fa ارزیابی خدمات ارتقای سلامت در مدارس ابتدایی دولتی: یک مطالعه مقطعی در غرب ایران Health promotion Health promotion پژوهشي Research <span style="font-size:12pt"><span style="line-height:150%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><strong><span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">مقدمه و هدف</span></span></span></strong><strong><span dir="LTR" style="font-size:14.0pt"><span style="line-height:150%">:</span></span></strong><br> <span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">مدرسه یکی از مهم‌ترین بسترهای ارتقای سلامت و شکل‌گیری رفتارهای سالم در کودکان است. با وجود اجرای برنامه‌های سلامت‌محور، شواهد از کاستی‌های خدمات ارتقای سلامت در مدارس ایران حکایت دارد. این مطالعه با هدف تعیین وضعیت خدمات ارتقای سلامت در مدارس ابتدایی دولتی شهر کرمانشاه انجام شد</span></span></span><b><span dir="LTR" style="font-size:14.0pt"><span style="line-height:150%">.</span></span></b></span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:150%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><strong><span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">مواد و روش‌ها</span></span></span></strong><strong><span dir="LTR" style="font-size:14.0pt"><span style="line-height:150%">:</span></span></strong><br> <span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">این مطالعه توصیفی-مقطعی بر روی </span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">۴۰</span></span></span><span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:"> مدرسه ابتدایی دولتی شهر کرمانشاه با روش نمونه‌گیری طبقه‌ای تصادفی انجام شد. داده‌ها با استفاده از چک‌لیست‌های استاندارد و محقق‌ساخته، از طریق مشاهده، مصاحبه با مدیران و بررسی مستندات جمع‌آوری و با آمار توصیفی شامل فراوانی، درصد، میانگین و انحراف معیار تحلیل شدند</span></span></span><b><span dir="LTR" style="font-size:14.0pt"><span style="line-height:150%">.</span></span></b></span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:150%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><strong><span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">یافته‌ها</span></span></span></strong><strong><span dir="LTR" style="font-size:14.0pt"><span style="line-height:150%">:</span></span></strong><br> <span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">وضعیت خدمات ارتقای سلامت در تمامی </span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">۹</span></span></span><span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:"> حوزه مورد بررسی شامل آموزش سلامت، سلامت محیط و ایمنی، سلامت روان، تغذیه، فعالیت بدنی، مراقبت بیماری‌ها، سلامت دهان و دندان، سلامت کارکنان و نیروی انسانی نامطلوب بود. دسترسی کامل به آب سالم، تجهیزات اطفای حریق و زنگ ورزش از نقاط قوت مدارس محسوب می‌شد. مهم‌ترین چالش‌ها شامل کمبود مراقب سلامت (</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">۳۷/۵</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span arial="" style="font-family:">٪</span></span></span><span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:"> مدارس)، نبود راه فرار اضطراری (</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">۶۵</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span arial="" style="font-family:">٪</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">)</span></span></span><span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">، عرضه مواد غذایی ناسالم در بوفه (</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">۹۷/۵</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span arial="" style="font-family:">٪</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">)</span></span></span><span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">، عدم اجرای وارنیش فلوراید (</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">۵۲/۵</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span arial="" style="font-family:">٪</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">) </span></span></span><span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">و ضعف خدمات سلامت کارکنان (</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">۶۰</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span arial="" style="font-family:">٪</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">) </span></span></span><span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">بود. از </span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">۴۰</span></span></span><span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:"> مدرسه، </span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">۱۲</span></span></span><span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:"> مدرسه (</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">۳۰</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span arial="" style="font-family:">٪</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">) </span></span></span><span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">در ناحیه یک، </span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">۱۲</span></span></span><span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:"> مدرسه (</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">۳۰</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span arial="" style="font-family:">٪</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">) </span></span></span><span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">در ناحیه دو و </span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">۱۶</span></span></span><span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:"> مدرسه (</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">۴۰</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span arial="" style="font-family:">٪</span></span></span><span lang="FA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">) </span></span></span><span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">در ناحیه سه قرار داشتند. همچنین، مدارس دارای مراقب سلامت در حوزه‌های آموزش سلامت، سلامت روان و مراقبت بیماری‌ها عملکرد مطلوب‌تری داشتند</span></span></span><b><span dir="LTR" style="font-size:14.0pt"><span style="line-height:150%">.