The effects of implementation fidelity in the Towards No Drug Abuse dissemination trial

Abstract

Purpose The current study examines the influence of contextual and provider-level factors on the implementation fidelity of a research-based substance abuse prevention program. Also, it investigates whether two provider-level factors, self-efficacy and beliefs about the value of the program, statistically moderate and mediate the effects of a provider training intervention on implementation fidelity. Design/methodology/approach Using generalized mixed-linear modeling, we examine relationships between program provider-, organizational, and community-level factors and implementation fidelity in a sample of 50 high school teachers from 43 high schools in 8 states across the U.S. Fidelity of implementation was assessed utilizing an observation procedure. Findings Implementation fidelity was negatively associated with the urbanicity of the community and the level of teachers’ beliefs about the value of the program, and positively predicted by the organizational capacity of the school. Comprehensive training significantly increased teachers’ self-efficacy, which resulted in an increase in implementation fidelity. Research implications School-based prevention program implementation is influenced by a variety of contextual factors occurring at multiple ecological levels. Future effectiveness and dissemination studies need to account for the complex nature of schools in analyses of implementation fidelity and outcomes. Practical implications Our findings suggest that both provider- and organizational-level factors are influential in promoting implementation fidelity. Before implementation begins, as well as throughout the implementation process, training and ongoing technical assistance should be conducted to increase teachers’ skills, self-efficacy, and comfort with prevention curricula. Originality/value The present study is one of the few to examine contextual and provider-level correlates of implementation fidelity and use mediation analyses to explore whether provider-level factors mediate the effects of a provider training intervention on implementation fidelity.

What strategies are used to build practitioners’ capacity to implement community-based interventions and are they effective?: a systematic review

“…In the seven studies reporting findings related to intervention effects on capacity, findings were mixed. Studies reported response rates of 75% or better and had sample sizes of 120 or more, with the exception of Florin et al ( n = 9, [ 32 ]) and Little et al ( n = 50, [ 41 ]). Researchers operationalized capacity as self-efficacy (or self-report of skills), awareness, knowledge, attitudes, and/or beliefs about the value of the EBI.…”

“…Researchers operationalized capacity as self-efficacy (or self-report of skills), awareness, knowledge, attitudes, and/or beliefs about the value of the EBI. In two cases, group randomized trials found significantly greater improvements in capacity in the intervention versus the comparison group (self-efficacy [ 41 ] and knowledge [ 42 ]) and in two they did not (self-efficacy [ 43 ] and beliefs [ 41 ]). Neither of the two group non-randomized trials found significant between group differences in capacity (awareness [ 44 ] and self-efficacy and attitude [ 20 ]) following the intervention.…”

“…In one study, researchers analyzed the role that capacity played as both a mediator and moderator of capacity building’s effects on implementation [ 41 ]. They found that changes in practitioners’ self-efficacy (but not in their beliefs) mediated the effects that training and TA had on implementation fidelity.…”

The Effects of Teacher Fidelity of Implementation of Pathways to Health on Student Outcomes

“…Therefore, when a principal supports the implementation of an intervention, teachers are likely to implement the program with greater fidelity (Gregory, Henry, & Schoeny, 2007; Kam, Greenberg, & Walls, 2003; Ringwalt et al, 2003). Other factors, such as teachers' beliefs about the benefits of a particular program and comfort implementing the program, have also been shown to increase implementation fidelity (Beets et al, 2008; Ennett et al, 2003; Kallestad & Olweus, 2003; Klimes-Dougan et al, 2009; Little, Sussman, Sun, & Rohrbach, 2013; Ringwalt et al, 2003). The influence of these types of contextual factors on the fidelity of prevention program implementation in schools is an integral, yet often overlooked, part of implementation research.…”

Metodologia participativa com educadores: prevenção ao consumo de drogas psicoativas em instituição escolar

“…necessidade de o professor acreditar nos resultados das ações de prevenção é enfatizada por estudos(LITTLE et al, 2013;LACHAUSSE, CLARK; CHAPPLE, 2014) que a associam ao adequado uso do tempo escolar, domínio do programa incentivo da sua aplicação e o apoio da direção escolar.Assim como os resultados deste estudo, a literatura(ARALDI, 2012; FERREIRA et al, 2010) menciona que ao ser questionado sobre ações de prevenção ao uso de drogas, o professor geralmente afirma que não tem conhecimentos suficientes, e que os alunos detêm um arcabouço de informações maior que o deles acerca das drogas. Por isso, justificam sua não realização devido ao despreparo e falta de informação que os faz delegar essa atividade a outros órgãos.Acerca da capacitação de professores,Ferreira et al (2010) afirmam que, geralmente, os professores participam de formações, cursos, palestras sobre a temática drogas, mas que na percepção desses, as informações fornecidas são muito superficiais.…”