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.
Prev Sci. 2024 Apr;25(3):436-447. doi: 10.1007/s11121-023-01614-1. Epub 2023 Nov 18.
Large-scale, evidence-based interventions face challenges to program fidelity of implementation. We developed implementation strategies to support teachers implementing an evidence-based HIV prevention program in schools, Focus on Youth in The Caribbean (FOYC) and Caribbean Informed Parents and Children Together (CImPACT) in The Bahamas. We examined the effects of these implementation strategies on teachers' implementation in the subsequent year after the initial implementation during the COVID-19 pandemic. Data were collected from 79 Grade 6 teachers in 24 government elementary schools. Teachers completed training workshops and a pre-implementation questionnaire to record their characteristics and perceptions that might affect their program fidelity. School coordinators and peer mentors provided teachers with monitoring, feedback, and mentoring. In Year 1, teachers on average taught 79.3% of the sessions and 80.8% of core activities; teachers in Year 2 covered 84.2% of sessions and 72.9% of the core activities. Teachers with "good" or "excellent" school coordinators in the second year taught significantly more sessions on average (7.8 vs. 7.0, t = 2.04, P < 0.05) and more core activities (26.3 vs. 23.0, t = 2.41, P < 0.05) than teachers with "satisfactory" coordinators. Teachers who had a "good" or "satisfactory" mentor taught more sessions than teachers who did not have a mentor (7.9 vs. 7.3; t = 2.22; P = 0.03). Two-level mixed-effects model analysis indicated that teachers' program fidelity in Year 1, confidence in the execution of core activities, and school coordinators' performance were significantly associated with Year 2 implementation dose. Implementation of FOYC + CImPACT was significantly associated with improved student outcomes. Teachers maintained high fidelity to a comprehensive HIV prevention program over 2 years during the COVID-19 pandemic. Future program implementers should consider additional implementation support to improve the implementation of school-based programs.
大规模的循证干预措施在实施的一致性方面面临挑战。我们制定了实施策略，以支持教师在巴哈马实施基于证据的艾滋病毒预防方案，即“关注加勒比青年”（FOYC）和“加勒比知情父母和儿童共同”（CImPACT）。我们考察了这些实施策略对教师在 COVID-19 大流行期间初始实施后的次年实施的影响。数据来自 24 所政府小学的 79 名六年级教师。教师们完成了培训研讨会和实施前问卷调查，记录了可能影响其方案一致性的特征和看法。学校协调员和同行导师为教师提供监测、反馈和指导。在第一年，教师平均教授了 79.3%的课程和 80.8%的核心活动；第二年，教师教授了 84.2%的课程和 72.9%的核心活动。第二年学校协调员“良好”或“优秀”的教师平均教授的课程明显更多（7.8 比 7.0，t=2.04，P<0.05），核心活动更多（26.3 比 23.0，t=2.41，P<0.05）比协调员“满意”的教师。有“良好”或“满意”导师的教师比没有导师的教师教授的课程更多（7.9 比 7.3；t=2.22；P=0.03）。两水平混合效应模型分析表明，教师在第一年的方案一致性、对核心活动执行的信心以及学校协调员的表现与第二年的实施剂量显著相关。FOYC+CImPACT 的实施与学生结果的改善显著相关。在 COVID-19 大流行期间，教师在两年内对综合艾滋病毒预防方案保持了高度的一致性。未来的方案实施者应考虑提供更多的实施支持，以提高学校方案的实施。
