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Prevention Science

, Volume 17, Issue 1, pp 122–133 | Cite as

The Impact of Teachers’ Modifications of an Evidenced-Based HIV Prevention Intervention on Program Outcomes

  • Bo Wang
  • Bonita Stanton
  • Sonja Lunn
  • Glenda Rolle
  • Maxwell Poitier
  • Richard Adderley
  • Xiaoming Li
  • Veronica Koci
  • Lynette Deveaux
Article

Abstract

The degree to which evidence-based program outcomes are affected by modifications is a significant concern in the implementation of interventions. The ongoing national implementation of an evidence-based HIV prevention program targeting grade 6 students in The Bahamas [Focus on Youth in The Caribbean (FOYC)] offers an opportunity to explore factors associated with teachers’ modification of FOYC lessons and to examine the impact of types and degrees of modifications on student outcomes. Data were collected in 2012 from 155 teachers and 3646 students in 77 government elementary schools. Results indicate that teachers taught 16 of 30 core activities, 24.5 of 46 total activities and 4.7 of 8 sessions. Over one-half of the teachers made modifications to FOYC core activities; one-fourth of the teachers modified 25 % or more core activities that they taught (heavily modified FOYC). Omitting core activities was the most common content modification, followed by lengthening FOYC lessons with reading, writing assignments or role-play games, and shortening core activities or adding educational videos. Mixed-effects modeling revealed that omitting core activities had negative impacts on all four student outcomes. Shortening core activities and adding videos into lessons had negative impacts on HIV/AIDS knowledge and/or intention to use condom protection. Heavy modifications (>1/4 core activities) were associated with diminished program effectiveness. Heavy modifications and omitting or shortening core activities were negatively related to teachers’ level of implementation. We conclude that poorer student outcomes were associated with heavy modifications.

Keywords

Implementation HIV prevention Modification of the intervention Fidelity of implementation Adolescents The Bahamas 

Notes

Compliance with Ethical Standards

Funding

This study was funded by the National Institute of Child Health and Human Development (R01HD064350).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants included in the study.

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Copyright information

© Society for Prevention Research 2015

Authors and Affiliations

  • Bo Wang
    • 1
  • Bonita Stanton
    • 1
  • Sonja Lunn
    • 2
  • Glenda Rolle
    • 3
  • Maxwell Poitier
    • 2
  • Richard Adderley
    • 2
  • Xiaoming Li
    • 1
  • Veronica Koci
    • 1
  • Lynette Deveaux
    • 2
  1. 1.Pediatric Prevention Research Center, Department of Pediatrics, School of MedicineWayne State UniversityDetroitUSA
  2. 2.Office of HIV/AIDSMinistry of HealthNassauThe Bahamas
  3. 3.Ministry of EducationNassauThe Bahamas

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