Initiating School-Based Health Programs: Management Perspectives from the Generation Healthy Kids Study

Abstract Effective implementation of school-based health program depends on successful pre-implementation, which may influence program adoption, delivery, and outcomes. Despite its importance, pre-implementation remains underexplored. The Generation Healthy kids (GHK) study examined factors influencing pre-implementation of a multicomponent health promotion program in Danish primary schools from a school management perspective using the Consolidated Framework for Implementation Research (CFIR). An online questionnaire was distributed to 43 school management representatives across 23 participating schools, including school leaders, vice principals, deputy heads, and department heads. In total, 37 representatives responded (86%). Questionnaire items reflected the CFIR 2.0 domains Inner setting and Implementation process . As CFIR-related items were administered only to intervention schools, the present analysis included 19 respondents from these schools: 12 school leaders and seven department heads (vice principals, deputy heads, and department heads). Fisher’s exact test was used to explore group differences. Descriptive differences were observed between school leaders and department heads. School leaders were more frequently identified logistical factors, including adequate facilities and preparation time, whereas department heads more frequently identified staff competency development and monitoring of staff engagement. Both groups identified school management support as relevant for pre-implementation. No statistically significant differences were found between groups. The findings suggest that perspectives on pre-implementation may vary across school management roles, although differences were not statistically significant and should be interpreted with caution. Considering multiple management perspectives may strengthen planning and support for implementation of school-based health programs. Future research should include broader stakeholder perspectives.