Influence of an Implementation Support Intervention on Barriers and Facilitators to Delivery of a Substance Use Prevention Program

Prevention Science - Implementation support interventions have helped organizations implement programs with quality and obtain intended outcomes. For example, a recent randomized controlled trial...     

Survey of Barriers and Facilitators to Engagement in a Multidisciplinary Healthy Lifestyles Program for Children

ObjectiveTo understand facilitators and barriers to engagement in a multidisciplinary assessment and intervention program for children and adolescents with obesity, particularly for Māori, the Indigenous people of New Zealand.MethodsWhānau Pakari participants and caregivers (n = 71, 21% response rate) referred to the family-based healthy lifestyles program in Taranaki, New Zealand, were asked to participate in a confidential survey, which collected self-reported attendance levels and agreement with statements around service accessibility and appropriateness and open-text comments identifying barriers and facilitators to attendance.ResultsSelf-reported attendance levels were higher when respondents reported sessions to be conveniently located (P = .03) and lower when respondents considered other priorities as more important for their family (P = .02). Māori more frequently reported that past experiences of health care influenced their decision to attend (P = .03). Facilitators included perceived convenience of the program, parental motivation to improve child health, and ongoing support from the program.Conclusions and ImplicationsProgram convenience and parental and/or self-motivation to improve health were facilitators of attendance. Further research is required to understand the relationship between past experiences with health care and subsequent engagement with services.     

A Comprehensive School-Based Smoking Prevention Program

Eighth, ninth and tenth graders (N = 281) from two schools in suburban New York participated in a study to test the efficacy of a 10-session comprehensive psychosocial smoking prevention program. Schools were randomly assigned to experimental and control conditions. All students were given a pretest, posttest and three-month follow-up which assessed smoking behavior as well as knowledge and personality variables. There were significantly fewer new "smokers" in the experimental school than in the control school at both the initial posttest (p less than .01) and the three-month followup (p less than .05) along with significantly greater changes on some of the knowledge and personality variables. Overall, these results support the use of a smoking prevention strategy that focuses on the main psychosocial factors promoting the onset of cigarette smoking by teaching students basic coping skills.     

The Linkage Approach Applied to a School-Based Smoking Prevention Program in the Netherlands

ABSTRACT: Effective diffusion strategies are necessary to enhance use of innovative health promotion programs. One strategy uses the linkage approach to innovation-development and diffusion planning. The linkage approach enhances collaboration among three systems: resource system (university-based researchers), linkage system (district health educators), and user system (teachers). This article illustrates how the linkage approach was applied in a smoking prevention research project. Identification of the linkage system and the collaborative process between the resource system and linkage system are described. Results from a process evaluation indicated the linkage approach was feasible in a school-based smoking prevention project.     

The Implementation and Institutionalization of a School-Based Youth Suicide Prevention Program

This paper describes the implementation and institutionalization of a comprehensive, county-wide, school-based youth suicide prevention program. Ten years after the program dissemination was begun, the extent of implementation and institutionalization was assessed utilizing a survey of the 46 public high schools in the county together with in depth interviews with informants from the first 11 schools that had adopted the program. All but one of the 31 survey respondents, and 9 of 11 interviewees had retained the student lessons that were the core of the program. Program retention was associated with a variety of factors suggested by the literature as supportive to the institutionalization of school-based innovations.     

Taking a School-Based Child Sexual Abuse Prevention Program to Scale: a Cost Analysis

Prevention Science - Cost analyses are used to determine overall costs of implementing evidence-based programming and may help decision makers determine how best to allocate finite resources. Child...     

Facilitators and Barriers to Implementation and Sustainability of Nutrition and Physical Activity Interventions in Early Childcare Settings: a Systematic Review

A stronger understanding of the factors influencing implementation of interventions in community-based early childcare settings is needed. The purpose of this systematic review was to synthesize existing research on facilitators and barriers to implementation and sustainability of nutrition and physical activity interventions in early childcare settings targeting 2–5-year-old children, including considerations for equitable implementation. This review adhered to PRISMA 2020 guidelines. Peer-reviewed literature was searched in PubMed, EMBASE, CINAHL, ERIC, and PsycINFO databases up to September 2020. Primary research studies that examined facilitators and barriers (or related synonyms) to the implementation and sustainability of nutrition and physical activity interventions in early childcare settings were eligible for inclusion. The search yielded 8092 records that were screened by four analysts in Covidence software with a final review of 24 studies. Two independent reviewers conducted study selection, data extraction, and quality appraisal (Mixed Methods Appraisal Tool). A “best fit” framework was applied using the Consolidated Framework for Implementation Research (CFIR) constructs to code barriers and facilitators. The most salient constructs were (1) “Available Resources,” which was composed of time, staffing, space, and staff trainings; (2) adaptability; and (3) compatibility, the latter two indicating that easily modifiable interventions facilitated a smoother “fit” and were more likely to be successful, given adequate site-level resources. Only nine (28%) reported the use of a theory, model, or framework to guide evaluation; six studies (24%) included factors related to sustainability; and nine studies (38%) conducted their interventions with low-income or minoritized groups. The findings point to the need for intervention evaluations examining nutrition and physical activity to more consistently consider (a) sustainability factors early on in design and adoption phases; (b) use of theory, model, or framework to guide evaluation; and (c) equity-related frameworks and considerations for how equitable implementation.

