Does Narrative Quality Matter during the Implementation Process of School-Based Intervention? a Test of Narrative Engagement Theory

Introduction: Narratives provide a powerful communication strategy for promoting health. However, implementing narrative interventions is more challenging than didactic approaches, yet is imperative for positive intervention outcomes. This study utilizes Narrative Engagement Theory to test the effects of teachers’ narrative quality on youth outcomes during a trial of the narrative-based keepin’ it REAL (kiR) evidenced-based middle school substance use prevention curriculum.

Methods: A total of 39 schools from rural school districts in Pennsylvania and Ohio participated and were randomly assigned to urban kiR treatment, rural kiR treatment, and control conditions. For the analysis, 2,230 survey responses were used (M = 12.81 years, SD = .53; 50% male; 96% European American) from students in the 25 treatment condition schools.

Results: Based on observational ratings, each treatment group was coded for teachers’ narrative quality and student engagement and linked to student survey responses on norms and lifetime substance use (alcohol, cigarette, marijuana and chewing tobacco use). A path analysis was run to test the direct and indirect effects of teachers’ narrative quality on youth substance use behaviors via student engagement and norms while controlling for gender. The results fit the data well: (χ² [17] = 45.82; RMSEA = .04; CFI = .99; SRMR = 0.03) and revealed significant directs effects: that is, narrative quality was positively related to student engagement. Student engagement was positively related to personal anti-substance use norms and best-friend anti-substance use injunctive norms whereas it was negatively associated with descriptive norms (perception of prevalence in substance use among peers). Personal norms were negatively related to substance use, whereas descriptive norms were positively related to substance use. The analysis also yielded support for the indirect effects of narrative quality on youth substance use via student engagement and personal norms as well as student engagement and descriptive norms.

Conclusions: Findings highlight important issues related to teacher-student interaction during implementation. Advancing knowledge in implementation quality with the focus on teachers narrative quality and student engagement contributes new evidence in prevention science that can aid both the program developer as well as the prevention community as interventions are scaled.