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For each of the seven weekly sessions, parents and youth spend one hour separately and a second hour together engaging in interactive exercises led by trained facilitators. In the present study, we examine average levels of adherence as well as variability across programme sites as one aspect of implementation quality. Thus, the implementation of the programme as intended is, in theory, straightforward. An important and under-studied aspect of implementation quality is the extent to which the context of programme delivery affects programme outcomes. We found 12 respondents who were planning to implement a programme; all but one agreed to be observed.
Facilitator training is standardised. Specifically, we examine 1 the degree to which an EBI delivered outside the context of a research trial remained faithful to the content and design of the programme as intended Chen, and as reported in experimental trials of the same programme Spoth et al, ; Spoth et al, ; Spoth et al, ; Fagan et al, ; and 2 whether implementation quality affected programme outcomes. By design, variability in contextual factors and in participant attributes is minimised in experimental trials, in order to control for factors that might be correlated with outcomes. In other words, although adherence did not appear to matter in the short term, over the long term individuals in the high-adherence group fared better. In observations of programmes delivered as part of the community team-led trial PROmoting School—community—university Partnerships to Enhance Resilience, or PROSPER , Spoth and colleagues examined the relationship of implementation quality to community team functioning. The number of facilitators per programme ranged from two to seven, with a mode and mean of four, and the number of families ranged from four to 26, with a mode of eight and a mean of Sixty-eight per cent of families attended five or more of the seven programme nights Table 1. In addition, most EBIs specify procedural aspects of programme delivery, such as number, length and frequency of sessions across which the material is to be delivered. In real-world applications, however, facilitators often have fewer resources and less control over these factors. For the purposes of this article, we define contextual characteristics of programme delivery as attributes that are not directly related to the content of a programme but instead define the context of its delivery. Observational studies of implementation quality in the original efficacy trial of SFP, a feasibility trial of SFP with African—American families, and the experimental community trials of SFP all indicated high levels of adherence to programme content assessed as percentage of programme content and activities that were covered. Sample Of the 11 programmes we observed, six were hosted by schools, two by faith-based organisations, one by a substance abuse rehabilitation centre, and two did not report sponsoring agencies. We report results of an observational study of 11 sites involved in the state-wide dissemination of an evidence-based substance abuse prevention programme, namely the Strengthening Families Programme for Parents and Youth 10—14 SFP. See other articles in PMC that cite the published article. Results from a controlled experimental study on a community team-based dissemination of SFP and other EBIs also showed significant differences between SFP and control group outcomes over time, though in that trial all children also received evidence-based prevention programmes at school Spoth et al, Community agencies that submit data are provided with reports describing programme outcomes and implementation and comparing programme data with statewide averages. Specifically, we examined characteristics of participants age, sex and minority status and programmes group size, number of facilitators, facilitator experience and match of minority status between participants and facilitators that have been shown in previous studies to relate to programme outcomes or that showed considerable variability as compared to the clinical trial. Programmes are also implemented by faith-based organisations, social service agencies, the juvenile justice system and community substance-abuse prevention coalitions. Parents and youth completed evaluation forms in separate rooms. Observers sat in on each session in an area of the room that was most unobtrusive, usually at the back of the room, and completed implementation fidelity forms during the session. Results from the experimental efficacy trial demonstrated that SFP reduced the age of initiation and frequency of substance use among participants as compared to controls Spoth et al, In the present study, we examined the relation of programme outcomes to these individual and contextual factors and to adherence. In both studies, investigators speculated that because implementation quality was high and variability across programmes was limited, potential relations between adherence and outcomes may have been obscured. At the later assessment, however, ISFP outcomes were significantly different from those of the control group only in the high-adherence group. With regard to the first goal, we expected to find lower adherence and greater variability in group size and other implementation factors in the community-based programmes than has been reported in the experimental trials. Thus, the data on implementation and outcomes reported in this article differ from those reported in the efficacy and effectiveness trials, in that the dissemination is not researcher-driven. Although theory about how programme context might affect outcomes is often implicit rather than explicit Chen, , there is evidence that contextual variables may be as important or even more important than content in determining intervention outcomes Kumpfer et al,
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