Abstract
Abstract
Background
Curriculum policies addressing health and life skills pose challenges for implementation research because implementation depends on local interpretation and professional judgement rather than uniform content, dosage, or delivery. Existing implementation measures, often developed for standardised interventions, may therefore be poorly suited to capturing how such policies are interpreted and enacted across school-system levels. This study describes the development and content validation of the Health and Life Skills Implementation Assessment (HLS-IA), designed to assess a nationwide curriculum policy across school-owner, school-leader, teacher, and classroom-practice levels.
Methods
Development combined implementation frameworks and reviews of existing measures with stakeholder involvement, two expert workshops, 17 cognitive interviews, and technical and quantitative pilot testing. These iterative procedures examined the relevance, comprehensibility, applicability, and practical feasibility of the questionnaires and informed successive revisions.
Results
The development process resulted in four coordinated HLS-IA questionnaires addressing implementation determinants, processes, and outcomes. The questionnaire targeting classroom practice is administered repeatedly as a lesson-based teacher log and distinguishes planned from enacted practice. Stakeholder involvement shaped both the implementation domains prioritised for assessment and the contextual framing of individual items. Expert appraisal, cognitive interviews, and pilot testing identified problems concerning redundancy, school terminology, interpretation, applicability, response options, and questionnaire routing, leading to the removal, reformulation, and refinement of items and response formats. The first national application in 2025 included responses from approximately 458 schools, demonstrating the practical feasibility of coordinated multilevel data collection while also highlighting recruitment challenges.
Conclusions
Developed through content-validation procedures, the HLS-IA provides a basis for examining how organisational and contextual conditions shape the local enactment of health- and life-skills-related aims in schools and for subsequent psychometric evaluation. The study also offers transferable methodological guidance for assessing complex health-promoting policies implemented through existing public institutions, particularly when professional judgement, local adaptation, and coordination across system levels are integral to implementation.