Exploring determinants of completeness of implementation and continuation of a Dutch school-based healthy diet promotion programme

Implementation strategy for the school-based sex education program Long Live Love

“…Several studies revealed that there is an implementation problem among teachers but teachers themselves do not perceive this sub-optimal implementation behavior as a problem (Bessems et al, 2014;Peters et al, 2009;Dusenbury et al, 2003;Dusenbury, Brannigan, Hansen, Walsh, & Falco, 2005;Martens, Van Assema, Paulussen, Schaalma, & Brug, 2006). In the case of LLL, teachers did not deliver lessons completely and according to the goals of program designers but teachers did not perceive this behavior as problematic or as a necessity to effectively provide the lessons.…”

“…The effect of these programs on the health of the youth is, besides the quality of the program itself, also dependent on the quality of implementation. The reach and implementation of school-based health promotion programs is, however, not optimal (Bessems, van Assema, de Vries, & Paulussen, 2014;Peters, Kok, Ten Dam, Buijs, & Paulussen, 2009;Schutte et al, 2014;Forman et al, 2009). Figure 1 shows the implementation process of school-based programs when program developers do not intervene in the process; only 70% of the target population is aware of the program, 50% decide to use it (adoption), 30% actually use it (implementation), and a small 10% continues to use the program in the long-run (continuation) (Paulussen, Kok, Schaalma, & Parcel, 1995;Paulussen, Kok, & Schaalma, 1994).…”

“…Teachers describe their implementation behavior as making a selection of program components, adjusting the program with their own additions, not delivering the program in its entirety, limited use of the teacher manual and a lack of planning, preparation and evaluation. This suboptimal implementation behavior may lead to reduced program effectiveness (Bessems et al, 2014;Peters et al, 2009 An inability to adequately deal with these difficulties can negatively interfere with optimal implementation of SRH programs. According to the respondents, teachers providing SRH lessons may encounter the following difficulties: (1) Barriers to creating a safe and trusted atmosphere in the classroom (2) Feelings of shame or a closed attitude towards sexuality (3) Dealing with personal questions asked to them or to other students (4) Coping with individual student problems related to SRH (5) Dealing with homo negative reactions and behavior of students in the classroom (6) Anticipating on negative events on social media and internet among students in relation to SRH (7) Providing SRH lessons in a culturally-, gender-and sexually divers classroom.…”

“…Implementation of school-based health promotion programs is, however, not optimal (Bessems et al, 2014;Peters et al, 2009;Schutte et al, 2014). These programs are not implemented with sufficient strength and fidelity to produce measurable outcomes (Gottfredson & Gottfredson, 2002).…”

“…Teachers need support in every phase of the implementation process to enable them to effectively carry out the program in their lessons (Durlak & DuPre, 2008;Rohrbach, Gunning, Sun, & Sussman, 2010). Most interventions were aimed at supporting teachers in the awareness and adoption of the program but little is known or created to support teachers in the implementation phase (Bessems et al, 2014;Domitrovich & Greenberg, 2000;Durlak, 1998;Fagan & Mihalic, 2003). Support in this phase is crucial, however, for optimal program effectiveness (Domitrovich & Greenberg, 2000).…”