Real World of Replication: A South Carolina Case Study

Background:  In 2010, the Office of Adolescent Health awarded $75million to 75 grantees across the country to support the replication of evidence-based teen pregnancy prevention programs (EB-TPP) which demonstrated, through rigorous evaluation, to be effective in preventing teen pregnancy and/or associated risks.  The intention of these awards was to help bring evidence-based initiatives to more communities across the country. 

Objective:  To discuss whether EB-TPPs with demonstrated effectiveness for a specific population can replicate with efficacy without adaptations to the local context.

Methods:  A randomized cohort of 1725 intervention and 1418 comparison students representing 24 middle schools across rural SC were surveyed pre, post and 12-month post exposure to a two year (12 lessons per year) school-based EB-TPP.  

Results: At the conclusion of the study, the implementation analyses demonstrated a high degree of fidelity to the original curriculum, high dosage, and equal attrition across the two study groups.  Preliminary impact analyses showed that the replication trial found different and conflicting results in onset of sexual initiation, number of sexual partners and contraceptive use at last sex, from the original evaluation conducted by the curriculum developers.

Conclusion:  Four key areas (facilitation, geographic region, implementation schedule and outcomes) that differentiated the original efficacy studies from this effectiveness trial will be discussed and how these differences could have influenced the impact of the replication study will be reviewed.  Presenters will discuss the challenge of how to interpret and use these findings to better understand the tension between replication with fidelity and program effectiveness.