Health-promoting programs are increasingly introduced in schools, yet their successful implementation often varies widely from school to school. In this qualitative study, we explored which contextual factors facilitate or hinder schools in implementing health-promoting activities in a structured way, using the Plan–Do–Study–Act (PDSA) cycle as an implementation approach.
We conducted group interviews with staff and parents from nine primary schools that differed in size, location, and socioeconomic context. By systematically analyzing these discussions following the Consolidated Framework for Implementation Research (CFIR), we identified key factors that influenced how feasible and manageable schools perceived the structured implementation process to be. These included leadership support, shared values around health promotion, available time and staff resources, parental involvement, and especially schools’ prior experience with structured project implementation.
We used a visualization (a Matrix Heat Map) that allowed for comparison across schools and highlighted differences as well as commonalities of contextual factors as facilitators or barriers. One notable tendency that emerged was that schools with previous experience in structured improvement approaches reported fewer barriers and more facilitators when anticipating working with the PDSA cycle for the implementation of health promotion.
Overall, our findings show once more that school contexts are highly diverse and that structured implementation approaches need to be adapted to these differences. For practice, this means that health-promoting programs should not rely on one-size-fits-all solutions. Instead, implementation should be tailored to schools’ specific contexts, experiences, and capacities to foster successful health promotion. Further, we contributed to the field by providing a step-by-step description of our methodological procedure, highlighting it as a valuable approach for investigating implementation context across heterogenous settings.
Sterr, K., Cragun, D., Mess, F., Butscher, F., Singer, M. & Blaschke, S. (2026). Visualizing contextual determinants in and across heterogeneous settings: a qualitative study on structured school health promotion implementation. Implement Sci Commun 7, 13. https://doi.org/10.1186/s43058-026-00861-x