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Wang B, Deveaux L, Lunn S, Dinaj-Koci V, Ghosh S, Li X, Marshall S, Rolle G, Forbes N, Stanton B. Bahamas National Implementation Project: Proposal for Sustainability of an Evidence-based HIV Prevention Intervention in a School Setting. JMIR Res Protoc 2020; 9:e14816. [PMID: 32821065 PMCID: PMC7474416 DOI: 10.2196/14816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 01/05/2020] [Accepted: 01/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sustained implementation of school-based prevention programs is low. Effective strategies are needed to enhance both high-level implementation fidelity and sustainability of prevention programs. OBJECTIVE This proposed study aims to determine if the provision of either biweekly monitoring and feedback and site-based assistance and mentorship or both to at-risk and moderate-performing teachers with monitoring through an enhanced decision-making platform by the Ministry of Education (MOE) and Ministry of Health (MOH) based on the real-time implementation data will increase national implementation fidelity and result in sustained implementation over time. METHODS This study will target government schools including 200 grade 6 teachers in 80 primary schools and 100 junior/middle high school teachers (and their classes) on 12 Bahamian islands. Teacher and school coordinator training will be conducted by the MOE in year 1, followed by an optimization trial among teachers in the capital island. Informed by these results, an implementation intervention will be conducted to train using different levels of educational intensity all at-risk and moderate-performing teachers. Subsequently selected training and implementation strategies will be evaluated for the national implementation of Focus on Youth in the Caribbean and Caribbean Informed Parents and Children Together in years 2 to 5. RESULTS It is hypothesized that a more intensive training and supervision program for at-risk and moderate-performing teachers will enhance their implementation fidelity to the average level of the high-performing group (85%), an HIV prevention program delivered at the national level can be implemented with fidelity in grade 6 and sustained over time (monitored annually), and student outcomes will continue to be highly correlated with implementation fidelity and be sustained over time (assessed annually through grade 9). The proposed study is funded by the National Institute of Child Health and Human Development from August 1, 2018, through May 31, 2023. CONCLUSIONS The study will explore several theory-driven implementation strategies to increase sustained teacher implementation fidelity and thereby increase the general public health impact of evidence-based interventions. The proposed project has potential to make significant contributions to advancing school-based HIV prevention research and implementation science and serve as a global model for the Fast Track strategy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/14816.
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Affiliation(s)
- Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | | | - Sonja Lunn
- Office of HIV/AIDS, Ministry of Health, Nassau, Bahamas
| | - Veronica Dinaj-Koci
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Samiran Ghosh
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Sharon Marshall
- Department of Pediatrics, Division of Adolescent Medicine, Children's Hospital of Michigan, Detroit, MI, United States
| | - Glenda Rolle
- Office of HIV/AIDS, Ministry of Health, Nassau, Bahamas
| | | | - Bonita Stanton
- Hackensack Meridian School of Medicine, Seton Hall University, Nutley, NJ, United States
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STI Health Disparities: A Systematic Review and Meta-Analysis of the Effectiveness of Preventive Interventions in Educational Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122819. [PMID: 30544919 PMCID: PMC6313766 DOI: 10.3390/ijerph15122819] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/08/2018] [Accepted: 12/09/2018] [Indexed: 12/04/2022]
Abstract
The purpose of this systematic review and meta-analysis was to address disparities related to sexual health among students by examining the effectiveness of sexually transmitted infection (STI) preventive interventions in educational settings. PubMed, Medline, Cochrane Library, Public Health Database, and EMBASE databases were used to conduct searches. Information relating to studies, programs, participants, and quantitative outcome variables were extracted. Risk of bias was assessed and meta-analysis was conducted. This systematic review included 16 articles. The outcomes were classified into behavioral and psychosocial categories. The behavioral category included sexual partners, sexual activity, condom use, STI/HIV testing, and alcohol/drug use before sex. The psychosocial category consisted of knowledge, motivational factors, and skills. Interventions had a significantly positive impact on both behavioral (OR, 1.28; 95% CI, 1.17–1.39) and psychosocial (OR, 1.92; 95% CI, 1.36–2.72) outcomes. Among the psychosocial outcomes, the interventions were most effective at promoting knowledge (OR, 3.17; 95% CI, 2.13–4.72), followed by enhancing motivational factors (OR, 1.69; 95% CI, 1.04–2.75) and increasing behavioral skills (OR, 1.43; 95% CI, 1.13–1.81). The results of this systematic review provide empirical evidence for public health professionals and policy makers regarding planning, implementation, evaluation, and modification of STI preventive intervention programs in educational settings.
