Trial reportImplementation science : IS2025
Mechanisms of change of a multifaceted implementation strategy on fidelity to a guideline for the prevention of mental health problems at the workplace: a mechanism analysis within a cluster-randomized controlled trial.
Trial report in Implementation science : IS, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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
2 citing papers in PubMed.
- The roads towards fidelity: a mixed-method study of mechanisms of a multifaceted implementation strategy to improve implementation of a guideline for the prevention of mental Ill-health at the workplace in a school setting.Implementation science communications · 2026Article
- Implementation fidelity of Ethiopia's Malaria test-and-treat guideline amid a resurgence in Amhara Region: A mixed-methods study.PloS one · 2026Article
Corrections and comments
- Update of
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7 authors.
Funding
Abstract
backgroundOccupational guidelines exist to support workplaces with the prevention of mental health problems (MHP) among their staff. However, knowledge of effective implementation strategies to support their implementation is limited. This study experimentally tested whether a multifaceted implementation strategy - comprising an educational meeting, five workshops, implementation teams, small cyclical tests of change, and facilitation - improves fidelity to a guideline for preventing MHP in a school setting through the pathway of change of the Capability Opportunity Motivation-Behavior (COM-B)-model. To gain a more granular understanding of the mechanisms of change, the Theoretical Domains Framework (TDF) was used to specify mediators related to capability, opportunity, and motivation. This study tested whether the multifaceted strategy versus a discrete strategy (1) improves fidelity, (2) enhances capability, opportunity, and motivation over time, and (3) if the strategy's effect on fidelity is mediated by capability, opportunity, and motivation.
methodsFifty-five schools were randomly assigned to a multifaceted strategy or a discrete strategy. Fidelity was measured by questionnaires at baseline and 12 months, while capability, opportunity, and motivation were assessed three times within this period (directly after the educational meeting and at three and nine months). The Determinants of Implementation Behavior Questionnaire was used to assess TDF hypothesized mediators corresponding to the COM-B components. Separate pathways were analyzed for each mediator. Linear Mixed Modeling was employed to test the strategy's effect on fidelity, and mediation analyses were conducted using the PROCESS Macro.
resultsThe multifaceted strategy led to improved fidelity at 12 months (B = 2.81, p < .001). Multifaceted schools reported higher scores for all mediators after nine months compared to schools receiving the discrete strategy. The effect of the multifaceted strategy on fidelity was partially mediated by all TDF mediators (p = < .05) except for beliefs about consequences. Capability-related mediators, including skills (Proportion-mediated = 41%, p = < .01) and behavioral regulation (Proportion-mediated = 35%, p = < .001), accounted for the largest proportion of the effect, followed by the motivation-related mediator goals (Proportion-mediated = 34%, p = < .01).
conclusionsThe multifaceted strategy improved guideline fidelity by enhancing capability, opportunity, and motivation confirming the proposed function of COM-B. This study addresses calls for experimental evidence on how multifaceted implementation strategies achieve implementation outcomes.
trial registrationClinicalTrials.org dr.nr 2020-01214.
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