School partner perspectives on the implementation of the Your Voice Your View sexual assault prevention program for high school students

Abstract

Despite the high risk for sexual assault among adolescents, few sexual assault prevention programs designed for implementation in high schools have sustained rigorous evaluation. The present study sought to better understand the factors that influenced the implementation of Your Voice Your View (YVYV), a four-session sexual assault prevention program for 10th grade students, which includes a teacher “Lunch and Learn” training as well as a 4-week school-specific social norms poster campaign. Following program implementation, eight school partners (i.e., health teachers, guidance counselors, teachers, and principals) participated in an interview to provide feedback on the process of program implementation. The Consolidated Framework for Implementation Research was utilized to examine site-specific determinants of program implementation. Participants discussed the importance of the design quality and packaging of the program, as well as the relative advantage of offering students a violence prevention program led by an outside team, as opposed to teachers in the school. School partners highlighted the importance of intensive preplanning before implementation, clear communication between staff, the utility of engaging a specific champion to coordinate programming, and the utility of offering incentives for participation. Having resources to support implementation, a desire to address sexual violence in the school, and a positive classroom climate in which to administer the small-group sessions were seen as school-specific facilitators of program implementation. These findings can help to support the subsequent implementation of the YVYV program, as well as other sexual assault prevention programs in high schools.

1 |. INTRODUCTION

Sexual violence is a serious public health concern among adolescents in the United States (Basile et al., 2020, 2022). According to the uniform definitions utilized for surveillance, sexual violence includes both noncontact, penetrative, and nonpenetrative sexual acts which occur without the victims’ expressed consent, or when a victim is unable to refuse or consent due to age, illness, violence, or threats of violence, or if someone is disabled, incapacitated, asleep, or unconscious (Basile et al., 2014). According to the 2011–2021 Youth Risk Behavior Survey Data Summary and Trends Report, 2 in 10 girls experienced sexual violence in the past year, and 1 in 10 was forced to have sex in the past year (Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 2023). Given the high prevalence of psychological and health consequences among survivors of adolescent sexual assault, widespread implementation of sexual assault prevention programs for high school youth is sorely needed.

Several research-based violence prevention programs exist for high school audiences. An assessment of the long-term impact of the Safe Dates program and booster session found that participants reported significantly less sexual dating violence perpetration and victimization 4 years following the program (Foshee et al., 2004). A cluster randomized trial of the Coaching Boys into Men Program, a coach-delivered violence prevention program for male high school athletes, also found significant impacts on participants’ ability to recognize abusive behavior and intentions to intervene as proactive bystanders to address sexual violence (Miller et al., 2012). Green Dot, a school-based bystander intervention approach to sexual violence prevention is associated with reductions in the perpetration of sexual violence among high school students (Bush et al., 2021; Coker et al., 2019). Edwards et al. (2019) evaluated a seven-session bystander intervention program implemented in high school classrooms, which was successful in producing changes in empathy toward victims of relational and sexual violence, barriers and facilitators of bystander intervention, ascription to rape myths, readiness to intervene, media literacy, and knowledge about interpersonal violence. As the number of evidence-based sexual assault prevention programs for high school students grows, it is vital to understand the extent to which high schools are adopting these curricula.

Across a range of organizations and systems, a cause for concern is that it can often take years to develop and implement a well-defined and well-researched intervention program (Bierman, 2002; Fixsen et al., 2010; Panzano & Roth, 2006). In response to this problem, research examining the adoption of evidence-based prevention and intervention programs in school settings is growing, including studies that examine factors that influence the implementation of programs addressing trauma in schools (Nadeem & Ringle, 2016). From this research, it is clear that there are numerous organizational factors that contribute to the implementation of school-based violence prevention programs, which can impact the impact and sustainability of an intervention (Hunter et al., 2001). Additional research examining the process of implementing sexual assault prevention programs in high schools is needed to understand the factors that might accelerate uptake, enhance the fidelity of administration, increase sustainability, and improve overall outcomes (Edwards et al., 2023). For example, recently Orchowski, Malone et al. (2023) examined the barriers and facilitators associated with implementing a 12-week social norms poster campaign to address dating and sexual violence in middle schools. Studies like Orchowski, Oesterle et al. (2023) can help organizations and schools better plan to implement evidence-based interventions and can also help program developers design curricula with implementation and dissemination in mind.

