Theoretical framework: School leaders are responsible for, and possible key actors in, leadership for health promoting activities as part of their wider governing responsibilities for education (Skott, 2021). However, research on health promotion (HP) in schools has mainly focused on health implementation strategies (cf. Hills et al., 2015; Kremser, 2011). There has been limited research on the influence of governance structures and processes and school leadership practices on promoting health in schools (Dadaczynski et al., 2015). This research aimed to fill this gap by focusing on HP located in a larger governance context. Applying a governance perspective enabled us to analyze the implementation, maintenance, and transformation of HP in schools by taking into account the coordination of actions between different actors in and across different levels of the multi-level education system (Maag Merki et al., 2014). Three research questions were addressed: 1. What are school principals’ roles in enhancing schools’ capacities in promoting the health of students in a centralized education system like Malaysia? 2. Who are the relevant actors, and what are the processes across different levels of the education system (national, regional, local, and school) that influence the implementation of school health promotion in Malaysia? 3. What are the challenges faced by school principals in Malaysia to manage, facilitate, and support the development and implementation of health promotion initiatives at their schools? Methods/methodology: We applied a qualitative research approach by interviewing six school principals who are experienced in school health promotion. The interviews were conducted in Malay and English and transcribed verbatim. The interview data were analyzed with ATLAS.ti 22 deductively and inductively. The transcripts were coded structurally to identify key stakeholders for various levels and processes according to a governance perspective, highlighting the coordination of actions between actors in and across levels with respect to setting goals and priorities as part of planning and implementing HP in schools. The research is embedded in the comparative study “School Health Promotion in Context” (Skedsmo, 2021), which allows comparison of the Malay and the Swiss context. The analysis situates the study’s contribution according to the current state of the research.

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