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Decker MJ, Price M, Unti L, Firpo-Triplett R, Atyam T, Spitzer J, Coyle K. Monitoring unplanned sexual health curricula adaptations: Using results to improve fidelity and support implementation. EVALUATION AND PROGRAM PLANNING 2022; 94:102126. [PMID: 35820289 DOI: 10.1016/j.evalprogplan.2022.102126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 06/20/2022] [Accepted: 06/25/2022] [Indexed: 06/15/2023]
Abstract
Maintaining fidelity to an evidence-based curriculum is important, yet educators may need to adapt to unexpected situations or particular contexts. The purpose of this study is to identify the reasons for unplanned adaptations during implementation of an evidence-based sexual health education program in California. Evaluators reviewed fidelity checklists from the implementation of 571 cohorts for activities with reported unplanned adaptations. Reasons were qualitatively coded and compared across two phases of implementation and by setting. Educators reported 319 unplanned adaptations, affecting 21.5% of the 571 cohorts and 2.9% of 13,782 activities. The most common reasons for unplanned adaptations were due to time management issues, site logistic issues, and to increase participant engagement. Over time, health educators reported fewer unplanned adaptations, particularly those due to time management, resulting in a decrease in the cohorts and activities affected. Adaptations to evidence-based curricula are necessary and often occur during implementation to fit local conditions and populations. Ongoing review of adaptation data provides an opportunity to refine training and technical assistance efforts. Guidance about the types of permitted adaptations and how to anticipate and plan for adaptations for future implementation can ensure fidelity to the core curriculum components and responsiveness to youth participants.
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Affiliation(s)
- Martha J Decker
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois St, Floor 7, San Francisco, CA 94158, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, Floor 2, San Francisco, CA 94158, USA.
| | - Melisa Price
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 490 Illinois St, Floor 7, San Francisco, CA 94158, USA.
| | - Lisa Unti
- ETR, 5619 Scotts Valley Dr, Suite 140, Scotts Valley, CA 95066, USA.
| | | | - Tara Atyam
- California Department of Public Health, Maternal, Child, and Adolescent Health Division, PO Box 997377, MS 0500, Sacramento, CA 95899-7377, USA.
| | - Jason Spitzer
- California Department of Public Health, Maternal, Child, and Adolescent Health Division, PO Box 997377, MS 0500, Sacramento, CA 95899-7377, USA.
| | - Karin Coyle
- ETR, 5619 Scotts Valley Dr, Suite 140, Scotts Valley, CA 95066, USA.
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Wang B, Deveaux L, Herbert C, Li X, Cottrell L, Adderley R, Poitier M, Mortimer A, Rolle G, Marshall S, Forbes N, Stanton B. Comparing standard versus enhanced implementation of an evidence-based HIV prevention program among Bahamian sixth grade students: findings from nationwide implementation trials. BMC Public Health 2022; 22:1442. [PMID: 35906572 PMCID: PMC9334549 DOI: 10.1186/s12889-022-13848-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Effective implementation strategies are needed to address the challenges encountered by teachers in implementation of evidence-based HV prevention programs in schools. The current study: 1) compares implementation fidelity of Focus on Youth in the Caribbean (FOYC) plus Caribbean Informed Parents and Children Together (CImPACT) intervention using enhanced implementation strategies (including biweekly monitoring/feedback and site-based mentoring) to those using more traditional approach (teacher training only); and 2) evaluates the impact of school coordinators’ and mentors’ performance on teachers’ implementation fidelity and student outcomes. Methods Data from an enhanced implementation trial in 2019–2020, involving 24 government primary schools, 79 teachers, and 2252 students, were compared to data from a standard implementation trial in 2011–2012, involving 35 government primary schools, 110 teachers and 2811 students using mixed-effects modeling and structural equation modeling. Findings Teachers in the 2019–2020 trial taught more core activities (28.3 vs. 16.3, t = 10.80, P < 0.001) and sessions (7.2 vs. 4.4, t = 9.14, P < 0.001) than those participating in the 2011–2012 trial. Teachers taught > 80% of the intervention curriculum in 2019–2020 compared to 50% curriculum delivery in 2011–2012. Teachers who had a “very good” or “excellent” school coordinator in their schools taught more core activities than those who had a “satisfactory” school coordinator (30.4 vs. 29.6 vs. 22.3, F = 18.54, P < 0.001). Teachers who worked in a school which had a “very good” mentor, taught more core activities than those teachers who did not have a mentor or had only a “satisfactory” mentor (30.4 vs. 27.6; t = 2.96; p = 0.004). Teachers’ confidence in implementing core activities, comfort level with the curriculum, attitudes towards sex education in schools, and perceived principal support were significantly related to increased self-efficacy, which in turn was related to teachers’ implementation fidelity. The degree of implementation was significantly associated with improved student outcomes. Implications/conclusion An evidence-based HIV prevention intervention can achieve a high degree of implementation when delivered with enhanced implementation strategies and implementation monitoring. Future program implementers should consider the purposeful selection and training of school coordinators and mentors to support low-implementing teachers as a potentially important strategy when attempting to achieve high-quality implementation of school-based interventions.
