This blog shares updates from our project on Community Participatory Research for Adolescent Health Promotion in Diverse Communities in Bangladesh (CRAB-B), supported by Elizabeth Blackwell Institute and Franklin-Adams endowment. We hear from researcher, Nuzhat Choudrury, on what was learned during meetings with key stakeholders, on visits to schools and health centres, and on the opportunities and challenges in supporting adolescents’ health in diverse communities in Bangladesh.
Photo caption: University of Bristol research team with Workshop participants at Asian University for Women
Preventable risk factors
Non-communicable diseases (NCDs) — including cardiovascular diseases, cancer, chronic respiratory diseases, and type 2 diabetes — pose a major global public health challenge. Bangladesh, a country undergoing rapid economic, demographic, and epidemiological transitions, faces a growing burden of NCDs. With evidence showing that more than one-third of adolescents in the country are exposed to four or more NCD risk factors, including smoking, unhealthy diets, low physical activity, and harmful use of alcohol. The prevalence of the double burden of malnutrition is also high amongst this population, with many adolescents becoming overweight or obese, while undernutrition is still common.
Most of these risk factors are preventable, and research demonstrates that behaviour change is most effective when interventions start early. This has generated global interest in schools as platforms for promoting healthy lifestyles among children and young people. This led to the World Health Organization (WHO) developing the Health Promoting Schools (HPS) framework, which strengthens a school’s capacity to foster healthy learning, living, and working environments in collaboration with teachers, staff, parents, and communities. Despite its global recognition, evidence on the implementation, effectiveness, challenges, and local adaptation of HPS is limited in low-and middle-income countries (LMICs), including Bangladesh. Moreover, urban, rural, and tea plantation communities in the country differ significantly, underlining the need for health promotion approaches that are context-specific and community-led.
Collaboration is key
Our project is a collaboration between researchers at the University of Bristol – Professor Nick Townsend, Dr Joey Murphy, and Dr Nuzhat Choudhury whose position is supported by a Franklin-Adams Fellowship from the Elizabeth Blackwell Institute, and members from the Asian University for Women, Chittagong, Bangladesh, led by Dr. Tuhin Biswas, an Assistant Professor of Public Health.
About the research
We are working with communities and adolescents across urban areas, rural villages, and tea plantation communities to explore the prevalence of NCD risk factors and the role schools can play in promoting health, as well as identifying the other sectors and stakeholders who can support them in this. We have started a realist review of existing literature and national policies to examine evidence on HPS approaches in Bangladesh and identify key stakeholders in adolescent health. In July 2025, we visited Dhaka, Chittagong, and Sylhet, where we met national stakeholders (WHO and UNESCO), our partner organisation AUW, two tea garden schools, and a local health centre. Whilst there we explored how community-based participatory research (CBPR) could be carried out in these areas. CBPR is a collaborative, equitable research approach where researchers, community members, and organisations work together as equals to address community needs and promote positive change.
Findings so far
Our realist review indicates that while several national policies and strategies support the whole-school approach, articulated through the HPS model, its practical implementation in Bangladesh remains limited. WHO and UNESCO are currently working with the Ministry of Health and the Ministry of Education, respectively, on an HPS situation analysis. However, both organisations highlighted funding as a key barrier to sustaining HPS and other school initiatives. Notably, neither organisation has given priority to tea garden areas, or their schools, in the context of implementing HPS and they are both keen to collaborate on the work we are doing in the area.
During our school visits, we observed that while classrooms and playgrounds were adequate, health-promoting activities were limited. Students participated in one 45-minute physical activity session per week, as well as monthly health awareness sessions. These sessions were delivered by staff from the Upazila Health Complex (UHC) – a primary, first-referral healthcare facility in Bangladesh’s public healthcare system that serves rural populations – and addressed topics such as menstrual hygiene, nutrition, and general health. However, teachers highlighted that the effectiveness of these sessions was constrained by external factors, in particular poverty, which pose a major barrier to behaviour change. Low parental literacy and limited awareness also hinder efforts to encourage adolescents to practice regular handwashing, eat healthily, and maintain clean clothes.
In addition, we visited the local UHC, which serves approximately 500,000 people with limited resources. Staff there identified common health issues among school-aged children, including abdominal pain, fever, and scabies. The facility provided a designated ‘NCD Corner’, where conditions such as hypertension and diabetes were identified and monitored in the adult population. Health care specifically targeting adolescents was limited to group counselling, with the delivery of this and other services restricted by a lack of resources.
Future plans
The next phase of research will involve working with members of these communities, including some that are now studying at AUW, to conduct qualitative research with schoolchildren, teachers, community members, and government officials to identify key stakeholders for the HPS initiative. While the literature has highlighted WHO, UNESCO, the Ministry of Health, and the Ministry of Education, additional actors, especially in tea garden areas, may also play important roles.
Our qualitative research will provide deeper insights into barriers and opportunities for implementing the HPS model in diverse Bangladeshi contexts. In parallel, we will conduct a social network analysis to examine how stakeholders are connected and to identify those best placed to support schools in promoting adolescent health, in recognition of the need for multi-sectoral action in the successful implementation of interventions at the community level.
Finally, we will organise community-level workshops to share findings, gather feedback, and guide future actions. Our project will conclude with a comprehensive report on the role of HPS in these communities, highlighting challenges and potential strategies for scaling up. We will share this report with key stakeholders and policymakers and will also seek funding to expand this work on a larger scale.