Building health-promoting school environments: a longitudinal qualitative study of the Explo'Santé program in France

Health inequalities among children and adolescents remain a major public health concern, with schools identified as key settings for integrated, context-sensitive interventions. The Explo'Santé program was developed in France to promote life skills and foster health-supportive school environments by targeting school-level determinants, including relational dynamics, organizational processes, and classroom environments.

A longitudinal qualitative study was conducted between 2022 and 2025 across six French districts, based on 36 semi-structured interviews with primary and middle school teachers involved in program implementation. Data were analyzed using thematic analysis to explore perceived environmental changes and contextual mechanisms influencing implementation.

Six main themes emerged, including spatial conditions, peer climate, teacher-student relationships, organizational flexibility, pedagogical formats, and institutional embedding. In primary schools, stable classroom environments enabled gradual symbolic and relational transformations, with improved emotional expression, peer interactions, and integration into routine practices. In contrast, middle schools were characterized by organizational fragmentation, reduced temporal and relational continuity, and more heterogeneous student engagement, limiting program integration. Sustainability appeared dependent on contextual alignment, coordination, and institutional support.

The findings highlight that school-based health promotion effects are context-dependent and shaped by interactions between develop-mental stage and institutional structure. Sustaining psychosocial gains appears to depend on maintaining relational and organizational continuity across educational stages, as well as on stronger integration of health promotion into formal school structures.