Co-creation of the logic model for a health-promoting school program in vulnerable areas in a Brazilian capital: ProMOVE Escolas + Saudáveis.

BACKGROUND: Although the World Health Organization recommends the Health-Promoting School (HPS-WHO) as a fundamental strategy for health promotion, school-based public health programs grounded in implementation science are still rare, especially in socially vulnerable areas. Considering the co-creation process of the implementation foundations (i.e., logic model, LM) of new interventions is relevant to enhancing acceptability and sustainability in different contexts and resource conditions. We aimed to describe the co-create process of the LM of a school health-promoting program among public schools from socially vulnerable areas in a large municipality in Brazil. METHODS: This study followed the co-creation process of the program's LM considering three main stages: planning, conducting and evaluating, and final validation. The Program's LM was structured based on the Implementation Research LM (determinants, implementation strategies, mechanisms, and outcomes). The planning stage considered five strategies, using theoretical, evidence, and practice-based information. Stakeholders were invited by personal contacts, including researchers, teachers, managers, health professionals, undergraduate students, and recent school graduates. After the thematic analysis and consensus for the first version of the situational analysis and LM's elements, a second workshop was conducted. The final version of the Program's LM was validated by stakeholders who participated in the workshops and approved the version through consensus and scoring. RESULTS: Four HPS-WHO documents, ten systematic reviews on the implementation of HPS-WHO programs, a survey with 121 stakeholders, eight meetings with school managers, and a 2-h workshop with 17 stakeholders supported the development of the first version of the situational analysis with 35 themes and the Program's LM. The final version of the Program's LM and elements were approved by 13 stakeholders, with scores of 4.7 points or higher. The final LM included 15 determinants, four core strategies, three mechanisms, and three outcome domains. CONCLUSIONS: After an interactive, multi-strategic, and multi-stakeholder process to co-create the LM, it may be used to guide the implementation and evaluation process of a public health program in all full-time public schools in the fifth most populous municipality in Brazil, in areas with very low Human Development Indexes. This highlights the essential role of cross-sectoral collaboration in strengthening primary health care through school-based strategies.