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de Medeiros ER, Rebouças DGDC, Paiva ACDS, do Nascimento CPA, Silva SYBE, Pinto ESG. Studies evaluating of health interventions at schools: an integrative literature review. Rev Lat Am Enfermagem 2018; 26:e3008. [PMID: 30020339 PMCID: PMC6053286 DOI: 10.1590/1518-8345.2463.3008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 01/04/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify and analyze the available evidence on the strategies used in the studies evaluating health interventions at school. METHOD this is an integrative review searching in LILACS, CINAHL, CUIDEN, ScienceDirect, and PubMed. From the pre-defined inclusion and exclusion criteria, there were 121 articles chosen to compose the sample. RESULTS english studies (97.5%), with a quantitative approach (80.2%), related to the interventions carried out in the Region of the Americas (54.6%) and the European Region (23.1%) predominated. For the most part, they are interventions as programs (70.2%), interested in evaluating results (73.5%) from the value judgment (83.4%). Prevalence of interventions focused on efficacy, effects or impact, and activities carried out on interventions were focused on physical activity, healthy eating, sexual and reproductive health, mental health, and use of tobacco, alcohol, and other drugs. They are worked through activities of clinical monitoring, health promotion and disease prevention. CONCLUSION the evidence indicates that the evaluations of health interventions in the school focus the results produced in programs through the judgment of value. The topics most addressed were healthy eating, physical activity, prevention of alcohol and other drugs, among others.
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Affiliation(s)
- Eliabe Rodrigues de Medeiros
- Doctoral student, Departamento de Enfermagem, Universidade Federal
do Rio Grande do Norte, Natal, RN, Brazil. Bolsista do Conselho Nacional de
Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Danielle Gonçalves da Cruz Rebouças
- Cardiology and Hemodynamics Specialist, Specialization student in
Public Health: Oncology Nursing, Escola da Assembleia Legislativa do Rio Grande do
Norte, Natal, RN, Brazil
| | - Alany Carla de Sousa Paiva
- Occupational Health Nursing Specialist, Specialization student in
Higher Education Teaching, Escola de Saúde, Universidade Potiguar, Natal, RN,
Brazil
| | - Camila Priscila Abdias do Nascimento
- Emergency and Trauma Nursing Specialist, Specialization student in
Public Health, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP,
Brazil
| | | | - Erika Simone Galvão Pinto
- PhD, Professor Adjunto, Departamento de Enfermagem, Universidade
Federal do Rio Grande do Norte, Natal, RN, Brazil
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Wang B, Stanton B, Deveaux L, Lunn S, Rolle G, Adderley R, Poitier M, Koci V, Marshall S, Gomez P. Multi-year school-based implementation and student outcomes of an evidence-based risk reduction intervention. Implement Sci 2017; 12:16. [PMID: 28187740 PMCID: PMC5303204 DOI: 10.1186/s13012-016-0539-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 12/16/2016] [Indexed: 11/10/2022] Open
Abstract
Background Intervention effects observed in efficacy trials are rarely replicated when the interventions are broadly disseminated, underscoring the need for more information about factors influencing real-life implementation and program impact. Using data from the ongoing national implementation of an evidence-based HIV prevention program [Focus on Youth in The Caribbean (FOYC)] in The Bahamas, this study examines factors influencing teachers’ patterns of implementation, the impact of teachers’ initial implementation of FOYC, and subsequent delivery of the booster sessions on students’ outcomes. Methods Data were collected from the 80 government elementary and 34 middle schools between 2011 and 2014, involving 208 grade 6, 75 grade 7, and 58 grade 8 teachers and 4411 students initially in grade 6 and followed for 3 years. Student outcomes include HIV/AIDS knowledge, reproductive health skills, self-efficacy, and intention to use protection. Data from teachers includes implementation and modification of the curriculum, attitudes towards the prevention program, comfort level with the curriculum, and attendance at training workshops. Structural equation modeling and mixed-effect modeling analyses were applied to examine the impact of teachers’ implementation. Results Teachers’ attitudes towards and comfort with the intervention curriculum, and attendance at the curriculum training workshop had a direct effect on teachers’ patterns of implementation, which had a direct effect on student outcomes. Teachers’ attitudes had a direct positive effect on student outcomes. Teachers’ training in interactive teaching methods and longer duration as teachers were positively associated with teachers’ comfort with the curriculum. High-quality implementation in grade 6 was significantly related to student outcomes in grades 6 and 7 post-implementation. Level of implementation of the booster sessions in grades 7 and 8 were likewise significantly related to subsequent student outcomes in both grades. Conclusions High-quality initial implementation of a prevention program is significantly related to better program outcomes. Poor subsequent delivery of booster sessions can undermine the positive effects from the initial implementation while strong subsequent delivery of booster sessions can partially overcome poor initial implementation. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0539-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bo Wang
- Division of Behavioral Sciences, Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, 6135 Woodward Ave, Detroit, MI, 48202, USA.
