Abstract
BackgroundMost Brazilian schools do not have a continuous program for drug use prevention. To address this gap, the Ministry of Health adapted the European evidence-based program Unplugged to improve the drug use prevention efforts of Brazilian public schools. The aim of this study was to evaluate the process of program implementation in three Brazilian cities among middle school students between 6th and 9th grade (11 to 14 years old).MethodsMixed methods were used in this process evaluation study, including focus groups, fidelity forms, and satisfaction questionnaires. Study participants included 36 teachers, 11 school administrators, 6 coaches, 16 stakeholders, and 1267 students from 62 classes in 8 schools.ResultsThe 12 Unplugged lessons were all implemented in 94 % of the classes. However, only 57 % of the classes were completed as described in the program's manual. The decision to exclude activities because of time constraints was made without a common rationale. Teachers reported difficulties due to the amount of time necessary to plan the lessons and implement the activities. In addition, they mentioned that the lack of support from school administrators was an obstacle to proper program implementation. The majority of students and teachers responded positively to the program, reporting changes in the classroom environment and in personal skills or knowledge.ConclusionsThe Unplugged program can be feasibly implemented in Brazilian public schools. However, it is necessary to reduce the number of activities per class and to restructure the format of the standard teaching schedule to ensure that the normal academic content is still taught while Unplugged is being implemented.
Highlights
Most Brazilian schools do not have a continuous program for drug use prevention
Given the current situation in Brazil, the Unplugged Program for drug prevention in the school environment [7] was selected by the Brazilian Ministry of Health to be adapted, implemented, and evaluated in the Brazilian setting
According to the data from the fidelity forms (n = 655), 56.9 % of the lessons were performed in the time allocated for one lesson; 11.5 % of the lessons lasted for one and a half lessons; 23.9 % of the Unplugged lessons lasted for the duration of two lessons; and 7.7 % of them lasted more than two full lessons
Summary
Most Brazilian schools do not have a continuous program for drug use prevention. To address this gap, the Ministry of Health adapted the European evidence-based program Unplugged to improve the drug use prevention efforts of Brazilian public schools. In Brazil, the average age of initial consumption among students is 13 years old for alcohol and between 13 and 14 years old for other drugs [2], with alcohol and tobacco being the most consumed substances among teens [3] Based on this data, it is necessary to consolidate interventions to prevent the initiation of substance use. Given the current situation in Brazil, the Unplugged Program for drug prevention in the school environment [7] was selected by the Brazilian Ministry of Health to be adapted, implemented, and evaluated in the Brazilian setting This program is based on a theoretical model of social influence [8] and promotes life skills, provides information on drugs, and develops critical thinking toward social and normative beliefs [9]. A large number of studies have noted the importance of evaluating the implementation of preventive interventions in the school environment [15, 16]
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