Table 8 Examples of cultural adaptations made to the overall intervention framework

Module 1: Establishment of the community platform

- Use of existing community platforms instead of creating a new one (e.g. Sweden): the Public Health council and the Child- and Youth steering council were platforms already meeting five to six times a year. These platforms cooperated to act as the community platform of the IDEFICS intervention.

- No establishment of a community platform (e.g. Italy): no community platform was created because of the involvement of four different municipalities in the intervention region. To overcome this problem, the school working groups (one for each municipality) were extended with one (or more) representative(s) of the municipality administration (acting on behalf of the Major of the town) and with a representative of the National Health Service (a community pediatrician). One school working group was established in each community because the municipalities involved in the IDEFICS intervention were small towns with one or two primary (plus kindergarten) schools that therefore include the whole population living in the area.

Module 4: Establishment of the school working groups

- Creation of school working groups at the level of the school boards (e.g. Belgium): several schools can be authorized under the same school board. These schools are mostly located at different places in the community. All schools of the same board, have to follow the same school policy which means that they are not independently operating. Therefore, it was not possible to create a school working group in each school and school working groups were created at the level of the school boards. This means that in the Belgian intervention region, 11 school working groups were created representing 21 schools in total.

- No establishment of school working groups (Cyprus): as the school system is strictly regulated by the Ministry of education, no changes can be made in schools without going through the Ministry. Therefore, the intervention at school level was not independently implemented from the intervention at the community level. No school working groups were created but they were integrated in the community platform. The platform consists of two main parts: a first part includes the local authorities and stakeholders and a second part includes the authorities of each school. The first part of the platform is taking the decisions while the second part is responsible for the implementation.

Module 5: Integration of the key behaviours in the classroom activities and providing related homework activities

- Adaptations to the timing of the healthy weeks because of a different timing of (summer) holidays across European countries (e.g. start of the healthy weeks in September in Sweden and in October in Belgium).

- Adaptation to the sequence of the healthy weeks based on local situations (e.g. Sweden): the healthy week about sleep duration was removed from June to September because an average day in June has about 20 hours of daylight which makes it complicate to talk about sleep duration.