Multi-year school-based implementation and student outcomes of an evidence-based risk reduction intervention

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Abstract

Background

Intervention effects observed in efficacy trials are rarely replicated when the interventions are broadly disseminated, underscoring the need for more information about factors influencing real-life implementation and program impact. Using data from the ongoing national implementation of an evidence-based HIV prevention program [Focus on Youth in The Caribbean (FOYC)] in The Bahamas, this study examines factors influencing teachers’ patterns of implementation, the impact of teachers’ initial implementation of FOYC, and subsequent delivery of the booster sessions on students’ outcomes.

Methods

Data were collected from the 80 government elementary and 34 middle schools between 2011 and 2014, involving 208 grade 6, 75 grade 7, and 58 grade 8 teachers and 4411 students initially in grade 6 and followed for 3 years. Student outcomes include HIV/AIDS knowledge, reproductive health skills, self-efficacy, and intention to use protection. Data from teachers includes implementation and modification of the curriculum, attitudes towards the prevention program, comfort level with the curriculum, and attendance at training workshops. Structural equation modeling and mixed-effect modeling analyses were applied to examine the impact of teachers’ implementation.

Results

Teachers’ attitudes towards and comfort with the intervention curriculum, and attendance at the curriculum training workshop had a direct effect on teachers’ patterns of implementation, which had a direct effect on student outcomes. Teachers’ attitudes had a direct positive effect on student outcomes. Teachers’ training in interactive teaching methods and longer duration as teachers were positively associated with teachers’ comfort with the curriculum. High-quality implementation in grade 6 was significantly related to student outcomes in grades 6 and 7 post-implementation. Level of implementation of the booster sessions in grades 7 and 8 were likewise significantly related to subsequent student outcomes in both grades.

Conclusions

High-quality initial implementation of a prevention program is significantly related to better program outcomes. Poor subsequent delivery of booster sessions can undermine the positive effects from the initial implementation while strong subsequent delivery of booster sessions can partially overcome poor initial implementation.

Electronic supplementary material

The online version of this article (doi:10.1186/s13012-016-0539-7) contains supplementary material, which is available to authorized users.

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Most cited references 20

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LK Muthén, BO Muthén, L. Muthén … (2012)

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Implementing the LifeSkills Training drug prevention program: factors related to implementation fidelity

Sharon Mihalic, Abigail Fagan, Susanne Argamaso (2008)

Background Widespread replication of effective prevention programs is unlikely to affect the incidence of adolescent delinquency, violent crime, and substance use until the quality of implementation of these programs by community-based organizations can be assured. Methods This paper presents the results of a process evaluation employing qualitative and quantitative methods to assess the extent to which 432 schools in 105 sites implemented the LifeSkills Training (LST) drug prevention program with fidelity. Regression analysis was used to examine factors influencing four dimensions of fidelity: adherence, dosage, quality of delivery, and student responsiveness. Results Although most sites faced common barriers, such as finding room in the school schedule for the program, gaining full support from key participants (i.e., site coordinators, principals, and LST teachers), ensuring teacher participation in training workshops, and classroom management difficulties, most schools involved in the project implemented LST with very high levels of fidelity. Across sites, 86% of program objectives and activities required in the three-year curriculum were delivered to students. Moreover, teachers were observed using all four recommended teaching practices, and 71% of instructors taught all the required LST lessons. Multivariate analyses found that highly rated LST program characteristics and better student behavior were significantly related to a greater proportion of material taught by teachers (adherence). Instructors who rated the LST program characteristics as ideal were more likely to teach all lessons (dosage). Student behavior and use of interactive teaching techniques (quality of delivery) were positively related. No variables were related to student participation (student responsiveness). Conclusion Although difficult, high implementation fidelity by community-based organizations can be achieved. This study suggests some important factors that organizations should consider to ensure fidelity, such as selecting programs with features that minimize complexity while maximizing flexibility. Time constraints in the classroom should be considered when choosing a program. Student behavior also influences program delivery, so schools should train teachers in the use of classroom management skills. This project involved comprehensive program monitoring and technical assistance that likely facilitated the identification and resolution of problems and contributed to the overall high quality of implementation. Schools should recognize the importance of training and technical assistance to ensure quality program delivery.

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Evidence-based practice in school substance use prevention: fidelity of implementation under real-world conditions.

S Ennett, S Haws, C Ringwalt … (2011)

Fidelity of program implementation under real-world conditions is a critical issue in the dissemination of evidence-based school substance use prevention curricula. Program effects are diminished when programs are implemented with poor fidelity. We assessed five domains of fidelity--adherence, exposure (dosage), quality of delivery, participant responsiveness and program differentiation (lack of contamination from other programs)--in a subset of respondents (N = 342) from a national random sample of public schools with middle school grades (N = 1721). Respondents taught 1 of 10 evidence-based universal substance use prevention programs as their primary program during the 2004-05 school year. Their responses to survey questions about their recent implementation practices indicated that fidelity was high for quality of delivery and participant responsiveness, low for program differentiation and modest for adherence and exposure--the two core domains of fidelity. Results suggest the need for continued emphasis on fidelity in program materials, trainings and on-going technical support. Particular attention should be paid to supporting use of interactive delivery strategies.

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Author and article information

Contributors

Bo Wang:

ORCID: http://orcid.org/0000-0002-0290-2134

313-577-1078 , bwang@med.wayne.edu

Journal

Journal ID (nlm-ta): Implement Sci

Journal ID (iso-abbrev): Implement Sci

Title: Implementation Science : IS

Publisher: BioMed Central (London )

ISSN (Electronic): 1748-5908

Publication date (Electronic): 10 February 2017

Publication date PMC-release: 10 February 2017

Publication date Collection: 2017

Volume: 12

Electronic Location Identifier: 16

Affiliations

[1 ]ISNI 0000 0001 1456 7807, GRID grid.254444.7, Division of Behavioral Sciences, Department of Family Medicine and Public Health Sciences, , Wayne State University School of Medicine, ; 6135 Woodward Ave, Detroit, MI 48202 USA

[2 ]Seton Hall-Hackensack Meridian School of Medicine, Hackensack Meridian Health, 400 South Orange Avenue, South Orange, NJ 07079 USA

[3 ]Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas

[4 ]Ministry of Education, Thompson Boulevard, PO Box N-3913, Nassau, Bahamas

[5 ]Department of Pediatrics, Division of Adolescent Medicine, Wayne State University School of Medicine, Children’s Hospital of Michigan, 3901 Beaubien Street, Detroit, MI48201 USA

Author information

Bo Wang http://orcid.org/0000-0002-0290-2134

Article

Publisher ID: 539

DOI: 10.1186/s13012-016-0539-7

PMC ID: 5303204

PubMed ID: 28187740

SO-VID: b97c28a4-7d24-426e-bca9-1982efea4b16

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 9 March 2016

Date accepted : 16 December 2016

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000071, National Institute of Child Health and Human Development;

Award ID: R01HD064350

Award Recipient : Bonita Stanton

Custom metadata

ScienceOpen disciplines: Medicine

Keywords: pattern of implementation,booster session,hiv prevention,program provider,program outcomes,adolescents,program evaluation

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ScienceOpen disciplines: Medicine

Keywords: pattern of implementation, booster session, hiv prevention, program provider, program outcomes, adolescents, program evaluation

Multi-year school-based implementation and student outcomes of an evidence-based risk reduction intervention

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Most cited references 20

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Implementing the LifeSkills Training drug prevention program: factors related to implementation fidelity

Evidence-based practice in school substance use prevention: fidelity of implementation under real-world conditions.

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