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Table 2 Effect of factors on the implementation of the programme at district / community level, and other factors which moderate key factor effect

From: Implementation of health promotion programmes in schools: an approach to understand the influence of contextual factors on the process?

Key factor: Implication of trainers at district and community level
Moderator (mod) Effect on implication
Initiation by decision-maker Positive effect: facilitated coordination and upscaled available resources. End result was enhanced implication.
Negative effect: reluctance of staff to participate in the programme was due to a concern that their practice would be instrumentalized by political decision-makers. Participation was sometimes perceived as being imposed.
Level of delegation from institutional hierarchy Positive effect: more room for initiative on the part of district teams led to higher implication. The level of delegation was related to the intention of protecting the teams from an “intrusive” programme.
Institutional support from Head of Regional Education Authority Positive effect: promoted active participation of the health and social district departments.
Negative effect: implementation was perceived as following a top-down mode of introduction, and adding constraints. This created reluctance to participate in the programme.
Counter-balance: development of relationships between participants counterbalanced the fact that the programme was in most cases imposed by staff at higher decision-making levels. This factors enhanced motivation and implication.
Implementation area Negative effect: the area referred to electoral districts and not national education districts. This led to tensions and reluctance as all the schools which related to the same school district could not be enrolled.
Name of programme Negative effect: the name was unclear and determined reluctance to participate in the programme on the part of district teams
Key factor: Appreciation and accession to the programme
Moderator Effect on appreciation
Programme content Positive effect: overall, the programme was appreciated due to concreteness of its content “for the first time, we went into pragmatic and concrete things”.
Negative effect: suggestions for programme development include: more focus on pragmatic issues, more focus on the needs of the different schools at the very start of the programme. Only one district focused on how staff could engage in the use of the tools introduced during the training. The development of specific content depended on the district staff’s competency (e.g. relaxation sessions). This situation affected school staff’s appreciation of the programme negatively.
Training Positive effect: inclusion of training in the programme enhanced accession to the programme as staff felt the programme was in line with their expectations.
Key factor: Development of partnerships
Moderator Effect on development of partnerships
Institutional support Positive effect: support from the head of the Regional Education Authority was beneficial to the implementation of the training, and the development of partnership work with the Teacher Training College.
Implication of the Teacher Training College. Positive effect: implication of the Teacher Training College in train-the trainer sessions had a positive effect on the initiation of partnerships.
Moderating factor to implication of the training college: low implication of the Teacher Training Colleges was due to organizational and communication issues between the two institutions.
  1. Key factors were found to influence the results of the implementation process, factors also influenced the type of outcomes which resulted from programme implementation. Other factors were associated to this process. Such factors had different types of moderating effects. Moderators influenced the way in which key factors had an impact on implementation. Moderators may enhance (positively impact) or hinder (negatively impact) the effect of key factors on the implementation of the programme. They may also counter-balance the effect of a key factor, or have no influence at all (neutral effect)