Measuring implementation of school programs and policies to promote healthy eating and physical activity among youth

Background. The measurement of program implementation and policy adoption is an essential evaluation component of any health intervention program. Data on program implementation are used to monitor program progress; identify elements of a program to be strengthened or eliminated; provide accountability; and help explain program effects. Method. This paper reviews approaches to measuring the implementation of school-based programs and policy to promote physical activity and healthful eating among youth. Areas examined include classroom instruction, food service, physical activity classes, and school policies. Operational definitions of implementation and methods of collecting data are described and compared. Results. Most implementation measures are focused on two dimensions: Quantity (dose or completeness) and quality (fidelity). Data collection methods include the use of teacher self-report recorded through check-lists, questionnaires, and interviews. Classroom observations by a trained observer are also used. Studies of policy development have used archival records and semi-structured interviews. Conclusions. Considerable variability exists across studies in how program of implementation is defined and measured. This is in part due to the need to tie measures closely to the content and format of the intervention. More work is needed to assess and compare the reliability and validity of various approaches to measuring implementation. (C) 2000 American Health Foundation and Academic Press.