Teacher Adaptations to Challenges of School-Based Drug Education Curriculum

Introduction: Teachers of drug prevention interventions face many challenges in managing imperatives for fidelity in delivering a manualized curriculum, while also responding actively in daily class management. Often teachers must make “in-the-moment” adaptations to make the curriculum fit “real world” situations. Thus, intervention adaptation is a pervasive practice among teachers who deliver a manualized curriculum. The purpose of this Robert Wood Johnson funded study is to examine the most frequently reported challenges and resulting adaptations as reported by drug education teachers. The study aim is to understand the process of teacher-initiated adaptations that maintain intervention effectiveness while also actively engaging students and promoting effective learning and skill development. Methods: The current sample consists 7 specifically-targeted drug education teachers from middle schools in rural communities having the highest rates of opioid use and mortality in the nation. Qualitative textual data was collected via in-depth mixed-methods interviews that lasted 30-45 minutes. These digitally-recorded telephone interviews were conducted by trained research assistants and were then transcribed. Thematic analyses were conducted to identify thematic categories for focus questions on the process of making adaptations when teaching a drug education curriculum. Two independent raters conducted identified Response Codes, then using these to conduct Thematic Coding. This was followed by a group “Roundtable” review with a third independent coder to finalize ratings by consensus. Results: The current results are based on a subset of the total number of cases targeted for inclusion into the final sample of teachers. In the present analyses, the most frequently reported challenge that triggered adaptations, was that curriculum contents “lacked relevance” for these students, as mentioned by 42.86% of the total number of response codes. Challenge categories consisted of three specific types whereby the manualized curriculum content: 1) was not relevant within the local rural community (e.g., referring to public transportation), 2) consisted of outdated examples (e.g., showing a car cigarette lighter), or 3) were uncommon events among this generation of students e.g., (ads in magazines instead of internet). The most frequently reported types of adaptations were, “Adding Materials not in the Instructions” as mentioned within 43.75% of the response codes. Teachers reported that they would add worksheets to quiz the students on the drug education information. Original videos were reportedly replaced by YouTube videos. Conclusions: Prevention science must offer science-based strategies that direct culturally-responsive adaptations that also avoid an erosion of intervention effectiveness. Information from the present study on intervention challenges and adaptations can inform drug education developers and implementers to improve current evidence-based interventions. Data collection is in progress, and these additional cases will be analyzed by spring 2018.