Hansen William B, Pankratz Melinda M, Dusenbury Linda, Giles Steven M, Bishop Dana C, Albritton Jordan, Albritton Lauren P, Strack Joann
Tanglewood Research, Inc.
Pacific Institute for Research and Evaluation.
Health Educ (Lond). 2013;113(4):345-363. doi: 10.1108/09654281311329268. Epub 2013 Jun 21.
To be effective, evidence-based programs should be delivered as prescribed. This suggests that adaptations that deviate from intervention goals may limit a program's effectiveness. This study examines the impact that number and quality of adaptations have on substance use outcomes.
We examined 306 video recordings of teachers delivering 'All Stars', a middle school drug prevention program. Multiple observers coded each recording, noting the number and type of adaptation each teacher made. Each adaptation was given a valence rating. Adaptations that were deleterious to program goals received negative valence ratings; positive ratings were given for adaptations that were likely to facilitate achievement of program goals; neutral ratings were given to adaptations that were expected to have neither a positive nor negative impact on program goals.
All teachers made adaptations. Teachers were consistent across time in the types of adaptations they made, suggesting each teacher has a personalized style of adapting. Those who made few adaptations, and whose average adaptation was rated as being positive had a higher percentage of students who remained non-drug users. In contrast, teachers who made many adaptations, whether their average valence rating was positive, neutral or negative, failed to have as many students remain non-drug users. Measures of fidelity, including quality of delivery and teacher understanding were related to valence of adaptations, with better performance related to making positive adaptations.
Through training and supervision, teachers should be guided and encouraged to follow programs directions, making few adaptations and ensuring that adaptations that are made advance the goals of intervention. Programs should define acceptable and unacceptable ways they may be adapted.
This study provides significant evidence about the challenges that face disseminated evidence-based programs.
为了有效，基于证据的项目应按规定实施。这表明偏离干预目标的调整可能会限制项目的有效性。本研究考察了调整的数量和质量对物质使用结果的影响。
我们检查了306段教师讲授中学毒品预防项目“全明星”的视频记录。多名观察者对每段记录进行编码，记录每位教师所做调整的数量和类型。对每一项调整给出一个效价评级。对项目目标有害的调整给予负效价评级；对可能促进项目目标实现的调整给予正评级；对预计对项目目标既无正面也无负面影响的调整给予中性评级。
所有教师都进行了调整。教师在调整类型上随时间保持一致，这表明每位教师都有个性化的调整风格。那些调整较少且平均调整被评为正面的教师，其保持不吸毒的学生比例更高。相比之下，进行大量调整的教师，无论其平均效价评级是正、中性还是负，其保持不吸毒的学生数量都较少。包括授课质量和教师理解在内的保真度指标与调整的效价相关，表现越好与进行正面调整相关。
通过培训和监督，应指导和鼓励教师遵循项目指导，少做调整，并确保所做的调整能推进干预目标。项目应明确其可调整的可接受和不可接受方式。
本研究为传播基于证据的项目所面临的挑战提供了重要证据。