Accordingly, the goal of the current study was to comprehensively assess barriers and facilitators to the successful implementation of Your Voice Your View (YVYV), a multisession sexual assault prevention intervention developed for high school students (Orchowski, Malone et al., 2023). YVYV includes four group-based workshops grounded in social norms theory and bystander intervention skills training and is designed to prevent sexual violence. A social norms approach to sexual assault prevention is based on the idea that correcting misperceptions about others’ support for harmful behaviors can decrease the perpetration of harm and increase the likelihood that individuals step in to serve as proactive bystanders (Orchowski & Berkowitz, 2022). Aligned with this model, the YVYV program aims to: (1) correct students’ misperceptions of peer norms regarding sexual violence and bystander intervention; (2) increase students’ understanding of consent for sexual activity, boundary-setting skills, and sexual communication skills; (3) increase students’ ability to identify and respond to risks for sexual violence; (4) increase students’ confidence and skills in bystander intervention; (5) increase students’ support for victims of sexual violence and for peers who engage in proactive bystander intervention; and (6) decrease students’ engagement in the perpetration of sexual aggression.

The Consolidated Framework for Implementation Research (CFIR) was used in the present study to examine perceived school-wide factors influencing the successful implementation of the YVYV program among school partners. The CFIR (Damschroder et al., 2022) is a well-established multilevel framework of implementation-related constructs that allows researchers and their partners to assess site-specific implementation determinants systematically and comprehensively (Damschroder et al., 2009). All CFIR constructs are grouped into five major domains that reflect varying aspects relating to effective implementation, including (1) characteristics of an intervention/innovation (i.e., intervention source, evidence strength, and quality, relative advantage, adaptability, trialability, complexity, design quality/packaging, cost); (2) outer setting characteristics (i.e., population needs/resources, cosmopolitanism, peer pressure, external policies/incentives); (3) inner setting characteristics (i.e., structural characteristics, networks/communication, culture, implementation climate, readiness); (4) characteristics of individuals (i.e., knowledge, self-efficacy, individual stage of change, individual identification with the organization); and (5) factors relating to processes of implementation (i.e., planning, engaging, executing, reflecting/evaluating; Damschroder et al., 2009). It is important to note that the domains and their constructs should not be viewed as isolated components of implementation, but rather as intersecting components of the implementation process. Numerous systematic reviews highlight CFIR’s use within implementation research (Birken et al., 2017; Kirk et al., 2015), including being used at various stages of intervention development and implementation (Breimaier et al., 2015), to evaluate facilitators and barriers to the successful implementation of health-related interventions (Stone et al., 2018), as well as within school-based settings (Koester et al., 2021; Wilhelm et al., 2021). CFIR can also be utilized to garner school partner perspectives on processes of intervention implementation, which may support subsequent intervention roll-out and uptake (Orchowski, Oesterle et al., 2023).

Given the qualitative nature of the research, no specific hypotheses were proposed. A series of eight interviews were conducted with one school partner (e.g., a principal, guidance counselor, or teacher) from each of the eight high schools in the study, all of which were located in the Northeastern United States. Interview participants were recruited from all schools. Interviews were conducted following the implementation of YVYV to all 10th grade students to understand how school partner perspectives on the barriers and facilitators of program implementation could be utilized to enhance uptake of the intervention at other schools in the future.

2 |. METHODS

2.1 |. Participants, recruitment, and procedures

A set of 27 high schools in the Northeast United States were enrolled in a larger evaluation of the YVYV program, and 14 of the schools in the study implemented the program as a part of the treatment group (Orchowski, Malone et al., 2023). Interviews were conducted from 2015 to 2018, following the completion of the program activities within each school. Schools were randomized to treatment or a wait-list control group. A school champion was appointed at the start of the study to assist with scheduling the intervention across classrooms in the school and to help connect students, parents, teachers, and other school administrators with members of the program team. School champions included school faculty and staff such as school principals, counselors, therapists, and teachers. After the intervention and all other study activities were complete, school champions were invited to participate in an interview to provide feedback on program implementation. School partners from 8 of the 14 high schools in the treatment group agreed to participate in the interview. This included partners from public, private, and charter schools.

