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扩散和传播过程的日益了解，使我们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。实施研究要解决的核心问题是更好地理解原始干预实施的保真度与原始干预有效结果的复制（保留）之间的关系。在过去的十年中，美国-巴哈马团队改编了CDC有效行为干预措施组合（DEBI）中的一项循证计划“聚焦青少年，与知情的父母和儿童一起”，制定了为期10节的青少年艾滋病毒预防计划（还有两次额外的后续加强会议），题为“聚焦加勒比地区的青少年”（FOYC），以及题为“加勒比知情的父母和儿童在一起（CImPACT）”的1小时家长监测干预措施。 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。基于 FOYC 36 个月的有效性，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 年级开展后续强化课程。拟议的研究将在全国实施 FOYC CImPACT 期间进行。这项研究将使我们能够完善和验证实施保真度的定义，该定义可以在实施科学领域使用；确定影响实施保真度的因素；并测试实施的保真度和干预结果的复制之间的关系。试点工作将在 5 所小学中进行，拟议的实施评估将在巴哈马其余 73 所小学中进行。受试者将包括约 300 名 6、7 和 8 年级教师，约 140 名校长和辅导员，以及约 4800 名 6 年级学生（基线并一直到 9 年级）。通过使用由训练有素的观察员完成的评估实施保真度的观察表、由教师、辅导员和校长填写的自我评估表来评估假设与实施保真度相关的因素，以及评估学生成绩的问卷（知识、技能、观念和行为），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）水平因素；目标 3：确定不同保真度水平的 FOYC CImPACT 交付与学生成果（包括知识、技能、风险认知、意图和行为）之间的关系；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.