Leadership of school principals for school health implementation among primary schools in Mataram, Indonesia: a qualitative study.

Background: Health-promoting schools (HPS) are acknowledged as a comprehensive approach to improving children's health and educational outcomes through learning and school life. Principals are key players in HPS implementation. However, concrete leadership practices in HPS in low- to middle-income countries have not been clarified. Therefore, this study aimed to explore and generate themes surrounding the leadership practices of principals in implementation of school health in Indonesia, a predominantly Muslim country consisting of diverse religions that have expanded HPS at the national level.

Methods: In-depth interviews and focus group discussions (FGDs) were conducted with the principals, teachers, parent representatives, and school board committee members in 10 target schools. FGDs were conducted with school health supervisory board members in Mataram City. All interviews were recorded and transcribed. Thematic analysis was undertaken to generate themes.

Results: The principals demonstrated leadership practices based on their religious beliefs, values, and morals. This may suggest that beliefs and morals support an understanding of their responsibility to ensure the well-being of all school community members, regardless of religion, in a diverse environment that is predominantly Muslim but also multicultural and multi-religious. Further, these beliefs and morals might reinforce implementation of school health. Importantly, the principals' coordination skills in cooperating with multiple sectors might contribute to successful implementation of school health. Also, principals emphasized they were tasked to develop capacity for implementation of school health. Thus, principals should understand leadership in the implementation of school health as their duty from the training stage to encourage health at the school level.

Conclusion: In this study, "have professional educators' beliefs and religious beliefs and Indonesia's morals" was generated as a new theme, whereas several common themes were found as in previous studies. The results of this study suggested the importance of leadership by principals in the implementation of school health. Strengthening the capacity of school principals by integrating the contents of school health leadership practice into pre- and in-service training through the development of a policy on principals' duties in school health might contribute to the successful implementation of school health.