van Pelt Dominique, Mérelle Saskia, Jenniskens Kristel, Creemers Daan, Spijker Jan, van Vuuren Leonie, van Nassau Femke, Popma Arne, Rasing Sanne
Behavioural Science Institute, Radboud University, Nijmegen, Netherlands.
113 Suicide Prevention, Amsterdam, Netherlands.
BMC Public Health. 2025 Sep 1;25(1):3002. doi: 10.1186/s12889-025-24219-5.
To ensure the effectiveness of school-based anxiety, depression and suicide prevention programmes, implementation fidelity, defined as the degree to which interventions are implemented as intended, is crucial. A comprehensive overview of fidelity measurements in these programmes is currently lacking, limiting the ability to compare and improve implementation efforts. This is particularly challenging in the context of scaling up prevention programmes, where ensuring both high-quality implementation and widespread adoption often proves insufficiently successful. With this review we aimed to (1) examine the extent to which fidelity measures were used and reported in existing studies of school-based anxiety, depression and suicide prevention programmes; (2) identify which fidelity components were measured; and (3) evaluate the quality of the fidelity measurements.
A systematic search was conducted across PubMed, PsycINFO, Medline, and ERIC using an AND-combination of search terms related to schools, adolescents, depression and interventions. Two researchers screened the selected articles, with discrepancies resolved by a third. Pre-defined inclusion criteria were used based on school-based prevention programmes, controlled trials, and psychological intervention techniques. For data extraction, fidelity components were extracted together with the methods for fidelity measurement. The quality of the measurements was assessed using criteria used in earlier fidelity research.
Of 13,131 identified articles, 190 met our inclusion criteria. Of these, 72 (38%) measured at least one fidelity component, most commonly adherence (57, 79%), followed by responsiveness (24, 33%), dosage (19, 26%), and quality of delivery (9, 13%). Programme differentiation was not measured. The quality of fidelity measurements was most frequently moderate for adherence (65%), dosage (53%), and quality of delivery (56%), but low for responsiveness (79%).
Most school-based anxiety, depression, and suicide prevention programmes lack fidelity measurements, and existing assessments are often of moderate to low quality. To improve fidelity measurement, future research should prioritise the development of standardised methods with clear definitions and practical tools for assessing fidelity components. Embedding fidelity as a central element in study designs is essential to better link implementation efforts to intervention outcomes and to fully understand and optimise programme effectiveness, while ensuring that fidelity can be feasibly monitored in real-world settings.
The online version contains supplementary material available at 10.1186/s12889-025-24219-5.
为确保以学校为基础的焦虑、抑郁和自杀预防计划的有效性，实施保真度（定义为干预措施按预期实施的程度）至关重要。目前缺乏对这些计划中保真度测量的全面概述，限制了比较和改进实施工作的能力。在扩大预防计划的背景下，这尤其具有挑战性，因为确保高质量实施和广泛采用往往不够成功。通过本综述，我们旨在：（1）研究在现有的以学校为基础的焦虑、抑郁和自杀预防计划研究中，保真度测量的使用和报告程度；（2）确定测量了哪些保真度组成部分；（3）评估保真度测量的质量。
在PubMed、PsycINFO、Medline和ERIC数据库中进行系统检索，使用与学校、青少年、抑郁和干预相关的检索词进行“与”组合检索。两名研究人员筛选选定的文章，如有分歧由第三名研究人员解决。根据以学校为基础的预防计划、对照试验和心理干预技术，使用预先定义的纳入标准。在数据提取方面，提取保真度组成部分以及保真度测量方法。使用早期保真度研究中使用的标准评估测量的质量。
在13131篇已识别的文章中，190篇符合我们的纳入标准。其中，72篇（38%）测量了至少一个保真度组成部分，最常见的是依从性（57篇，79%），其次是响应性（24篇，33%）、剂量（19篇，26%）和实施质量（9篇，13%）。未测量计划差异。依从性（65%）、剂量（53%）和实施质量（56%）的保真度测量质量大多为中等，但响应性的测量质量较低（79%）。
大多数以学校为基础的焦虑、抑郁和自杀预防计划缺乏保真度测量，现有的评估质量往往为中等或较低。为了改进保真度测量，未来的研究应优先开发具有明确定义的标准化方法和用于评估保真度组成部分的实用工具。将保真度作为研究设计的核心要素至关重要，以便更好地将实施工作与干预结果联系起来，并充分理解和优化计划效果，同时确保在现实环境中能够切实可行地监测保真度。
在线版本包含可在10.1186/s12889-025-24219-5获取的补充材料。
