Building Bridges to a Brighter Tomorrow: A Systematic Evidence Review of Interventions That Prepare Adolescents for Adulthood.

BACKGROUND: Data suggest that adverse social determinants during adolescence can set in motion a lifetime of poor social and health outcomes. Vulnerable youths are at particularly high risk in this regard. OBJECTIVES: To identify and assess the current evidence base for adolescent-focused interventions designed to influence adulthood preparation that could affect longer-term social determinants. SEARCH METHODS: Using a systematic review methodology, we conducted an initial assessment of intervention evaluations targeting 6 adulthood preparation subject (APS) areas to assess the quality and character of the evidence base. The review is specific to evaluated interventions that address at least 1 of the 6 APS areas: healthy relationships, adolescent development, financial literacy, parent-child communication, educational and career success, and healthy life skills. SELECTION CRITERIA: The inclusion criteria were as follows: (1) published in English in an independent, peer-reviewed journal; (2) conducted in developed, English-speaking countries; (3) implemented an intervention that addressed at least 1 of the 6 APS areas, delivered in an in-person setting; (4) included youths at the 5th- through 12th-grade levels or aged 10 to 18 years at some point during intervention implementation; (5) included an evaluation component with a comparison group and baseline and follow-up measures; (6) included behavioral measures as outcomes; and (7) reported statistical significance levels for the behavioral outcome measures. DATA COLLECTION AND ANALYSIS: We developed an abstraction form to capture details from each article, including key details of the intervention, such as services, implementer characteristics, and timing; adulthood preparation foci; evaluation design, methods, and key behavioral measures; and results, including key statistically significant results for behavior-based outcome measures. We assessed study quality by using several key factors, including randomization, baseline equivalence of treatment and control groups, attrition, and confounding factors. We characterized the quality of evidence as high, moderate, or low on the basis of the described design and execution of the research. Our assessment included only information stated explicitly in the manuscript. MAIN RESULTS: A total of 36 independent intervention evaluations met the criteria for inclusion. Of these, 27 (75%) included significant findings for behavioral outcomes related to adulthood preparation. Quality was mixed across studies. Of the 36 studies reviewed, 27 used a randomized controlled design (15 group randomization, 12 individual randomization), whereas the others used observational pre-post designs. Ten studies used mixed-methods approaches. Most (n = 32) studies used self-report questionnaires at baseline with a follow-up questionnaire, and 14 studies included multiple follow-up points. Of the studies reviewed, 7 studies received a high-quality rating, indicating no significant issues identified within our quality criteria. We rated 23 studies as moderate quality, indicating methodological challenges within 1 of the quality criteria categories. The most common reasons studies were down-rated were poor baseline equivalency across treatment groups (or no discussion of baseline equivalency) and high levels of attrition. Finally, 6 studies received a low-quality rating because of methodological challenges across multiple quality domains. The studies broadly represented the APS areas. We identified no systematic differences in study quality across the APS areas. AUTHOR'S CONCLUSIONS: Although some of the intervention results indicate behavioral changes that may be linked to adulthood preparation skills, many of the extant findings are derived from moderate- or poor-quality studies. Additional work is needed to build the evidence base by using methodologically rigorous implementation and evaluation designs and execution. Public Health Implications. Interventions designed to help adolescents better prepare for adulthood may have the potential to affect their longer-term social determinants of health and well-being. More theory-driven approaches and rigorously evaluated interventions could strengthen the evidence base and improve the effectiveness of these adulthood preparation interventions.

Implementers' Perspectives on Fidelity of Implementation.

Fidelity of implementation is an essential factor in realizing outcomes of evidence-based interventions. Yet perspectives vary on the degree to which fidelity is necessary or desirable, implementers may receive limited guidance on fidelity, and research on implementers' understanding and operationalization of fidelity is lacking. We conducted key informant interviews with 20 individuals who implemented an evidence-based teen dating violence prevention curriculum in seven sites. Interviews addressed how implementers defined fidelity and the adaptations they made in implementing the curriculum. Although all implementers reported delivering the curriculum with fidelity, their definitions of fidelity varied. Most defined fidelity in terms of adherence to the published curriculum, although definitions sometimes allowed modifications of pedagogy or adding or subtracting materials. A smaller group of implementers defined fidelity in terms of their perceptions of the curriculum's core messages. All implementers described variations from the published curriculum, which were frequently inconsistent with their own definitions of fidelity. Implementers committed to the value of implementation with fidelity may need support in its definition and application. Developers can support implementers by communicating program theory in terms that implementers will understand, clarifying expectations for fidelity and allowable adaptations, and codifying lessons learned from previous implementation.

Feasibility and acceptability of a computer-based tool to improve contraceptive counseling.

OBJECTIVE: The objective was to test the feasibility and acceptability of a computerized tool, Smart Choices, designed to enhance the quality of contraceptive counseling in family planning clinics. The tool includes (a) a questionnaire completed by patients and summarized in a printout for providers and (b) a birth control guide patients explore to learn about various contraceptive methods. STUDY DESIGN: In 2 family planning clinics, we conducted interviews with 125 women who used the Smart Choices computerized tool and 7 providers. RESULTS: Smart Choices integrated into clinic flow well in one clinic, but less well in the other, which had very short waiting times. Patients were generally enthusiastic about Smart Choices, including its helpfulness in preparing them and their providers for the counseling session and increasing their knowledge of contraceptive methods. Providers varied in how much they used the printout and in their opinions about its usefulness. Some felt its usefulness was limited because it overlapped with the clinic's intake forms or because it did not match with their concept of counseling needs. Others felt it provided valuable information not collected by intake forms and more honest information. Some found Smart Choices to be most helpful with patients who were unsure what method they wanted. CONCLUSIONS: Smart Choices is feasible to implement and well received by patients, but modifications are needed to increase provider enthusiasm for this tool. IMPLICATIONS: The Smart Choices tool requires refinement before widespread dissemination.

"In my house": laying the foundation for youth HIV prevention in the Black church.

BACKGROUND: This article describes the process our community-academic partnership used to lay the groundwork for successful implementation of an adolescent-focused, evidence-based HIV/AIDS prevention curriculum in two Black churches. OBJECTIVES: We highlight the challenges encountered and lessons learned in building a relationship with two churches, garnering the pastor's support, and implementing the curriculum within church youth groups. METHODS: We engaged a Community Advisory Board (CAB) made up of youth, parents, and diverse faith leaders to ensure community relevance and guide project development, implementation, and evaluation. LESSONS LEARNED: Using a community-based participatory research (CBPR) approach helped us to (1) engage diverse, intergenerational community members, (2) initiate a "culturally humble" process to build relationships with faith leaders, (3) remain responsive to stakeholder concerns, and (4) open the door to HIV prevention in the Black church. CONCLUSIONS: Finding effective and responsive ways to implement HIV/AIDS prevention in faith settings is facilitated by engaging diverse partners throughout the research process.