Yes | Partly | No | |
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Intervention component 1: Please describe the intervention component in sufficient detail (specify content, duration, frequency, coverage if applicable) | |||
Did you use this item as described in terms of duration? (if applicable) | □ | □ | □ |
Did you use this item as described in terms of frequency? (if applicable) | □ | □ | □ |
Did you use this item as described in terms of coverage? (if applicable) | □ | □ | □ |
Did you find this item helpful for the implementation of the recommendation/to reach the targets? | □ | □ | □ |
Did you adapt the content or format of this item in any way? If yes, please specify below! | □ | □ | □ |
Intervention component 2: Please describe the intervention component in sufficient detail (specify content, duration, frequency, coverage if applicable) | |||
… | □ | □ | □ |
Comments: | |||
Free text field: Can you think of other intervention components which might have been more helpful in order to improve the implementation of the recommendations/to reach the targets? |