Replicating a Clinic-Based Teen Pregnancy Prevention Program: The Role of Organizational Capacity in Maintaining Quality and Fidelity

Introduction: A major priority for the U.S. Department of Health and Human Services (HHS) is finding ways to reduce teenage pregnancy. A key part of the strategy for achieving this goal is the Teen Pregnancy Prevention Program, which invests in replicating existing evidence-based programs for populations at highest risk for teen pregnancy. However, little is known about what it takes to replicate these programs to achieve impacts on a broader scale than was originally achieved by the efficacy trial. Hennepin County, MN, received funding from HHS to replicate with fidelity and rigorously evaluate the Safer Sex Intervention (SSI), a clinic-based HIV/STI prevention program for sexually active girls ages 13 – 19. The program incorporates motivational interviewing during four individualized sessions with a health educator focused on reducing sexual risk-taking behaviors, increasing condom use, and preventing the incidence or recurrence of STIs. SSI previously demonstrated a positive, statistically significant impact on number of sexual partners in a randomized controlled trial conducted by the developer in a single clinic in Boston, MA.

Methods: Over four years, Hennepin County replicated SSI in 19 diverse clinic settings in collaboration with multiple community partners and health educators. Within each clinic, 968 participants were randomly assigned to either receive SSI or were offered the clinic’s standard of care. Web-based surveys, administered at enrollment and nine months later, assessed impacts on knowledge, attitudes, motivation, and intentions related to sexual risk-taking behaviors, as well as the behaviors themselves. Program staff and the external evaluator closely monitored implementation.

Results: At the nine month follow-up, results show that SSI was implemented with fidelity and positively impacted intentions to use condoms, refusal skills, and recent unprotected sex. The organizational factors that enabled the County and its community partners to replicate SSI while maintaining quality included partner selection decisions, innovative fidelity monitoring approaches, a peer support network, and using implementation data for continuous feedback.

Conclusions: These early findings are an important step in understanding the organizational and provider contexts that influence the ability to replicate evidence-based programs and achieve positive impacts on a broader scale.