a response from school administrators.
Rather than implementing multiple programs, it is likely to be more efficient and effective to target multiple behaviors with the same intervention or program. An integrative approach is a promising way to develop MHBC interventions, and in the present study we examined the transfer of learning approach as a strategy for expanding the scope of broad-based life skills education programs. The transfer of learning approach represents a core concept in education and is a major objective for educators and schools We argue that the transfer of learning approach should be prioritized for school health promotion so that students can learn knowledge, attitudes, and skills in one health promotion context or behavioral domain and then learn how to apply them in other contexts or domains 12 , 44 , The present study aimed to identify the characteristics of an evidence-based life skill education program that can facilitate the transfer of learning to different health behaviors not targeted by the program, the elements that should be reinforced to facilitate the transfer, and the strategies to do so successfully.
A Delphi method was used involving experts in school health promotion, life skill education, and teaching. Results revealed strong consensus among experts about the potentialities of the LifeSkills Training program in promoting the transfer of skills from one health domain to another. Many elements already included in the program were identified as facilitators of transfer, and strategies to improve effective transfer were defined and clarified. These results confirm the strong potential of the transfer of learning approach in the health promotion area.
Some studies have already been published 12 , 44 , 45 , that verify the effectiveness of the transfer of learning from one health behavior to others. Life skill education has already been proven to be effective to prevent multiple health risk behaviors and promote healthy habits 47 , 48 , and many MHBC programs have used this strategy 8 , 21 , However, the conditions required to effectively achieve transfer of learning have not been adequately defined and conceptualized in previous research.
The findings from the present study demonstrate for the first time a consensus among experts in the field that life skills education is an adequate and promising approach for MHBC. Most of the strategies that emerged in this study are related to teaching methods e.
Contents about specific behaviors were cited, but participants suggested that they be integrated into the curriculum or addressed through recontextualization of skills and techniques already taught. These results confirmed that the transfer of learning process should consider not only the content of the program and the behavioral determinants targeted, as suggested by many authors 34 — 36 , but also the implementation conditions.
This idea is consistent with the implementation science approach which recognizes that health promotion strategies consist of complex interventions influenced by multifaceted contexts and dynamic conditions. So, the effectiveness of these strategies depends on how they are implemented, the contexts in which they are used, and the targets they reach 74 , Previous studies about the transfer of learning conditions focused mainly on teaching methods and conditions 12 , 34 , 42 , 54 , Their relevance was also recognized by the experts involved in this study.
For example, the importance of contextualization, decontextualization, and recontextualization was confirmed 12 , The study results also increase our knowledge about these teaching methods and conditions, and provide a more in-depth perspective on how teachers can implement them.
Other factors and strategies identified, such as those related to educational consistency, underlined the importance of the contextual and organizational aspects to promote the transfer of learning. The categories and subcategories related to the educational approaches showed also the need to define a common and explicit educational perspective that values transferability. Again, the organizational and school community elements were highlighted by experts, which confirms the relevance of a whole-school approach to promote both educational and health outcomes promoted by the Health Promoting School approach 26 — There are several strengths in the present study.
The use of a qualitative bottom-up approach and an integrative analysis based on the Delphi methodology helped to identify several codes and subcategories and define a rich and in-depth description of factors and strategies to promote the transfer of learning. Moreover, the involvement of experts in the health promotion area from both health educational and health sectors further enhances the elements identified and the consensus achieved among diverse experts enhances the validity of the findings.
The present study has some limitations that could be addressed in future studies. A three rounds Delphi study would be more appropriate for better distinguishing the categorization phase from the validation and ranking phase.
Moreover, validation could be requested for all subcategories identified. However, a preliminary face-to-face phase prepared and briefed all participants for the study, which served to increased first-round quality and facilitated participants' interactions in the second phase.
Furthermore, the second-round of the study allowed all participants to comment and improve others' responses, and validation rates were high. Data saturation was reached in the second-round, and no categories were added, indicating high consensus. Another limitation was that the experts involved all belonged to the same intervention context. However, a broad range of participants from different disciplines, sectors education and health promotion , organizations, and cultural background were selected.
The present study aimed to identify the conditions necessary to effectively promote transfer of learning in an evidence-based life skill education program to different health behaviors.
The use of the Delphi method findings produced a consensus among experts in the health promotion area from both the educational and health sectors. The qualitative analysis demonstrated several key necessary conditions for the transfer of learning in a health promotion context and to define them in depth. The study confirmed the importance of investigating the transfer of learning in the health promotion area. Future studies should focus on different life skill education programs to generalize results better.
Moreover, new studies are needed to evaluate the concrete effectiveness of multi behavior life skill education programs and to verify the concrete transfer of learning from one domain to another. Other Delphi studies could analyze the differences between experts from the educational and health sectors. In this study, the authors decided to explore an integrative approach to reach consensus among different expert perspectives, but an investigation of the differences can also be useful to define effective collaborative strategies.
The results have also practical implications. The identification of elements to facilitate the transfer of learning offers a solution to find a balance between the importance of applying skills to a particular topic to be effective and the need to reinforce young people in different areas of their development The factors identified in this study can be used to adapt several life skill education programs to MHBC or to design new ones.
The theories that underlie the LST program and the life skills targeted by it are also observed in many similar programs. Life skills programs, although more holistic in nature, also focus on knowledge, attitudes, and skills for each task or goal and these general principles are required for certain behavioral skills such as problem-solving. Moreover, the conditions identified are related to general teaching methods, curriculum definition, and school organization and could be adapted to the different programs.
For example, most life skill education programs reinforce skills through specific tasks or analysis. A transfer of learning approach requires identifying general principles and rules, decontextualizing learning, and improving metacognition skills and mindful abstraction.
The results of the study identified specific strategies to integrate these perspectives and practices. The use of a Delphi study also suggests strategies to adapt programs considering experts, stakeholders and community points of view and to integrate literature guidelines with practice 76 — Considering that most elements identified were related to educational methods and strategies, the present results can also be used to improve teacher training by promoting actions aimed to promote the transfer of learning and raise awareness of its importance.
These results also provide guidance on evidence-based program implementation and integration with a whole school approach. First, the analysis of participants responses illustrates how the perspectives of health and educational experts can be effectively integrated. School staff had the chance to explicitly state their educational perspective, and health professionals were able to integrate health promotion concepts with teaching and pedagogy.
Then, results show the importance of the integration of an evidence-based program with organizational and contextual elements and with program providers' representations and beliefs 68 , 79 — To integrate the program into the curriculum and make explicit the educational strategies were found to be the most valued strategies.
These factors should be considered when defining the role of health professionals in supporting a school in health promotion program implementation or the HPS approach. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. The studies involving human participants were reviewed and approved by the Regional Committee of Health Promoting School Network, by the Regional Coordinators of the LifeSkills Training adaptation group, institutional review boards who reviewed the study for ethical standards.
VV managed all the phases of the study. CC revised and discussed the questionnaire design and analysis. KG offered methodological support. Estensione LST group represents the coordinators of the study and the wider project. All authors contributed to the paper and involved in the study design. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.
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