The integrity of smoking prevention curriculum delivery

Introduction This paper describes a study of integrity of delivery of one component of a social resistance smoking prevention curriculum-resistance skills training. The subjects were instructors (n = 15) who had delivered the curriculum during a largescale efficacy trial 2 months earlier. An analogue procedure was used in which subjects led two role plays in a classroom with students who had received the curriculum. The role plays were videotaped and later rated by five individuals. Two components of integrity were measured: the degree to which instructors followed curriculum guidelines for role plays (adherence) and quality of delivery. An Integrity Index was created (1.4 = minimum, 15.3 = maximum), representing the degree of adherence, overall ability to use the Socratic method, and overall skill as a leader of role plays. Instructors' scores on the index ranged from 4.04 to 12.65, with a mean of 9.27. Integrity scores were related to self-reported measures of instructor characteristics and quality of program delivery. Those who were above the median on the Integrity Index were more animated, articulate, and confident during program delivery and were less authoritarian than those with low integrity. The implications of these results for instructor recruitment, training, and monitoring of program implementation are discussed. Institute for Health Promotion and Disease Prevention Research, University of Southern California, 35 North Lake Avenue, Suite 200, Pasadena, CA 91101, USA 'Present address: Prevention Research Center, School of Public Health, University of Illinois at Chicago, PO Box 6998 (M/C 922), Chicago, IL 60680, USA Research over the past 10 years has confirmed the effectiveness of psychosocial approaches in preventing or delaying the onset of substance use among adolescents (Flay, 1985; Tobler, 1986). Whereas early efforts were concerned with determining whether or not these approaches worked at all, present research is beginning to tackle the difficult questions of why psychosocial approaches work, for whom they are most effective, and the optimal conditions for program delivery. An assessment of how a program is implemented is critical to the exploration of all of these issues. Inclusion of program implementation measures and use of such in data analysis enhances considerably the validity of randomized field trials designed to assess program outcomes (Cook and Campbell, 1979; Basch et al., 1985). One of the most important elements to measure is program integrity, generally defined as the degree to which actual delivery of a program corresponds to ideal or intended delivery (Boruch and Gomez, 1977; Fullan and Pomfret, 1977; Sechrest et al., 1979). Information about how well an intervention was implemented can improve the interpretability of outcomes of intervention trials (Basch et al., 1984). Integrity measures also enable researchers to determine the reasons for success or failure of a program. In the absence of evidence that a program was implemented as designed, strong conclusions about program effectiveness cannot be made. Despite the importance of assessing program integrity, relatively little attention has been paid to it in evaluations of school health education and prevention programs. However, two recent studies