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

描述（由申请人提供）：我们对有效预防干预措施的传播和推广过程的了解有所增加，从而更加敏锐地认识到需要重点关注实施有效干预措施的相关但独特的问题。实施研究中要解决的问题之一是更好地理解原始干预措施实施的保真度与原始干预措施有效成果的复制（保留）之间的关系。在过去的十年里，美国-巴哈马研究小组从疾病预防控制中心的有效行为干预传播（DEBI）项目组合中改编了一个以证据为基础的项目“关注青少年，让父母和孩子一起了解情况”，以制定一个10期的青少年艾滋病预防项目（以及另外两次后续助推会议），题为“关注加勒比青年”和一个1-名为"加勒比知情父母和儿童在一起“（CImPACT）的家长监测干预活动。FOYC+CImPACT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。根据FOYC在36个月内的成效，巴哈马教育部决定将FOYC+CImPACT纳入巴哈马所有78所公立小学的六年级课程，并在七年级和八年级开展后续助推课程。拟议的研究将在FOYC+CImPACT的国家实施期间进行。这项研究将使我们能够完善和验证的保真度的定义，可用于整个领域的实施科学的实施，以确定影响保真度的实施的因素，并测试以下的关系保真度的实施和复制的干预结果。除了在5所小学进行试点工作外，拟议的执行情况评估将在巴哈马其余73所小学进行。受试者将包括约300名6年级、7年级和8年级的教师，约140名校长和指导顾问，以及约4800名6年级的学生（基线），并随访至9年级。通过使用由受过训练的观察员填写的评估执行忠实度的观察表，由教师、辅导员和校长填写的评估假设与执行忠实度有关的因素的自我评估表，以及评估学生成果的问卷（知识，技能，感知和行为），我们将解决：目标1：评估与FOYC+CImPACT实施保真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）因素;目标3：确定FOYC+CImPACT交付与不同保真度水平和学生成果（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.