Quality Improvement in Teen Pregnancy Prevention: Follow-Up to a "Focus on Fidelity".

BACKGROUND: In teen pregnancy prevention (TPP) evidence-based program replication, fidelity toolkits (FTKs) provide structure to ensure that essential curricular components are delivered as intended. OBJECTIVE: The purpose of this project was to extend quality improvement efforts (Flinders, 2017) through analysis of FTKs from four years of TPP implementation. METHODS: An evidence-based TPP program was delivered to females, 15-19 years of age (n = 1,658) from four suburban Ohio counties. Fidelity rates were calculated by agency staff and undergraduate nursing students. Grounded theory was used to identify themes from the narrative sections of the FTKs. Plan-Do-Study-Act methodology (Agency for Healthcare Research and Quality, 2008) guided this quality improvement work. RESULTS: Staff fidelity was reported as 98.38%. Student fidelity was reported at 99.05%. Key themes, identified as a result of the qualitative analysis, were categorized as participant factors, site factors, or presenter factors. CONCLUSIONS: Toolkits created an effective safeguard to ensure the replication of the evidence-based TPP program, with fidelity. IMPLICATIONS FOR NURSING: Undergraduate students are capable of implementing evidence-based programming, with fidelity, to meet the educational needs of their communities. Analysis of narrative comments from toolkits can influence FTK revisions to improve program delivery.

Improving Quality in Teen Pregnancy Prevention Through Effective Replication: A Mixed Methods Focus on Fidelity.

Fidelity monitoring is an essential component of evidence-based replication in teen pregnancy prevention. Fidelity toolkits ensure that core curriculum is adhered to, by providing a detailed checklist of expected activities. When systematically reviewed, fidelity toolkits offer critical information on challenges and barriers that can inform and improve future programming. The purpose of this project was to implement an educational program to improve sexual health in teens, using a fidelity toolkit to promote and evaluate program fidelity. Participants, from a suburban Ohio county, included faculty, junior-level baccalaureate nursing students, and females, 15-19 years of age. Plan-do-study-act methodology was used to carry out this quality improvement initiative. Twenty-three nursing students, divided among 3 clinical sections, and their 3 faculty members completed the fidelity toolkits. Part I fidelity ranged from 82.73% to 100% (M = 97.8%), Part II fidelity ranged from 75% to 95.83% (M = 92.76%), Part III fidelity ranged from 81.5% to 95.83% (M = 91.8%), and Part IV fidelity ranged from 57% to 100% (M = 98.2%). Overall, fidelity of the program averaged 96.4%. Several themes were identified as a result of the qualitative analysis of narrative toolkit responses, in the categories of participant factors, site factors, and presenter factors. Toolkit use led to a high level of program fidelity.