Implementation Quality for Drug Prevention Interventions: Implications for Intervention and Translational Science

Introduction: Evidence-based drug prevention interventions cause little to no changes in intended outcomes if implemented poorly. Once efficacy has been established, an intervention’s implementation quality (IQ) is critical for translational science because IQ defines the degree of disconnect between an intervention’s design and its implementation. Quantifying the impacts of IQ on intervention outcomes informs researchers about the intervention’s design, delivery, and evaluation. Similarly, quantifying IQ during clinical encounters with patients informs clinicians and researchers about the delivery and evaluation.

The purpose of this paper is to propose the use of the IQ measurement approach to advance translational science and discuss its implications in drug prevention interventions.

The authors compared and contrasted intervention encounters during a research study with health care provider-patient clinic visit encounters. The intervention encounters are drawn from the Mighty Girls Program’s DRAMA-RAMA, a highly individualized component of an innovative skill building intervention for Latina middle schools girls to resist peer pressure. The health care provider-patient clinic visit encounters are taken from the providers’ clinic visits for early adolescent patients using the Bright Futures Clinical Guidelines, a program to support well-child/adolescent care. The Guidelines include general questions focusing on alcohol and drug use. Additionally, the CRAFFT screener (a behavioral screening tool for substance use recommended for adolescents) is included under the comprehensive history section.

Methods: The DRAMA-RAMA research protocol, progress notes, and interdisciplinary meeting notes were used to extract the information pertinent to how IQ was measured. Then, the authors applied the IQ measurement approach to the clinical encounters using the Bright Futures Clinical Guidelines.

Results: The IQ measurement approach used in DRAMA-RAMA consists of adherence, quality of intervention delivery, and engagement. Although adherence is captured in clinical encounters through the use of Bright Futures Clinical Guidelines, quality of intervention delivery and engagement are not. In addition, IQ measures are analyzed in relation to study outcomes in DRAMA-RAMA. However, without measuring all the components of IQ, they cannot be linked to patient outcomes. The authors propose research and policy implications in creating IQ measures and evaluation mechanisms to make meaningful use of such measures in clinical settings.

Conclusions: An understanding of IQ is critical to advancing intervention science. Such understanding informs application of appropriate IQ measures, helping to assure effective translation of evidence-based drug prevention interventions into real-life settings.