The manner in which health promotion (HP) practice unfolds in various schools is contingent on the policies regulating it and school professionals’ understanding and enactment of said policies (Elsayed et al., 2023; Simovska et al., 2016). However, policies are often general prescriptions and professional understandings of them are not always aligned (Gherardi, 2019; Guvå & Hylander, 2012). Moreover, the interpretation of policies can be influenced by how school actors navigate the institutional complexity resulting from the (co)existence of multiple potentially conflicting institutional logics (understood as socially constructed value systems) that permeate school organizations (Ackesjö, 2022; Thornton et al., 2012).

School professionals often need to navigate complex institutional landscapes to accomplish HP work (Bennett et al., 2016). This is particularly salient in decentralized school systems (e.g., Swedish) where HP is enacted within multiple organizational frames (Hjörne, 2018). Institutional complexity may challenge school HP work (Ekornes, 2015) but may also facilitate some practices related to HP such as teaching (Gullberg & Svensson, 2020). While the effects of institutional complexity on organizational structures and responses have been extensively explored in literature, fewer studies have focused on the relation between this complexity and professional practices (Schatzki, 2023; Wu et al., 2023). This study explores how HP practices are understood by school professionals with respect to the institutional context in which they are deployed. The research questions are (i) how do school professionals understand HP as an institutionally regulated practice? and which institutional logics foreground professionals’ understandings of HP in schools? 

The study is based on empirical data produced from nineteen semi-structured interviews with school professionals in Sweden. Data analysis is informed by practice theory (Gherardi, 2019; Schatzki, 2019) and the metatheoretical framework of institutional logics (Thornton et al., 2012). Practice theory contends that practices are the unit of analysis of the social. Practices are accomplished in bundles and organized via rules and sets of practitioners’ understandings (Schatzki, 2019). In institutional practices, rules can be seen as decontextualized formulations and may be further negotiated by practitioners (Gherardi, 2019). Professional understandings, (co)shaped by the prevailing institutional logics in a given organization (e.g., school), can influence how institutional rules are interpreted and enacted (Schatzki, 2023). Thornton et al. (2012) described several generic institutional logics (e.g., professional, corporate) that can guide (not circumscribe) analyses.

The findings indicate that policy formulations represent the infrastructure of HP practice which is governed locally at the municipal and school levels. Participants had to navigate the complex and heterogenous (national, municipal, school) policy landscape. Some policies were perceived as ambiguous or unrealistic (e.g., imposing demands on schools which were not feasible within the available resources) motivating professionals to negotiate and occasionally contest them. School professionals perceived leadership as a key link between institutional directives and professional practices but they problematized dual leadership (municipality and school) as a potential source of interprofessional conflicts that can undermine the practice.

Professionals invoked various institutional logics in their attempts to reconcile their professional values with the institutionally imposed practice rules (including written policies and governance systems). They invoked a bureaucratic logic to indicate compliance with institutional regulations, and three different instantiations of a professional logic (competence, pragmatic and entrepreneurial) by way of committing to professional values and maximizing efficiency. There were occasional tensions between the bureaucratic logic on one side and one or more of the professional logic instantiations on the other. These tensions were addressed in different ways, including disrupting the bureaucratic logic, attempting to reconcile it with one or more instantiations of the professional one, or occasionally using it as a resource to structure professional practices.

Empirical context This study has been carried out in Sweden where school HP is a diffuse practice accomplished in different settings (e.g., health visits to the school nurse, physical education lessons). Schools are either municipal, independent (friskolor in Swedish), or private. Each school has a student health team, often composed of the school leader, nurse, psychologist, counselor, and special needs educator. Other professionals (e.g., teachers) are invited to team meetings as need arises. Moreover, schools are allowed to recruit private providers (e.g., psychologists) for specific services such as student counselling or staff training. Participants In order to capture the potential variations in practice arising from different organizational affiliations (e.g., municipal, private) or from ascribing to different domains of knowledge (e.g., health, education), a diverse pool of professionals was invited to participate in the study. Maximum variation followed by snow ball sampling were used to recruit participants allowing for a varied and diverse study population while simultaneously limiting sample skewness (Tracy, 2012). The sample (n=19) included different professionals (e.g., teacher, nurse, principal, psychologist, social worker) who worked in municipal, independent, or private schools. The sample also included private providers. Data were generated from in-depth semi structured interviews with the participants. Data analysis An abductive approach to data analysis was used whereby code generation was informed by both theory and participants’ accounts (Tavory & Timmermans, 2014). Data were iteratively analysed in four rounds. Code books were kept for each round and used for an audit trail to enhance transparency and validity (Creswell & Miller, 2000). Moreover, during the coding stage several peer review sessions were arranged which contributed to the refinement of codes and their aggregation into relevant themes. Code generation was informed by practice theory (Gherardi, 2019; Schatzki, 2019). The institutional logics used by participants within the generated codes were identified using a mixture of pattern induction and pattern matching as described by Reay and Jones (2016). The induction was grounded in participants’ accounts. The inducted logics were then matched against the generic institutional logics described by Thornton et al. (2012).

The study sheds light on school HP as a multidisciplinary professional practice that incorporates several practices such as teaching, counseling and leadership. The study highlights the occasional tensions generated due to the conflict between professional values and situated responsivity on the one side and the institutional regulation of school HP on the other. The study also demonstrates how various institutional logics are used to mediate the translation of practice regulations into viable professional understandings. The activation of three instantiations of professional logic vis a vis the bureaucratic logic that governs the practice indicates a professional resilience operationalized to effectuate the highest possible degree of professional efficiency. This professional resilience is used to construct practice strategies that are simultaneously congruous with professional values and compliant with institutional directives. The findings indicate that rules were sometimes used as resources to structure and bolster professional practice. However, the multiple levels of governance contribute to the complexity of policy landscape which in turn can strain professional understanding of the practice particularly when the policy rhetoric is ambiguous or incomplete. Moreover, some ambiguities in policy formulations (e.g., regarding the core of the practice) may challenge interprofessional collaboration and the ultimate attainment of school HP objectives. The present study contributes to the body of school HP literature by providing an in-depth understanding of the professional negotiations involved in the enactment of education policies in HP practices in a highly decentralized school system. Insofar as the study responds to rather recent recommendations of incorporating an institutional logics perspective in practice studies (Schatzki, 2023), it can also be seen as a theoretical contribution to the understanding of institutional practices.

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