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Background: Although many public schools offer sex education, few provide evidence-based interventions (EBIs). We introduced a sexual health education EBI in Los Angeles County (LAC) public middle schools in areas with high teenage birth and STD rates, assessed teachers’ implementation fidelity, and identified logistical challenges and solutions.
Methods: Health, science and physical education teachers from 24 LAC schools agreed to implement “It’s Your Game, Keep It Real,” a 24-lesson curriculum for 7th and 8th grades that was effective at delaying onset of sexual activity among minority adolescents in Houston, Texas. Teachers received training, supporting materials, and technical assistance. To document fidelity including lesson completion, teachers were incentivized to complete curriculum logs (CL) for each lesson and were observed once. In year 1 (Y1), only 7th grade lessons were implemented; both grades received lessons in year 2 (Y2). Based on Y1 CL submission rates (72%), we revised the incentive structure and CL system to encourage complete and timely CL entry.
Results: In Y1, 66 teachers implemented in 298 classrooms (7,628 students). Of 5,022 lessons prescribed, teachers submitted 3,591 logs (72% of prescribed lessons completed) and verbally confirmed another 1,208 lessons (24%), totaling 95% of prescribed lessons delivered. Project staff observed 65 lessons which averaged 4.2 in quality (scale 1=low to 5=high quality). In Y2, 120 teachers implemented in 634 classrooms (14,969 students). Of 7,962 lessons prescribed, teachers completed 7,021 logs (88% of lessons delivered), and verbally confirmed another 245 (3%), totaling 91% of prescribed. The 145 observations averaged 4.4 in quality rating.
Conclusions: Teachers delivered 90% of prescribed lessons each year, although the Y1 estimate may be less reliable because many did not submit CLs. Despite consensus on the importance of using EBIs, documenting and maintaining program fidelity is burdensome for teachers and requires robust funding and systems that facilitate reporting.