The settings-based approach to health promotion, recognised as a gold standard by the WHO and the research community (Clift et al., 2007; WHO & UNESCO, 2021), provides a holistic framework for conceptualising health promotion programs in school environments (Paulus, 2022). The settings approach aims for holistic and sustainable change processes involving all stakeholders, structures, and conditions of the school system. It is considered very effective by the research community but can be demanding to implement in practice, as it is highly complex and resource-intensive (Bartelink & Bessems, 2019; Dadaczynski et al., 2020). Even though the settings approach is a widely acknowledged concept in the field of health promotion, it remains theoretically underspecified (Dadaczynski et al., 2016). Paulus (2022) highlights the absence of a comprehensive framework in school health promotion that effectively integrates and aligns theory-driven research with practical application. This gap creates challenges in systematically guiding both the development, implementation and evaluation of health promotion strategies within schools. Implementation research in public health addresses the gap between theory and practice by examining the practical execution of evidence-based programs and activities (Nilsen, 2020). It identifies factors influencing the implementation process and conditions that impact settings-based school health promotion (Durlak & DuPre, 2008; Ogden & Fixsen, 2014; Samdal & Rowling, 2015). School leaders for example, were identified as crucial key players for the implementation of a settings-based approach (Dadaczynski et al., 2022). However, implementation research does not fully capture how these factors interact within broader systems or how governance structures and strategies influence implementation. The educational governance perspective provides a heuristic framework for analysing actions, roles, and interdependencies of various actors in the multidimensional school system (Altrichter & Maag Merki, 2016). It shifts the focus from individual programs and schools to overarching structures and processes in the education system, identifying governance mechanisms across multiple levels and actors. This dissertation project seeks to develop a comprehensive framework in combining the settings-approach, implementation research with an educational governance perspective in order to define and describe relevant factors at various levels of the educational system that are related to school health promotion. The following research questions are addressed in the dissertation project:

1. What are the key areas of conceptual and terminological convergence among the three perspectives to school health promotion?
2. How can the role of school leaders be conceptualized through the lens of these three perspectives?
3. How can insights from these perspectives be integrated into a comprehensive framework to improve school health promotion?

To address the first question, we conducted a targeted literature review across three relevant fields. While the review was not exhaustive, it aimed to cover key studies and foundational works in each area. This was followed by theoretical analysis to identify key concepts and terminologies within each perspective. A contrasting strategy was applied to highlight distinctions and conceptual overlaps, which was visualised by creating concept maps (Daley, 2004) To answer research questions two and three we draw on the results of three studies. The first is a quantitative study examining school leaders' attitudes and health literacy through an online survey (N=358) conducted in June 2021 across Switzerland. Multiple linear regression and simple slope analyses were performed using PROCESS for SPSS. The second project compares school health promotion in Switzerland and Malaysia, using the same 2021 survey data (N=1058). Implementation was measured with the SSPESH scale, and regression analyses were conducted using SPSS 28 and PROCESS for SPSS. The third project investigates governance structures in Switzerland through document analysis from the cantons of Schwyz and Bern and interviews with school leaders (6 in Schwyz, 4 in Bern). Content analysis was used following Kuckartz and Rädiker (2022).

Preliminary results indicate that the settings approach, implementation research, and educational governance each use distinct terminology, yet their core concepts often overlap. Clarifying these terms is essential for fostering a shared understanding and enabling effective communication among stakeholders. All three approaches recognize the multidimensional nature of health promotion, shaped by the complex interaction of actors and factors across individual, institutional, and systemic levels. A common thread is the crucial role of school leaders. They emerge as policy mediators, organizational change agents, and brokers of competing demands. School leaders are not passive reform implementers but active shapers of their policy environments, ensuring schools function as both educational institutions and broader social ecosystems. This highlights the need for a comprehensive framework that focuses on the multilevel engagement of school leaders and other stakeholders in school health promotion. Key questions arise around synchronizing efforts across levels and integrating health promotion into governance structures. Furthermore, the balance between autonomy and regulation must be addressed to support effective school health promotion. Taking this integrative approach has helped us to better understand the context of school health promotion and has opened new opportunities for cross-disciplinary exchange. However, integrating different perspectives can be challenging because they often rely on different methods and underlying assumptions. Simply combining them is not enough; a truly integrative framework must bridge these differences and create meaningful connections. Without this, the framework risks being merely a collection of ideas rather than a cohesive approach. Achieving real integration requires thoughtful dialogue, alignment of key concepts, and methods that work across disciplines.

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