'Side effects' of health promotion: an example from Austrian schools

While the existence of side effects of medical interventions is common knowledge and widely investigated, possible unintended effects of health promotion (HP) interventions are only sparsely discussed in the HP literature. Drawing on qualitative evaluation data generated within an on-going process evaluation of a regional health-promoting schools network in Austria, we demonstrate which desirable and undesirable effects HP practice can have for teachers. Thirteen group discussions with teachers (n = 63) and headteachers (n = 9) acting as health coordinators in the network schools were conducted between 2010 and 2013. These data were analysed using systems and thematic analyses. In our example, desirable side effects included health coordinators gaining new relationships, new skills and benefiting from improved infrastructure. The undesirable side effects centred on stress, work overload and frustration, due to the additional work brought about by HP practice, negative reactions by colleagues as well as by technicalities of the network. The undesirable side effects of HP predominated in our study, pointing to several implications like the need to accommodate the concept of HP in the teachers' core responsibilities; the participation of all staff members and students in a whole-school approach toward SHP, and the need for changes on an organizational level. Based on this study, we come to the conclusion that a systematic approach to investigating and analysing side effects of HP is currently lacking in HP research and suggest that theoretical examination and more empirical research is needed.