2.2 |. Overview of the prevention program

The YVYV program was developed by Day One, a rape crisis center located in Rhode Island. The program began with a 20-min “Lunch and Learn” workshop for all teachers in the school. The training provided an overview of the intervention topics and primed teachers to discuss the YVYV program and social norms marketing campaign with students. Teachers were also provided with instructions on how to implement bystander intervention strategies for addressing risky student behavior and how to educate students about norm misperceptions. The research study involved surveys for teachers at baseline and 6 months, as well as surveys for 10th grade students at baseline, 2 and 6 months.

All 10th grade students in the school were invited to participate in the YVYV program as a part of their standard health or physical education classes. The series of four interactive workshops were facilitated by a two-person team, including a member of the rape crisis center education team and a trained member of the research staff. Each session was 50 min in length. Following each session, the facilitators remained in the building for at least 30 min for “Question Time.” This component of the program was designed to allow students to ask questions to program facilitators in a more private setting. Program facilitators also used this time to address any disclosures of harm during or after the program and ensure that the planned follow-up procedures for addressing disclosures of harm were properly executed. Additional details of the program are reported by Orchowski, Malone et al. (2023).

Session 1 focused primarily on norms regarding what students’ peers think about sexual violence and the responsibility of bystanders. Session 2 focused on recognizing sexually abusive behaviors. Activities challenged students to examine their personal boundaries, increase their awareness of their peers’ boundaries, and recognize different forms of verbal and nonverbal communication. Session 3 split students into gender-specific groups to discuss how sexual violence and peer pressure affect teens differently depending on whether they are socialized as boys or girls. Transgender and other gender-diverse students were encouraged to attend the session they were most interested in, and in some schools, an alternate session was offered for students not wishing to attend either session. The session for boys focused on the intersection of masculinity and sexual aggression and was modeled upon The Men’s Workshop (Gidycz et al., 2011), and the session for girls was grounded in the Assess, Acknowledge, Act (“AAA”) approach to reducing risk for sexual violence victimization (Rozee & Koss, 2001). Session 4 focused on the modeling of bystander intervention behaviors and engaged students in the active practice of bystander intervention skills through a review of scenarios and active practice.

After the four YVYV workshops, a series of four social norms marketing posters highlighting positive school-specific norms were disseminated throughout the school, with poster content reflecting data collected from a school-wide social norms survey. The poster campaign was designed to present accurate data regarding positive prosocial norms within the school community, with the goal of correcting misconceptions regarding peer support for violence. Posters were tailored to address the most significant discrepancies between actual and perceived norms in the school. Data for the posters were school-specific and were garnered from a school-wide survey of students conducted during lunchrooms and homeroom periods. Sample poster messages included “95% of students at [insert school name] believe that bystanders can take steps to prevent sexual violence” and “92% of students at [insert school name] would believe someone who says they were sexually assaulted.” Normative messages were selected for use in a poster only if the data being presented would target a discrepancy between the perceived and actual norm among students. The number of students answering the survey was reported on the poster, as well as the percentage of students who said that they answered honestly. For 2 weeks following the program, two different posters were displayed throughout the school. The posters were replaced after 2 weeks to avoid habituation to the message. Study staff tracked whether posters were damaged (i.e., through graffiti) or taken down during the 2-week period. Posters served to highlight key content in the intervention and also foster discussion to challenge misperceptions of social norms among students.

2.3 |. Interview procedure

Study procedures were approved by the local Institutional Review Board, as well as the superintendent/head of school, and each local school committee at each study site. At the end of the project year, school champions involved in the research were invited by a study research assistant via email to participate in an interview to provide feedback on program administration. School champions received a stipend for serving in a supportive role for the study. As such, participants in the interview were not compensated for their time. School champions were told that they were not required to complete the interview (i.e., participation was voluntary). Participants were also told that they could refuse to answer any question that they did not want to discuss. Participants in the interview completed an informed consent form before study participation. Given that the schools had ongoing relationships with members of the rape crisis center who offered the YVYV program, participants were informed that their responses were anonymous and would not impact their ability to continue to offer the program in the future. The 60–90 min interview was conducted in a private meeting room by a trained member of the research team. The interview was audio recorded and transcribed. The semistructured interview script was developed to identify a range of school-specific implementation considerations, including facilitators and barriers to implementing the prevention program (see Appendix A). Questions were open-ended and research staff was trained to probe using nonspecific follow-up questions (e.g., “can you tell me more about that?”).

