Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas.
BMC Public Health. 2022 Jul 29;22(1):1442. doi: 10.1186/s12889-022-13848-9.
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.
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.
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.
需要有效的实施策略来解决教师在学校实施循证艾滋病毒预防项目时遇到的挑战。本研究：1）比较使用强化实施策略（包括双周监测/反馈和现场指导）和仅使用传统方法（仅教师培训）实施重点关注青年在加勒比地区（FOYC）加加勒比知情父母和儿童共同（CImPACT）干预的实施保真度；2）评估学校协调员和导师的表现对教师实施保真度和学生结果的影响。
比较了 2019-2020 年强化实施试验的数据，涉及 24 所政府小学、79 名教师和 2252 名学生，以及 2011-2012 年标准实施试验的数据，涉及 35 所政府小学、110 名教师和 2811 名学生，使用混合效应建模和结构方程建模。
与参加 2011-2012 年试验的教师相比，2019-2020 年试验中的教师教授了更多的核心活动（28.3 比 16.3，t=10.80，P<0.001）和课程（7.2 比 4.4，t=9.14，P<0.001）。2019-2020 年，教师教授的干预课程超过 80%，而 2011-2012 年课程交付仅为 50%。在他们的学校中，有一位“非常好”或“优秀”的学校协调员的教师比那些有一位“满意”的学校协调员的教师教授更多的核心活动（30.4 比 29.6 比 22.3，F=18.54，P<0.001）。在有“非常好”导师的学校工作的教师比没有导师或只有“满意”导师的教师教授更多的核心活动（30.4 比 27.6；t=2.96；p=0.004）。教师对实施核心活动的信心、对课程的舒适度、对学校性教育的态度以及对校长支持的看法与自我效能感的提高显著相关，而自我效能感又与教师的实施保真度相关。实施程度与学生成绩的提高显著相关。
当提供强化实施策略和实施监测时，基于证据的艾滋病毒预防干预措施可以实现高度的实施。未来的项目实施者应考虑有针对性地选择和培训学校协调员和导师，以支持低实施教师，这可能是尝试实现基于学校的干预措施高质量实施的一项重要策略。
