Prevention Science

, Volume 16, Issue 1, pp 90–99 | Cite as

Adherence and Delivery: Implementation Quality and Program Outcomes for the Seventh-Grade keepinit REAL Program

  • Jonathan Pettigrew
  • John W. Graham
  • Michelle Miller-Day
  • Michael L. Hecht
  • Janice L. Krieger
  • Young Ju Shin


Poor implementation quality (IQ) is known to reduce program effects making it important to consider IQ for evaluation and dissemination of prevention programs. However, less is known about the ways specific implementation variables relate to outcomes. In this study, two versions of keepinit REAL, a seventh-grade drug prevention intervention, were implemented in 78 classrooms in 25 schools in rural districts in Pennsylvania and Ohio. IQ was measured through observational coding of 276 videos. IQ variables included adherence to the curriculum, teacher engagement (attentiveness, enthusiasm, seriousness, clarity, positivity), student engagement (attention, participation), and a global rating of teacher delivery quality. Factor analysis showed that teacher engagement, student engagement, and delivery quality formed one factor, which was labeled delivery. A second factor was adherence to the curriculum. Self-report student surveys measured substance use, norms (beliefs about prevalence and acceptability of use), and efficacy (beliefs about one’s ability to refuse substance offers) at two waves (pretest, immediate posttest). Mixed model regression analysis which accounted for missing data and controlled for pretest levels examined implementation quality’s effects on individual level outcomes, statistically controlling for cluster level effects. Results show that when implemented well, students show positive outcomes compared to students receiving a poorly implemented program. Delivery significantly influenced substance use and norms, but not efficacy. Adherence marginally significantly predicted use and significantly predicted norms, but not efficacy. Findings underscore the importance of comprehensively measuring and accounting for IQ, particularly delivery, when evaluating prevention interventions.


Implementation quality Program evaluation Substance use Adolescents 


Author’s Note

This publication was supported by Grant Number R01DA021670 from the National Institute on Drug Abuse to The Pennsylvania State University (Michael Hecht, Principal Investigator). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health. (NIH Manuscript # NIHMS272843). Portions of this paper were presented at the 2013 annual meeting of the Society of Prevention Research.


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Copyright information

© Society for Prevention Research 2014

Authors and Affiliations

  • Jonathan Pettigrew
    • 1
    • 2
  • John W. Graham
    • 3
    • 4
  • Michelle Miller-Day
    • 1
    • 5
  • Michael L. Hecht
    • 1
    • 4
  • Janice L. Krieger
    • 6
  • Young Ju Shin
    • 1
    • 7
  1. 1.Department of Communication Arts and SciencesPenn StateState CollegeUSA
  2. 2.School of Communication StudiesUniversity of TennesseeKnoxvilleUSA
  3. 3.Department of Biobehavioral HealthPenn StateState CollegeUSA
  4. 4.Prevention Research CenterPenn StateState CollegeUSA
  5. 5.Department of Communication StudiesChapman UniversityOrangeUSA
  6. 6.School of CommunicationThe Ohio State UniversityColumbusUSA
  7. 7.Department of Communication StudiesIndiana University–Purdue University IndianapolisIndianapolisUSA

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