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We studied the speed and completeness of implementation and the effect on pregnancy care practices including intrapartum antibiotic use, test ordering, and maternal and neonatal health.
Teacher appreciation proved potentially important for completeness of implementation.
Completeness of implementation was also assessed by means of the teacher logbooks.
Some moderately strong relations were found between teacher appreciation and completeness of implementation scores.
With regard to completeness of implementation only a few studies have measured completeness of implementation of specific programme elements, which is a strength of our study, making it more specific.
Levels of completeness of implementation were high, but several teachers did not adhere to the intended implementation period.
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Further quantitative research is needed to investigate relations between appreciation by target group members and programme implementers, completeness of programme implementation and programme adherence.
A significant negative relation was found between the number of optional activities implemented and the completeness of lesson implementation.
The moderately negative relation between the number of optional activities implemented and the completeness of lesson implementation (in terms of activities per lesson) indicates that some teachers may have favoured quantity over quality.
Data from these multiple sources will be triangulated to assess fidelity and completeness of intervention implementation in a manner similar to previous work by members of the investigative team [ 32, 33].
The only study which reported comparable measures of completeness of lesson implementation (in terms of activities per lesson) showed a slightly higher rate of 90% (similar to a score of 0.90 for our measure) [ 37], compared to our average rate of 0.70 for fixed lessons and 0.83 for optional activities.
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