Aims: This study outlines a protocol aimed at identifying and mapping health promotion practices in need of development from the perspectives of key sectors responsible for it at the local level and from an intersectoral perspective across four Spanish regions. Design: A complementary multi‐method study combining survey methods and qualitative interviews will be adopted. Methods: Purposive snowball sampling will be employed to select potentially rich informants from city councils, primary care centres, primary and secondary schools, and public health and civil society organizations in 12 municipalities sensitive to local health. Data on the degree of execution of health promotion activities, the level of intersectorality in their implementation, and their origins will be collected using PromoACTIVA questionnaires, an intersectoral typology model and an interview protocol. A parallel mixed analysis encompassing descriptive statistics and a ‘framework analysis’ will be performed.DiscussionThis study is expected to yield thorough and reliable insights into health promotion practices and omissions at the local level by focusing on key stakeholders, both individually and collaboratively. This information can enhance health promotion planning and improve its effectiveness, efficiency and contextual relevance. The development and testing of a methodology for the integration and interpretation of these data will ensure sustainable capacity building.ImpactManagers and practitioners interested in health promotion planning in the researched settings can benefit from a comprehensive map of the current state of their practices and insights into the starting points of collaboration. In addition, planners from other local settings will gain access to tools and methodologies to replicate and expand these maps to their own contexts.Stakeholder EngagementEngaging key stakeholders with experience working in or with primary care centres, public health organizations, primary and secondary schools, civil society organizations, and city councils was vital to ensure the study's relevance and feasibility.

Background: The World Health Organization (WHO) defines health promotion as the process of enabling individuals to gain control over and improve their health. This shifts the focus from lifestyle choices to broader social determinants of health, requiring involvement from healthcare, authorities, industry, civil society, and the media. Civil society engagement in health initiatives offers benefits such as empowerment, service delivery, flexibility, policy participation, and credibility. However, identifying specific health promotion actions for civil society organizations (CSOs) is challenging. The lack of assessment tools for CSOs hinders evaluation and improvement. Objective: To develop a tool, ‘PromoACTIVA-SC’, to assess CSOs’ health promotion practice by identifying essential actions that constitute the health promotion process. Methods: ‘PromoACTIVA-SC’ was developed through documentary analysis and validated by experts. CSOs’ members participated in cognitive interviews for comprehensibility, and the tool was pilot tested for administration and Likert scale evaluation. Results: The final questionnaire, consisting of 8 phases and 40 items, demonstrated good content validity. Its use can help to map CSOs’ practices and identify areas needing improvement. CSOs can use it for self-assessment and in collaborative health promotion and disease prevention efforts. Conclusions: ‘PromoACTIVA-SC’ is the first tool designed to assess civil society’s role in the health promotion process. Its future use will reveal the extent to which civil society organizations actively participate in health promotion. It can also be used to promote CSOs’ involvement in health policy and administration, enhancing public health outcomes through collaborative, cross-sectoral efforts.

Background
This study aimed to develop, refine, and assess content validity of the PromoACTIVA-CE questionnaire, designed to assess health promotion activities in primary and secondary education. The tool addresses the need for a culturally and contextually relevant instrument to systematically evaluate and support health promotion initiatives in schools.
Methods
Questionnaire development followed a five-phase process that included the following phases: (1) conceptualization; (2) item generation, structure and format; (3) content validation; (4) comprehensibility and semantic fit testing; and (5) pilot testing
Results
The PromoACTIVA-CE questionnaire was successfully developed and validated, resulting in a reliable tool with 37 items classified into eight health promotion action areas. Minor floor effects were observed, but no ceiling effects were detected.
Conclusions
The PromoACTIVA-CE questionnaire is a valid and reliable tool for assessing health promotion activities in primary and secondary schools. Its development leveraged existing evidence-based practices while ensuring cultural and contextual relevance. The tool facilitates systematic assessment and operationalization of health promotion activities, contributing to the sustainability and effectiveness of health promotion initiatives in educational settings. Future research should explore the questionnaire’s sensitivity to changes over time and its applicability in diverse school contexts.

