Discussion
SECONDARY
In the present study, we aimed to investigate whether there were
differences in the primary and secondary outcomes between the
multifaceted and discrete implementation strategy at 6 and 12 months.
Results showed no differences for either primary or secondary outcomes
at 6 months, while at 12 months differences between the groups were
found for most of the outcomes, however unexpectedly to the advantage of
the discrete group. Next, we examined whether the level of adherence was
related to changes in the organizational and social work environment in
schools, regardless of the group. Results showed that the level of
adherence to the guideline was associated with improvements in several
individual and organizational level outcomes at both 6 and 12 months,
ie, higher levels of adherence were related to better outcomes.When looking at the intervention effect at 12 months follow-up,
improvements in the primary outcome exhaustion and secondary outcomes
stress, recovery, work-life conflict and work engagement were to the
advantage of those schools receiving the discrete implementation
strategy. These findings are in line with the results on implementation
outcomes as reported previously in Toropova et al (Our findings on the association of guideline adherence and
health-related outcomes, psychosocial safety climate, and organizational
and social work-environment factors confirm the general assumption in
the field that intervention effectiveness is dependent on implementation
effectiveness; without successful implementation, intervention effects
are unlikely to occur (Our findings can be compared to those few studies of
organizational-level interventions that have been conducted within a
school-setting. A 2015 Cochrane systematic review on the effectiveness
of organizational-level interventions for improving well-being and
reducing work-related stress among teachers showed low-quality evidence
for improvements in teacher well-being (In line with the study by Bakhuys Roozeboom et al (