Training prior to implementing evidence-based interventions (EBIs) is essential to reach high levels of fidelity. However, the time and cost of in-person training are often barriers to implementation. Online learning offers a potential solution, though few studies examine the relationship between online training and fidelity of implementation. This study explored whether teachers trained online have similar levels of adherence, dosage, quality of delivery, and student responsiveness compared to teachers trained in-person on the Botvin LifeSkills Training (LST) middle school program, a universal prevention intervention proven to reduce substance use and violence, as part of a national dissemination project. This study involved a sample of 989 LST teachers across 114 school districts, representing 296 schools in 14 states. All teachers were first trained in LST implementation between 2016 and 2019. Hierarchical linear models were used to assess relationships between training modality and the four fidelity outcomes. Online training was associated with lower ratings of quality of delivery compared to in-person training, but no significant associations existed between online training and adherence to the curriculum, dosage, or student responsiveness. Findings from this study generally indicate that online training builds competencies important for school-based EBI implementation, while also highlighting potential shortcomings related to quality of delivery. Ensuring the inclusion of experiential learning activities (e.g., practice delivering content, receiving feedback on delivery) may be key to quality of delivery as online trainings for facilitators of school-based EBIs evolve.

Background Human papillomavirus (HPV) infection is the most common cause of cervical cancer and can be prevented with vaccination, but HPV vaccination rates remain low. An intervention to improve health care provider communication about vaccination has been shown to increase HPV vaccination rates in an initial trial in Colorado, where about 160 cases of cervical cancer are diagnosed each year. Methods Census data were combined with Colorado cancer and immunization registry data to identify clinics in locations that would most benefit from implementation of this intervention to improve HPV vaccination rates. ArcGIS Pro was used to map cervical cancer incidence, immunization rates, population data, and location of clinics participating in practice‐based research networks (PBRNs). Results from the provider communication intervention trial and published estimates of the number needed to vaccinate to prevent a case of cervical cancer were used to predict the number of cervical cancer cases prevented based on increased vaccination due to the intervention. Results Ninety‐eight Colorado PBRN clinics were analyzed. For the 10 clinics with the highest predicted number of cervical cancer cases prevented, 5218 additional patients would be vaccinated and 43 cervical cancer cases prevented with implementation of the intervention. If implemented in all 98 clinics, the intervention would lead to 20 490 additional patients vaccinated (range 7‐658/clinic) and 171 cases of cervical cancer prevented (range 0.05‐5.48/clinic). Conclusions Geographic data from cancer and immunization registries can inform the dissemination of evidence‐based practices like the provider communication intervention for HPV vaccination to maximize impact on public health.

The development of evidence-based interventions (EBIs) for the prevention of behavioral health problems is well supported. However, limited data exist on the sustainability of EBIs once initial support has ceased. The current study assessed, at 2 years after initial start-up support: (1) What percent of schools sustained EBI implementation? (2) To what degree did sustaining schools implement the EBI with fidelity? (3) What were the primary reasons for not sustaining the EBI? (4) What theoretical and contextual factors during initial start-up support predicted sustainment of the EBI? The study used process evaluation data from the dissemination of the Botvin LifeSkills Training (LST) middle school program in 158 school districts (including 419 schools). Fifty-one percent of districts sustained the EBI and most of these sustaining districts reported following key fidelity guidelines. Primary reasons for discontinuing centered around low teacher or administrative support and turnover. Significant predictors of sustaining LST were higher ratings of LST’s complexity, benefit, and compatibility by teachers; more positive perceptions of organizational support from administrators; and smaller proportions of Black students. Results show that EBI sustainment and fidelity of implementation post-initial startup support are feasible, though likely not for all schools. Findings also suggest that cultivating support for the EBI among staff during start-up support may be helpful for sustainment and that social determinants of a school have a complex relationship with EBI sustainment. Future research should explore true causes of differences due to race/ethnicity as well as COVID-19 effects.

A correction to this paper has been published: https://doi.org/10.1007/s11121-021-01250-7