RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA, 15213, USA.
Implement Sci. 2018 Oct 22;13(1):131. doi: 10.1186/s13012-018-0825-7.
Community organizations can have difficulty implementing evidence-based prevention programs. More research is needed on implementation support interventions designed to help these organizations implement programs with quality.
Preparing to Run Effective Programs (PREP) is a randomized controlled trial testing Getting To Outcomes (GTO), a 2-year implementation support intervention. It compares 15 Boys and Girls Club sites implementing CHOICE (control group), a five-session evidence-based alcohol and drug prevention program, with 14 similar sites implementing CHOICE supported by GTO (intervention group). PREP replicates a previous GTO study that had the same design, but featured a teen pregnancy prevention program instead. All sites received typical CHOICE training. Fourteen intervention sites received GTO manuals, training, and onsite technical assistance to help practitioners complete implementation best practices specified by GTO (i.e., GTO steps). During the first year, technical assistance providers helped the intervention group adopt, plan, and deliver CHOICE. Then, this group was trained on evaluation and quality improvement steps of GTO using feedback reports summarizing their own data, which yielded revised plans for subsequent implementation of CHOICE. This paper presents results regarding GTO's impact on CHOICE fidelity (adherence, quality of delivery, dosage) and the proximal outcomes of the youth participants (aged 10-14)-attitudes and intentions regarding cigarettes, alcohol, and marijuana use. Fidelity was assessed at all sites by observer ratings and attendance logs. Proximal outcomes were assessed via survey at baseline, 3, and 6 months.
After 1 year, fidelity and proximal outcomes were similar between Intervention and control groups. After 2 years (which included GTO quality improvement activities that took place between years 1 and 2), intervention sites had higher ratings of CHOICE adherence and quality of delivery (dosage remained similar). Proximal outcomes did not differ between groups in either year, although there was universally high endorsement of prosocial responses to those outcomes from the start.
Findings suggest that systematic implementation support provided by GTO can help community organizations achieve better fidelity. Findings replicate the implementation results from a previous GTO study using the same design, but with a different evidence-based program and different fidelity measures. Although proximal outcomes did not change, in large part due to ceiling effects, the implementation findings suggest GTO can support a variety of programs.
This project is registered at ClinicalTrials.gov with number NCT02135991 . The trial was first registered on May 12, 2014.
社区组织在实施基于证据的预防计划方面可能会遇到困难。需要更多的研究来确定旨在帮助这些组织高质量实施计划的实施支持干预措施。
“准备有效项目”（PREP）是一项随机对照试验，测试“实现成果”（GTO），这是一项为期两年的实施支持干预措施。它将 15 个男孩和女孩俱乐部实施 CHOICE（对照组）的地点与 14 个实施 CHOICE 并获得 GTO 支持的类似地点（干预组）进行比较。PREP 复制了之前的 GTO 研究，其设计相同，但采用了青少年怀孕预防计划。所有地点都接受了典型的 CHOICE 培训。14 个干预地点收到了 GTO 手册、培训和现场技术援助，以帮助从业者完成 GTO 规定的实施最佳实践（即 GTO 步骤）。在第一年，技术援助提供者帮助干预组采用、计划和提供 CHOICE。然后，该组使用总结其自身数据的反馈报告接受了 GTO 评估和质量改进步骤的培训，这为随后实施 CHOICE 制定了修订计划。本文介绍了 GTO 对 CHOICE 保真度（遵从性、交付质量、剂量）和青年参与者（年龄在 10-14 岁）的近端结果（对香烟、酒精和大麻使用的态度和意图）的影响的结果。在所有地点，通过观察员评分和出勤记录评估保真度。在基线、3 个月和 6 个月时通过调查评估近端结果。
1 年后，干预组和对照组的保真度和近端结果相似。2 年后（包括 1 年至 2 年期间进行的 GTO 质量改进活动），干预组对 CHOICE 依从性和交付质量的评价更高（剂量保持相似）。在任何一年中，两组的近端结果都没有差异，尽管从一开始，参与者就普遍对这些结果表示支持亲社会的回应。
研究结果表明，GTO 提供的系统实施支持可以帮助社区组织实现更高的保真度。研究结果复制了之前使用相同设计的 GTO 研究的实施结果，但使用了不同的基于证据的计划和不同的保真度措施。尽管近端结果没有变化，在很大程度上是由于上限效应，但实施结果表明 GTO 可以支持各种计划。
本项目在 ClinicalTrials.gov 注册，编号为 NCT02135991。该试验于 2014 年 5 月 12 日首次注册。
