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Table 3 First-, second- and third-order constructs

From: A systematic review and synthesis of theories of change of school-based interventions integrating health and academic education as a novel means of preventing violence and substance use among students

First-order constructs Second-order constructs Third-order constructs Overall social/psychological process (line of argument)
Academic platform used to simultaneously build academic and health skills Degree of integration of academic and health curricula (full or partial) Eroding boundaries between health and academic education Eroding boundaries at multiple and mutually reinforcing levels—by integrating academic and health education, by promoting stronger, more affective relationships between teachers and students, by generalising learning from classrooms to the wider school environment, and by ensuring consistent messaging between schools and families—will lead to the development of a community of engaged students oriented towards pro-social behaviour and away from substance use, violence and other risk behaviours.
Health curricula bridged into academic curricula, with academic curricula sometimes intended to reinforce health messages and vice versa
Decreasing time during the school day for health education due to an emphasis on academic achievement (measured through standardised test scores) Pragmatic rationale for integration
Mutually reinforcing effect of improved academic and health outcomes Scientific rationale for integration
Students being less resistant to health messaging in integrated curricula Additional rationale for integration
Integrated curriculum providing opportunities for repetition
Opportunities for experiential learning provided
Teachers’ internalisation of curriculum’s messages Normalisation of prosocial behaviours through teacher internalisation of curricula Eroding boundaries between teachers and students
Teachers’ role-modelling of curriculum’s promoted behaviours
Forming bonds between prosocial peers and adults and acceptance of behaviours demonstrated within these relationships
Establishment of good relationships between students and teachers Establishing student connectedness to the classroom through positive teacher-student relationships
Rewards for prosocial behaviours being given to students Positive reinforcement of prosocial behaviours Eroding boundaries between classroom and the wider school
Students internalising prosocial beliefs and feeling positive about themselves following the demonstration of prosocial behaviours, leading to more prosocial behaviours
Students having the opportunity to practice valued skills at multiple levels
A sense of connectedness and bonding with the school is linked to overall emotional wellbeing and security experienced by students in school Establishing student connectedness to the school
Connectedness to school fosters better academic learning as the school becomes a more positive environment that students are invested in
Role modelling of prosocial behaviours at home Normalisation of prosocial behaviours Eroding boundaries between schools and families
Parents aware of curricula and expect prosocial behaviours (e.g. conflict resolution skills) to be practiced at home Provision of opportunities for practical skill development