Factors influencing implementation of an evidence-based HIV prevention program among Bahamian sixth-grade students

Background: Implementation of evidence-based HIV prevention programs at a national level remains uncommon.  Using Wave 2 data from the national implementation of Focus on Youth in the Caribbean (FOYC) in The Bahamas, this study examines the relationships among factors influencing teacher’s fidelity of implementation based on a hypothesized theoretical model and the association of implementation fidelity with student outcomes.

Methods: Data were collected from 140 teachers, 46 principals or school administrators, and 3068 students in 81 government primary schools in The Bahamas. Structural equation modeling and mixed-effects modeling were conducted to examine the relationships among factors influencing teachers’ fidelity of implementation and student outcomes (including knowledge, skills, perception and intention).

Results:Teachers taught 18.5 out of 30 core activities, 28.3 out of 46 total activities and 5 out of 8 sessions on average.  Teacher’s confidence in teaching FOYC lessons and perception of importance of FOYC had direct positive effects on teacher’s fidelity of implementation; implementation fidelity in turn affects student’s outcomes. School administrator’s attitudes towards HIV prevention had a direct and indirect effect (through teacher’s perception) on teacher’s fidelity of implementation. Teacher’s confidence in teaching is influenced by whether they received training on FOYC curriculum and student engagement in FOYC.

Conclusions: An evidence-based HIV prevention intervention can be implemented at a national level after proper preparation of implementation. School administrator’s attitudes towards HIV prevention, teachers’ perception of importance of the HIV prevention intervention and their confidence in teaching the curriculum are main factors that influence implementation fidelity and student outcomes.