Further quantitative research is needed to investigate relations between appreciation by target group members and programme implementers, completeness of programme implementation and programme adherence.
The traceability between the theory, numerical algorithms, and implementation facilitates achieving completeness and consistency, as well as simplifies the process of verification and the associated certification.
To evaluate the completeness, implementation and understanding of the methodology, PAHO professionals participated in all stages of the evaluation.
Using a mixed-methods approach, the focus was on fidelity (quality of implementation), dose delivered (completeness), dose received (exposure and satisfaction), reach (participation rate), recruitment, and context.
The process evaluation plan was structured using the theoretical elements 'fidelity' (quality of implementation), 'dose delivered' (completeness), 'dose received' (exposure; satisfaction), 'reach' (participation rate), 'recruitment', and 'context' as proposed by Saunders and colleagues [ 19], as well as the Normalisation Process Model [ 22] to explore the element 'context' in greater detail.
The process evaluation plan was designed according to seven theoretical elements proposed by Saunders and colleagues [ 21], as adapted from Baranowski and Stables [ 22] and Linnan and Steckler [ 23]: fidelity (quality of implementation), dose delivered (completeness), dose received (exposure; satisfaction), reach (participation rate), recruitment, and context.
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.
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.
