title: The Impact of Teachers' Modifications of an Evidenced-Based HIV Prevention Intervention on Program Outcomes.
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.
authors: Pediatric Prevention Research Center, Department of Pediatrics, School of Medicine, Wayne State University, 4707 St. Antoine, Suite W534, Detroit, MI, 48201, USA. bwang@med.wayne.edu.
authors: Bo
authors: B
authors: Wang
authors: Pediatric Prevention Research Center, Department of Pediatrics, School of Medicine, Wayne State University, 4707 St. Antoine, Suite W534, Detroit, MI, 48201, USA.
authors: Bonita
authors: B
authors: Stanton
authors: Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, The Bahamas.
authors: Sonja
authors: S
authors: Lunn
authors: Ministry of Education, Thompson Boulevard, PO Box N-3913, Nassau, The Bahamas.
authors: Glenda
authors: G
authors: Rolle
authors: Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, The Bahamas.
authors: Maxwell
authors: M
authors: Poitier
authors: Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, The Bahamas.
authors: Richard
authors: R
authors: Adderley
authors: Pediatric Prevention Research Center, Department of Pediatrics, School of Medicine, Wayne State University, 4707 St. Antoine, Suite W534, Detroit, MI, 48201, USA.
authors: Xiaoming
authors: X
authors: Li
authors: Pediatric Prevention Research Center, Department of Pediatrics, School of Medicine, Wayne State University, 4707 St. Antoine, Suite W534, Detroit, MI, 48201, USA.
authors: Veronica
authors: V
authors: Koci
authors: Office of HIV/AIDS, Ministry of Health, Shirley Street, Nassau, The Bahamas.
authors: Lynette
authors: L
authors: Deveaux
mesh_terms: D001444:Bahamas; D003479:Curriculum; D055317:Evidence-Based Practice; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D017063:Outcome Assessment, Health Care; D012572:School Health Services / Q000458:organization & administration*; D013663:Teaching
keywords: Adolescents; Fidelity of implementation; HIV prevention; Implementation; Modification of the intervention; The Bahamas