</span></span></b></span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:150%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><strong><span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">نتیجه‌گیری</span></span></span></strong><strong><span dir="LTR" style="font-size:14.0pt"><span style="line-height:150%">:</span></span></strong><br> <span lang="AR-SA" style="font-size:14.0pt"><span style="line-height:150%"><span b="" nazanin="" style="font-family:">خدمات ارتقای سلامت در مدارس ابتدایی دولتی کرمانشاه با استانداردهای ملی و بین‌المللی فاصله قابل‌توجهی دارد. کمبود نیروی انسانی متخصص، ضعف ایمنی و مشکلات تغذیه از مهم‌ترین چالش‌های شناسایی‌شده بودند. تقویت نیروی انسانی سلامت، ارتقای ایمنی مدارس و اصلاح سیاست‌های تغذیه‌ای از اولویت‌های مداخله محسوب می‌شود. انجام مطالعات تحلیلی برای بررسی عوامل مؤثر بر کیفیت خدمات ارتقای سلامت نیز پیشنهاد می‌شود</span></span></span><b><span dir="LTR" style="font-size:14.0pt"><span style="line-height:150%">.</span></span></b></span></span></span></span></span><br> &nbsp; <span style="font-size:11pt"><span style="line-height:115%"><span style="font-family:Calibri,sans-serif"><b><span style="font-size:12.0pt"><span style="line-height:115%"><span new="" roman="" style="font-family:" times="">Background: </span></span></span></b><span style="font-size:12.0pt"><span style="line-height:115%"><span new="" roman="" style="font-family:" times="">Schools represent one of the most influential settings for promoting children&#39;s health and establishing lifelong healthy behaviors. The World Health Organization&#39;s Health-Promoting Schools framework emphasizes the integration of health education, supportive environments, preventive services, healthy nutrition, physical activity, and mental health into routine school practices. Despite the implementation of national school health programs in Iran, evidence regarding the quality and comprehensiveness of health promotion services in primary schools remains limited. This study aimed to assess the status of health promotion services in public primary schools in Kermanshah, western Iran.</span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:115%"><span style="font-family:Calibri,sans-serif"><b><span style="font-size:12.0pt"><span style="line-height:115%"><span new="" roman="" style="font-family:" times="">Methods: </span></span></span></b><span style="font-size:12.0pt"><span style="line-height:115%"><span new="" roman="" style="font-family:" times="">A descriptive cross-sectional study was conducted in 2024 among 40 public primary schools selected using proportional stratified random sampling from three educational districts of Kermanshah. Data were collected through direct observation, document review, and structured interviews with school principals using standardized Ministry of Health checklists and researcher-developed instruments. Nine domains of school health promotion were evaluated, including health education, environmental health and safety, nutrition, physical activity, disease prevention, mental health, oral health, staff health, and human resources. Data were analyzed using descriptive statistics in SPSS version 24.</span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:115%"><span style="font-family:Calibri,sans-serif"><b><span style="font-size:12.0pt"><span style="line-height:115%"><span new="" roman="" style="font-family:" times="">Results: </span></span></span></b><span style="font-size:12.0pt"><span style="line-height:115%"><span new="" roman="" style="font-family:" times="">Although all participating schools had access to safe drinking water, firefighting equipment, and scheduled physical education classes, substantial deficiencies were identified across several health promotion domains. Only 62.5% of schools employed dedicated health personnel, while 65% lacked emergency exits. Healthy food was exclusively available in only 2.5% of school canteens, and fluoride varnish programs were implemented in only 47.5% of schools. Staff health services were available in 40% of schools. Schools with dedicated health personnel demonstrated better performance in health education, mental health promotion, and disease prevention activities.</span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:115%"><span style="font-family:Calibri,sans-serif"><b><span style="font-size:12.0pt"><span style="line-height:115%"><span new="" roman="" style="font-family:" times="">Conclusions: </span></span></span></b><span style="font-size:12.0pt"><span style="line-height:115%"><span new="" roman="" style="font-family:" times="">Health promotion services in public primary schools of Kermanshah remain considerably below national and international standards. Strengthening the school health workforce, improving school safety infrastructure, promoting healthy nutrition policies, and expanding preventive health services should be prioritized. Future analytical and interventional studies are recommended to identify determinants of service quality and evaluate the effectiveness of school-based health promotion strategies.</span></span></span></span></span></span> ,واژه‌های کلیدی: ارتقای سلامت,مدارس ابتدایی,خدمات سلامت,سلامت محیط,سلامت روان,تغذیه مدرسه,کرمانشاه. ,Keywords: Health promotion,School health services,Primary schools,Health-promoting schools,Environmental health,Mental health,School nutrition,Disease prevention,Iran 53 63 http://jhsp.medilam.ac.ir/browse.php?a_code=A-10-82-2&slc_lang=fa&sid=1 Amin Mirzaei امین میرزایی mirzaei.amin62@gmail.com 1003194753284600467 1003194753284600467 Yes School of Public Health دانشکده بهداشت mohsen jalilian محسن جلیلیان jalilian91@yahoo.com 1003194753284600468 1003194753284600468 No School of Public Health دانشکده بهداشت Sdiqhe Falah صدیقه فلاح مهکی sdiqhef@gmail.com 1003194753284600469 1003194753284600469 No School of Public Health دانشکده بهداشت