Evidence‐Informed Program Improvement: Using Principles of Effectiveness to Enhance the Quality and Impact of Family‐Based Prevention Programs

In recent years, federal, state, and local governments and other funding organizations have increased pressure for greater effectiveness and accountability of prevention programs, including those oriented toward families. This rising demand for program accountability has fueled a growing interest in evidence‐based programs. Drawing on what is known about evidence‐based prevention programs, we discuss some common principles of effective programs and present a process for how practitioners can use these principles to improve the quality and impact of existing family programs. We term this approach evidence‐informed program improvement.     

Self‐Directed,Therapist‐Directed,and Assessment‐Based Interventions for Premarital Couples*

Abstract: In this study, we present the findings of an investigation of the effectiveness of 3 models of premarital education. The study compares the outcomes between a workbook‐only self‐directed program, a therapist‐directed (unstructured) program, and an assessment‐based (RELATE) relationship enhancement program. Results revealed significant differences in effectiveness between the 3 approaches at the 6‐month follow‐up. The assessment‐based program had more influence than the therapist‐directed and self‐directed programs on problem areas and was better than the therapist‐directed program at improving communication and relationship satisfaction. Participants indicated that the most helpful aspects of these programs were the opportunity to discuss previously undiscussed issues, improvements in communication, and the perspectives provided by the facilitator.     

Premarital counseling as perceived by newlywed couples: an exploratory study

Ten couples from a marriage enrichment program for newlyweds and 68 female graduates from a high school course on family life were surveyed about their involvement in and their perceptions of the effectiveness of premarital counseling for preparing them for the realities of married life. Perceived effectiveness of premarital counseling was found to be related to duration of counseling in hours and to the degree to which the program was seen as voluntary. Perceived effectiveness was not consistently related to the duration of courtship. Suggestions for future research with larger samples are presented, along with recommendations for program design in premarital counseling programs.     

Do Premarital Education Programs Really Work? A Meta‐analytic Study

Previous studies (J. S. Carroll & W. J. Doherty, 2003 ) have asserted that premarital education programs have a positive effect on program participants. Using meta‐analytic methods of current best practices to look across the entire body of published and unpublished evaluation research on premarital education, we found a more complex pattern of results. We coded 47 studies and found that premarital education programs do not improve relationship quality/satisfaction when unpublished studies are included in the analysis, although studies that follow couples past the honeymoon stage to detect prevention effects are rare. In contrast, premarital education programs appear to be effective at improving couple communication, with studies that employed observational measures rather than self‐report measures producing large effects. Still, given the mixed, modest results, there is ample room and a real need to improve the practice of premarital education.     

Impacts of a School‐Wide,Peer‐Led Approach to Sexuality Education: A Matched Comparison Group Design

BACKGROUND

Teen Prevention Education Program (PEP) is a school‐wide, peer‐led comprehensive sexuality education program currently implemented in more than 50 schools across 2 states. Many teen pregnancy prevention researchers and practitioners view peer‐led programs as a promising approach for reducing teen pregnancy and associated sexual risk behaviors. However, prior research on the effectiveness of these programs indicates mixed results.

METHODS

We randomly assigned schools to implement Teen PEP immediately (intervention group) or on a delayed schedule (comparison group) and used propensity score matching to improve the comparability of the study groups. We surveyed students at baseline and about 6 months after the program ended.

RESULTS

Teen PEP did not significantly impact rates of sexual activity or unprotected sex; however, the program led to improvements in exposure to information about sexual health topics and knowledge of preventing pregnancy and transmission of sexually transmitted infections.

CONCLUSIONS

Teen PEP succeeded in accomplishing some of its most proximal goals, increasing students' access to information and knowledge. However, we found little evidence that the program affects sexual risk‐taking within 6 months of its conclusion. Future research will examine the program's longer‐term impacts on sexual risk behaviors.

