Multi-year school-based implementation and student outcomes of an evidence-based risk reduction intervention

Area of Science:

• Public Health
• Education
• Implementation Science

Background:

• Efficacy trials rarely replicate real-world intervention effects, necessitating research into implementation factors.
• The Focus on Youth in The Caribbean (FOYC) program's national rollout in The Bahamas provides a case study.
• Understanding implementation influences is key to maximizing program impact.

Purpose of the Study:

• Examine factors affecting teachers' implementation of the FOYC HIV prevention program.
• Assess the impact of initial FOYC implementation and booster sessions on student outcomes.
• Identify links between teacher characteristics, implementation fidelity, and student health knowledge and behaviors.

Main Methods:

• Longitudinal study (2011-2014) involving 80 elementary and 34 middle schools.
• Data from 208 grade 6, 75 grade 7, and 58 grade 8 teachers and 4411 students.
• Structural equation and mixed-effect modeling analyzed teacher implementation and student outcomes (knowledge, skills, self-efficacy, intention).

Main Results:

• Teacher attitudes, comfort, and training attendance directly influenced implementation patterns and student outcomes.
• High-quality grade 6 implementation positively impacted student outcomes in grades 6 and 7.
• Effective booster session delivery in grades 7 and 8 significantly improved subsequent student outcomes.

Conclusions:

• High-quality initial program implementation is critical for positive student outcomes.
• Booster session delivery quality can mitigate or enhance the effects of initial implementation.
• Teacher training and positive attitudes are vital for successful program dissemination.