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Adherence and delivery: implementation quality and program outcomes for the seventh-grade keepin' it REAL program.

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High-quality implementation of drug prevention programs like keepin' it REAL significantly improves student outcomes. Program delivery and adherence to curriculum are key factors influencing substance use and norms.

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Area of Science:

  • Public Health
  • Education
  • Psychology

Background:

  • Poor implementation quality (IQ) diminishes the effectiveness of prevention programs.
  • Understanding the specific impact of implementation variables on program outcomes is crucial for effective dissemination.

Purpose of the Study:

  • To examine the relationship between specific implementation quality variables and outcomes of a seventh-grade drug prevention intervention.
  • To assess the influence of program delivery and curriculum adherence on student substance use, norms, and efficacy.

Main Methods:

  • Two versions of the keepin' it REAL intervention were implemented in 78 classrooms across 25 schools.
  • Implementation quality was assessed via video coding of adherence and teacher/student engagement, with factor analysis identifying 'delivery' and 'adherence' factors.
  • Mixed-effects regression analysis examined the impact of IQ on student substance use, norms, and efficacy, controlling for pretest scores and clustering effects.

Main Results:

  • Well-implemented programs led to better student outcomes compared to poorly implemented ones.
  • Program delivery significantly impacted student substance use and norms, but not self-efficacy.
  • Curriculum adherence showed a marginal significant effect on substance use and a significant effect on norms, with no impact on efficacy.

Conclusions:

  • Implementation quality, particularly program delivery, is a critical determinant of prevention program effectiveness.
  • Comprehensive measurement and consideration of IQ are essential for accurate evaluation and successful dissemination of interventions.
  • Focusing on enhancing program delivery can lead to improved outcomes in drug prevention efforts.