In recent years, the nutritional pattern of the Dutch adolescent has cautiously improved. However, progress can be gained if more Dutch adolescents adhere to the nutritional guidelines. School-based initiatives offer opportunities to deal with the unhealthy eating behaviours of adolescents via nutrition educational interventions. In designing and/or re-designing school-based interventions, it is important to enhance optimal context-oriented implementation adaptation by involving the complex adaptive school system. This paper elaborates on the way of dealing with the dynamic implementation context of the educational programme “Krachtvoer” (ENG: “Power food”) for prevocational schools, how the programme can be adapted to each unique implementation context, and how the programme can be progressively kept up to date. Following a co-creation-guided approach with various intersectoral stakeholders within and outside the school setting, action-oriented mixed research methods (i.e., observations, semi-structured interviews, focus group interviews, programme usage monitoring, and questionnaires) constantly provide input to develop the programme and its implementation strategy via continuous micro-process cycles. Successful co-creation of school-based health promotion seems to be dependent on proper intersectoral cooperation between research and practice communities, a national partner network that can provide project-relevant insights and establish capacity building aimed at improving contextual fit, and a time-investment balance in and between sectors.

PurposeAdapting the Health Promotion School (HPS) approach to context specifics is acknowledged as being essential for implementation and achieving optimal effectiveness. This study aims to explore implementation variations on seven HPS spectra (such as top-down to bottom-up involvement of stakeholders) on which implementation of the HPS approach can vary, and the factors that relate to navigation on these spectra.Design/methodology/approachIn 2020, fourteen HPS researchers and professionals from ten European countries participated in semi-structured interviews.FindingsNavigation variations on the HPS spectra occurred throughout most spectra. Further, a tendency was found towards spectrum extremes of addressing multiple core-components, implementing non-disruptive Health Promotion (HP) programmes, and evaluating the HPS approach through an action-oriented research approach. Important general factors were resources, staff capacity and time available to staff members for implementing the HPS approach. Some spectra required more specific factors like organisational skills, leadership or a certain level of democracy.Practical implicationsThe implementation of the HPS approach should be supported by implementation strategies addressing the spectrum-specific factors, but more generic factors such as staff capacity, resources and the level of democracy should also be considered.Originality/valueThis study explores navigation variations throughout HPS spectra rather than the HPS approach in general. It also nuances implementation diversity across and within different European contexts.

SamenvattingHet actief bevorderen van het implementatieproces van gezondheidsbevorderende interventies, waardoor deze in de praktijk voldoende en op de juiste wijze worden gebruikt, vereist een planmatige aanpak. Vele soorten implementatiestrategieën kunnen hiervoor worden ingezet, geselecteerd op basis van geïdentificeerde determinanten van het implementatieproces in de specifieke implementatiecontext. In het implementatieproces kunnen hierbij meerdere fasen worden onderscheiden, namelijk adoptie, daadwerkelijk gebruik, borging, opschaling en de-implementatie van de interventie. Dit artikel beschrijft welke implementatiestrategieën er zijn en worden ingezet om het implementatieproces van het lesprogramma Krachtvoer te bevorderen, een interventie over gezonde voeding voor leerlingen in de onderbouw van het vmbo. Tevens worden de bezoekersgegevens van de website Krachtvoer.nu gedurende de schooljaren 2019–2020, 2020–2021 en 2021–2022 gepresenteerd. Een reflectie op de aanpak benadrukt het belang van de kartrekkersrol van het domeinoverstijgende projectteam, de cocreatie met de gebruikers en de intersectorale samenwerking met het landelijke partnernetwerk. Een landelijk (financierings)beleid in Nederland ter ondersteuning van de borging van bewezen effectieve en goed implementeerbare gezondheidsbevorderende interventies wordt node gemist.