Advancing Health Promotion Practice in Nigerian Secondary Schools: A Systems Thinking Analysis

Health promotion in Nigerian secondary schools involves complex interactions between students, educators, school systems, family environments, and community structures that linear programme evaluation frameworks cannot fully capture. This study applied systems thinking methodology to analyse and advance health promotion practice in Nigerian secondary schools, drawing data from schools across the South West, North Central, and South East geopolitical zones. A participatory systems analysis methodology was used, incorporating causal loop diagramming with 18 stakeholder groups including students, teachers, school administrators, health educators, and ministry officials from 12 states. System dynamics modelling was employed to simulate the long-term effects of different policy interventions on health promotion outcomes. Qualitative rich picture development and soft systems methodology supplemented the quantitative modelling. Results identified reinforcing feedback loops between low health educator staffing, poor programme quality, minimal student engagement, and declining administrative investment as the primary systemic drivers of ineffective school health promotion. Disruptive leverage points were identified in the areas of pre-service teacher health education training, dedicated school health budget lines, and student health leadership programmes. The study makes an original methodological contribution by demonstrating the utility of systems thinking for school health promotion policy design in Nigeria. Keywords: health promotion, secondary schools, systems thinking, Nigeria, school health policy