Influence of Classroom-Level Factors on Implementation Fidelity During Scale-up of Evidence-Based Interventions.

Autor: Combs KM; Institute of Behavioral Science, University of Colorado Boulder, 1440 15th St, Boulder, CO, 80309, USA. katie.combs@colorado.edu., Buckley PR; Institute of Behavioral Science, University of Colorado Boulder, 1440 15th St, Boulder, CO, 80309, USA., Lain MA; Institute of Behavioral Science, University of Colorado Boulder, 1440 15th St, Boulder, CO, 80309, USA., Drewelow KM; Institute of Behavioral Science, University of Colorado Boulder, 1440 15th St, Boulder, CO, 80309, USA., Urano G; Department of Anthropology, University of California San Diego, La Jolla, CA, 92092, USA., Kerns SEU; Graduate School of Social Work, University of Denver, Denver, CO, 80208, USA.; The Kempe Center, University of Colorado, Aurora, USA.
Jazyk: angličtina
Zdroj: Prevention science : the official journal of the Society for Prevention Research [Prev Sci] 2022 Aug; Vol. 23 (6), pp. 969-981. Date of Electronic Publication: 2022 Apr 29.
DOI: 10.1007/s11121-022-01375-3
Abstrakt: As evidence-based interventions (EBIs) become more widely disseminated, fidelity of implementation (FOI) often wanes. This study explores the association between FOI and malleable variables within classrooms that could be targeted to optimize resources without compromising FOI as school-based EBIs are disseminated across real-world settings. We utilized process evaluation data from a national dissemination project of the Botvin LifeSkills Training (LST) middle school program, a universal prevention intervention shown to reduce substance use. The sample included 1,626 teachers in 371 schools across 14 states. Hierarchical linear models examined the relationship between observational measures of implementation factors and three domains of fidelity (e.g., adherence, student responsiveness, and quality of delivery). Findings suggest that curriculum modifications, student misbehavior, and shortage of time to implement the LST middle school program were factors most associated with lower FOI. Class size, access to program materials, and whether LST was delivered in a traditional classroom setting that is well-suited for instruction (versus in a less structured environment such as the school cafeteria) are less predictive. In scale-up of classroom-based universal interventions targeting behavioral health outcomes, our findings indicate that carefully vetting modifications, supporting classroom management strategies, and ensuring sufficient class time for implementation of highly interactive EBIs such as LST are important considerations. Since changes to EBIs are inevitable, efforts are needed to guide facilitators in making adjustments that improve program fit without compromising the essential intervention activities deemed necessary to produce desired outcomes.
(© 2022. The Author(s).)
Databáze: MEDLINE
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