Introduction
School is a fundamental setting for the growth and development of students and school staff, influencing their health and lifestyles. At the international level, the World Health Organization (WHO) promotes the "Health-Promoting School" (HPS) approach. A HPS adopts a whole-school approach, comprising all aspects of the life of a school. The literature highlights the importance of the quality of the implementation of the HPS approach for its effectiveness. Adopting the HPS approach implies several changes and activities, which are challenging for schools. Furthermore, schools can implement the HPS approach according to their context-specific values, needs, resources, and characteristics. Therefore, identifying different ways in which schools can implement the model as it is recommended by international guidelines and local needs is vital to further research with respect to the effectiveness of the HPS approach.


Purpose
In the Lombardy Region (Italy), the HPS approach is well-established and 14 provincial and sub-provincial HPS Networks operate, totaling over 500 schools. The purpose of the study is to identify different implementation typologies within the HPS Networks of Lombardy.


Method
A latent analysis (LCA/LPA) will be performed based on a series of health promotion practices listed in a regional document. These will be used to create indicators based on the HPS characteristics and components. A survey investigating the implementation status of these practices was administered to schools from April to September 2025. The survey was sent by the School Regional Office, and participation was promoted by the leading schools, the school provincial offices' staff, and the local healthcare units' staff.


Results
A total of 405 schools responded to the survey, yielding a high response rate from the schools within the Networks (79%). The results of the analysis will provide insights on the status of HPS within Lombardy.