Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun;95(6):423-432.
doi: 10.1111/josh.70009. Epub 2025 May 4.

Balancing Fidelity and Adaptation: Action-Oriented Research Towards Implementing a Nutrition Education Program Among Adolescents

Marion D Driessen-Willems  1 , Nina H M Bartelink  1 , Kathelijne M H H Bessems  1 , Stef K Kremers  1 , Patricia van Assema  1
Affiliations

Balancing Fidelity and Adaptation: Action-Oriented Research Towards Implementing a Nutrition Education Program Among Adolescents

Marion D Driessen-Willems et al. J Sch Health. 2025 Jun.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: action‐oriented research; adolescents; implementation fidelity and adaptation; nutrition education.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Conceptual framework of contextual fit [26].
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Langford R., Bonell C., Jones H., et al., “The World Health Organization's Health Promoting Schools Framework: A Cochrane Systematic Review and Meta‐Analysis,” BMC Public Health 15 (2015): 130, 10.1186/s12889-015-1360-y. - DOI - PMC - PubMed
    1. Suhrcke M. and de Paz Nieves C., The Impact of Health and Health Behaviours on Educational Outcomes in High‐Income Countries: A Review of the Evidence (World Health Organization, Regional Office for Europe, 2011).
    1. Rutter H., Savona N., Glonti K., et al., “The Need for a Complex Systems Model of Evidence for Public Health,” Lancet 390, no. 10112 (2017): 2602–2604, 10.1016/S0140-6736(17)31267-9. - DOI - PubMed
    1. Chambers D. A., Glasgow R. E., and Stange K. C., “The Dynamic Sustainability Framework: Addressing the Paradox of Sustainment Amid Ongoing Change,” Implementation Science 8 (2013): 117, 10.1186/1748-5908-8-117. - DOI - PMC - PubMed
    1. Glasgow R. E., Vogt T. M., and Boles S. M., “Evaluating the Public Health Impact of Health Promotion Interventions: The RE‐AIM Framework,” American Journal of Public Health 89, no. 9 (1999): 1322–1327, 10.2105/ajph.89.9.1322. - DOI - PMC - PubMed

LinkOut - more resources