Driessen-Willems Marion D, Bartelink Nina H M, Bessems Kathelijne M H H, Kremers Stef K, van Assema Patricia
Department of Health Promotion, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands.
J Sch Health. 2025 Jun;95(6):423-432. doi: 10.1111/josh.70009. Epub 2025 May 4.
Implementation of school-based health promotion programs requires contextual fit. To strengthen the nutrition education program "Krachtvoer" (ENG: "Power Food") and learn general lessons about contextual fit, this study examined how the program, the context, and program-context interactions affected teachers' balancing between implementation fidelity and adaptation.
As part of a co-creation process with continuous micro-process cycles of implementing, measuring, evaluating, and adapting the program, action-oriented research was conducted during the pilot implementation of program modules by 25 teachers in 32 classes with 635 students. Using observations and interviews, data were collected about indicators of the implementation process, technology, layout, and content aspects of the program, inner and broader school contextual factors including teacher, student, and school characteristics, and interactions between program- and context-related aspects that influence the implementation process.
Even small mismatches between the program and the context affected the implementation process. Differences in the technological savviness of teachers and students, "adaptive management" skills to respond to changing circumstances of teachers, and the maturity and attention span of students were among the many contextual differences in and between schools.
IMPLICATION FOR SCHOOL-BASED HEALTH PROMOTION: Sustainability of health promotion programs fitting the context requires continuous and co-creating efforts from all stakeholders.
Action-oriented research with micro-process cycles proved appropriate for strengthening the program. However, further research is needed on capacity building among program implementers in balancing fidelity and adaptation.
实施校本健康促进项目需要与具体情境相契合。为了加强营养教育项目“Krachtvoer”（英文：“Power Food”）并汲取有关情境契合的一般性经验教训，本研究考察了该项目、情境以及项目与情境的相互作用如何影响教师在实施保真度和适应性之间的平衡。
作为一个包含实施、测量、评估和调整项目的持续微观过程循环的共创过程的一部分，在25名教师于32个班级对635名学生进行项目模块试点实施期间开展了行动导向研究。通过观察和访谈，收集了关于项目实施过程、技术、布局和内容方面的指标数据，学校内部和更广泛的情境因素，包括教师、学生和学校特征，以及影响实施过程的项目与情境相关方面之间的相互作用的数据。
即使项目与情境之间存在细微的不匹配也会影响实施过程。教师和学生在技术熟练程度上的差异、教师应对不断变化情况的“适应性管理”技能，以及学生的成熟度和注意力持续时间，都是学校内部和学校之间存在的众多情境差异。
适合情境的健康促进项目的可持续性需要所有利益相关者持续的共创努力。
具有微观过程循环的行动导向研究被证明适合加强该项目。然而，在项目实施者在平衡保真度和适应性方面的能力建设方面还需要进一步研究。
