Implementation evaluation of an iron supplementation programme in high-school students: the crosswise model

Objective: To evaluate the implementation of the national health promotion programme (through nutritional education and Fe supplementation) among female high-school students in Iran and to assess the application of the crosswise model (CM) for evaluating the programme's implementation. Design: Two cross-sectional surveys in female high-school students, one using the direct questioning (DQ) method and the other using the CM, were conducted. Two survey questionnaires used to collect the data contained questions about three aspects of the programme: delivering the Fe supplements, consuming them and holding nutritional training sessions. Setting: Female high schools, West Azerbaijan Province, Iran. Participants: A sample of 2180 students, of whom 1740 were surveyed by the CM and 440 were interviewed by DQ. Results: The CM resulted in estimates that were consistently lower than the estimates of the DQ. The proportion of students in the DQ and CM who reported receiving the pills weekly and on a regular basis was 73 center dot 2 and 22 center dot 5 %, respectively. About 43 and 31 % of students in the DQ and CM surveys reported consuming all pills delivered to them. In the DQ method, only 12 % of students who reported the number of pills consumed had taken the complete dose (sixteen pills). Conclusions: Implementation of the Fe supplementation programme in female high schools was poor and insufficient, so that it seems unsuccessful in reducing Fe-deficiency anaemia in adolescent girls. The CM might be considered for evaluating the health programme's implementation at high schools.