Actionable companion · Governance and equitable decisions

From leadership research to district action: Multi-level factors influencing the implementation of Cambodia’s National Policy on School Health: a qualitative case study

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Background Since the 2000 World Education Forum, international organizations have encouraged low- and middle-income countries to strengthen school health systems through national school health policies based on the Health Promoting School (HPS) concept. While these policies offer proven benefits, implementation remains challenging in many low- and middle-income settings. In Cambodia, despite the establishment of the National Policy on School Health (NPSH), implementation remains uneven and insufficient across administrative levels. While implementation factors have been identified at the national, provincial, and elementary school levels, evidence remains limited at the secondary school level. Therefore, the current study investigated the factors influencing NPSH implementation at the public secondary school level in Battambang province. Methods This qualitative case study assessed complementary information from 27 key informant interviews (KIIs) with stakeholders involved in policy implementation and 13 documents related to previous implementation efforts. Participants represented national policy, provincial, district, commune, and school perspectives. Content analysis combined deductive coding guided by Vince Whitman’s wheel of factors influencing the implementation of policy and practice, with inductive coding of context-specific themes. Results Nine thematic domains were identified to influence NPSH implementation. Policy reform, policy implementation-adapted strategy, and champions and leaders at all levels were described primarily as enabling implementation. Dissemination gaps and limited understanding within the international and national guidelines domain, attention to external forces, and gender gap and mandated roles were described primarily as inhibitors. Dedicated time and resources, administrative and management support, and stakeholder ownership and participation contained both enabling and constraining processes. These categories describe reported implementation experience rather than measured effect or the relative importance of factors. Conclusions Participants described an interaction between a binding legal mandate and perceived local autonomy in the implementation of NPSH. Their accounts suggest that a clearer legal framework, support for local adaptation, leadership, and cross-sector participation may help implementation in this setting. This study did not establish causal effects or examine students’ health and learning outcomes. Research across additional provinces, incorporating frontline staff, parents, students, and independent implementation data, is needed to assess the interpretations and their transferability.

A 90-day district inquiry

1. Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
2. Days 16–30 · Design. Select one recurring district decision. Publish the decision owner, evidence requirements, consultation process and appeal route; test the process on a bounded low-risk decision. Agree participation, privacy protections, baseline and stopping rules before starting.
3. Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
4. Days 61–90 · Decide. Track decision time, unresolved objections, documented reasons, appeals and access differences. Review whether the process changes who can participate and who carries the burden. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Saray Pheng; Vandy Tep; Takashi Asakura; Sokhom Chan; Marie Ueno; Noudéhouénou Credo Adelphe Ahissou; Jun Kobayashi. Multi-level factors influencing the implementation of Cambodia’s National Policy on School Health: a qualitative case study. Tropical Medicine and Health (2026-10-29). https://doi.org/10.1186/s41182-026-01103-5

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.