A Case Study Analysis of Settings Approaches to Health Promotion in Higher Education

<p dir="ltr">Higher Education Institutions (HEIs) in The United States of America (U.S.) play an important role in shaping society through significant social, environmental, and economic impacts at the regional, national, and global levels. These institutions also provide opportunities for comprehensive strategies and infrastructure for health promotion. While many institutions offer wellness programming and health education, few engage in the broader process of health promotion as defined by international frameworks. Even fewer apply a settings approach, which emphasizes changing the social, organizational, and environmental contexts in which people live, work, and learn. The Okanagan Charter: An International Charter for Health Promoting Universities and Colleges (The Charter) calls on HEIs to embed health into all aspects of campus life and institutional culture using a settings-based, whole university lens. In the U.S., where public health efforts often emphasize individual behavior change, this approach remains underexplored and unevenly applied.</p><p dir="ltr">This qualitative case study examines how U.S. HEIs that have adopted the Okanagan Charter interpret and integrate settings approaches to health promotion. The study explores alignment with the Charter’s calls to action, identifies facilitators and barriers to integration, and gathers recommendations to enhance settings-level integration among aspiring health promoting campuses. Data were collected in two phases: document analysis of materials submitted to the United States Health Promoting Campuses Network (USHPCN) and semi-structured interviews with campus representatives. Thematic analysis was conducted using MAXQDA® software, applying both a priori and emergent codes.</p>