Abstract
BackgroundResearch is needed to evaluate the impact of implementation support interventions over and above typical efforts by community settings to deploy evidence-based prevention programs.MethodsEnhancing Quality Interventions Promoting Healthy Sexuality is a randomized controlled trial testing Getting To Outcomes (GTO), a 2-year implementation support intervention. It compares 16 Boys and Girls Club sites implementing Making Proud Choices (MPC, control group), a structured teen pregnancy prevention evidence-based program with 16 similar sites implementing MPC augmented with GTO (intervention group). All sites received training and manuals typical for MPC. GTO has its own manuals, training, and onsite technical assistance (TA) to help practitioners complete key programming practices specified by GTO. During the first year, TA providers helped the intervention group adopt, plan, and deliver MPC. This group then received training on the evaluation and quality improvement steps of GTO, including feedback reports summarizing their data, which were used in a TA-facilitated quality improvement process that yielded revised plans for the second MPC implementation. This paper presents results regarding GTO’s impact on performance of the sites (i.e., how well key programming practices were carried out), fidelity of MPC implementation, and the relationship between amount of TA support, performance, and fidelity. Performance was measured using ratings made from a standardized, structured interview conducted with participating staff at all 32 Boys and Girls Clubs sites after the first and second years of MPC implementation. Multiple elements of fidelity (adherence, classroom delivery, dosage) were assessed at all sites by observer ratings and attendance logs.ResultsAfter 2 years, the intervention sites had higher ratings of performance, adherence, and classroom delivery (dosage remained similar). Higher performance predicted greater adherence in both years.ConclusionsThese findings suggest that in typical community-based settings, manuals and training common to structured EBPs may be sufficient to yield low levels of performance and moderate levels of fidelity but that systematic implementation support is needed to achieve high levels of performance and fidelity.Trial registrationClinicalTrials.gov, NCT01818791
Highlights
Research is needed to evaluate the impact of implementation support interventions over and above typical efforts by community settings to deploy evidence-based prevention programs
Amount of Getting To Outcomes (GTO) implementation support As in past GTO studies [24, 33], the control group did inadvertently receive some technical assistance (TA) hours, not including the time devoted to Making Proud Choices (MPC) training
Large randomized trials—likely funded by a combination of sources—will be able to shed light on the utility of implementation support at a large scale. These findings suggest that sites receiving the GTO implementation support intervention experienced a benefit related to their performance of key programming practices and level of fidelity
Summary
Research is needed to evaluate the impact of implementation support interventions over and above typical efforts by community settings to deploy evidence-based prevention programs. There is little theorydriven research using rigorous designs that test whether these support interventions improve program delivery or participant outcomes. This is especially the case in the domain of teen pregnancy and sexually transmitted infection (STI) prevention, where programs are often implemented in low-resource, community-based settings that some argue have been under-studied in implementation science [2]. EQUIPS tested GTO’s impact in helping a communitybased setting (Boys and Girls Club sites) implement an evidence-based, teen pregnancy and STI prevention program called Making Proud Choices (MPC) [3].
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