Fidelity and Outcomes of National Implementation of FOYC+CImPact in the Bahamas

说明(申请人提供)：我们对有效预防干预措施的传播和传播过程的了解不断加深，使我们更加清楚地认识到，有必要把重点放在实施有效干预措施的相关但独特的问题上。在实施研究中需要解决的核心问题是更好地理解执行原始干预措施的保真度与复制(保留)原始干预措施的有效结果之间的关系。在过去的十年中，美国-巴哈马团队从疾控中心的有效行为干预传播(DEBI)组合中调整了一个基于证据的计划“关注有知情的父母和孩子在一起的青年”，以产生一个为期10节的青少年艾滋病毒预防计划(另外还有两个后续助推会)，题为关注加勒比青年(FOYC)和一个1小时的父母监测干预，题为加勒比知情的父母和儿童一起(CImPACT)]。FOYC CImPACT是通过一项涉及15所巴哈马小学的随机对照纵向试验进行评估的。基于FOYC在36个月内的有效性，巴哈马教育部决定将FOYC CImPACT纳入巴哈马所有78所公立小学的6年级课程，并在7年级和8年级进行后续强化课程。拟议的研究将在FOYC CImPACT的全国实施期间进行。这项研究将使我们能够完善和验证可用于整个执行科学领域的执行保真度的定义；确定影响执行保真度的因素；并测试执行保真度与复制干预结果之间的关系。为了在五所小学中开展试点工作，拟议的执行情况评估将在巴哈马的其余73所小学中进行。研究对象包括约300名6年级、7年级和8年级教师、约140名校长和辅导员以及约4800名六年级学生，从基线到九年级。通过使用由受过培训的观察员完成的评估实施忠诚度的观察表、由教师完成的自我评估表、评估假设与实施忠诚度有关的因素的辅导顾问和校长以及评估学生结果(知识、技能、感知和行为)的问卷，我们将解决：目标1：评估与FOYC CImPACT实施忠诚度相关的学校层面因素；目标2：评估与FOYC CImPACT实施保真度相关的课堂(教师)水平因素；目标3：确定不同保真度水平的FOYC CImPACT教学与学生结果(包括知识、技能、风险认知、意图和行为)之间的关系；以及目标4(次要)：探索保真度测量中的问题。

DESCRIPTION (provided by applicant): Our increased understanding of the processes of diffusion and dissemination of effective prevention interventions has lead to keener recognition of the need for focus on the related but unique issues of implementation of effective interventions. Central among the issues to be addressed in implementation research is better understanding of the relationship between fidelity of implementation of the original intervention with replication (retention) of the effective outcomes of the original intervention. Over the past decade, the US-Bahamian team adapted an evidence-based program "Focus on Youth with Informed Parents and Children Together" from the CDC's Diffusion of Effective Behavioral Interventions (DEBI) portfolio to produce a 10-session adolescent HIV prevention program (with two additional follow-up booster sessions) entitled Focus on Youth in The Caribbean (FOYC) and a 1-hour parental monitoring intervention entitled Caribbean Informed Parents and Children Together (CImPACT)]. FOYC+CImPACT was evaluated through a randomized, controlled longitudinal trial involving 15 Bahamian elementary schools. Based on the effectiveness of FOYC through 36 months, the Bahamian Ministry of Education has decided to incorporate FOYC+CImPACT into the grade 6 curriculum throughout all 78 government elementary schools in The Bahamas, with follow-up booster sessions in grades 7 and 8. The proposed research will be conducted during the national implementation of FOYC+CImPACT. The research will enable us to refine and validate a definition of fidelity of implementation which can be used across the field of implementation science; to identify factors which impact fidelity of implementation; and, to test the relationship Following between fidelity of implementation and replication of intervention outcomes. pilot work among five elementary schools, the proposed implementation assessment will be conducted among the remaining 73 elementary schools in The Bahamas. Subjects will include ~ 300 grade 6, 7 and 8 teachers, ~ 140 principals and guidance counselors and ~4800 students in grade 6 at baseline and followed forward through grade 9. Through the use of observation forms assessing fidelity of implementation to be completed by trained observers, self-assessment forms to be completed by teachers, guidance counselors and principals assessing factors hypothesized to be related to fidelity of implementation, and a questionnaire assessing student outcomes (knowledge, skills, perceptions and behaviors), we will address: Aim 1: Assess the school level factors associated with fidelity of implementation of FOYC+CImPACT; Aim 2: Assess the classroom (teacher) level factors associated with fidelity of implementation of FOYC+CImPACT; Aim 3: Determine the relationship between delivery of FOYC+CImPACT with varying levels of fidelity and student outcomes including knowledge, skills, risk perceptions, intentions and behaviors; and, Aim 4 (secondary): Explore issues in the measurement of fidelity.