Understanding key implementation determinants for a school-based universal prevention intervention: a qualitative study

This study examined how teachers discuss various factors as impacting their ability to execute with fidelity the Michigan Model for Health (MMH), an evidence-based health universal prevention curriculum widely adopted throughout Michigan. Researchers have found a robust relationship between fidelity and participant outcomes, including in schools. While previous studies have identified barriers that inhibit fidelity, few have focused on identifying key barriers and deepening our understanding of how these factors influence intervention fidelity. We conducted a thematic analysis using the reflexive thematic approach to identify key barriers and facilitators and deepen our understanding of how these factors influence MMH implementation. Guided by the Consolidated Framework for Implementation Research (CFIR) and the Implementation Outcomes Framework, we conducted semistructured interviews with 23 high school health teachers across Michigan. Teachers identified intervention characteristics (e.g., design quality, packaging, and program adaptability), student needs (e.g., trauma exposure, substances), and the fit between the intervention and the context as factors that contributed to acceptability. They also discussed the curriculum and its alignment with their teaching style and/or experiences as contributing to fidelity. Teachers shared how they would often go “off protocol” to improve intervention-context fit and meet students’ needs. Our results identified acceptability, a perceptual implementation outcome, as demonstrating an important role in shaping the relationship between CFIR factors and fidelity. Results provide guidance for systematically designing implementation strategies that address key barriers to improve acceptability, enhance fidelity, and ultimately achieve desired public health objectives.

Mental health prevention in children and adolescents in the European Union and measures taken in Poland – good practices and limitations

Mental health of children and adolescents is one of important issues managed as part of preventive interventions not only in Poland, but throughout the European Union. Many studies have shown continuous deterioration of mental health among children and adolescents. Alarming data have been published by the World Health Organization, which show that up to 20% of children suffer from various types of mental problems, hence the need for interventions that will put an end to this process. The most important target set by the European Union countries is to introduce large-scale multilevel preventive measures aimed at the total population, referred to as universal prevention. In addition to universal prevention, European Union countries, including Poland, implement targeted interventions for those at risk and those already diagnosed, as part of preventive mental health care. These measures are part of the WHO Comprehensive Mental Health Action Plan 2013–2030, which encompasses the following objectives: promote mental well-being, enhance recovery, and reduce the mortality, morbidity and disability for persons with mental disorders. This plan was intended to focus on improving mental health care and implementing comprehensive actions at the local level in all European Union countries, which often requires legislative changes in member states. Mental health is becoming the focal point of national and local interventions in Poland. Fast and free access to specialists close to one’s place of residence becomes crucial.

“Aventuras do Búzio e da Coral” – Benefícios do jogo de prevenção universal do abuso sexual para crianças em idade escolar

Sexual abuse is a high prevalence problematic that has a very significative and negative impact in a child or young person’s life, its family and the community. Disseminating the usage of universal prevention programs is fundamental. The aim of this study is to analyze whether the game “Vamos prevenir! As aventuras do Búzio e da Coral” (Agulhas et al., 2016), designed to be played by children between 6 and 10 years old, promotes the acquisition of knowledge to deal with eventual sexual abuse situations. We developed a quantitative study (with pre and post test), with a sample of 101 children from that age group, male and female, which had played the game. The results show that children evaluated the game in a very positive way; statistically significant differences in the number of incorrect and uncertain answers were found from the pre to the post test. Although modest, these results show the importance of increasing children’s understanding about sexual abuse enhancing protection factors.