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Open AccessArticle

Implementation of KEIGAAF in Primary Schools: A Mutual Adaptation Physical Activity and Nutrition Intervention

Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 HA Maastricht, The Netherlands
Department of Industrial Design, Eindhoven University of Technology, 5612 AZ Eindhoven, The Netherlands
School of Sport Studies, Fontys University of Applied Sciences, 5644 HZ Eindhoven, The Netherlands
Academic Collaborative Center for Public Health, Public Health Service South-Limburg, 6400 AA Heerlen, The Netherlands
Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, 6229 GT Maastricht, The Netherlands
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(3), 751;
Received: 28 November 2019 / Revised: 20 January 2020 / Accepted: 22 January 2020 / Published: 24 January 2020
(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)
School health promotion is advocated. Implementation studies on school health promotion are less often conducted as effectiveness studies and are mainly conducted conventionally by assessing fidelity of “one size fits all” interventions. However, interventions that allow for local adaptation are more appropriate and require a different evaluation approach. We evaluated a mutual adaptation physical activity and nutrition intervention implemented in eight primary schools located in low socioeconomic neighborhoods in the Netherlands, namely the KEIGAAF intervention. A qualitative, multiple-case study design was used to evaluate implementation and contextual factors affecting implementation. We used several qualitative data collection tools and applied inductive content analysis for coding the transcribed data. Codes were linked to the domains of the Consolidated Framework for Implementation Research. NVivo was used to support data analysis. The implementation process varied greatly across schools. This was due to the high level of bottom-up design of the intervention and differing contextual factors influencing implementation, such as differing starting situations. The mutual adaptation between top-down and bottom-up influences was a key element of the intervention. Feedback loops and the health promotion advisors played a crucial role by navigating between top-down and bottom-up. Implementing a mutual adaptation intervention is time-consuming but feasible. View Full-Text
Keywords: school health promotion; implementation; context; adaptation; qualitative school health promotion; implementation; context; adaptation; qualitative
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Verjans-Janssen, S.R.; Gerards, S.M.; Verhees, A.H.; Kremers, S.P.; Vos, S.B.; Jansen, M.W.; Van Kann, D.H. Implementation of KEIGAAF in Primary Schools: A Mutual Adaptation Physical Activity and Nutrition Intervention. Int. J. Environ. Res. Public Health 2020, 17, 751.

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