Teach one, reach one (TORO): Process evaluation lessons learned from an intervention to teach parent-adolescent communication and monitoring

Background: Research demonstrates children whose parents communicate about sex and monitor children's social activities are less likely to engage in high risk sexual activities. “TORO” is a lay health advisor intervention in which parents learn sexual health information, communication, and monitoring skills. Objective: To describe the process evaluation for “Teach One, Reach One (TORO)”, a community based participatory research project. Methods: Between June and September 2008, we piloted the twelve lesson curriculum in two rural, North Carolina counties. The process evaluation assessed the clarity and acceptability of the curriculum and intervention delivery fidelity. The process evaluation was not designed to assess behavioral change outcomes. Evaluation documents included notes from structured lesson observation guides; transcripts from focus groups with participants following the pilot; and interviews with project staff. Results: Although the curriculum was highly accepted by parents, there were significant issues with participant recruitment and retention. High functional illiteracy rates in the target community necessitated restructuring many curricular activities. Treatment dose, measured by total curricular content received, varied widely as few parents attended the majority of sessions due to scheduling conflicts. Despite formal facilitator training, intervention delivery was compromised due to variable facilitation skills and low adherence to the written curriculum. For the subsequent pilot, facilitator selection criteria were revised, facilitator training was more comprehensive, additional recruiters were hired, and increased time for recruitment was allotted. Conclusions: Efforts to promote attendance by busy parents are necessary. Ensuring adequate facilitator training and planning for functional literacy levels in target communities is critical.