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.

项目总结/摘要 在过去的二十年里，巴哈马教育部（莫伊）和卫生部（MOH）以及我们的研究 该小组改编了疾病预防控制中心的“最佳证据”艾滋病毒预防计划，以制作“关注青年人”， 加勒比地区（FOYC）和加勒比地区“父母和儿童共同知情”（CImPACT） 巴哈马艾滋病防治方案。FOYC的两项随机、对照纵向试验 FOYC+CImPACT发现这些项目在提高知识、安全套使用技能和/或 自我报告的危险行为。2010年，莫伊决定将FOYC（后勤复杂性低于 FOYC+CImPACT）在全国政府六年级课程中，在七年级和八年级有助推器。的 莫伊现在计划将服务范围扩大到更有效但后勤更复杂的FOYC+ CImPACT 版本.莫伊、MOH和我们的研究小组研究了与FOYC教学保真度相关的因素 在283名教师中，4，411名教师的教学忠诚度与学生成绩之间的关系 学生教师教授的课程略多于FOYC核心活动的50%。评估显示，学生们在 “低绩效”教师在艾滋病毒/艾滋病知识、安全套使用技能、自我教育、 有效性，和意图;相反的是真正的学生的“高绩效”教师。筛选 工具和跟踪程序，以确定教师在低执行风险，并以证据为基础 已经确定/制定了实施支持和补救方案， 实施.每两周进行一次“实时”数据收集和分析，为正在进行的决策提供信息， 莫伊和MOH将对FOYC+CImPACT实施计划进行的调整或变更如下 这一提案的重点。巴哈马特有的实践社区调整，执行 监察和反馈，以及创新培训是加强教师执行的策略。的 拟议的研究解决了三个假设的公共卫生的重要性：1。更密集的训练和 对有风险或表现中等教师的监督计划将提高他们对 高绩效组的平均水平（85%）; 2.在国家一级提供的艾滋病毒预防方案 a）忠实地实施（在FOYC和CImPACT中交付>85%的核心活动 与开发人员描述的一致）;以及，B）持续一段时间（每年监测）; 和3.学生的成果（知识，生殖健康技能，看法和自我报告的行为）将： a）继续与执行的准确性高度相关;以及，B）随着时间的推移而持续（评估 （每年9级）。我们的目标是确定是否提供一个或两个a）双周监测， 通过“实践社区”向处境危险和表现一般的教师提供反馈和支持;以及B） 莫伊和MOH基于实时实施数据的增强型决策平台 将：1）提高国家执行的忠实度; 2）随着时间的推移，导致持续的执行。