2.4 |. Data analysis plan

Qualitative coding of each interview was conducted by a three-person coding team using the NVivo software to organize and manage data and codes. The coding team consisted of two primary coders and a consensus coder. Using a deductive process (Hsieh & Shannon, 2005), directed content analysis was conducted using an a priori coding framework drawn from the CFIR, which comprises 39 constructs organized across five major domains: (a) intervention characteristics, (b) inner setting, (c) outer setting, (d) characteristics of individuals, and (e) processes of implementation. Coders were trained by senior researchers with considerable experience in qualitative coding within the context of sexual assault prevention intervention development. Coders deductively identified CFIR constructs that aligned with the participant’s responses independently. Codes were considered mutually exclusive so that no two CFIR codes would be used in one segment of text. Coefficient κ was assessed to determine consensus between coders, with κ values below 0.60 requiring recoding until criteria were met. After two independent attempts, the coders met together in real-time to discuss and resolve discrepancies. In the event of disagreement between coders, a senior researcher was available to provide guidance on themes within the quotes and help the two coders come to a consensus. Through this process, coders were able to achieve 100% agreement on coding content.

3 |. RESULTS

Qualitative analyses revealed that school partners discussed issues related to 10 constructs situated within three of CFIR’s domains: (a) intervention characteristics, (b) inner setting, and (c) implementation process (see Tables 1–3). Within these CFIR domains, only the codes that demonstrated sufficient saturation (>8 codes) are reported. Below, each domain and the constructs within it are described, with particular emphasis given to how each construct manifested within the present study. Reflections on the meaning and significance of each domain and construct are provided below.

TABLE 1.

Codes relating to Your Voice Your View intervention characteristics.

Subtheme	N	Description	Example
Design quality and packaging	28	Perceived excellence in how the intervention is bundled, presented, and assembled.	“The kids loved it. They loved the topics that they talked about. I only sat in one session, but the advisor seemed to have a really good response to it as well. The posters were really nice. I thought they were great, really colorful. I loved them.”
Relative advantage	9	School partners’ perception of the advantage of implementing the intervention versus an alternative solution.	“Yeah and it wasn’t the same face they’re used to me they know what I do so to have someone else come in and talk about it too was I think like oh fresh perspective, new people, new activity, new things to talk about. I think they enjoyed that.”

Note: N refers to the number of times the code was indicated across the eight transcripts.

TABLE 3.

Codes relating to the inner setting implementation climate of Your Voice Your View.

Code	N	Description	Example
Resources to support implementation	25	The level of resources dedicated to the implementation and ongoing operations including money, training, education, physical space, and time to provide readiness for implementation.	“...logistically it was a little tricky to find rooms, and um, available staff. I think it would’ve been easier if we could just leave them with the researchers to run the classes, but I know behavior management, classroom management can be tricky, so um most of the time I think we were able to figure it out, but I would say logistically that was one of the trickier things is location, and appropriate staff.”
Tension for change	11	The degree to which school partners perceive the current situation as intolerable or needing change.	“I think there are times where, um, you know one person or the other in some sort of sexual situation feels like um, that maybe, they’ve implied that they don’t want it to go any further, but they don’t necessarily know how to voice that.”
Learning climate	56	A climate in which team members feel that they are essential, valued, and knowledgeable partners in the change process, and individuals feel psychologically safe to try the intervention.	“. the kids were really participating. I saw two of the three groups; the girls were like engaged and really working with the facilitator. So, it was nice to see that they weren’t just sitting there bored and not engaging with the facilitator.”

Note: N refers to the number of times the code was indicated across the eight transcripts.

3.1 |. Intervention characteristics

Understanding how partners perceive specific aspects of a program, including programmatic design, quality of content and materials used within an intervention, and the relative advantage one program has over another, is critical when assessing the viability of implementation. The constructs represented in the intervention characteristics domain captured participants’ perceptions of how the YVYV program was packaged and presented, along with perceptions of the ability of the program to address students’ and school needs.

