1. Effectiveness and utilization of a parent education curriculum: a two-level evaluation of educators and parents
Sheetal Malhotra , MBBS, MS
Diane Santa Maria, APHN, MSN
Melissa Steiner, MSA, CHES

2. Objectives
Describe a training of educators to provide a parenting-adult curriculum to their communities.
Evaluate the effectiveness and utilization of the curriculum training
Identify challenges to curriculum training implementation and possible solutions.

3. Background
The Medical Institute developed the Building Family Connections (BFC) curriculum
Developed from previous work with grandparents and parents
Information and skills training for parenting adults on parent-child connectedness
Goal to increase parent-child sexual health communication and connectedness
Ref:
Markham CM, Lormand D, Gloppen KM, et al. Connectedness as a predictor of sexual and reproductive health outcomes for youth. J Adolesc Health Mar;46(3 Suppl):S Epub 2010 Jan 22. Review.
To review research examining the influence of ‘‘connectedness’’ on adolescent sexual and reproductive health (ASRH). Connectedness, or bonding, refers to the emotional attachment and commitment a child makes to social relationships in the family, peer group, school, community, or culture. A systematic review of behavioral research (1985–2007) was conducted. Inclusion criteria included examination of the association between a connectedness sub-construct and an ASRH outcome, use of multivariate analyses, sample size of 􏰂100, and publication in a peer-reviewed journal. Results were coded as protective, risk, or no association, and as longitudinal, or cross sectional. Findings from at least two longitudinal studies for a given outcome with consistent associations were considered sufficient evidence for a protective or risk association. Eight connectedness sub-constructs were reviewed: family connectedness (90 studies), parent–adolescent general communication (16 studies), parent–adolescent sexuality communication (58 studies), parental monitoring (61 studies), peer connectedness (nine studies), partner connectedness (12 studies), school connectedness (18 studies), and community connectedness (four studies). There was sufficient evidence to support a protective association with ASRH outcomes for family connectedness, general and sexuality-specific parent– adolescent communication, parental monitoring, partner connectedness, and school connectedness. Sufficient evidence of a risk association was identified for the parent over control sub-construct of parental monitoring. Connectedness can be a protective factor for ASRH outcomes, and efforts to strengthen young people’s pro-social relationships are a promising target for approaches to promote ASRH.
Source:
Markham,CM et al. J Adolesc Health. 2010 3

4. Background
Parent-child communication and connectedness associated with
reduction in adolescent risk behaviors including sexual activity1,2
Parents face many barriers to communicating with their children about sex
lack of knowledge, communication skills, and self-efficacy3,4
Kirby, D., Lepore, G., & Ryan, J. (2005). Sexual risk and protective factors–factors affecting teen sexual behavior, pregnancy, childbearing and sexually transmitted disease: Which are important? which can you change FIX
Connectedness as a Predictor of Sexual and Reproductive Health Outcomes for Youth Christine M. Markham, Ph.D.a,*, Donna Lormand, M.P.H.a, Kari M. Gloppen, M.P.H.b, Melissa F. Peskin, Ph.D.a, Belinda Flores, M.P.H.a, Barbara Low, Dr.P.H.a, and Lawrence Duane House, M.A.c
de Graaf, H., Vanwesenbeeck, I., Woertman, L., Keijsers, L., Meijer, S., & Meeus, W. (2010). Parental support and knowledge and adolescents' sexual health: Testing two mediational models in a national Dutch sample. Journal of Youth and Adolescence, 39(2), doi: /s
Miller, K. S., Fasula, A. M., Dittus, P., Wiegand, R. E., Wyckoff, S. C., & McNair, L. (2009). Barriers and facilitators to maternal communication with preadolescents about age-relevant sexual topics. AIDS and Behavior, 13(2),
Sources:
1. Kirby, D et al Sexual risk and protective factors
2. Markham,CM et al. J Adolesc Health. 2010
3. de Graaf, H et al J Youth Adolescences
4. Miller, K et al AIDS and Behavior

5. Exponential Program Effects
Community educators can be effective mediators to overcome parental barriers through education and skill building
Each trained educator can reach numerous parenting adults producing an exponential effect on parent-child sexual health communication
Training community educators across the country
The train the trainer or train-the-facilitator model is popular in public health education to reach large portions of the target population by training a small cadre of trainers/facilitators. Several evaluations of community educators trainings have been conducted to assess effectiveness of such trainings by assessing changes in knowledge and skills of educators. However, there is not much information on what happens after educators leave the training with their new skills. There is not much information on the uptake and utilization of training information by the trainers/facilitators. This study aims to assess the utilization and real effectiveness of a sexual health education and communication curriculum after the educators have been trained in it. Not only does this study assess effectiveness of the training, but also aims to evaluate effectiveness at a second level – transfer of this information to the end-user. The study will address these topics by discussing two levels of evaluation: that of the training for the trainers as well as the course conducted by these trainers in their communities and how well this information is transferred to the community members. This abstract will add to the practice by determining how training evaluations can be taken further to assess the real impact of any training on the end-users who are the ultimate target of such trainings. In a way, such two level evaluations are essential to assess the real effectiveness of the train-the-trainer model. Such evaluations can also help improve the train-the trainer model to ensure maximum effectiveness for the target population.