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Affiliation(s)
- Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
| | - Lynette Deveaux
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Carly Herbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, 915 Greene Street, Suite 408, Columbia, SC, 29208, USA
| | - Lesley Cottrell
- Department of Pediatrics, West Virginia University, 959 Hartman Run Road., Morgantown, WV, 26506, USA
| | - Richard Adderley
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Maxwell Poitier
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Arvis Mortimer
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Glenda Rolle
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Sharon Marshall
- Department of Pediatrics, Wayne State University School of Medicine, 400 Mack Avenue, Detroit, MI, 48201, USA
| | - Nikkiah Forbes
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Bonita Stanton
- Hackensack Meridian School of Medicine, 340 Kingsland, St., Nutley, NJ, 07110, USA
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Caruso I, Valdez ES, Lovell CC, Chan J, Beatriz E, Gubrium A. The Need for Community-Responsive and Flexible Sex Ed for Historically Marginalized Youth. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 20:94-102. [PMID: 35494623 PMCID: PMC9038439 DOI: 10.1007/s13178-022-00717-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
Introduction When it is offered, sexuality education in the USA is far from standardized. While studies have explored differences in delivery and type of sexuality education across the USA, sexual and reproductive health inequities persist among historically marginalized groups (Latino/a/x, Black, African American, LGBTQ +). There is a critical need to better understand the systemic barriers to receiving effective sexuality education in these communities. Methods Participatory research methods were used in working with a community advisory board (CAB)-consisting of emerging adults and service providers from community-based organizations (CBOs) serving youth-to examine how structural barriers contribute to adolescent sexual and reproductive health (ASRH) inequities in Massachusetts. CAB meetings and semi-structured interviews were conducted in the cities of Springfield (n = 14) and Lynn (n = 9) between December 2020 and May 2021. Results Inflexible funding guidelines, a related evidence-based curricular mandate, and a lack of community-responsive sexuality education fail to meet the sexual and reproductive health (SRH) needs of these youth. Conclusions Current evidence-based mandates must be revisited to improve young people's access to quality sexuality information in public schools. To guarantee sexuality education curricula is centered in the context of the community and population in which it is implemented, collaboration between youth-serving CBOs and school districts could improve students' overall experience and social-emotional growth by providing comprehensive, positive, and community-responsive curricula. Policy Implications Funders and programming should prioritize community responsiveness by financially supporting and developing and/or adapting evidence-based curricula to better match the community's needs, which can be completed through culture-centered training and community-based partnership.
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Affiliation(s)
- Isabella Caruso
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 305 Arnold House, 715 North Pleasant Street, Amherst, MA 01003 USA
| | - Elizabeth Salerno Valdez
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 305 Arnold House, 715 North Pleasant Street, Amherst, MA 01003 USA
| | - Camille Collins Lovell
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 305 Arnold House, 715 North Pleasant Street, Amherst, MA 01003 USA
| | - Jazmine Chan
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 305 Arnold House, 715 North Pleasant Street, Amherst, MA 01003 USA
| | - Elizabeth Beatriz
- Massachusetts Department of Public Health, 250 Washington St, Boston, MA 02108 USA
| | - Aline Gubrium
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, 305 Arnold House, 715 North Pleasant Street, Amherst, MA 01003 USA
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Different Approaches to Address Bullying in KiVa Schools: Adherence to Guidelines, Strategies Implemented, and Outcomes Obtained. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 22:299-310. [PMID: 33098542 PMCID: PMC8032636 DOI: 10.1007/s11121-020-01178-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2020] [Indexed: 11/12/2022]
Abstract
We examined the extent to which school personnel implementing the KiVa® antibullying program in Finland during 2009–2015 systematically employed the program-recommended approaches (confronting or non-confronting), used one or the other depending on the bullying case (case-specific approach), or used their own adaptation when talking to perpetrators of bullying, and whether they organized follow-up meetings after such discussions. In addition to investigating adherence to program guidelines, we tested how effective these different approaches were in stopping bullying. Finally, we tested the contribution of follow-up meetings and the number of years KiVa had been implemented in a school to the effectiveness of the interventions, using reports from both school personnel and victimized students. The data were collected annually across 6 years via online questionnaires and included responses from 1221 primary and secondary schools. The school personnel were more likely to use the confronting approach than the non-confronting approach. Over time, rather than sticking to the two program-recommended approaches, they made adaptations (e.g., combining the two; using their own approach). Two-level regression analyses indicated that the discussions were equally effective, according to both personnel and victimized students, when the confronting, non-confronting, or a case-specific approach had been used. The discussions were less effective when the personnel used their own adaptation or could not specify the method used. Perceived effectiveness was higher in primary school and when follow-up meetings were organized systematically after each intervention, but unrelated to the number of years KiVa had been implemented.
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