A mixed methods investigation of implementation determinants for a school-based universal prevention intervention

Area of Science:

• Public Health
• Implementation Science
• Educational Psychology

Background:

• Effective implementation of evidence-based prevention interventions in schools is crucial for reducing drug use.
• Suboptimal implementation often stems from a poor fit between the intervention and the school setting.
• Understanding how intervention characteristics and context influence implementation is key to improving public health impact.

Purpose of the Study:

• To examine implementation determinants for an evidence-based health curriculum using a mixed-methods approach.
• To understand the perspectives of health teachers delivering the Michigan Model for Health (MMH) curriculum.
• To identify barriers and facilitators to intervention-context fit in school settings.

Main Methods:

• Convergent mixed methods design integrating qualitative and quantitative data.
• Examined implementation determinants from the perspective of high school health teachers.
• Data analyzed for alignment, expansion, and divergence across qualitative and quantitative strands.

Main Results:

• Identified three key domains: Acceptability, intervention-context fit, and adaptability.
• Low acceptability correlated with low fidelity; curriculum-student needs fit predicted fidelity.
• Teachers reported challenges with fit for trauma-exposed youth and emerging drug trends, despite high adaptability.

Conclusions:

• Advances implementation research by deepening understanding of determinants for universal prevention in schools.
• Findings support designing strategies to address barriers and improve public health impact.
• Effective strategies should balance fidelity and adaptation for optimal student well-being.