AN EXAMINATION OF THE RE-INVENTION PROCESS OF A HEALTH PROMOTION PROGRAM: THE CHANGES AND EVOLUTION OF "FOCUS ON KIDS" HIV PREVENTION PROGRAM.

Abstract

Behavioral prevention programs remain one of our most powerful tools in slowing the human immunodeficiency virus (HIV) epidemic. However, questions persist on balancing fidelity of these programs and adapting them to a different target population or setting. The current study explored the extent to which "Focus on Kids," an HIV prevention program with efficacious results from a carefully conducted study, was re-invented when adopted by other agencies and implemented in new settings. This study investigated the quality of re-invention by using a proxy variable of adherence to the core components of the curriculum thought to be responsible for the positive behavior change. The use of a snowball sampling technique identified 34 service providers who had utilized the curriculum. After conducting a telephone survey with the participants, an ex post facto design was used to determine the relationship between reasons for re-invention and other variables thought to be associated with re-invention quality. Results indicated that considerable re-invention occurred. Organizations frequently changed and deleted activities and over half of respondents added new activities. The research allowed the construction of a model of re-invention with factors that were both positively and negatively associated with quality re-invention. Decreasing re-invention quality was associated with citing certain reasons for re-invention: time constraints or the host agency required change. Factors associated with quality implementation included an adopter organization being a national non-governmental organization, having a researcher on the team, or citing expanding to new topics as a reason for re-invention. The results of this study demonstrate the need for curriculum developers to understand the real world environment in which HIV prevention curricula are used. Developers must facilitate practitioners' understanding of the theory and core components of the curriculum thought to be responsible for behavior change.