Long Live Love. The implementation of a school-based sex-education program in the Netherlands

Abstract

Implementation of health education programs is often inadequately considered or not considered at all in planning, developing and evaluating interventions. With the focus being predominantly on the adoption stage, little is known about the factors influencing the implementation and continuation stages of the diffusion process. This study contributes to the understanding of factors that promote or impede each stage of the diffusion process in the school setting using the sex education program Long Live Love (LLL) as an example. A survey integrating different diffusion-related concepts was completed by 130 teachers. Results showed that teacher curriculum-related beliefs were associated with all stages in the diffusion process. Although adoption of LLL was predominantly related to teacher curriculum-related beliefs, implementation completeness and fidelity and continued use of LLL were also enhanced by contextual factors, namely teacher training and interactive context variables (school policy, governing body support and student response), respectively. The results of this study can be used to optimize the adoption, implementation and continuation of school-based (sexual) health promotion programs.

Implementation strategy for the school-based sex education program Long Live Love

“…The effect of these programs on the health of the youth is, besides the quality of the program itself, also dependent on the quality of implementation. The reach and implementation of school-based health promotion programs is, however, not optimal (Bessems, van Assema, de Vries, & Paulussen, 2014;Peters, Kok, Ten Dam, Buijs, & Paulussen, 2009;Schutte et al, 2014;Forman et al, 2009). Figure 1 shows the implementation process of school-based programs when program developers do not intervene in the process; only 70% of the target population is aware of the program, 50% decide to use it (adoption), 30% actually use it (implementation), and a small 10% continues to use the program in the long-run (continuation) (Paulussen, Kok, Schaalma, & Parcel, 1995;Paulussen, Kok, & Schaalma, 1994).…”

“…Further description of and foundation for this framework can be found in Schutte et al, (2014). At baseline (T0) we measured background characteristics of the teachers, including (SRH/LLL) teaching experience and their LLL-curriculum related beliefs, and student response.…”

“…In school-based sexual health promotion, teachers are the key players for the implementation of these programs. Their implementation is, however, often sub-optimal; Programs are not being implemented completely or with sufficient fidelity to produce measurable outcomes (Bessems et al, 2014;Gottfredson & Gottfredson, 2002;Hoekstra et al, 2009;Peters et al, 2009;Schutte et al, 2014). There is a need for greater attention to the quality of implementation and its related determinants, namely teachers' beliefs about the innovation and characteristics of the innovation, organisational factors and characteristics of the implementationenhancing intervention (Fagan & Mihalic, 2003;Paulussen et al, 1995;Schutte et al, 2014).…”

“…To stimulate the correct implementation, with completeness and fidelity, of the (revised) school-based sex education program 'Long Live Love' (LLL) (Schaalma et al, 1996;Schutte et al, 2014), an e-coaching intervention ('lesgeveinindeliefde.nl' -'teachinglove.nl') was systematically developed (Schutte, van den Borne, Kok, Meijer, & Mevissen, 2016). The e-coach aimed to improve teachers' implementation behavior through self-reflection and skills development.…”

“…Implementation is, however, often sub-optimal (Bessems et al, 2011;Peters et al, 2009;Schutte et al, 2014); programs are not being implemented completely or with sufficient fidelity to produce measurable outcomes (Gottfredson & Gottfredson, 2002;Hoekstra et al, 2009). …”