ArticleBMC public health2018
Process evaluation of implementation fidelity in a Danish health-promoting school intervention.
Article in BMC public health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 27 citations in OpenAlex.
- Educational Programs for the Promotion of Health at School: A Systematic Review.International journal of environmental research and public health · 2021Pooled it
- A systematic review of the use and reporting of evaluation frameworks within evaluations of physical activity interventions.The international journal of behavioral nutrition and physical activity · 2020Pooled it
- A Health Promoting School Intervention in 10th Grade ("My Life - I Decide"): Protocol for a Pragmatic Controlled Trial.JMIR research protocols · 2026Trial
- Process evaluation of Project Daire: a food environment intervention that impacted food knowledge, wellbeing and dietary habits of primary school children.BMC public health · 2025Trial
- Implementation of the health promoting school program in Poland: results from a national cross-sectional study.BMC public health · 2026Article
- A Regional Scoping Review of School-Based Nutrition Interventions Conducted Across Nordic Countries.Health science reports · 2026Review
- Shared medication coordination in a social psychiatric residence: adaptation to meet local requirements.BMC psychiatry · 2025Article
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- Why Are Enrichment Practices in Zoos Difficult to Implement Effectively?Animals : an open access journal from MDPI · 2022Article
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- Evaluating Digital Program Support for the Physical Activity 4 Everyone (PA4E1) School Program: Mixed Methods Study.JMIR pediatrics and parenting · 2021Article
- Evaluation of the Direct Health Facility Financing Program in Improving Maternal Health Services in Pangani District, Tanzania.International journal of women's health · 2021Article
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background"We Act" is a health-promoting school intervention comprising an educational, a parental and a school component. The intervention was implemented in 4 Danish public schools with 4 control schools. The objectives were to improve pupils' dietary habits, physical activity, well-being and social capital using the Investigation, Vision, Action & Change (IVAC) health educational methodology. The target group was pupils in grades 5-6. The purpose of this study was to evaluate implementation fidelity and interacting context factors in the intervention schools.
methodsThe Medical Research Council's new guidance for process evaluation was used as a framework. Data were collected concurrently and evenly at the 4 intervention schools through field visits (n = 43 days), questionnaires (n = 17 teachers, 52 parents), and interviews (n = 9 teachers, 4 principals, 52 pupils). The data were analysed separately and via triangulation.
resultsA total of 289 pupils participated, and 22 teachers delivered the educational component in 12 classes. In all schools, the implementation fidelity to the educational methodology was high for the Investigation and Vision phases as the teachers delivered the proposed lessons and activities. However, the implementation fidelity to the Action & Change phase was low, and little change occurred in the schools. The pupils' presentation of their visions did not work as intended as an impact mechanism to prompt actions. The implementation of the parental and the school components was weak. The main context factors influencing implementation fidelity were a poor fit into the school-year plan and weak management support.
conclusionsAlthough 'We Act' was designed to comply with evidence- and theory-based requirements, IVAC and the health-promoting school approach did not result in change. The time dedicated to schools' preparation and competence development may have been too low. This must be considered in future process evaluation research on health-promoting schools and by school health promotion administrators when planning future school interventions.
trial registrationISRCTN85203017.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.