The Effectiveness of Two Implementation Strategies for Improving Teachers’ Delivery of an Evidenced-based HIV Prevention Program

Abstract

Background Effective implementation strategies are needed to enhance the success of evidence-based prevention programs. The current study evaluates the effects of two implementation strategies on teachers’ implementation of an evidenced-based HIV intervention. Methods Using our 7-item pre-implementation school screening tool, we identified teachers who were at-risk for not implementing the Focus on Youth HIV-risk reduction intervention curriculum which targets grade six through grade 8 students. After completing a two-day curriculum workshop, 81 low- and moderate-performing teachers were randomly assigned to one of four experimental conditions and were asked to teach the two-month intervention curriculum. This optimization trial examines the impact of two implementation strategies: biweekly monitoring/feedbacks (BMF) and site-based assistance/mentorship (SAM). The primary outcome is implementation fidelity defined as number of core activities taught. Linear mixed-effects model was used to examine the association of the implementation strategies with implementation fidelity. Results BMF and SAM were significantly associated with teachers’ implementation fidelity. Teachers who received both BFM and SAM taught the greatest numbers of core activities (15 core activities on average), followed by teachers who received either BMF (6.9 activities) or SAM (7.9 activities). Teachers who did not receive BMF or SAM taught the lowest numbers (4.1 activities). Teachers’ sustained implementation of FOYC in the prior school year was related to increased implementation fidelity during the optimization trial. Teachers’ confidence in implementing five core activities, attitudes toward sex education in schools, and perceived principal support were significantly related to increased self-efficacy, which in turn was related to teachers’ fidelity of implementation before the optimization trial. Conclusion BMF and SAM are effective in promoting teachers’ implementation of youth evidence-based interventions. Researchers and future program implementers should consider teacher training, teachers’ attitudes toward sex education, perceived principal support, and self-efficacy when attempting to maintain the effects of teacher-delivered interventions in schools.

Implementing a school-based HIV prevention program during public health emergencies: lessons learned in The Bahamas

“…FOYC+CImPACT is poised to make significant contributions to school-based HIV prevention and implementation science, through the commitment and ongoing involvement of both the Ministry of Education (MOE) and Ministry of Health (MOH) in The Bahamas and its adoption in China, Vietnam, and Namibia. Having been developed, tailored to The Bahamas, and implemented for over 20 years, it has achieved high levels of successful implementation [ 16 ] and student outcomes [ 19 , 32 , 33 ]. However, implementation fidelity in the Family Islands was affected by Hurricane Dorian and the COVID-19 pandemic.…”

“…Further, school coordinators communicated with the FOYC research team to identify issues that could be addressed by leaders and policies (e.g., online data collection) in the outer context. These enhanced implementation strategies were shown to be effective for supporting FOYC implementation fidelity prior to waves 1 and 2 of the national implementation and have been described in detail elsewhere [ 19 ]. Initially, each school was supposed to be assigned a school coordinator and have mentors.…”

“…When travel to the islands resumed, a 14-day quarantine was imposed on all travelers. Thus, the FOYC team was unable to travel to the more remote Family Island schools, conduct community forums (for community buy-in), train teachers in-person to implement the program, or use the enhanced implementation strategies as they had in years past [ 19 ].…”

Comparing standard versus enhanced implementation of an evidence-based HIV prevention program among Bahamian sixth grade students: findings from nationwide implementation trials

“…Students taught by low-implementation teachers demonstrated poorer outcomes in regard to HIV/AIDS knowledge, reproductive health skills, self-efficacy, and behavioral intentions [37]. With support from the NIH, our team collaborated with The Bahamas Ministry of Education (MOE) to develop several culturally appropriate implementation strategies (e.g., biweekly monitoring and feedback, site-based mentorship and assistance) to increase teachers' implementation fidelity and sustainability [38]. The MOE has deployed these innovative teacher training and support programs for the subsequent national implementation of FOYC+CImPACT in 66 government elementary schools (including the first wave of implementation in 24 schools in New Providence) since 2019.…”

Socioeconomic factors and the evaluation of HIV/AIDS prevention programs: A psychometric analysis of an instrument

“…However, past studies seem to have made little effort in associating stigmatization with the evaluation of HIV/AIDS prevention programs. Studies on HIV prevention programs have assessed "couple-focused prevention programs" [46,47], HIV prevention programs for school effectiveness [48,49], care and support [50], parents' HIV prevention program [51], rural prevention programs [3,52], and programs aimed at raising the awareness of youths and adolescents [53,54] and so on. Nevertheless, none of the cited studies considered stigmatization in evaluating HIV/AIDS prevention programs.…”