     

Do HIV prevention interventions in Asia lead to increase in condom utilization?: A meta‐analysis study

This meta‐analytic review synthesizes the findings of published independent studies that assessed the effectiveness of HIV prevention interventions in promoting condom usage in Asia. We focused on 20 studies that used randomized control studies to establish whether HIV prevention interventions lead to increased condom utilization. As compared with the average control group client, we found that 68% of the clients who participated in an intervention group increased their condom usage. The effectiveness of HIV prevention intervention is not related to country and rural‐urban contexts, to male‐female samples, to the type of outcome measured, or the timing of the latest follow‐up assessment. The implications of these findings are that policy‐makers, health administrators, and international donors should view behavioral HIV prevention interventions as an effective approach through which to increase condom usage in order to reduce the HIV infection rate in Asia.     

The Couples Coping Enhancement Training (CCET): A new approach to prevention of marital distress based upon stress and coping*

We describe a distress prevention training program for couples and three empirical studies that support its effectiveness. The program, Couples Coping Enhancement Training (CCET), is based both upon stress and coping theory and research on couples. In addition to traditional elements of couples programs (e.g., communication and problem‐solving skills), the CCET also addresses individual and dyadic coping in promoting marital satisfaction and reducing marital distress. The CCET enjoys good consumer acceptance. Outcome results indicate that, in addition to acquiring relationship skills, participants experienced reduced martial distress and increased marital satisfaction, even among couples who have been in long‐standing relationships where dissatisfaction exists.     

学校预防艾滋病教育对中学生知识态度和技能的影响

目的 通过学校预防AIDS教育，促进学生预防AIDS知识、态度和技能，为在我国中学开展预防AIDS教育提供重要的实践经验。方法 对学校健康教育教师进行了为期两天的培训。为评价教育前后学生预防AIDS知识、态度和技能的变化，对约8000名参与此项研究的初一、高一学生进行了教育前和教育后的问卷调查。结果 教育后学生预防AIDS基本知识平均得分由教育前的7．3提高到11．2(满分为15分)；知道如何避免感染AIDS的比例由教育前的47．9％上升到83．8％；与家长及朋友谈论HIV／AIDS的比例分别由教育前的31．1％、39．6％上升到44．2％和59．2％；表示愿意与HIV感染者／AIDS病人同班上课的比例由教育前的7．4％上升到26．1％；反对男青年及女青年婚前性行为的比例分别由教育前的45．3％、50．6％上升到54．9％和61．2％。结论学校预防AIDS健康教育对增加学生预防艾滋病知识、培养正确的性道德观念、不歧视HIV感染者以及促进学生谈论和宣传预防HIV／AIDS知识等方面均产生了积极的影响。     

A review of studies on school-based smoking prevention programs]

Research papers on school-based programs designed to prevent adolescent smoking were reviewed to determine trends in the development of smoking prevention programs as well as measures and methods of evaluation. In the USA and Europe, evaluation studies have demonstrated that the most promising smoking prevention approaches are those that focus primary attention on the psychosocial factors promoting smoking initiation. In Japan, however, most programs have shown little success. The following recommendations are made for improving the methods for evaluating program effectiveness and the future of research orientation of educational program on adolescent smoking. 1) Refinement and standardization of evaluation methods to be valid and feasible for use in studies of Japanese adolescents. 2) Improved study designs for evaluation of program effectiveness which include control groups and long term follow-up. 3) Applying smoking prevention programs which were demonstrated to be effective in the USA and Europe. 4) Development of effective cessation programs for adolescent smokers.     

沈阳市中学生预防艾滋病教育影响评价

目的 探讨学校预防AIDS教育对学生知识、态度的影响。方法 以沈阳市9所中学初一、高一学生为研究对象,由受过培训的健康教育教师在学校对学生进行教育,于教育前后对学生进行有关预防AIDS知识和态度方面的不记名问卷调查。结果 教育后学生预防AIDS基本知识平均得分由教育前的6．67提高到10．98（满分为15分）;反对男青年及女青年婚前性行为的比例分别由教育前的47．8％、52．0％上升到57．3％和63．0％;表示愿意与AIDS患同班上课的比例由教育前的5．1％上升到22．6％。结论 学校预防AIDS教育使学生预防AIDS基本知识得到提高,拥有正确态度的学生比例增加。但学生中拥有正确态度的比例仍有待进一步提高,因此,在今后的教育中除了应重视基本知识的传授外,还应重视发展学生与预防AIDS有关的正确态度。     

