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传播过程的理解日益加深，从而更加敏锐地认识到需要关注实施有效干预措施的相关但独特的问题。实施研究中需要解决的核心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结果的复制（保留）之间的关系。在过去的十年里，美国-巴哈马团队改编了美国疾病控制与预防中心有效行为干预推广项目（DEBI）中的一个基于证据的项目“关注父母和孩子一起知情的青少年”，制定了一个名为“关注加勒比青年”（FOYC）的10期青少年艾滋病预防项目（另外两次后续促进会议）和一个名为“加勒比知情父母和孩子一起知情”（CImPACT）的1小时父母监测干预项目。FOYC+CImPACT是通过一项涉及15所巴哈马小学的随机、对照纵向试验来评估的。基于36个月以来FOYC的成效，巴哈马教育部决定将FOYC+CImPACT纳入巴哈马所有78所政府小学的六年级课程，并在七年级和八年级进行后续加强课程。建议的研究将在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可以在整个实施科学领域使用的实施保真度的定义；识别影响实施保真度的因素；检验实施保真度与干预结果复制之间的关系。在五所小学进行试点工作，拟议的执行情况评估将在巴哈马其余73所小学进行。研究对象包括约300名六年级、七年级和八年级教师，约140名校长和辅导员，以及约4800名六年级学生，从基线一直持续到九年级。通过使用由训练过的观察员完成的评估实施保真度的观察表格，由教师、辅导员和校长完成的评估假设与实施保真度相关因素的自我评估表格，以及评估学生成果（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：确定不同保真度的FOYC+CImPACT的交付与学生成果（包括知识、技能、风险感知、意图和行为）之间的关系；目标4（次要）：探讨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.