title: Exploring facilitating factors and barriers to the nationwide dissemination of a Dutch school-based obesity prevention program "DOiT": a study protocol.
abstract: BACKGROUND
  The evidence-based Dutch Obesity Intervention in Teenagers (DOiT) program is a school-based obesity prevention program for 12 to 14-year olds attending the first two years of prevocational education. This paper describes the study protocol applied to evaluate (a) the nationwide dissemination process of DOiT in the Netherlands, and (b) the relationship between quality of implementation and effectiveness during nationwide dissemination of the program in the Netherlands.
  
  
  METHODS
  In order to explore facilitating factors and barriers for dissemination of DOiT, we monitored the process of adoption, implementation and continuation of the DOiT program among 20 prevocational schools in the Netherlands. The study was an observational study using qualitative (i.e. semi-structured interviews) and quantitative methods (i.e. questionnaires and logbooks). Eight process indicators were assessed: recruitment, context, reach, dosage, fidelity, satisfaction, effectiveness and continuation. All teachers, students and parents involved in the implementation of the program were invited to participate in the study. As part of the process evaluation, a cluster-controlled trial with ten control schools was conducted to evaluate the effectiveness of the program on students' anthropometry and energy balance-related behaviours and its association with quality of implementation.
  
  
  CONCLUSIONS
  The identified impeding and facilitating factors will contribute to an adjusted strategy promoting adoption, implementation and continuation of the DOiT program to ensure optimal use and, thereby, prevention of obesity in Dutch adolescents.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN92755979.
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. f.vannassau@vumc.nl.
authors.forename: Femke
authors.initials: F
authors.lastname: van Nassau
authors.forename: Amika S
authors.initials: AS
authors.lastname: Singh
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
authors.forename: Theo G W M
authors.initials: TG
authors.lastname: Paulussen
authors.forename: Johannes
authors.initials: J
authors.lastname: Brug
authors.forename: Mai J M
authors.initials: MJ
authors.lastname: Chinapaw
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D002648:Child; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D009426:Netherlands; D063766:Pediatric Obesity / Q000517:prevention & control*; D015397:Program Evaluation; D036301:Qualitative Research; D012572:School Health Services / Q000458:organization & administration*; D013334:Students / Q000523:psychology* / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires