A mixed methods investigation of implementation determinants for a school-based universal prevention intervention.
A mixed methods investigation of implementation determinants for a school-based universal prevention intervention.
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DOI：
10.1177/26334895221124962
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发表时间：
2022-01
影响因子：
--
通讯作者：
Kilbourne, Amy M.
中科院分区：
文献类型：
--
作者：
Eisman, Andria B.;Palinkas, Lawrence A.;Brown, Suzanne;Lundahl, Leslie;Kilbourne, Amy M.
在学校有效实施循证预防干预措施对于减轻吸毒负担及其后果至关重要。由于执行不力，普遍预防干预措施往往无法达到预期的公共卫生结果。实施效果不佳的一个核心原因是干预措施与环境之间的契合度有限。需要进行研究，以增加我们对干预特征和背景如何影响学校干预实施的理解，以设计将消除障碍和改善公共卫生影响的实施战略。使用收敛的混合方法设计，我们从全州高中健康教师教授课程的角度，检查了基于证据的健康课程密歇根健康模式(MMH)实施决定因素的定性和定量数据。我们独立检查了数据链，并通过调查数据对齐、扩展和分歧将它们集成在一起。我们确定了三个混合方法领域：(1)可接受性，(2)干预-背景匹配，(3)适应性。我们发现了数据链之间的一致性，因为报告低可接受性的教师也报告了低保真度。学生需求和课程之间的契合度预示着保真度(扩大)。教师们提到了干预-背景匹配(不协调)不佳的例子，包括在满足创伤暴露的青年的需求和保持对青年吸毒趋势的最新了解时。教师报告了高适应性(和谐)，但也有适应具有挑战性的情况(不和谐)。这项调查通过加深我们对学校循证普遍预防干预实施决定因素的理解，促进了实施研究。这将支持制定有效的执行战略，以消除障碍，提高干预措施对公共卫生的影响，解决所有青年面临的重要风险和保护因素。(1)关于这一主题已知的内容是什么？虽然存在许多以证据为基础的干预措施，以解决青少年中的关键健康问题，包括药物使用和精神健康，但在学校等社区环境中有效实施的干预措施很少。在学校实施普遍预防存在明显的多层次障碍。研究人员发现，干预措施与背景之间的不协调是许多实施努力没有达到预期结果的一个关键原因。(2)本文件补充了什么？本文结合定性和定量研究方法的优点，从最终用户的角度，确定和理解干预的挑战-适合于在整个密歇根州广泛采用的全面健康课程-密歇根健康模式(MMH)的背景。本文还利用实施研究的综合框架和实施成果框架来指导我们对实施复杂干预措施和在学校实施的关键障碍的理解。这项研究为设计有效的战略提供了基础，这些战略将平衡课程的保真度和适应性，以实现公共卫生目标。(3)对实践、研究或政策有何影响？我们需要实施战略，指导学校提供EBI服务的灵活性和忠诚度。虽然教师总体上认为课程是可适应的，并满足了学生的需求，但他们也提到了他们将从额外的实施支持中受益的具体情况，例如进行调整以满足创伤暴露的青少年的需求，以及保持与新出现的药物的联系。为应对这些挑战而设计的实施战略可以提高保真度，最终提高学生的幸福感。
Effective implementation of evidence-based prevention interventions in schools is vital to reducing the burden of drug use and its consequences. Universal prevention interventions often fail to achieve desired public health outcomes due to poor implementation. One central reason for suboptimal implementation is the limited fit between the intervention and the setting. Research is needed to increase our understanding of how intervention characteristics and context influence intervention implementation in schools to design implementation strategies that will address barriers and improve public health impact. Using a convergent mixed methods design we examined qualitative and quantitative data on implementation determinants for an evidence-based health curriculum, the Michigan Model for HealthTM (MMH) from the perspective of health teachers delivering the curriculum in high schools across the state. We examined data strands independently and integrated them by investigating data alignment, expansion, and divergence. We identified three mixed methods domains: (1) Acceptability, (2) intervention-context fit, and (3) adaptability. We found alignment across data strands as teachers reporting low acceptability also reported low fidelity. The fit between student needs and the curriculum predicted fidelity (expansion). Teachers mentioned instances of poor intervention-context fit (discordance), including when meeting the needs of trauma-exposed youth and keeping updated on youth drug use trends. Teachers reported high adaptability (concordance) but also instances when adaptation was challenging (discordance). This investigation advances implementation research by deepening our understanding of implementation determinants for an evidence-based universal prevention intervention in schools. This will support designing effective implementation strategies to address barriers and advance the public health impact of interventions that address important risk and protective factors for all youth. (1) What is Already Known About the Topic? While many evidence-based interventions (EBIs) exist to address key health issues among youth including substance use and mental health, few of these interventions are effectively implemented in community settings, such as schools. Notable multilevel barriers exist to implement universal prevention in schools. Researchers identify that misalignment between the intervention and the context is a key reason why many implementation efforts do not achieve desired outcomes. (2) What Does This Paper Add? This paper combines the strengths of qualitative and quantitative research methods to identify and understand challenges to intervention-context fit for a comprehensive health curriculum, the Michigan Model for HealthTM (MMH) which is widely adopted throughout Michigan, from the perspective of end users. This paper also utilizes the consolidated framework for implementation research and implementation outcomes framework to guide our understanding of implementing complex interventions and key barriers to implementation in schools. This research provides a foundation to design effective strategies that will balance curriculum fidelity and adaptation to achieve public health objectives. (3) What are the Implications for Practice, Research, or Policy? We need implementation strategies that guide flexibility and fidelity in EBI delivery in schools. While overall teachers felt the curriculum was adaptable and met student needs, they also mentioned specific instances when they would benefit from additional implementation support, such as making adaptations to meet the needs of trauma-exposed youth and keeping up-to-date with emerging drugs. Implementation strategies designed to address these challenges can improve fidelity and ultimately student well-being.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
DOI：
10.1007/s11121-019-01017-1
发表时间：
2019-08
期刊：
Prevention science : the official journal of the Society for Prevention Research
影响因子：
--
作者：
Cook CR;Lyon AR;Locke J;Waltz T;Powell BJ
通讯作者：
Powell BJ
DOI：
10.1186/1748-5908-8-117
发表时间：
2013-10-02
期刊：
Implementation science : IS
影响因子：
--
作者：
Chambers DA;Glasgow RE;Stange KC
通讯作者：
Stange KC
DOI：
10.1007/s10488-014-0541-9
发表时间：
2015-03-01
影响因子：
2.6
作者：
Boustani, Maya M.;Frazier, Stacy L.;Pasalich, Dave S.
通讯作者：
Pasalich, Dave S.
影响因子：
16.4
作者：
BANDURA, A
通讯作者：
BANDURA, A