Academic journal article International Electronic Journal of Health Education

National Implementation of an Evidence-Based HIV Prevention and Reproductive Health Program for Bahamian Youth

Academic journal article International Electronic Journal of Health Education

National Implementation of an Evidence-Based HIV Prevention and Reproductive Health Program for Bahamian Youth

Article excerpt


Spanning more than a quarter century, efforts toward HIV prevention and improved reproductive health have yielded a wide array of effective behavioral interventions. (1,2) Despite these successes, still challenging to the field have been efforts to widely implement effective interventions in a manner which retains their effectiveness. These problems emerged as a result of cultural differences in the new settings and inadequate infrastructure capacity in overburdened public health or educational venues tasked with delivery of the intervention. Even with successful in-country longitudinal research prior to broader dissemination, there remained the challenges associated with implementation fidelity including adherence to an intervention's content and dosage, and delivery processes and competence. (3)

Within school environments, specific challenges may be faced during implementation of a new program. Fullan, Cultress & Kilcher (4) discussed "implementation dip" as a normal expectancy when implementing programs within schools. The concept of implementation dip recognizes and anticipates that even when a program (e.g., new curriculum) is structurally sound and has gone through appropriate adaptation processes, there will be awkwardness at start-up of implementation. Teachers need to be trained both to implement the program and to expect this "dip". Without proper training, teachers may give up or resist the change when problems begin to destabilise the existing standard curriculum. With training, these "dips" can be minimized and teachers can experience positive outcomes earlier in the implementation process as they integrate the new program into the existing curriculum.

In this manuscript, the national implementation efforts of the "Focus on Youth in the Caribbean (FOYC) and Caribbean Informed Parents and Children Together (ClmPACT)" adolescent HIV prevention program in The Bahamas are described. To contextualize the implementation efforts, we briefly described the history of the FOYC-CImPACT program, including the adaptation process of the original US-based intervention, for use within the socio-cultural and epidemiologic context of The Bahamas. A brief summary of the evaluation process and outcomes of the effectiveness trial of FOYC-CImPACT followed. The remainder of the manuscript described the national school-based implementation of FOYC-CImPACT at the grade-six level, including the components of the evaluation process, reactions to the program on the part of teachers and wider community, and the processes followed to address the challenges and successes encountered with the integration of FOYC within the existing grade six curriculum, the "Health and Family Life Education" course.

Background to the Development and Evaluation of FOYC-CImPACT

Political-economic and Socio-cultural Contexts in the Bahamas

The Bahamas, an archipelago of predominantly rural islands, is a young nation celebrating just four decades of independence from Great Britain. The population of 323,000 includes an estimated 10% Creole population; 65% of Bahamians reside on the tiny island of New Providence. (5) Approximately 85% of Bahamians are of African descent. As children of freed slaves, Bahamians describe themselves with pride as religious and bound by significant kinship ties throughout their inhabited islands and cays. (6-9) Approximately 70% of the population is Protestant congregants, the majority of whom are Baptist.

The government of The Bahamas is a parliamentary-based democracy. The Bahamas maintains a strong economic linkage to the United States and strong cultural linkages to the African American culture. Tourism directly and indirectly (e.g., tourism-related construction) accounts for approximately one half of all employment. (5)

HIV and Reproductive Health Issues in the Bahamas

The HIV prevalence rate in The Bahamas was estimated at 3% among the general population. …

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