Replicating sexual health programs in school-based settings: A model for schools

Background: Texas has the third highest teen birth rate in the nation, yet effective sex education programs are not widely implemented in schools. Previous models aimed at increasing implementation of evidence-based sexual health programs (EBPs) have targeted community organizations rather than schools, with a heavy emphasis on adaptation and evaluation. However, these models may not be applicable to school-based settings. Community-based models lack key components unique to schools. Purpose: To develop a model to guide replication of EBPs in school-based settings. Methods: Intervention Mapping (IM) served as the framework for model development. Inductive and deductive knowledge acquisition approaches were employed. Key community informant interviews (n=10), participant observations (n=20), and theoretical and empirical evidence were used to (a) identify barriers to adoption and implementation and (b) specify behavioral objectives for program adoption, implementation, and maintenance. This knowledge was subsequently engineered for model development. Results: Behavioral matrices (n=8), performance objectives (n=66), and change objectives (n>400) were developed using IM. The model provides 7 steps that encompass phases of assessment, preparation, implementation, and maintenance: Prioritize, Asses, Select, Approve, Prepare, Implement, and Maintain. Each step is comprised of 2 to 6 measureable performance indicators (n=31; mode=6) to assess progress in replicating EBPs as well as the core elements of advocacy and support elicitation for sexual health education. Conclusions: This model represents a systematic, practical, and innovative approach for schools to gain support for sexual health education and ultimately implement EBPs.