Rural Teacher Insights to Promote Youth Engagement in Drug Prevention Education

Introduction: In teacher delivery of drug education lessons, teachers have reported making lesson adaptations 68% of the time, whereas objective observations have documented that this occurs 97% of the time (Miller-Day et al., 2013). Teachers made these adaptations: (a) in response to time and other constraints, (b) in response to student needs, and (c) to enhance student engagement. The present study extends this analysis by further examining teacher adaptations to promote student engagement. We presented teachers a scenario involving contrasting imperatives: (a) to deliver a lesson with high fidelity, while also (b) needing to conduct adaptations to re-establish student engagement. At a population level, low rates of engagement, have emerged as a major barrier to the effective EBI delivery (Barrera et al, 2017).

Methods: Potential study participants were teachers from 39 middle schools who participated over seven year ago in a randomized controlled trial of the keepin' it REAL drug education intervention. These schools are located in low-income rural regions of central Pennsylvania and Ohio, the epicenter of the national opiate epidemic. Using a concurrent mixed methods research design (Creswell & Creswell, 2018) we administered structured telephone interviews with digitally-recorded responses from experience drug education teachers. We used NVivo 11 to conduct thematic analyses guided by the Integrative Mixed Methods methodology (Castro et al., 2010). We conducted “in vivo” coding to identify “response code phrases” which constitute answers to the Overarching Focus Question: "What do drug education teachers say about guidelines and principles, … to help teachers make appropriate adjustments (adaptations) to a drug education program’s curriculum … ? This thematic analysis from 10 teachers produced 109 response code phrases used to identify emergent themes.

Results: This thematic analysis generated five themes: (a) the importance of adherence to the lesson’s goals versus the importance of making adptive changes to promote student engagement: “If you are having problems, be willing to change … to adapt to the situation…” Other themes were: (b) personalizing lesson contents to increase relevance: (c) to re-engage students, make change to break the impasse; (d) establish classroom norms to promote respect for others; and (e) give students a voice to tell their stories. Each theme contained several teacher quotes that provide an in-depth understanding of situational contexts and teacher responses to this fidelity-adaptation dilemma.

Conclusions: Results yielded in-depth inter-related processes and systemic effects on these five themes. Teacher adaptations may appear to be in conflict with a strict adherence to the lesson’s curriculum. Nonetheless, our data suggests that adaptations to promote engagement may actually enhance learning when the teacher maintains fidelity to core lesson goals (the theory-based “active ingredients”) while also acting to re-establish engagement. Additional analysis of teacher response narratives will be presented that can inform the development of Guidelines and Principles for more efficacious drug education.