Helpful and harmful expectations of premarital interventions

Despite the demonstrated effectiveness of premarital programs, estimates indicate that only 30% of couples use these services. This study examined the helpful and harmful aspects of premarital programs that may encourage or discourage participation. As expected, participants identified improved communication and problem solving skills as most beneficial. Disclosing secrets or past relationship issues that threaten the stability of the relationship was viewed as most harmful. Implications for the recruitment of couples and for the design and implementation of premarital programs are discussed.     

Where are the Young Men in HIV Prevention Efforts? Comments on HIV Prevention Programs and Research from Young Men Who Sex with Men in Los Angeles County

Despite increasing rates of HIV infection among young men who have sex with men (YMSM), only a minority participate in formal HIV prevention efforts. Semi-structured mixed-methods interviews were conducted with a diverse sample of YMSM (N?=?100, M _age?=?25.0?years) in Los Angeles, California, to identify facilitators and barriers to participation in HIV prevention programs. Summative content analyses were used to evaluate transcribed field notes from these interviews. Results showed that 28.0?% of all participants had previously attended an HIV prevention program, and that 21.3?% of those who were also asked if they had ever participated in any research pertaining to HIV prevention had done so. A significantly higher percentage of those who had participated in HIV prevention programs had been tested for HIV in the past 6?months compared to those who had not (p?<?.05). The most frequently mentioned barriers to participation in such a program were being too busy to attend (12.0?%), not perceiving themselves to be at risk for HIV infection (14.0?%), and believing that they already knew everything they needed to know about HIV transmission (23.0?%). YMSM suggested that future interventions should use technology (e.g., the Internet, mobile devices), engage their social networks, and highlight HIV prevention as a means for community connection. Collectively, these results provide some explanations for why YMSM account for a minority of HIV prevention program participants and offer possible directions for future HIV prevention efforts that target YMSM.     

Community-Based Prevention Programs for Anxiety and Depression in Youth: A Systematic Review

Little is known about the effectiveness of prevention and early intervention programs for young people and adolescents once they leave or dropout from school. The effectiveness of 18 anxiety and 26 depression studies addressing prevention in community programs were identified using systematic review methodology. Anxiety and depression symptoms were reduced in ~60% of the programs. Cognitive behavioral therapy programs were more common than other interventions and were consistently found to lower symptoms or prevent depression or anxiety. Automated or computerized interventions showed promise, with 60% of anxiety programs and 83% of depression programs yielding successful outcomes on at least one measure. Further research is needed to determine the active components of successful programs, to explore cost-effectiveness and scalability factors, to investigate individual predictors of successful outcome, and to design best practice prevention programs.     

南宁市西乡塘区2009—2011年一站式免费婚前医学检查效果分析

目的通过分析南宁市西乡塘区一站式免费婚前医学检查结果,总结免费婚检的工作经验,以达到提高婚检率、降低出生缺陷的目的。方法选择2009—2011年在广西自治区妇幼保健院进行婚前医学检查的人员作为研究对象。结果开展一站式免费婚检服务后,结婚登记人群的婚检率由2009年的4．05％上升至2011年的100％。疾病检出率由1．86％上升至16．91％。其中地中海贫血筛查阳性率由7．19％上升为14．75％。结论婚姻登记和婚前保健相结合的一站式整体服务模式,可显著提高婚检率和疾病检出率,对降低出生缺陷,提高出生人口素质有重要意义。     

Eleven Components of Effective Drug Abuse Prevention Curricula

ABSTRACT: A review of school-based drug abuse prevention programs was conducted for 1989–1994. In addition to a comprehensive literature review, interviews were conducted with a panel of 15 leading experts in prevention research. Key elements of promising prevention curricula were identified. Effective prevention programs were found to be based on a sound theoretical or research foundation. They included developmentally appropriate information about drugs, social resistance skills training, and normative education. Broader based personal and social skills training appeared to enhance program effects. Effective programs used interactive teaching techniques and teacher training, and provided adequate coverage and sufficient follow-up. Cultural sensitivity to the target population was found to be critical to program success. Additional program components were expected to enhance curriculum effectiveness. Finally, experts agreed that adequate evaluation of prevention curricula was critical. Unfortunately, despite information about the types of curricula that are effective, the most promising prevention curricula are not widely disseminated. Reasons for under-utilization are explored, and recommendations made for correcting the situation.     

