The evaluation of programme implementation has a critical role to play in advancing knowledge and practice in mental health promotion. While much progress has made in recent years in establishing a sound evidence base for mental health promotion (Hosman and Jané-Llopis,1999; Friedli, 2003), research on programme implementation has been relatively neglected. The published research studies and systematic reviews are mainly concerned with programme outcomes and provide little or no data on implementation or the quality of programme delivery necessary for positive outcomes to be produced (Durlak, 1998; Dane and Schneider, 1998; Domitrovich and Greenberg, 2000). As a result there is a dearth of published information to guide practitioners and decision-makers regarding the practical aspects of programme adoption and replication. From those studies that have
monitored implementation, it is clear that implementation is often variable and imperfect in field settings. Durlak (1998) cautions that programmes may not be implemented with a high degree of fidelity and that between 23% to 81% of programme activities may be omitted. When implementation is documented it is clear that the level and quality of implementation influences programme effectiveness and that higher quality implementation is associated with stronger, more positive outcomes (Dane and Schneider, 1998; Durlak, 1998; Domitrovich and Greenberg, 2000; Mihalic, Fagan, Irwin, Ballard and Elliott, 2002).
Expanding the evidence base in order to inform the implementation of effective, feasible and sustainable programmes across diverse cultural contexts and settings is a key challenge in the mental health promotion area (WHO, 2002). This calls for a focus on researching the process of implementing programmes in naturalistic settings, i.e., outside of
controlled research conditions, and identifying the key factors and conditions which can facilitate high quality implementation. This is essential if the
area is to move to a new level of understanding and sophistication beyond the question of whether programmes work (efficacy), to also consider what
makes them work, with whom and under what circumstances (effectiveness). An increasing body of research has been devoted to establishing the efficacy and effectiveness of interventions through trials, mainly in high-income countries, and it is now timely to invest in community-based dissemination research in order to examine how evidence can be used effectively to guide the adoption and adaptation of interventions when applied across different cultural settings or used with different populations (Barry and McQueen, 2005, in press). In particular, there is an urgent need to identify how effective programmes derived from efficacy and effectiveness studies can be translated and sustained in low-income countries and in various settings such as schools and communities.