A Cluster-Randomized Trial of Getting to Outcomes’ Impact on Implementation and Sexual Health Outcomes in Community-Based Settings

BACKGROUND: Implementation research is needed in prevention-oriented, community-based settings, which often have limited resources that can undermine implementation quality and outcomes. METHODS: This presentation describes a Hybrid Type II, cluster-randomized controlled trial comparing two conditions across two years: (1) 16 Boys & Girls Club (BGC) sites implementing an evidence-based, teen pregnancy prevention called Making Proud Choices (MPC Only); (2) 16 similar BGC sites implementing MPC augmented with a two-year implementation support intervention called Getting To Outcomes (MPC+GTO). All sites received training and manuals typical for MPC. GTO consists of its own manuals, training, and onsite technical assistance (TA) to help practitioners complete key programming tasks specified by GTO’s 10 Step model. In Year 1, TA providers helped MPC+GTO sites adopt, plan, and deliver MPC. Sites then received training on GTO’s evaluation and quality improvement steps, along with feedback reports summarizing their data, which were used in a TA-facilitated quality improvement process that yielded a revised plan for Year 2 MPC implementation. The trial assessed whether GTO improves performance of key programming tasks (e.g., goal setting, planning, evaluation, quality improvement), fidelity to MPC, and youth sexual health outcomes. Performance was measured using ratings made from a standardized, structured interview with participating staff at all 32 BGC sites after the first and second years of MPC implementation. Multiple elements of fidelity (adherence, classroom delivery, dosage) were assessed at all sites by observer ratings and attendance logs. Youth sexual health outcomes (attitudes and intentions regarding abstinence and condoms, knowledge of pregnancy and sexually transmitted infections, frequency of sex) were assessed via surveys before, immediately following, and 6-months after MPC. RESULTS: After Year 1, MPC+GTO sites had significantly higher ratings of performance than MPC Only sites, but were similar on all other measures. After Year 2, MPC+GTO sites had significantly higher ratings of performance, classroom delivery, and adherence (e.g., 92% vs. 55% MPC activities fully implemented). Dosage remained similar. Youth in MPC+GTO sites showed greater improvement on attitudes and intentions regarding condoms than MPC Only youth. There were no differences in sex behaviors, however, the base rates were very low. CONCLUSIONS: These findings suggest that in typical community-based settings, prevention program manuals and trainings alone may yield modest fidelity and some improvement in outcomes (evidenced in Year 1), but that more systematic implementation support (e.g., GTO) is needed to achieve high fidelity and greater improvement in outcomes (evidenced in Year 2).