Effectiveness and implementation of an intervention strategy-based health promoting schools framework to reduce idiopathic scoliosis and myopia among children and adolescents in Shanghai, China: study protocol.

BACKGROUND: Idiopathic scoliosis (IS) and myopia have emerged as major public health concerns affecting children and adolescents worldwide, with a confirmed comorbid association. Both conditions share common risk factors, including outdoor activity, sedentary behaviour, screen time, and sleep duration. This protocol describes a study designed to evaluate the effectiveness of the "ATPISM" intervention strategy, which is developed based on the six core characteristics of the Health Promoting School (HPS) framework advocated by the World Health Organization (WHO). Appropriate Techniques for the Prevention of Idiopathic Scoliosis and Myopia (ATPISM) aim to establish a comprehensive preventive intervention strategy against idiopathic scoliosis and myopia within the HPS framework, and to assess and explore the implementation of ATPISM across five dimensions: acceptability, feasibility, adoption, usage, and maintenance.

METHODS AND ANALYSIS: This is a two-phase hybrid type I effectiveness implementation trial. A 1:1 parallel-group cluster randomized controlled trial will be conducted in 30 schools (15 intervention, 15 control) across three districts in Shanghai, involving approximately 5964 students. The primary outcomes will include differences in IS and myopia screening positivity rates, body composition and behavioral indicators among children and adolescents. Secondary outcomes will assess the Reach, Effectiveness, Adoption, Implementation, and Maintenance of the ATPISM intervention using the RE-AIM framework. To account for school clustering effects, mixed-effects models will be developed to compare group differences. Subgroup analyses will be conducted to identify interaction effects (stratification factor×group) and examine differences in intervention effects across strata. Additionally, Difference in Differences (DID) analysis will be employed.

DISCUSSION: This study is the first to apply the HPS framework for concurrent prevention of IS and myopia in China. The ATPISM strategy, centered on schools and supported by families and communities, is expected to reduce IS and myopia prevalence and improve health behaviors. Findings will provide evidence-based insights for scaling up HPS in China and offer a replicable model for global adolescent health promotion, safeguarding the physical and mental well-being of children and adolescents.

TRIAL REGISTRATION: ChiCTR2600117433. Registered January 23, 2026.