The Health Promoting University (HPU) concept encourages universities to incorporate health into the university culture, processes and policies in an effort to promote the health of the university community. Universities worldwide have adopted the approach and a framework for action has been developed to guide universities to become a HPU. However, information on how universities translate the framework into actions is scarce. This study explored the way in which 54 universities from 25 countries across the world implemented the HPU framework. An online questionnaire was used to assess the action areas and items of work addressed by the universities and to determine their adherence to the components of the HPU framework: use of the whole systems approach; multiservice collaboration; recognition by the university authorities; funding availability; membership of a HPU network and evaluation of the initiative. The results showed that these components were addressed by most universities. A Multi Correspondence and cluster analysis identified four types of universities based on the implementation of the components: ‘emerging’ HPUs that are not recognized by the university authorities and tend to not apply the whole systems approach or evaluation of the initiative, and ‘established’ HPUs that are recognized by the authorities, apply the whole systems approach and evaluate the initiative but that differ with regard to funding and membership of a HPU network. These results demonstrate that universities implement the HPU framework for action differently in order to become a Health Promoting University.