Predicting Implementation Quality of the Healthwise South Africa Prevention Program: Preliminary Analysis

In South Africa (SA),  addressing sexual risk behavior and substance use is extremely important. About 1/4 of HIV-infected individuals are under the age of 25 and AIDS is responsible for 71% of all deaths in those 15 to 49 years old, and 1 in 8 SA high school students begins drinking alcohol before the age of 13.

To address these health risk issues, we have worked over the past decade on an intervention, HealthWise (HW) South Africa, which has been the first school-based experimental study conducted in SA to report any positive findings. The goal of this study is to identify whether enhanced teacher training (ETT); teacher support and supervision (SS); and enhanced school environment (ESE) individually or in combination are more effective in promoting implementation quality of HW in 56 schools in the Western Province.

A pre- and posttest survey in Grade 8 addressed perceptions of self-efficacy for teaching HW, knowledge and value of HW, and HW materials and methods.  Teachers logged how much of each lesson they covered and altered, student interest, and ease of teaching. Of the 67 teachers who completed the logs, 51 completed the pre-survey, and 39 completed both the pre and post-surveys.

Pretest indicates that years of teaching is negatively associated with confidence in small group and role play activities (r = from -.23 to -.28), knowledge of HIV/AIDS (r=-.32) and substance use (r=-.26). Females and older teachers had lower levels of knowledge about leisure resources, leisure motivation and leisure boredom (r = from -.23 to -.26).

From pre to post, focusing on the last lesson, increased clarity was associated with less altering of content (r=-.35) and ease of teaching (r=.37). Increases in feeling supported by one’s principle was associated with less lesson alteration (r=.45) and feeling consulted at the beginning of 8^th grade was associated with ease of teaching (r=.29). Feeling more satisfied with one’s job predicted more content being covered (r=.34) and more interest among students (r=.31).

Preliminary evidence also indicates the following average significant effects: ETT teachers covered less content and reported lower student interest in the last lesson but altered the last lesson less and thought it was easy as compared to teachers not in the ETT. SS teachers altered the last lesson less and thought it was easy as compared to teachers not in the SS, averaged across the effects of being in the ETT/ESE.

These findings will help develop strategies for increasing and sustaining implementation quality outside of a randomized control study, especially when challenging methods (such as small group discussion and role play) and challenging topics (such as condom use and leisure motivation and resources) are included in the curriculum.