     

Short-Term Effects of a School-Based Program on Gambling Prevention in Adolescents

PurposeTo evaluate short-term effects of a school-based media education program for sixth- and seventh-grade adolescents on gambling knowledge, attitudes, and behavior.MethodsA two-wave cluster randomized control trial with two arms (intervention vs. control group) was conducted in the German Federal State of Schleswig-Holstein. The intervention group received a four-unit media education program, which contained one unit on gambling. The program was implemented by trained teachers during class time. The control group attended regular classes without any specific intervention. Survey data from 2,109 students with a mean age (SD) of 12.0 (.85) years was collected before and shortly after the intervention.ResultsThirty percent of the sample reported lifetime gambling; 6.7% were classified as current gamblers. Results of multilevel mixed-effects regression analyses revealed significant program effects in terms of an increased gambling knowledge (d = .18), decreased problematic gambling attitudes (d = .15), as well as a decrease of current gambling (d = .02) in the intervention group compared to the control group. The program had no significant influence on lifetime gambling.ConclusionsA 90-minute lesson about gambling can improve gambling knowledge and change attitudes toward gambling and gambling behavior among adolescents. Studies with a longer follow-up period are needed to test the long-term effects of such an intervention.     

A Mixed-Methods Exploration of Barriers and Facilitators to Evidence-Based Practices for Obesity Prevention in Head Start

ObjectiveTo identify positive and negative deviant cases using quantitative fidelity data from a previous implementation of a nutrition intervention, Together, We Inspire Smart Eating (WISE), and to determine barriers and facilitators to fidelity by conducting qualitative interviews with deviant cases.DesignExplanatory sequential mixed methods.SettingHead Start Program agencies in 2 southern US states.ParticipantsQuantitative fidelity data were collected in 42 Head Start classrooms. Recruitment for qualitative interviews prioritized those who were positive or negative deviants across fidelity components (African American, n = 21; white, n = 19; and Hispanic, n = 3).InterventionWISE introduces children to fruits and vegetables using evidence-based practices of role modeling, positive feeding, mascot use, and hands-on exposure.AnalysisA directed content analysis approach informed by the integrated Promoting Action on Research Implementation in Health Service framework.Phenomenon of InterestBarriers and facilitators to WISE evidence-based practices implementation.ResultsQualitative analyses identified themes of culture, leadership support, and mechanisms for embedding change as key contextual factors. Key findings related to recipient characteristics were beliefs about what works, personalized strategies to use WISE, and classroom management. Primary themes for the innovation construct were time and preparation, degree of fit, and WISE advantage. Finally, findings relative to the construct of facilitation included trainer support and desire for additional training.Conclusions and ImplicationsThe study of cases at the extreme ends of the fidelity spectrum can provide unique perspectives on barriers and facilitators to implementation of interventions.     

Motivational Interviewing as a Component of a School-Based Obesity Prevention Program for Adolescent Girls

Over the past decade, motivational interviewing has been used by health professionals to promote health behavior changes and help individuals increase their motivation or “readiness” to change. This paper describes a preliminary study that evaluated the feasibility of motivational interviewing as a component of New Moves, a school-based obesity prevention program. New Moves is a program for inactive adolescent high school girls who are overweight or at risk of becoming overweight due to low levels of physical activity. Throughout the 18-week pilot study, 41 girls, age 16 to 18 years, participated in an all-girls physical education class that focused on increasing physical activity, healthful eating, and social support. Individual sessions, using motivational interviewing techniques, were also conducted with 20 of the girls to develop goals and actions related to eating and physical activity. Among the 20 girls, 81% completed all seven of the individual sessions, and girls set a goal 100% of the time. Motivational interviewing offers a promising component of school-based obesity-prevention programs and was found to be feasible to implement in school settings and acceptable to the adolescents.     

Effects of a School-Based Prevention Program on European Adolescents' Patterns of Alcohol Use

PurposeSchool-based substance abuse prevention programs are widespread but are rarely evaluated in Europe. We aimed to evaluate the effect of a new school-based prevention program against substance use on the frequency of alcohol consumption and alcohol-related problem behaviors among European students.MethodsDuring the school year 2004–2005, a total of 7,079 students aged 12–14 years from 143 schools in seven European countries participated in this cluster randomized controlled trial. Schools were randomly assigned to either control (65 schools, 3,532 students) or to a 12-session standardized program based on the comprehensive social influence model (78 schools, 3,547 students). Alcohol use and frequency of alcohol-related problem behaviors were investigated through a self-completed anonymous questionnaire at baseline and 18 months thereafter. The association between intervention and changes in alcohol-related outcomes was expressed as odds ratio (OR), estimated by multilevel regression model.ResultsThe preventive program was associated with a decreased risk of reporting alcohol-related problems (OR = .78, 95% confidence intervals [CI] = .63–.98), although this reduction was not statistically significant in the subgroup of 743 current drinkers at baseline. The risk for alcohol consumption was not modified by exposure to the program (OR = .93, 95% CI = .79–1.09). In the intervention group, nondrinkers and occasional drinkers at baseline progressed toward frequent drinking less often than in the control group.ConclusionsSchool curricula based on the comprehensive social-influence model can delay progression to frequent drinking and reduce occurrence of alcohol-related behavioral problems in European students. These results, albeit moderate, have potentially useful implications at the population level.