How prevention curricula are taught under real‐world conditions

Abstract

Purpose As interventions are disseminated widely, issues of fidelity and adaptation become increasingly critical to understand. This study aims to describe the types of adaptations made by teachers delivering a school-based substance use prevention curriculum and their reasons for adapting program content. Design/methodology/approach To determine the degree to which implementers adhere to a prevention curriculum, naturally adapt the curriculum, and the reasons implementers give for making adaptations, the study examined lesson adaptations made by the 31 teachers who implemented the keepin' it REAL drug prevention curriculum in 7th grade classrooms (n = 25 schools). Data were collected from teacher self-reports after each lesson and observer coding of videotaped lessons. From the total sample, 276 lesson videos were randomly selected for observational analysis. Findings Teachers self-reported adapting more than 68 percent of prevention lessons, while independent observers reported more than 97 percent of the observed lessons were adapted in some way. Types of adaptations included: altering the delivery of the lesson by revising the delivery timetable or delivery context; changing content of the lesson by removing, partially covering, revising, or adding content; and altering the designated format of the lesson (such as assigning small group activities to students as individual work). Reasons for adaptation included responding to constraints (time, institutional, personal, and technical), and responding to student needs (students' abilities to process curriculum content, to enhance student engagement with material). Research limitations/implications The study sample was limited to rural schools in the US mid-Atlantic; however, the results suggest that if programs are to be effectively implemented, program developers need a better understanding of the types of adaptations and reasons implementers provide for adapting curricula. Practical implications These descriptive data suggest that prevention curricula be developed in shorter teaching modules, developers reconsider the usefulness of homework, and implementer training and ongoing support might benefit from more attention to different implementation styles. Originality/value With nearly half of US public schools implementing some form of evidence-based substance use prevention program, issues of implementation fidelity and adaptation have become paramount in the field of prevention. The findings from this study reveal the complexity of the types of adaptations teachers make naturally in the classroom to evidence-based curricula and provide reasons for these adaptations. This information should prove useful for prevention researchers, program developers, and health educators alike.

Adaptations in a Community-Based Family Intervention: Replication of Two Coding Schemes

“…These findings could inform the development of efficient program monitoring tools like implementation checklists, which could be used to guide facilitator decisions regarding adaptation. Running out of time, which often leads to modifications to the program that involve deleting important curriculum content, was a significant issue in our study and aligns with previous findings (Hill et al, 2007;Miller-Day et al, 2013;Moore et al, 2013;Ozer et al, 2010). By noting this and other commonly reported types and reasons for adaptations, particularly those that are more likely to be made reactively and those negatively aligned with the program's theory, facilitators can proactively brainstorm strategies to handle common issues in ways that adhere to the program model.…”

“…Facilitators have also reported deleting activities due to insufficient time to complete them or changing delivery styles because they believed that a different format or process would be better. Disagreement with content, clarification of or emphasis on specific content, and technical difficulties have also been reported as common reasons for adaptations (Cohen et al, 2008;Hill, Maucione, & Hood, 2007;Miller-Day et al, 2013;Moore et al, 2013;Ozer, Wanis, & Bazell, 2010). Our study aims to extend our knowledge of types of and reasons for program adaptation in community settings through the replication of two multidimensional coding systems.…”

“…The primary adaptation types reported in those few studies are changes to program content, format, and delivery context. Studies also commonly report that facilitators provide additional information or resources; change the program's target population; add rewards, prizes, or celebrations; and modify training or evaluation processes (Cohen et al, 2008;Lara et al, 2011;Miller-Day et al, 2013;Moore, Bumbarger, & Cooper, 2013;Stirman, Miller, Toder, & Calloway, 2013;Veniegas, Kao, & Rosales, 2009).…”

“…Also, most adaptation studies have not taken into account alignment with program theory and timing of the adaptation but focus on categorizing types of adaptations (Cohen et al, 2008;Lara et al, 2011;Miller-Day et al, 2013;Ozer et al, 2010). Hansen et al (2013) included valence, which is similar to our conceptualization of alignment, and Miller- included timing.…”

“…Some recent studies of evidence-based program adaptations have utilized coding systems that categorize the multiple dimensions of program adaptations (Berkel, Murray, Roulston, & Brody, 2013;Cohen et al, 2008;Hansen et al, 2013;Hill et al, 2007;Lara et al, 2011;Miller-Day et al, 2013;Ozer et al, 2010;Moore et al, 2013;Stirman et al, 2013). For example, Stirman and colleagues developed a system to classify modifications (i.e., adapations) made to a variety of mental and behavioral health interventions according to who made the modification (e.g., individual practitioner, administrator), what was modified (e.g., content, context), at what level of delivery the modification was made (e.g., individual patient, group), the types of context modifications made (e.g., format, setting), and the nature of the content modifications made (e.g., adding or removing elements).…”