Table 4.

Key learning points

How to create a disruption?
1.	Creating a disruption in a school takes time and needs bottom-up involvement	This learning point shows the importance of bottom-up involvement as indicated in the programme theory. Moreover, it also relates back to the several loops of feedback arrows between HPSF and the school context. In the four participating schools was seen that creating bottom-up involvement immediately at the start of the developmental phase took time but seemed to increase people’s ownership and support. Implementation of changes also took time as the school needed to find a new way of working in the school to create for example a good collaboration between the teachers and the external PE.
2.	Regular contact among all actors is required to get to know each other and to manage expectations.	This learning point relates back to the importance of sufficient coordination and team cohesion. In the four participating schools was seen that regular contact between the people involved, not only to discuss the content, but also to get to know each other, helped to create more understanding and feelings of mutual support. Regular contact between teachers and external PE improved team cohesion in the school, which enhanced implementation. In particular, communication about expectations of everybody’s responsibilities appeared to be important.
3.	Top-down advice and external practical support are important for creating a disruption.	This learning point shows the importance of external support, as indicated in the programme theory. In the four participating schools was seen that top-down advice and practical support from external partners helped the schools by providing personnel, money, materials, and knowledge.
4.	To contextualize and realize changes feedback loops are required among all involved actors.	This fourth learning point does not only relate back to the several loops of feedback arrows in the programme theory between HPSF and the school context, it also shows the importance of external support and the involvement from bottom-up. In the four participating schools was seen that feedback loops in school among staff, children, and parents made a change better fit into the school context with its specific needs and wishes. Feedback loops between school and external partners made the external support to school, to realize the changes, as efficient as possible.
How to use a disruption?
5.	A disruption is useful for implementing additional HP changes on the same topic.	This last learning point relates back to the loop in the bottom of the programme theory which indicates the momentum-effect. In this study the provided lunch disrupted the existing dynamics in the school and created momentum for nutrition-related additional HP changes, as people perceived these additional HP changes as something that came along with the provided lunch. The health promoters felt that due to the lunch in S1 and S2, additional nutrition-related HP changes were implemented with less discussion and easier acceptance, compared to other schools in the region, due to an improved health-promoting mind-set. However, the lunch did not create momentum for not nutrition-related initiatives, i.e., PA-related.