A Cluster-Randomized Trial of Getting To Outcomes’ Impact on Sexual Health Outcomes in Community-Based Settings

Abstract

The USA has high teen pregnancy rates compared to other developed nations. Many community-based organizations need assistance conducting evidence-based teen pregnancy prevention programs (EBPs) appropriately. This study evaluated the impact of an implementation support intervention called Getting To Outcomes (GTO) designed to help such organizations. This cluster randomized controlled trial compared 16 Boys and Girls Clubs (BGCs) implementing a teen pregnancy prevention EBP called Making Proud Choices for two years, with 16 BGCs implementing MPC augmented with GTO training, tools, and technical assistance. Participating middle school youth were compared on proximal outcomes (knowledge, attitudes, and intentions about sex and condoms from baseline to post) and sexual behaviors (frequency of sex and condom use, from baseline to 6-month follow-up). In year 1, there were no significant effects of GTO for any proximal outcome. After GTO-stimulated quality improvement in year 2, the GTO group improved significantly more on condom attitudes and use intentions. Frequency of sex and condom use did not differ between the two groups in either year; however, base rates of these behaviors in the sample were very low. Findings suggest that in typical community-based settings, detailed manuals and training common to structured EBPs may be sufficient to yield some improvement in key proximal outcomes, but that more systematic implementation support is needed to achieve greater improvement in these outcomes. Using GTO with many communities, as currently supported by various federal agencies, could yield public health impact via improvements in condom attitudes and use intentions.

Testing implementation support for evidence-based programs in community settings: a replication cluster-randomized trial of Getting To Outcomes®

“…The trial assessed fidelity (e.g., adherence, quality of CHOICE delivery, dosage) and the alcohol and drug outcomes of participating middle school youth. Based on results from the EQUIPS trial [ 40 , 41 ], it was hypothesized that the intervention sites would be higher on fidelity than the control sites in the second year, and that the youth in the intervention sites would show more improvement in alcohol and drug outcomes than youth in control sites in the second year.…”

Getting to implementation: a protocol for a Hybrid III stepped wedge cluster randomized evaluation of using data-driven implementation strategies to improve cirrhosis care for Veterans

“…GTO is an implementation support intervention with written guides and support, which has been used in multiple trials to help community organizations choose and run programs with higher fidelity and yield better outcomes [ 28 , 29 ]. Up to now, GTO has not been used to help healthcare settings select and implement their own implementation strategies to support EBPs.…”

“…In contrast, what has not yet been explored is an adaptation of the implementation strategy bundle called Getting To Outcomes (GTO), which was specifically designed to be accessible for practitioners. GTO is a guided, manualized approach that was designed to help community organizations plan, implement, and evaluate evidence-based, often multicomponent interventions, to address a variety of problems such as substance use and homelessness in Veterans and teen pregnancy in community clinics [26][27][28][29][30][31][32]. GTO is stakeholder-driven, collaborative, and easily understood.…”

“…GTO is evidence-based. In multiple randomized trials, organizations that used GTO were able to implement programs with higher fidelity and achieve better outcomes [26][27][28][29][30][31][32]. The hypothesis of this evaluation is that the infrastructure of the GTO approach could be adapted to help teams in healthcare settings choose implementation strategies.…”

“…The GTO steps are a generic approach that has been applied to many content domains and settings. For example, Boys and Girls Clubs have used GTO to choose and adapt drug prevention and teen pregnancy programs to their context [26][27][28]31]. VA case managers used GTO to better implement evidence-based substance abuse treatment among Veterans who were formerly homeless [30,32].…”