How can school-based programmes improve physical and mental health outcomes in low-and-middle-income countries? An umbrella review and logic model
Winsper, Catherine Tuomainen, Helena Jilka, Sagar Goutham, Sanjana Morroni, Dafne Akpan, Usoro Giacco, Domenico Gill, Paramjit Iyer, Srividya N Lohumi, Isha
Winsper, Catherine
Tuomainen, Helena
Jilka, Sagar
Goutham, Sanjana
Morroni, Dafne
Akpan, Usoro
Giacco, Domenico
Gill, Paramjit
Iyer, Srividya N
Lohumi, Isha
Abstract
School-based programmes offer a promising approach for improving physical and mental health trajectories in low-and-middle-countries (LMICs). This umbrella review and logic model explores how and in which contexts these programmes are effective. A systematic search of electronic databases identified 20 systematic reviews (5 meta-analyses) on school based (SB) physical (n = 13; primary studies = 214) and mental (n = 7; primary studies = 120) health programmes across a range of low, lower-middle, and upper-middle income countries. Programmes included universal (all students), selective (e.g., high-risk students), and indicated (e.g., students with symptoms) approaches. Evidence was stronger for proximal (e.g., nutritional knowledge), and intermediate (e.g., dietary behaviour) outcomes than for distal (e.g., obesity reduction) outcomes, and there were some variations in outcome by geographical region. Evidence for combined physical and mental health programmes was scant, with limited overlap between the two types of programmes (i.e. some shared components and outcomes). Moderators of programme effectiveness included recipient (e.g., gender, age) and programme (e.g., longer duration, multi-component) characteristics, and inner (e.g., school resources, support for teachers) and outer (e.g., partnerships with Non-Governmental Organisations) settings. Cultural adaptations and implementation quality were highlighted as important (yet rarely fully reported) factors in ensuring programme sustainability and scaling-up. There is some supportive evidence for SB programmes in LMICs, though evidence for effectiveness varies by temporality of outcome and geographical location. This highlights the importance of considering implementation barriers across outcome trajectories and ensuring sufficient attention is given to cultural adaptations. Dual programmes combining balanced physical and mental health modules might offer promise for addressing the growing burden of non-communicable diseases in LMICs.
MIDER Authors
Affiliations
University of Warwick; Coventry and Warwickshire Partnership NHS Trust; McGill University, Montreal; Centre for Mental Health Law & Policy, Indian Law Society, Pune, India; University of Ibadan; Post Graduate Institute of Medical Education and Research, Chandigarh, India; Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, India
Date
2026-04
Type
Article
Subject
Collections
Citation
Winsper C, Tuomainen H, Jilka S, Goutham S, Morroni D, Akpan U, Giacco D, Gill P, Iyer SN, Lohumi I, Bella-Awusah T, Thakur JS, Omigbodun O, Srinivasan SP, Kalha J, Thara R, Pathare S, Singh SP. How can school-based programmes improve physical and mental health outcomes in low-and-middle-income countries? An umbrella review and logic model. Clin Psychol Rev. 2026 Apr;125:102727. doi: 10.1016/j.cpr.2026.102727. Epub 2026 Mar 13. PMID: 41849914.