Enhancing Quality Interventions Promoting Healthy Sexuality (EQUIPS)
As a nation, the U.S. invests heavily in community-based organizations to conduct interventions, proven through research, to reduce the high rates of unplanned pregnancies and sexually transmitted infections (STIs) and HIV among teens. Much less is invested in helping communities implement these programs with quality. Although many research-based programs exist to address teen pregnancy and STIs, communities face difficulty implementing them and achieving the same outcomes as researchers. This "gap" is because resources are limited, prevention is complex, and communities often lack the capacity—or the knowledge, attitudes, and skills—needed to implement "off the shelf" programs well. Common ways to bridge this gap, such as information dissemination, fail to change practice or outcomes at the local level in part because it does not sufficiently address capacity of community practitioners. Therefore, building a community's capacity is a method that could improve the quality of implementation and outcomes. The proposed study will use a randomized controlled design and primary data from middle school youth (960) and program staff from 32 cooperating Boys and Girls Clubs (Clubs) to assess how a capacity building intervention called Getting To Outcomes (GTO) augments the quality of implementation of a research-based intervention to improve teen sexual health (Making Proud Choices, MPC). Specifically, the study will: (1) Assess the utilization of and subsequent effects of GTO on program staff capacity to implement MPC; (2) Assess the degree to which Clubs using GTO show greater improvements in MPC fidelity than Clubs that are not using GTO; and (3) Assess the degree to which Clubs using GTO show greater improvements on teen sexual health outcomes than the comparison Clubs. To address these aims we will collect data on the delivery and utilization of GTO (e.g., method of delivery, duration, topics); staff capacity to implement research-based interventions; observations of program delivery (fidelity monitoring); and youth participants' sexual activity, pregnancy, STIs, condom use, and knowledge/ attitudes towards sex. Analyses will examine differences between intervention and control sites over time, accounting for clustering of youth within site. These outcomes are important to NICHD's focus on providing opportunities for youth to become healthy and productive adults.
Pregnancy in Adolescence
Behavioral: Making Proud Choices
Behavioral: Making Proud Choices AND Getting To Outcomes
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Crossover Assignment
Masking: Open Label
Primary Purpose: Prevention
|Official Title:||Enhancing Quality Interventions Promoting Healthy Sexuality|
- Change in Youth sexual knowledge, attitudes, and behavior [ Time Frame: Baseline, Post (8 weeks later), 6 month follow-up from baseline ] [ Designated as safety issue: No ]Several sets of outcomes are on the Youth Survey including sexual activity, STIs, condom use, and pregnancy. In addition, the Youth Survey asks about attitudes and beliefs about sexual activity, condom use, and pregnancy, as well as knowledge about HIV, STIs, condom use, and pregnancy.
- Interview about change in capacity [ Time Frame: At baseline (prior to GTO), midpoint of GTO (after 1 year), post GTO (after 2 years), and after a year of no GTO (for GTO+MPC group) or after a year of GTO after not having it for the previous two years (for MPC only group). ] [ Designated as safety issue: No ]Investigators are using the Capacity Interview to assess BGC staff capacity to conduct high-quality teen pregnancy programming. Although programs consist of individual people with varying levels of abilities, capacity ratings are made at the program level since programs operate as a unit. The ratings are made using a structured interview with key program personnel at all 32 BGC sites. The ratings reflect how well each BGC site is carrying out the tasks tied to each of the ten steps of the GTO model, from "highly faithful" to "highly divergent" from ideal practice.
- Change in Fidelity [ Time Frame: Twice per site in each of the two intervention years ] [ Designated as safety issue: No ]Adherence -Over the two year intervention period, trained local data collectors are visiting each BGC site and rating how closely BGC staff adhere to each MPC module as designed. Dosage - BGC staff are recording how many of the eight modules each youth receives. Quality of delivery - During site visits, local data collectors are rating BGC staff on their teaching style—communication skills, interactions with participants, enthusiasm, and pacing—using a standardized rating sheet. Participant response - During site visits, local data collectors are rating student participation.
|Study Start Date:||July 2012|
|Estimated Study Completion Date:||June 2016|
|Primary Completion Date:||December 2014 (Final data collection date for primary outcome measure)|
Active Comparator: Making Proud Choices alone
These sites will be trained in Making Proud Choices.
Behavioral: Making Proud Choices
Making Proud Choices (MPC) is a well-established pregnancy and HIV/STI risk-reduction EBP with multiple trials demonstrating its effectiveness. Using Social Cognitive Theory, the Theories of Reasoned Action, and Planned Behavior, MPC aims to influence adolescents' knowledge and beliefs about risk, efficacy, and control to change behavior. MPC stresses the role of sexual responsibility, community, and pride in making safer sexual choices. The program promotes abstinence first, but also provides information and skills needed for safer-sex decision-making and practices (e.g., condom use).
Experimental: Making Proud Choices+Getting To Outcomes
These sites will receive training in Making Proud Choices and receive the Getting To Outcomes intervention.
Behavioral: Making Proud Choices
Making Proud Choices (MPC) is a well-established pregnancy and HIV/STI risk-reduction EBP with multiple trials demonstrating its effectiveness. Using Social Cognitive Theory, the Theories of Reasoned Action, and Planned Behavior, MPC aims to influence adolescents' knowledge and beliefs about risk, efficacy, and control to change behavior. MPC stresses the role of sexual responsibility, community, and pride in making safer sexual choices. The program promotes abstinence first, but also provides information and skills needed for safer-sex decision-making and practices (e.g., condom use).Behavioral: Making Proud Choices AND Getting To Outcomes
In addition to MPC, these sites receive the Getting To Outcomes(GTO) intervention, which builds capacity for EBPs by strengthening the knowledge, attitudes, and skills needed to choose, plan, implement, evaluate, and sustain those EBPs. GTO poses ten "steps" that must be addressed and provides practitioners with the guidance necessary to address those steps with quality—i.e., as close to the ideal as possible. Implementation of these ten steps is facilitated by three types of assistance: the GTO manual of text and tools originally published by the RAND Corporation and then applied to teen pregnancy (PSBA-GTO), face-to-face training, and onsite TA. Consistent with social cognitive theories of behavioral change exposure to GTO training and TA leads to more knowledge about performing GTO-related activities, which leads to more positive attitudes towards these activities, which in turn leads to the execution of more GTO-related behaviors.
Show Detailed Description
Please refer to this study by its ClinicalTrials.gov identifier: NCT01818791
|United States, Alabama|
|Boys & Girls Clubs of Greater Lee County|
|Auburn, Alabama, United States, 36830|
|Boys & Girls Clubs of North Alabama|
|Huntsville, Alabama, United States, 35804|
|Boys & Girls Clubs of Montgomery|
|Montgomery, Alabama, United States, 36104|
|United States, Georgia|
|Atlanta Boys and Girls Club|
|Atlanta, Georgia, United States, 30303|
|Principal Investigator:||Matthew Chinman, PhD||RAND Corporation|