National Implementation of FOYC+CImPACT in the Bahamas: implementation strategies and improved outcomes.

巴哈马 FOYC CImPACT 的国家实施：实施策略和改进成果。

• 批准号: 10405613
• 负责人: Bo Wang
• 金额: $ 61.19万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10405613
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Achievement; Acquired Immunodeficiency Syndrome; Address; Administrator; Adolescent; Bahamas; Bahamian; Behavior; Behavior Therapy; Caribbean region; Centers for Disease Control and Prevention (U.S.); Child; Community Health; Community of Practice; Competence; Complex; Data; Decision Making; Diffusion; Education; Educational Curriculum; Educational process of instructing; Educational workshop; Enrollment; Ensure; Epidemic; Evaluation; Exhibits; Exposure to; Feedback; Funding; Goals; Government; HIV; HIV Infections; HIV Seroprevalence; HIV resistance; HIV risk; Health; Health Services Accessibility; Institutes; Intervention; Knowledge; Literature; Logistics; Mentors; Mentorship; Monitor; Outcome; Parents; Patient Self-Report; Pattern; Perception; Performance; Prevention; Prevention program; Process; Public Health; Qualitative Research; Randomized; Reporting; Reproductive Health; Research; Research Personnel; Resources; Risk; Risk Behaviors; Risk Reduction; Schools; Self Efficacy; Site; Students; Supervision; System; Time; Training; Training Support; United States National Institutes of Health; Youth; base; condoms; design; emerging adult; evidence base; follow-up; implementation fidelity; implementation process; implementation science; implementation strategy; improved; improved outcome; innovation; instrument; interactive teaching; point of care; preventive intervention; programs; prototype; remediation; risk perception; screening; self reported behavior; skills; teacher; theories

Project Summary/Abstract Over the past two decades, the Bahamian Ministries of Education (MOE) and Health (MOH) and our research team have adapted a CDC “Best Evidence” HIV Prevention Program to produce the “Focus on Youth in the Caribbean (FOYC) and Caribbean Informed Parents and Children Together” (CImPACT) risk reduction program to address the HIV epidemic in The Bahamas. Two randomized, controlled longitudinal trials of FOYC and FOYC+CImPACT found the programs to be effective in improving knowledge, condom-use skills and/or self-reported risk behaviors. In 2010 the MOE decided to include FOYC (logistically less complex than FOYC+CImPACT) in the government grade-6 curriculum nationwide, with boosters in grades-7 and -8. The MOE now plans to expand the offering to the more effective but logistically more complex FOYC+ CImPACT version. The MOE, MOH and our research team examined factors associated with fidelity of teaching FOYC among 283 teachers, and the relationship between fidelity of teaching with student outcomes among 4,411 students. Teachers taught slightly over 50% of FOYC's core activities. Evaluations indicate that students taught by “low-performing” teachers exhibited poorer outcomes in HIV/AIDS knowledge, condom-use skills, self- efficacy, and intentions; the reverse was true for students of “high-performing” teachers. Screening instruments and tracking processes to identify teachers at risk of low implementation, and evidence-based implementation support and remediation programs have been identified/developed for use throughout implementation. Biweekly “real-time” data-gathering and analysis to inform ongoing decision-making about adjustments or changes to be made to the implementation plan of FOYC+CImPACT by the MOE and MOH are the focus of this proposal. A Bahamian-specific adaptation of communities of practice (CoP), implementation monitoring and feedback, and innovative training are strategies to enhance teachers' implementation. The proposed research addresses three hypotheses of public health importance: 1. A more intensive training and supervision program for at-risk or moderate-performing teachers will enhance their implementation fidelity to the average level of the high-performing group (85%); 2. An HIV-prevention program delivered at the national level can be a) implemented with fidelity (delivering >85% of core activities in both FOYC and CImPACT consistent with that described by the developers) in grade-6; and, b) sustained over time (monitored annually); and, 3. Student outcomes (knowledge, reproductive health skills, perceptions and self-reported behaviors) will: a) continue to be highly correlated with implementation fidelity; and, b) be sustained over time (assessed annually through grade 9). We aim to determine if the provision of either or both a) biweekly monitoring, feedback and support through a “community of practice” to at-risk and moderate-performing teachers; and b) an enhanced decision-making platform by the MOE and MOH based on the real-time implementation data will: 1) increase national implementation fidelity; and 2) result in sustained implementation over time.

项目摘要/摘要 在过去的二十年里，巴哈马教育部(MOE)和卫生部(MOH)以及我们的研究 该团队将美国疾病控制与预防中心的“最佳证据”艾滋病预防计划改编为“关注青少年”。 加勒比(FOYC)和加勒比知情父母和儿童“(CImPACT)减少风险 应对巴哈马艾滋病毒流行的方案。FOYC的两个随机对照纵向试验 FOYC+CImPACT发现，这些计划在提高知识、避孕套使用技能和/或 自我报告的危险行为。2010年，教育部决定将FOYC纳入其中(逻辑上没有 FOYC+CImPACT)在全国范围内的政府六年级课程中，7年级和8年级都有助推器。这个 教育部现在计划将这一服务扩展到更有效、但在物流上更复杂的FOYC+CImPACT 版本。教育部、卫生部和我们的研究团队调查了与FOYC教学忠诚度相关的因素 在283名教师中，4411名教师的教学忠诚度与学生成绩之间的关系 学生们。教师在FOYC核心活动中的授课比例略高于50%。评估表明，学生教的是 由于表现不佳，教师在艾滋病毒/艾滋病知识、避孕套使用技能、自我教育等方面的表现较差 效果和意图；相反，“高绩效”教师的学生则是如此。筛选 工具和跟踪进程，以确定教师执行率低的风险，并以证据为基础 已确定/制定了实施支持和补救计划，以便在整个过程中使用 实施。两周一次的“实时”数据收集和分析，为持续的决策提供信息 教育部和卫生部对FOYC+CImPACT实施计划进行的调整或更改包括 这项提案的重点。巴哈马特有的实践社区适应(COP)，执行 监督和反馈以及创新培训是加强教师实施的战略。这个 拟议的研究解决了公共卫生重要性的三个假设：1.更密集的培训和 针对高危或中等表现教师的监督计划将提高他们的执行忠诚度，以 高绩效群体的平均水平(85%)；2.在全国范围内实施的艾滋病毒预防方案 水平可以是a)实施(在FOYC和CImPACT中交付85%的核心活动 与开发人员描述的一致)6级；以及，b)随着时间的推移(每年监测)； 学生成绩(知识、生殖健康技能、认知和自我报告的行为)将： A)继续与执行工作的忠诚度高度相关；和，b)随着时间的推移保持(评估 每年到九年级)。我们的目标是确定是否提供一个或两个)双周监测， 通过“实践社区”向有风险和表现一般的教师提供反馈和支持；以及b) 基于实时执行数据的教育部和卫生部的增强型决策平台 将：1)提高国家执行的保真度；2)随着时间的推移导致持续的执行。