Using the Social Ecological Model to explore policy and institutional aspects of the school environment in relation to healthy eating and physical activity: An audit of female-only high schools in the Kingdom of Saudi Arabia.

ObjectiveIn the Kingdom of Saudi Arabia (KSA), non-communicable diseases (NCDs) cause 73% of deaths, with high body mass index (BMI) as the leading risk factor. Among adolescents, 79% reported physical inactivity (PA), 30% and 10% were living with overweight/obesity and prediabetes, respectively. Little is known about the influence of school environments in shaping healthy eating (HE) and PA behaviours. This study addressed this gap through two steps: (1) Documentary review of obesity prevention policies, (2) Assessing the school environment in relation to HE and PA. DesignThe documentary review consisted of two parts; Part 1: Web-searching literature, hand-searching targeted websites, and stakeholder consultations to confirm the literature findings. Part 2: School-based environmental audit employing the ISCOLE tool and the Saudi Ministry of Education Regulations for School Canteens policy. SettingThree female high schools were selected from differing economic deprivation levels in Riyadh, KSA. ParticipantsISCOLE questionnaires were completed by the researcher in conjunction with a staff member; photo-documentation and observations were made. ResultsSeventeen obesity prevention policies were identified; stakeholder consultations identified one additional policy document, and assessment highlighted challenges in policy implementation. The audit revealed notable differences between schools in HE and PA provisions ConclusionIn KSA, female high schools face significant challenges regarding a school environment that supports both HE and PA. These challenges include the absence of HE provisions and lack of suitable PA facilities, coupled with a gap between policy and practice. Understanding the school context will help support the development of future obesity prevention school-based interventions.