Institute of Behavioral Science, University of Colorado Boulder, 1440 15th St, Boulder, CO, 80309, USA.
Department of Anthropology, University of California San Diego, La Jolla, CA, 92092, USA.
Prev Sci. 2022 Aug;23(6):969-981. doi: 10.1007/s11121-022-01375-3. Epub 2022 Apr 29.
As evidence-based interventions (EBIs) become more widely disseminated, fidelity of implementation (FOI) often wanes. This study explores the association between FOI and malleable variables within classrooms that could be targeted to optimize resources without compromising FOI as school-based EBIs are disseminated across real-world settings. We utilized process evaluation data from a national dissemination project of the Botvin LifeSkills Training (LST) middle school program, a universal prevention intervention shown to reduce substance use. The sample included 1,626 teachers in 371 schools across 14 states. Hierarchical linear models examined the relationship between observational measures of implementation factors and three domains of fidelity (e.g., adherence, student responsiveness, and quality of delivery). Findings suggest that curriculum modifications, student misbehavior, and shortage of time to implement the LST middle school program were factors most associated with lower FOI. Class size, access to program materials, and whether LST was delivered in a traditional classroom setting that is well-suited for instruction (versus in a less structured environment such as the school cafeteria) are less predictive. In scale-up of classroom-based universal interventions targeting behavioral health outcomes, our findings indicate that carefully vetting modifications, supporting classroom management strategies, and ensuring sufficient class time for implementation of highly interactive EBIs such as LST are important considerations. Since changes to EBIs are inevitable, efforts are needed to guide facilitators in making adjustments that improve program fit without compromising the essential intervention activities deemed necessary to produce desired outcomes.
随着循证干预措施（EBIs）的广泛传播，实施的保真度（FOI）往往会下降。本研究探讨了实施保真度与课堂内可塑变量之间的关联，这些变量可以在不影响实施保真度的情况下进行优化，从而在现实环境中传播基于学校的 EBI。我们利用了一项全国范围内推广 Botvin 生活技能培训（LST）中学项目的过程评估数据，该项目是一种已被证明可减少药物使用的普遍性预防干预措施。该样本包括来自 14 个州的 371 所学校的 1626 名教师。分层线性模型考察了实施因素的观察性测量与三个保真度领域（例如，依从性、学生反应性和交付质量）之间的关系。研究结果表明，课程修改、学生行为不当和实施 LST 中学项目的时间短缺是与较低 FOI 最相关的因素。班级规模、获得课程材料的机会以及 LST 是否在适合教学的传统教室环境中（而非在学校自助餐厅等结构化程度较低的环境中）提供，与 FOI 的相关性较小。在针对行为健康结果的基于课堂的普遍性干预措施的扩展中，我们的研究结果表明，仔细审查修改、支持课堂管理策略以及确保为高度互动的 EBI（如 LST）提供足够的课堂时间实施是非常重要的考虑因素。由于对 EBI 的改变是不可避免的，因此需要努力指导促进者进行调整，以提高项目适应性，而又不损害被认为是产生预期结果所必需的基本干预活动。
