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

Area of Science:

• Public Health
• Education
• Psychology

Background:

• Evidence-based interventions (EBIs) are crucial for addressing behavioral health in schools.
• Maintaining fidelity of implementation (FOI) during EBI dissemination is a significant challenge.
• Understanding factors influencing FOI is essential for successful real-world application.

Purpose of the Study:

• To investigate the association between malleable classroom variables and FOI in school-based EBIs.
• To identify factors that can be optimized to support FOI without compromising intervention integrity.
• To inform resource allocation and implementation strategies for widespread EBI dissemination.

Main Methods:

• Utilized process evaluation data from a national dissemination project of Botvin LifeSkills Training (LST).
• Included 1,626 teachers across 371 schools in 14 states.
• Employed hierarchical linear models to analyze observational measures of implementation factors and FOI domains (adherence, responsiveness, quality).

Main Results:

• Curriculum modifications, student misbehavior, and insufficient time were significantly associated with lower FOI.
• Class size, material access, and delivery setting (traditional vs. unstructured) were less predictive of FOI.
• These findings highlight key areas for intervention optimization during scale-up.

Conclusions:

• Carefully vetting curriculum modifications and ensuring adequate class time are critical for implementing interactive EBIs like LST.
• Supporting classroom management strategies is essential for maintaining FOI.
• Guiding facilitators in making adjustments that preserve core intervention activities is necessary for successful EBI dissemination.