School-level determinants of superior performance in health-promoting universities and colleges in Taiwan

Objectives: Since 2012, Taiwanese universities and colleges have actively implemented health promoting school (HPS) programs, with most institutions receiving funding subsidies. However, only a small proportion have demonstrated superior performance. This study examined the school-level determinants associated with superior performance in universities and colleges participating in HPS programs from 2019 to 2021. Methods: Data from 145 universities and colleges were analyzed using the School Status Survey Questionnaire and Annual Health Promotion Evaluation Reports. The questionnaire assessed school policy, the composition of school personnel, healthcare capacity, evidence-based health promotion strategies, tobaccorelated practices, and smoke-free campus policies. The reports, in turn, evaluated tobacco control, weight management, and sexuality education through process and impact assessments. Institutions ranking in the top 10% were classified as superior-performing. Chi-square tests and t-tests identified significant variables, followed by logistic regression to examine key predictors. Structural equation modeling (SEM) examined the relationships between school-level variables and superior performance. Results: Superior-performing institutions had significantly greater student enrollment, more faculty and staff, and higher subsidy funding. These schools also implemented significantly more evidence-based strategies across the domains of weight management, sexuality education, and tobacco control. SEM results revealed that faculty and staff numbers positively predicted student enrollment and campus health center size, which in turn influenced the number of campus nurses and the provision of smoking cessation services. Path analysis revealed that weight management strategies influenced tobacco control strategies, which in turn impacted sexuality education strategies, highlighting their interconnection. Conclusions: Findings highlight the importance of institutional resources, human capital, and comprehensive implementation of evidence-based strategies in driving superior HPS performance. The results provide valuable insights for policy development and institutional planning to strengthen health promotion initiatives in higher education.