Long Live Love. The implementation of a school-based sex-education program in the Netherlands Lisette Schutte 3 *, Ree M. Meertens 2 , Fraukje E. F. Mevissen 3 , Herman Schaalma 3 , Suzanne Meijer 1 and Gerjo Kok 3 1 Department of Youth, STI AIDS Netherlands, The Netherlands, 2 Department of Health Promotion, Nutrition and Toxicology Research Institute Maastricht (NUTRIM) and Care and Public Health Research Institute (Caphri), Maastricht University and 3 Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands. *Correspondence to: L. Schutte. E-mail: lisette.schutte@maastrichtuniversity.nl Received on May 1, 2013; accepted on April 8, 2014 Abstract Implementation of health education programs is often inadequately considered or not considered at all in planning, developing and evaluating interventions. With the focus being predomin- antly on the adoption stage, little is known about the factors influencing the implementation and continuation stages of the diffusion process. This study contributes to the understanding of factors that promote or impede each stage of the diffusion process in the school setting using the sex education program Long Live Love (LLL) as an example. A survey integrating different diffusion-related concepts was com- pleted by 130 teachers. Results showed that teacher curriculum-related beliefs were associated with all stages in the diffusion process. Although adoption of LLL was predominantly related to teacher curriculum-related beliefs, im- plementation completeness and fidelity and continued use of LLL were also enhanced by con- textual factors, namely teacher training and interactive context variables (school policy, governing body support and student response), respectively. The results of this study can be used to optimize the adoption, implementation and continuation of school-based (sexual) health promotion programs. Introduction School-based sex-education programs are the pri- mary means by which adolescents in the Netherlands receive information and skills related to safe sex, communication about sex and managing relationships [1]. A multitude of interventions have been developed globally for sex education of young- sters in school [2, 3]. Although sometimes proven effective, other interventions show only short-term or no effects [1, 4]. Besides due to an ineffective content, these inconsistent findings may also be ex- plained by inadequate implementation. Not being completely or correctly implemented can greatly undermine the effectiveness of an intervention [5]. Indeed, the impact of school-based health education programs is often attenuated by inadequate teacher implementation [6]. Implementation is thus a crucial aspect of planning and delivering successful health education programs yet it receives insufficient atten- tion [5, 7, 8]. There are few published accounts of the process of implementation of interventions once they have been formally adopted by schools, particularly in relation to sex education. Little is known about if, how or how well the material is covered. Research conducted in the implementation field has tended to focus primarily on the adoption stage [9]. Considerably less effort has been devoted to HEALTH EDUCATION RESEARCH 2014 Pages 1–15 ß The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com doi:10.1093/her/cyu021 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. Health Education Research Advance Access published May 10, 2014 at Maastricht University on May 11, 2014 http://her.oxfordjournals.org/ Downloaded from