| | - Bonita Stanton
- Seton Hall-Hackensack Meridian School of Medicine, Hackensack Meridian Health, 400 South Orange Avenue, South Orange, NJ, 07079, USA
| | - Lynette Deveaux
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Sonja Lunn
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Glenda Rolle
- Ministry of Education, Thompson Boulevard, PO Box N-3913, Nassau, Bahamas
| | - Richard Adderley
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Maxwell Poitier
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
| | - Veronica Koci
- Division of Behavioral Sciences, Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, 6135 Woodward Ave, Detroit, MI, 48202, USA
| | - Sharon Marshall
- Department of Pediatrics, Division of Adolescent Medicine, Wayne State University School of Medicine, Children's Hospital of Michigan, 3901 Beaubien Street, Detroit, MI48201, USA
| | - Perry Gomez
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, Bahamas
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Wang B, Stanton B, Lunn S, Patel P, Koci V, Deveaux L. Development of a Brief Pre-Implementation Screening Tool to Identify Teachers Who Are at Risk for Not Implementing Intervention Curriculum and High-Implementing Teachers. HEALTH EDUCATION & BEHAVIOR 2017; 44:83-91. [PMID: 27198536 PMCID: PMC5116286 DOI: 10.1177/1090198116639242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Few questionnaires have been developed to screen for potentially poor implementers of school-based interventions. This study combines teacher characteristics, perceptions, and teaching/training experiences to develop a short screening tool that can identify potential "low-performing" or "high-performing" teachers pre-implementation. Data were gathered from 208 teachers and 4,411 students who participated in the national implementation of an evidence-based HIV intervention in The Bahamas. Sensitivity and specificity were evaluated for the detection of "low-performing" and "high-performing" teachers. The validity of the screening tool was assessed using receiver operating characteristics analysis. The School Pre-implementation Screening Tool consists of seven predictive factors: duration as teacher, working site, attendance at training workshops, training in interactive teaching, perceived importance of the intervention, comfort in teaching the curriculum, and program priority. The sensitivity and specificity were 74% and 57% in identifying "low-performing" teachers and 81% and 65% with "high-performing" teachers. The screening tool demonstrated an acceptable/good validity (area under the receiver operating characteristics curve was 0.68 for "low-performing teachers" and 0.78 for "high-performing" teachers). Our brief screening tool can facilitate teacher training and recruitment of engaged teachers in implementation of school-based interventions.
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Affiliation(s)
- Bo Wang
- Pediatric Prevention Research Center, Department of Pediatrics, Wayne State University School of Medicine, 4707 St. Antoine, Suite W534, Detroit, MI 48201, USA
| | - Bonita Stanton
- Pediatric Prevention Research Center, Department of Pediatrics, Wayne State University School of Medicine, 4707 St. Antoine, Suite W534, Detroit, MI 48201, USA
| | - Sonja Lunn
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, The Bahamas
| | - Pooja Patel
- Pediatric Prevention Research Center, Department of Pediatrics, Wayne State University School of Medicine, 4707 St. Antoine, Suite W534, Detroit, MI 48201, USA
| | - Veronica Koci
- Pediatric Prevention Research Center, Department of Pediatrics, Wayne State University School of Medicine, 4707 St. Antoine, Suite W534, Detroit, MI 48201, USA
| | - Lynette Deveaux
- Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, The Bahamas
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