The aim of this systematic review was to summarize systematically the existing evidence for the effects of student participation in designing, planning, implementing and/or evaluating school health promotion measures. The focus was on the effects of participation in school health promotion measures rather than on student involvement at school in general. Participation is a core value for health promotion but empirical evidence of its outcomes is scarce. We searched major bibliographic databases (including ASSIA, ERIC, PsycINFO, Scopus, PubMed and the Social Sciences Citation Index). Two reviewers independently decided about inclusion and exclusion of the identified abstracts (n = 5075) and full text articles. Of the 90 full text articles screened, 26 papers met the inclusion criteria. We identified evidence for positive effects, especially for the students themselves, the school as organization, and interactions and social relations at school. Almost all included studies showed personal effects on students referring to an increased satisfaction, motivation and ownership, an increase in skills, competencies and knowledge, personal development, health-related effects and influence on student perspective. Given that student participation has more been discussed as a value, or ideal of health promotion in schools, these findings documenting its effectiveness are important. However, further research is needed to consider the level or intensity of involvement, different approaches and stages of participation in the health promotion intervention, as well as mediating factors such as gender, socio-cultural background or academic achievement, in a more systematic manner.

This paper addresses the issue of student participation and learning about health from the perspective of health-promoting schools. The combination of the democratic approach to health-promoting schools, characterized by the concepts of student participation and action competence, and the sociocultural theory of learning provides the conceptual framework for the discussion. The two sets of concepts help the building of a heuristic that views teaching and learning as mutually constitutive, establishing an integrated unit of analysis. Data are generated from a Web-based international project ‘Young Minds exploring links between youth, culture and health’. The project has its roots in the European Network of Health Promoting Schools (ENHPS). The methodological framework is constructed as theoretically based qualitative case study, using Web contents analysis and interviews with the participating teachers and students. A model distinguishing between two different qualities of student participation—token and genuine—is used as an analytical tool in analyzing the empirical data. The analysis of the case study illuminated the trajectories of participation in which students learned about health in intentional, relational and purposeful ways. These participation trajectories were viewed as situated in activity structures consisting of a variety of mutual interactions and different forms of participation.

The concept of student participation is currently a popular notion in health promoting schools as well as in general education. However, phrases such as 'involvement', 'participation', 'co-determination' and 'influence' are frequently used without careful definition. In this article two models, developed in the context of health promoting schools in two different cultures, are presented and discussed. The first model makes a fundamental distinction between token and genuine participation. Token participation in health promotion is characterised by focusing on prescribed knowledge, closed and convergent outcomes and targeting individuals isolated from the surrounding environment. In contrast, genuine participation stresses students' own construction of knowledge, open and divergent outcomes and targeting individuals in their context. Genuine participation is in accordance with a democratic health promoting school aiming at students' empowerment and action competence. The second model clarifies a number of different categories of students' participation in health promotion. The different categories illustrate how the teacher in various ways can play an active role in participatory approaches as a responsible professional. The more the students are involved in health projects, the more important it will be for the teacher to provide support, insight and knowledge to facilitate the learning processes. Furthermore, the different participation categories have to be related to a number of decisions which are normally included in a school health project. The model illustrates that participation should always be viewed in relation to the context and that it makes no sense to establish a single ideal way of working with participation in a health promoting school. The theoretical models are illuminated by concrete examples from health promoting schools. The overall conclusion is that participation is a complex term and rather than providing definitive answers, the models can be used as a framework for discussion among all stakeholders in planning, implementation, evaluation and managing projects involving student participation. Finally, specific implications and challenges for future health promoting schools are outlined. These are as follows: •a participatory approach does not imply that health content should be regarded as vague or superfluous; • teachers need flexible educational models and resources to manage participatory projects in health promoting schools; · schools have to be acknowledged as cultural systems with firmly rooted rules and routines that are often difficult to change; • a participatory approach has to influence all aspects of a democratic health promoting school rather than solely the teaching strategies.

The paper addresses the issue of student participation from the perspective of the health‐promoting schools initiative. It draws on experience from the Macedonian Network of Health‐Promoting Schools and its collaboration with the Danish as well as other country networks within the European Network of Health‐Promoting Schools. Student participation is viewed as one of the main focal points of the conceptual framework and model of a health‐promoting school developed within the Macedonian context. This model and the model distinguishing between two different qualities of participation—genuine and token participation—are presented and discussed in the paper. Underpinning values that these models endorse as important for the processes of health promotion in schools include self‐determination, participation, democracy, diversity and equity.