Aims:
This study outlines a protocol aimed at identifying and mapping health promotion practices in need of development from the perspectives of key sectors responsible for it at the local level and from an intersectoral perspective across four Spanish regions.
Design:
A complementary multi-method study combining survey methods and qualitative interviews will be adopted.
Methods:
Purposive snowball sampling will be employed to select potentially rich informants from city councils, primary care centres, primary and secondary schools, and public health and civil society organizations in 12 municipalities sensitive to local health. Data on the degree of execution of health promotion activities, the level of intersectorality in their implementation, and their origins will be collected using PromoACTIVA questionnaires, an intersectoral typology model and an interview protocol. A parallel mixed analysis encompassing descriptive statistics and a ‘framework analysis’ will be performed.
Discussion:
This study is expected to yield thorough and reliable insights into health promotion practices and omissions at the local level by focusing on key stakeholders, both individually and collaboratively. This information can enhance health promotion planning and improve its effectiveness, efficiency and contextual relevance. The development and testing of a methodology for the integration and interpretation of these data will ensure sustainable capacity building.
Impact:
Managers and practitioners interested in health promotion planning in the researched settings can benefit from a comprehensive map of the current state of their practices and insights into the starting points of collaboration. In addition, planners from other local settings will gain access to tools and methodologies to replicate and expand these maps to their own contexts.
Stakeholder Engagement:
Engaging key stakeholders with experience working in or with primary care centres, public health organizations, primary and secondary schools, civil society organizations, and city councils was vital to ensure the study's relevance and feasibility., This study has been funded by the Spanish Ministerio de Ciencia,
Innovación y Universidades through the Instituto de Salud Carlos IIII
(PI21/01449). Open access funding provided by Universidad Pública
de Navarra.

Background: The World Health Organization (WHO) defines health promotion as the process of enabling individuals to gain control over and improve their health. This shifts the
focus from lifestyle choices to broader social determinants of health, requiring involvement
from healthcare, authorities, industry, civil society, and the media. Civil society engagement
in health initiatives offers benefits such as empowerment, service delivery, flexibility, policy
participation, and credibility. However, identifying specific health promotion actions for
civil society organizations (CSOs) is challenging. The lack of assessment tools for CSOs
hinders evaluation and improvement. Objective: To develop a tool, ‘PromoACTIVA-SC’,
to assess CSOs’ health promotion practice by identifying essential actions that constitute
the health promotion process. Methods: ‘PromoACTIVA-SC’ was developed through
documentary analysis and validated by experts. CSOs’ members participated in cognitive
interviews for comprehensibility, and the tool was pilot tested for administration and Likert
scale evaluation. Results: The final questionnaire, consisting of 8 phases and 40 items,
demonstrated good content validity. Its use can help to map CSOs’ practices and identify
areas needing improvement. CSOs can use it for self-assessment and in collaborative health
promotion and disease prevention efforts. Conclusions: ‘PromoACTIVA-SC’ is the first tool
designed to assess civil society’s role in the health promotion process. Its future use will
reveal the extent to which civil society organizations actively participate in health promotion. It can also be used to promote CSOs’ involvement in health policy and administration,
enhancing public health outcomes through collaborative, cross-sectoral efforts., This research was funded by the Spanish Ministerio de Ciencia, Innovación y Universidades through the Instituto de Salud Carlos IIII (PI21/01449).

Background This study aimed to develop, refine, and assess content validity of the PromoACTIVA-CE questionnaire,
designed to assess health promotion activities in primary and secondary education. The tool addresses the need for a
culturally and contextually relevant instrument to systematically evaluate and support health promotion initiatives in
schools. Methods Questionnaire development followed a five-phase process that included the following phases: (1)
conceptualization; (2) item generation, structure and format; (3) content validation; (4) comprehensibility and
semantic fit testing; and (5) pilot testing. Results The PromoACTIVA-CE questionnaire was successfully developed and validated, resulting in a reliable tool
with 37 items classified into eight health promotion action areas. Minor floor effects were observed, but no ceiling
effects were detected. Conclusions The PromoACTIVA-CE questionnaire is a valid and reliable tool for assessing health promotion activities
in primary and secondary schools. Its development leveraged existing evidence-based practices while ensuring
cultural and contextual relevance. The tool facilitates systematic assessment and operationalization of health
promotion activities, contributing to the sustainability and effectiveness of health promotion initiatives in educational
settings. Future research should explore the questionnaire’s sensitivity to changes over time and its applicability in
diverse school contexts., This study has been funded by the Spanish Ministerio de Ciencia, Innovación y Universidades through the Instituto de Salud Carlos III (PI21/01449).