The implementation of the Five Ways to Wellbeing innovation in 16 Norwegian schools: Lessons learned and future directions

Background The decline in adolescents’ mental health and wellbeing call for effective action, and teacher-delivered health promoting interventions represent a cost-effective approach with potential for universal reach. The Five Ways to Wellbeing framework has demonstrated effectiveness among adults but has not previously been implemented with children or adolescents. We adapted this framework into a school-based intervention called Five Ways to Wellbeing at School (5Ways@School) and implemented it in 16 schools with 3,324 students aged 10–16 years in Moss municipality, Norway. In this paper, we examine the implementation process and discuss how the intervention can be optimised for future use. Methods The 5Ways@School study employed a hybrid effectiveness-implementation design using a mixed methods approach. Data were collected through web-based questionnaires completed by students and teachers, supplemented by qualitative interviews with teachers, spanning November 2023 to December 2024. The study was longitudinal, two-armed, and non-randomised, with the intervention first administered to half of the students, while the remaining students served as a control group before receiving the intervention seven weeks later. This paper presents results based on questionnaires from 2,226 students and 113 teachers, analysed using descriptive statistics, analyses of variance (ANOVA), t-tests, and linear regression. Qualitative data from teachers’ free-text responses were analysed using thematic analysis (TA). Results User satisfaction with the intervention was moderate among students and teachers in Grades 5–7 but lower in Grades 8–10, particularly among teachers. Implementation fidelity was high across all grade levels. Teacher feedback indicated a need for greater flexibility to adapt the programme to classroom contexts, more age‑appropriate adjustments, and increased use of activity‑based learning. Conclusions The 5Ways@School programme is feasible but requires further refinement to enhance flexibility, support age‑appropriate adaptation, and incorporate more activity‑based content. Improving teacher engagement—especially in Grades 8–10—and more explicitly integrating the Five Ways into the broader school curriculum will be important for successful future implementation. Registry : ClinicalTrials.gov, TRN: NCT06144502, Registration date: 16 November 2023.