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Background To ensure the effectiveness of school-based anxiety, depression and suicide prevention programmes, implementation fidelity, defined as the degree to which interventions are implemented as intended, is crucial. A comprehensive overview of fidelity measurements in these programmes is currently lacking, limiting the ability to compare and improve implementation efforts. This is particularly challenging in the context of scaling up prevention programmes, where ensuring both high-quality implementation and widespread adoption often proves insufficiently successful. With this review we aimed to (1) examine the extent to which fidelity measures were used and reported in existing studies of school-based anxiety, depression and suicide prevention programmes; (2) identify which fidelity components were measured; and (3) evaluate the quality of the fidelity measurements. Methods A systematic search was conducted across PubMed, PsycINFO, Medline, and ERIC using an AND-combination of search terms related to schools, adolescents, depression and interventions. Two researchers screened the selected articles, with discrepancies resolved by a third. Pre-defined inclusion criteria were used based on school-based prevention programmes, controlled trials, and psychological intervention techniques. For data extraction, fidelity components were extracted together with the methods for fidelity measurement. The quality of the measurements was assessed using criteria used in earlier fidelity research. Results Of 13,131 identified articles, 190 met our inclusion criteria. Of these, 72 (38%) measured at least one fidelity component, most commonly adherence (57, 79%), followed by responsiveness (24, 33%), dosage (19, 26%), and quality of delivery (9, 13%). Programme differentiation was not measured. The quality of fidelity measurements was most frequently moderate for adherence (65%), dosage (53%), and quality of delivery (56%), but low for responsiveness (79%). Conclusion Most school-based anxiety, depression, and suicide prevention programmes lack fidelity measurements, and existing assessments are often of moderate to low quality. To improve fidelity measurement, future research should prioritise the development of standardised methods with clear definitions and practical tools for assessing fidelity components. Embedding fidelity as a central element in study designs is essential to better link implementation efforts to intervention outcomes and to fully understand and optimise programme effectiveness, while ensuring that fidelity can be feasibly monitored in real-world settings.

Abstract Medical Advice for Sick-reported Students (MASS) is an intervention that aims to reduce medical absenteeism and prevent dropout among students. The current study reports on a process evaluation of the implementation of MASS at a vocational school in the Netherlands. The evaluation included the implementation process, fidelity, context, and participant satisfaction. The study had a qualitative case study design. Data was gathered through semi-structured interviews with relevant stakeholders, including a child and youth healthcare physician, MASS coordinators, career advisors, mentors, and students with concerning sickness absence. MASS was largely implemented as intended, but some deviations from the original intervention were found. For example, not all mentors identified concerning sickness absence through recommended criteria. A fit between the intervention and the values of the involved organizations was found. Facilitating contextual factors were identified, such as a perceived need for reducing school absence recognized within the care network, as well as hampering contextual factors, for example the limited visibility of students’ absence during the COVID-19 pandemic. Participants were generally satisfied with MASS and its implementation. Overall, MASS was implemented well according to interviewees, but several improvement points for both the implementation and execution of MASS were identified. These include full implementation across the setting, providing and repeating necessary trainings, minimizing administrative burden, and securing financial and human resources for sustainment of the intervention. These points could help to guide future implementation efforts, as they may help to overcome common barriers to implementation. Lay Summary Medical Advice for Sick-reported Students (MASS) is an intervention that aims to reduce sickness absence and prevent dropout among students. The current study looked at how this intervention was put to practice at a vocational school in South Limburg, The Netherlands. For this, interviews were conducted with people from the vocational school and the Public Health Services (GGD) South Limburg who were involved in MASS, including a child and youth healthcare physician, MASS coordinators, students, career advisors, and mentors. These interviews showed that overall, MASS was used in practice as intended, it fitted well with the vocational school and the GGD, and most people involved were satisfied with the intervention and how it was put to practice. However, several improvement points for future use were identified as well. These improvement points can help improve MASS at the vocational school in The Netherlands, and could also be useful for other public health interventions.