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Predictors and mediators of sustainable collaboration and implementation in comprehensive school health promotion

Katharina K. Pucher (Department of Health Promotion, Maastricht University, Maastricht, The Netherlands) (Institute of General Practice and Family Medicine, Witten/Herdecke University, Witten, Germany)
Math J.J.M. Candel (Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands)
Nicole M.W.M. Boot (Department of Education and Research, Zuyd Hogeschool, Heerlen, The Netherlands)
Nanne K. de Vries (Department of Health Promotion and School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands)

Health Education

ISSN: 0965-4283

Article publication date: 3 January 2017




The Diagnosis of Sustainable Collaboration (DISC) model (Leurs et al., 2008) specifies five factors (i.e. project management, change management, context, external factors, and stakeholders’ support) which predict whether collaboration becomes strong and stable. The purpose of this paper is to study the dynamics of these factors in a study of multiple partnerships in comprehensive school health promotion (CSHP).


A Dutch two-year DISC-based intervention to support coordinators of five CSHP partnerships in the systematic development of intersectoral collaboration was studied in a pretest-posttest design. To uncover the determinants of sustainable collaboration and implementation of CSHP and to find possible mediators, the authors carried out multi-level path analyses of data on the DISC factors obtained from 90 respondents (response of approached respondents: 57 percent) at pretest and 69 respondents (52 percent) at posttest. Mediation mechanisms were assessed using joint significance tests.


The five DISC factors were important predictors of implementation of CSHP (explained variance: 26 percent) and sustainable collaboration (explained variance: 21 percent). For both outcomes, stakeholders’ support proved to be the most important factor. Regarding sustainable collaboration, mediation analysis showed that stakeholders’ support fully mediated the effects of change management, project management, external factors and context. This indicates that the extent of stakeholders’ support (e.g. appreciation of goals and high levels of commitment) determines whether collaboration becomes sustainable. The authors also found that the extent of stakeholders’ support in turn depends upon a well-functioning project management structure, the employment of change management principles (e.g. creation of a common vision and employment of appropriate change strategies), a favorable organizational context (e.g. positive experience with previous collaboration) and external context (e.g. positive attitudes of financing bodies and supporting health and educational policies). For the actual implementation of CSHP, partial mediation by the support factor was found. There was a direct positive effect of change management indicating that organizational knowledge is also necessary to implement CSHP, and a direct negative effect of project management, probably pointing to the negative effects of too much negotiation in the collaboration.

Research limitations/implications

A design lacking a control group, a small sample and a relatively early assessment after implementation support stopped limit the generalizability of the results.

Practical implications

Strategies targeting the DISC factors can enhance stakeholders’ support and thereby promote sustainable intersectoral collaboration and the implementation of CSHP.


The DISC model provides a fruitful conceptual framework for the study of predictors and processes in public health partnerships. The importance of stakeholders’ support and other factors in the model are demonstrated.



Pucher, K.K., Candel, M.J.J.M., Boot, N.M.W.M. and de Vries, N.K. (2017), "Predictors and mediators of sustainable collaboration and implementation in comprehensive school health promotion", Health Education, Vol. 117 No. 1, pp. 2-23.



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