Effectiveness of a universal drug abuse prevention approach for youth at high risk for substance use initiation

BACKGROUND: Universal school-based prevention programs for alcohol, tobacco, and other drug use are typically designed for all students within a particular school setting. However, it is unclear whether such broad-based programs are effective for youth at high risk for substance use initiation. METHOD: The effectiveness of a universal drug abuse preventive intervention was examined among youth from 29 inner-city middle schools participating in a randomized, controlled prevention trial. A subsample of youth (21% of full sample) was identified as being at high risk for substance use initiation based on exposure to substance-using peers and poor academic performance in school. The prevention program taught drug refusal skills, antidrug norms, personal self-management skills, and general social skills. RESULTS: Findings indicated that youth at high risk who received the program (n = 426) reported less smoking, drinking, inhalant use, and polydrug use at the one-year follow-up assessment compared to youth at high risk in the control condition that did not receive the intervention (n = 332). Results indicate that a universal drug abuse prevention program is effective for minority, economically disadvantaged, inner-city youth who are at higher than average risk for substance use initiation. CONCLUSIONS: Findings suggest that universal prevention programs can be effective for a range of youth along a continuum of risk.     

Prevent 2nd Stroke: a pilot study of an online secondary prevention program for stroke survivors

Objective: The prevalence of modifiable health risk factors and psychological distress following a stroke is high and markedly increase the chance of a second stroke. This study aimed to examine the usability and acceptability of an online secondary prevention program addressing modifiable psycho‐behavioural risk factors for stroke survivors. Methods: A pre–post pilot study was conducted in Australia between 2016 and 2017. Participants were recruited through the Australian Stroke Clinical Registry and completed measures of health‐related quality of life, physical activity, smoking status, depression and anxiety, alcohol status, nutrition and internet use. Participants also used an online secondary prevention program (Prevent 2^nd Stroke) over a two‐week period. At follow‐up, acceptability and usability of the program were assessed. Results: A total of 18 out of 19 participants reported engaging in multiple health risk behaviours. Participants reported that they were interested in receiving an online program that provided health information (73.7%). Participants indicated Prevent 2^nd Stroke was easy to use (63.1%) and that they would recommend the program to other stroke survivors (63.1%). Conclusions: The results indicated that online programs are an acceptable way to address these health outcomes. Implications to public health: Further research is needed to assess the effectiveness of these interventions using powered trials.     

Fidelity of implementation in a treatment effectiveness trial of Reconnecting Youth

In 'a treatment effectiveness trial', a program is evaluated in a real-world setting, with an emphasis on achieving high implementation fidelity. Through fidelity assessment, the link between program implementation and outcomes is systematically evaluated and ultimately leads to a greater understanding of program success or failure. This paper reports the results of an implementation fidelity study of the 'Reconnecting Youth' (RY) prevention program. The research questions were (i) was the program implemented with fidelity? and (ii) did better fidelity predict better outcomes? RY is an indicated drug abuse prevention program for high school students that seeks to 'reconnect' high-risk youth to school before they drop out. The results reported here were part of a randomized controlled effectiveness trial of the RY prevention program conducted in two urban school districts in which 15 teachers taught 41 RY classes. Overall, implementation fidelity was high with an average 90% of core lessons being taught. Unexpectedly, increased quality of implementation predicted increased alcohol use and anger. Adherence (teaching more of the curriculum) predicted increased marijuana use, while exposure (student attendance) significantly increased bonding to high-risk peers, alcohol use and anger.