Online Program

Teachers' modifications of an evidenced-based HIV prevention program and student outcomes: Findings from a nationwide dissemination

Monday, November 2, 2015 : 12:50 p.m. - 1:10 p.m.

Bo Wang, PhD, Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI
Veronica Dinaj-Koci, PhD, School of Medicine, Wayne State University, Detroit, MI
Lynette Deveaux, BS, Office of HIV/AIDS, Bahamas Ministry of Health, Nassau, Bahamas
Sonja Lunn, MBBS, Office of HIV/AIDS, Bahamas Ministry of Health, Nassau, Bahamas
Glenda Russell-Rolle, Bahamian Ministry of Education, Nassau, Bahamas
Bonita Stanton, MD, Wayne State University School of Medicine, Detroit, MI
Background: Evidence-based interventions are frequently modified during the implementation process. The degree to which program outcomes are affected by modifications is a significant concern. The national implementation of an evidence-based HIV prevention program targeting grade six students in The Bahamas [Focus on Youth in The Caribbean (FOYC)] offers an opportunity to explore factors associated with teachers’ modification of FOYC lessons.

Methods: Data were collected in the final wave of national implementation conducted in 2012, involving 155 teachers and 3646 students in 77 government elementary schools. Mixed-effects modeling analysis was used to examine the association of teachers’ types and degrees of modification with student outcomes. 

Results: Over one half (54.2%) of the teachers made modifications to FOYC core activities; One-fourth of the teachers modified 25% or more core activities. A high degree of modifications to FOYC curriculum (1/4 core activities) caused diminished program effectiveness. Omitting core activities is the most commonly identified content modification, followed by lengthening FOYC lessons with reading, writing assignments or role-play games, shortening core activities. Omitting core activities has negative impacts on all four student outcomes.  Shorteningcore activities has negative impacts on HIV/AIDS knowledge and/or protective intention.

Conclusions: Teachers who heavily modify the FOYC curriculum demonstrated low levels of implementation and poor student outcomes compared those who make few or no changes to the FOYC curriculum. More intensive pre-intervention training and technical assistance should be provided to the teachers who express low levels of comfort in teaching the intervention curriculum to ensure high quality of implementation.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs

Learning Objectives:
Describe frequencies and types of modifications of FOYC lessons reported by teachers; Identify characteristics and perceptions of teachers who heavily modified FOYC lessons; Evaluate the association of teachers’ types and degrees of modification with student outcomes.

Keyword(s): Evidence-Based Practice, HIV Interventions

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been conducting research in implementation of HIV behavioral interventions for over five years and was fully involved in data analysis of this paper.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.