6. Objectives
Evaluate the effectiveness of BFC curriculum training for community educators
Assess uptake and utilization in educators’ communities nationwide
Evaluate effectiveness in transferring this information to parenting adults through trained community educators.

8. Methods: Training & Delivery
10-hour BFC curriculum
2.5-day training for community educators to
learn and practice facilitation skills
plan, recruit, & market program
provide BFC to parents in their communities

9. Methods: Training & Delivery (cont.)
Community courses
implemented based on parent feedback
scientific knowledge and effective parenting & communication strategies
interactive and skill building formats

10. Methods: Evaluation Training evaluation usability capacity building
logistics & delivery
Pre/post-surveys
knowledge
attitudes
intents
behaviors

11. Results May 2008: BFC Curriculum Training 34 educators trained
pre/post surveys
training evaluation
: BFC curriculum courses
23 courses by 7 educators
>320 parents reached

13. Results: Educators 34 educators; 6 males, 27 females
Age: 25 to 65 years; median = 37 years
Ethnicity
26% Black
15% Hispanic
44% White
12% Asian
3% Other

14. Results: Educators Significant increases in participant knowledge Item
Pre-survey
N (%)
Post Survey p
Site of fertilization
18 (60)
33 (100)
<0.05
Problem of dating violence
14 (44)
23 (70)
Risk of pregnancy in girls with boyfriends more than 3 years older then them
23 (74)
32 (97)
<0.10
Decision making maturity among teens
17 (57)
25 (78)

15. Results: Educators

16. Results: Educators Participants strongly agreed that the training
was useful (97%)
was enjoyable (94%)
materials were useful (91%)
objectives were achieved (82%)
prepared them to hold the BFC course (82%)

19. Results: Parenting Adults
7 trained educators have held 34 courses
>320 parenting adults; 32 males, 287 females
Age: 18 to 80 years; median = 39 years
Ethnicity
89% Hispanic
7% White
4% Black
1% Other

20. Results: Parenting Adults
Matched Responses:
209 parenting adults; 22 males, 186 females
Age: 18 to 69 years; median = 40 years
Ethnicity
85% Hispanic
9% White
5% Black
<1% Other

21. Results: Knowledge Item Pre-survey N (%) Post survey N (%) p
Cause of cervical cancer
124 (66)
193 (95)
<0.001
Risk of infertility with STIs
154 (78)
188 (90)
<0.01
Condoms make sex “safe”
152 (73)
196 (94)
Early sexual debut and risk of multiple sexual partners
137 (69)
198 (95)
Most pregnant teens are abandoned by their partners
180 (87)
199 (96)

22. Results: Knowledge (cont.)
Item
Pre-survey
N (%)
Post Survey p
Risk of pregnancy in girls who have a boyfriend more than 3 yrs older than them
100 (49)
182 (88)
<0.001
Site of fertilization
50 (26)
192 (95)
Dating violence problem
128 (63)
163 (79)
<0.01
Link between dating violence and sexual activity
138 (72)
178 (89)
Abuse as a risk factor for multiple sexual partners
97 (52)
180 (88)

23. Results: Attitudes Item Pre-survey N (%) Post Survey p
Its okay for my child to start having sex when they are in a committed relationship such as marriage
159 (79)
197 (95)
<0.001
Feel comfortable talking to children about STIs and how to prevent them
156 (79)
187 (92)
<0.01

24. Results: Skills & Behaviors
Item
Pre-survey
N (%)
Post survey p
Strategies to start a conversation with youth about sex
174 (88)
201 (97)
<0.01
Frequency of communication regarding sexual health
89 (47)
121 (61)
<0.001

25. Results: Parenting Adults

27. Results: Parenting Adults

28. Conclusions
Training is effective in increasing knowledge and skills of educators
Trained educators can then provide BFC curriculum to parents in their communities
Utilization of BFC curriculum has shown enhanced parent-child sexual health communication

29. Implications for Evaluation Practice and Research
Use of trained educators to reach parents is a viable and effective model
Training evaluations can be taken further to assess the real impact on end-users
Two level evaluations can help improve the train-the-trainer model to ensure effectiveness
Further research on utilization and impact of such models needed ie., in youth
This abstract will add to the practice by determining how training evaluations can be taken further to assess the real impact of any training on the end-users who are the ultimate target of such trainings. In a way, such two level evaluations are essential to assess the real effectiveness of the train-the-trainer model. Such evaluations can also help improve the train-the trainer model to ensure maximum effectiveness for the target population.

31. Funding for the Study
This study was supported by grant # 5U58DP from the Centers for Disease Control (CDC) and Prevention Division of Adolescent and School Health (DASH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC, DASH, or the Department of Health and Human Services or the U.S. government. 31

32. Thank You! For more information contact Sheetal Malhotra, MBBS, MS
ext 206 32