Table 4 Summary of data reported for achieving adequate implementation (propositions four and five)

Proposition four: Adequate implementation

Quantitative descriptions of the intervention implementation, the amount and extent of engagement, include:

1. duration (time period);

2. intensity (depth of engagement such as passive receipt of information, interaction, or an environmental change);

3. exposure (total educational time, total minutes/hours/years of exposure);

4. investment (direct funding or in-kind contributions from various sources);

5. reach (e.g., total number of participants, proportion of population)

General information was often reported on the targeted audience rather than the reach (estimated numbers or proportions receiving intervention)

'Programme activities are usually simple and practical in order to facilitate their enactment by the widest spectrum of the community. Rather than the highly sophisticated services are generally simple basic services for a few people, simple basic services are generally provided for the largest possible stratum of the population' [30: p.48]

'All eighth graders enrolled in public schools' [34: p.219]

Duration was generally reported for the overall program; total time for specific interventions was reported less frequently.

A TV series of 15 programmes called 'Key to Health' was broadcast during the 1984–85 school year.' [30: p.300]

'Systematic risk factor screening and education were conducted during the first 3 years of the intervention program' [35: p.202]

'first intervention – competition: took place over a 4 week community-wide competition' [34: p.219]

Descriptions provided regarding the depth of engagement, including the passive receipt of information, to interaction, and environmental change

'The following list gives some idea of the extent to which print media were exploited during the five first years of the project (1972–77): local newspaper articles (877.000 column mm) 1509;...Health education leaflets (series of five) 278.000 copies...' [30: p.279]

'Activities were experiential – designed to require active participation' [37: p.1211]

'Activity was encouraged through a competition...role modeling...and environmental change' [34: p.219]

Challenges to reporting cost and cost-benefits, as well as information regarding investment were described.

In evaluating the smoking component, cost-benefits were not calculated based on per-capita investment because a) cost of the smoking programme and its administration is 'impossible to estimate, or differentiate from usual operation', and b) the 'cost to some unites such as volunteers is not calculated' because of 'difficulty estimate it' [39: p.131]

'In 1990 the North Karelia Project employed nine full-time and eight part-time field office staff, who worked a total of over 18 000 hours that year' [30: p.66]

'The money to employ staff and finance the work has come from various sources' [39: p.72]

Proposition five: Appropriate implementation

Qualitative descriptions regarding the quality of the intervention including:

1. fidelity (implementing all essential components of interventions as intended)

2. alignment with changing context (to ensure best fit);

3. implementing the most potent 'active ingredients'.

No explicit data reported regarding the quality of implementation

Descriptions regarding the quality of implementation were implicit, embedded in reporting of:

1. program features, such as priority setting or strategies undertaken to enhance quality implementation

2. explanations for problems with intervention fidelity relevant to explaining the results.

'One third (1/3) of the budget was dedicated to funding well-defined projects initiated locally that serve the objective of the program....' [38: p.17]

'Over its 20 years, the project has initiated or been otherwise involved in hundreds of training seminars. Although the nature of the seminars has changes, the focus has always been the discussion of practical tasks (derived for the objectives), action needed, and progress and feedback.' [30: p.278]

'After [the early years of the project ] it became both possible and necessary to introduce more specialized services to support the basic activities. These were prepared and tested by the project and implemented gradually'. [30: p.274]