Enhancing Quality Interventions Promoting Healthy Sexuality

描述(申请人提供)：作为一个国家，美国大力投资于以社区为基础的组织，以进行经研究证明的干预措施，以降低青少年中意外怀孕、性传播感染(STI)和艾滋病毒的高比率。用于帮助社区高质量实施这些计划的投资要少得多。尽管存在许多基于研究的计划来解决青少年怀孕和性传播感染问题，但社区面临着实施这些计划并取得与研究人员相同的结果的困难。这一“差距”是因为资源有限，预防工作复杂，社区往往缺乏实施好“现成”方案所需的能力--或知识、态度和技能。弥合这一差距的常见方式，如信息传播，未能改变地方一级的做法或成果，部分原因是它没有充分解决社区从业人员的能力问题。因此，建设社区的能力是一种可以提高执行质量和成果的方法。这项拟议的研究将使用随机对照设计和来自32个合作的男孩和女孩俱乐部(俱乐部)的中学青年(960人)和项目工作人员的原始数据来评估名为获得结果(GTO)的能力建设干预措施如何提高基于研究的干预措施的实施质量，以改善青少年的性健康(Making Proud Choices，MPC)。具体地说，这项研究将：(1)评估GTO的利用及其对计划工作人员实施MPC能力的后续影响；(2)评估使用GTO的俱乐部在MPC忠诚度方面比没有使用GTO的俱乐部在多大程度上表现出更大的改善；以及(3)评估使用GTO的俱乐部在青少年性健康结果方面比对照俱乐部表现出更大程度的改善。为了实现这些目标，我们将收集以下方面的数据：GTO的交付和利用(例如，交付方法、持续时间、主题)；实施以研究为基础的干预措施的工作人员能力；项目交付的观察(保真度监测)；以及青年参与者的性活动、怀孕、性传播感染、避孕套使用和性知识/态度。分析将检查干预地点和对照地点随着时间的推移的差异，说明地点内青年的聚集情况。这些成果对于NICHD将重点放在为青年提供机会，使其成为健康和富有成效的成年人方面具有重要意义。 公共卫生相关性：这项拟议的研究特别相关，因为它侧重于青少年在青少年怀孕率和生育率不断上升的情况下的性健康结果。研究如何在社区环境中提供以研究为基础的干预措施也是相关的，因为尽管美国的社区组织在促进健康方面发挥了关键作用，但它们往往无法达到研究试验所取得的结果。正如医学研究所所概述的那样，需要各种社区组织进行高质量的健康促进，以履行公共卫生的使命，确保“人们能够健康的条件”。具体地说，防止青少年获得性传播感染、艾滋病毒和意外怀孕的方案对于确保青少年健康发育和过渡到成年至关重要。

DESCRIPTION (provided by applicant): As a nation, the U.S. invests heavily in community-based organizations to conduct interventions, proven through research, to reduce the high rates of unplanned pregnancies and sexually transmitted infections (STIs) and HIV among teens. Much less is invested in helping communities implement these programs with quality. Although many research-based programs exist to address teen pregnancy and STIs, communities face difficulty implementing them and achieving the same outcomes as researchers. This "gap" is because resources are limited, prevention is complex, and communities often lack the capacity-or the knowledge, attitudes, and skills-needed to implement "off the shelf" programs well. Common ways to bridge this gap, such as information dissemination, fail to change practice or outcomes at the local level in part because it does not sufficiently address capacity of community practitioners. Therefore, building a community's capacity is a method that could improve the quality of implementation and outcomes. The proposed study will use a randomized controlled design and primary data from middle school youth (960) and program staff from 32 cooperating Boys and Girls Clubs (Clubs) to assess how a capacity building intervention called Getting To Outcomes (GTO) augments the quality of implementation of a research-based intervention to improve teen sexual health (Making Proud Choices, MPC). Specifically, the study will: (1) Assess the utilization of and subsequent effects of GTO on program staff capacity to implement MPC; (2) Assess the degree to which Clubs using GTO show greater improvements in MPC fidelity than Clubs that are not using GTO; and (3) Assess the degree to which Clubs using GTO show greater improvements on teen sexual health outcomes than the comparison Clubs. To address these aims we will collect data on the delivery and utilization of GTO (e.g., method of delivery, duration, topics); staff capacity to implement research-based interventions; observations of program delivery (fidelity monitoring); and youth participants' sexual activity, pregnancy, STIs, condom use, and knowledge/ attitudes towards sex. Analyses will examine differences between intervention and control sites over time, accounting for clustering of youth within site. These outcomes are important to NICHD's focus on providing opportunities for youth to become healthy and productive adults. PUBLIC HEALTH RELEVANCE: The proposed study is particularly relevant because it focuses on teen sexual health outcomes in the face of increasing rates of teen pregnancy and births to teens. It is also relevant to study how research-based interventions are delivered in community settings because while community organizations in the U.S. have a key role in promoting health, they often fail to achieve the outcomes achieved in research trials. High-quality health promotion by a wide variety of community-based organizations is needed in order to fulfill the mission of public health to ensure "conditions in which people can be healthy", as outlined by the Institute of Medicine. Specifically, programs to prevent adolescents from acquiring a STI, HIV, and unintentionally becoming pregnant are critical to ensuring healthy adolescent development and transition into adulthood.