3.1.1 |. Design quality and packaging

The construct design quality and packaging reflected how programmatic content and delivery, including broad and specific attributes, were valued by school partners. Most school partners provided feedback on specific aspects of the program. As mentioned by one participant below, the actual programmatic content and presentations were positively regarded: “I think all the presentations were very well done, and the girls received them well.” Participants also provided even more nuanced feedback on presentations, citing specific attributes they found most valuable:

I’d sat in on a couple of them. I really liked the use of media, like the YouTube videos, and the conversations they were having, and the incentives, the kids were all about the incentives, and it really did work, I think they were very into it

In addition to comments regarding the content provided within the presentations, numerous participants spoke about the usefulness of the social norms poster campaign in reinforcing key messages communicated in the YVYV workshops. One participant positively remarked on the aesthetics of the poster, along with feedback on the messages shared on the posters, stating:

I thought the posters were beautiful, they were colorful. They were eye catching. The statements were great on the percentage of students that believed in certain things

Additionally, another participant recalled discussions that were generated because of the posters presented:

Related to the poster campaign, it did generate questions and statements and feedback from: “What are those posters doing up there?” or “Who said that?” um, inquiries around “How do they know that’s true?

Successful implementation of social norms marketing campaigns requires students, faculty, staff, and teachers to both notice the posters and discuss the believability of the messages shared. The design quality and packaging construct provided critical and in-depth feedback that spoke directly to key processes of the successful implementation of this program. Students and teachers noticed the posters and were drawn to the colorful designs. They also reported discussing the school-specific norms presented in the poster, which were designed to target misperceptions of student norms in the school. Teachers mentioned that the training that they received in the social norms approach was beneficial to them in guiding these discussions.

3.1.2 |. Relative advantage

Codes captured under the subconstruct of relative advantage reflected participant perceptions of the utility and usefulness of using the program being evaluated. Specifically, participants often discussed the usefulness of bringing in an external organization to present this material versus delivering these workshops on their own:

It’s good to have someone come out from the community that can really talk to them in a way that we might not be able to, they might, you know take you guys more seriously than they would take us, they feel like we play kind of a parental role in the nagging, you know, um role, so for them, I think having someone come from outside associated with the hospital has more integrity than just the teacher who’s been around forever

The construct relative advantage primarily captured positive effects, such as legitimizing the messages shared within the program and the utility of having an external group present this information versus having an existing member of the school share this content.

3.2 |. Process of program implementation

The semistructured interview used within this study emphasized process-related questions to better understand implementation factors related to programmatic logistics to prepare for future widespread implementation of the program. The process domain captured aspects of program implementation, spanning from program planning, coordination, and facilitation, engaging champions within each school, and ultimately to reflecting and evaluating implementation success.

3.2.1 |. Planning

As a process-related construct, planning captured participant feedback related to how various aspects of the program were coordinated, including how tasks were coordinated between the study team and school staff, while also including considerations related to resources needed for the successful implementation of the intervention. Additionally, the planning construct also includes feedback related to ongoing communication between the research team and school staff. Numerous participants commented on aspects of planning that went well or resulted in successfully implementing this program in challenging settings. One participant suggested that meeting with teachers and school staff before implementation significantly helped with buy-in:

Sure, it was absolutely helpful, useful to have the program, programming staff meet directly with the education staff, um, it was because it allowed them to talk to the program directly and ask questions and feel engaged in the process vs. just their always present social worker disseminating information on behalf of the program. It was much more impactful for them to meet and greet with the folks who were coming in to work with them and their students….most importantly the buy-in shot right up. And already this year folks have started to ask, some folks, some of our social team mentioned in our previous conversation that teachers are already asking and ready to schedule

Participants also provided feedback on areas related to program planning and logistics that were challenging and difficult for school staff to accommodate. Numerous program-related events were discussed and scheduled in planning meetings between study staff and school participants, including parent information sessions, survey administration, intervention delivery, and other intervention events. As such, it was often difficult to definitively agree on finalized dates for all events, which created challenges when implementing the program. One participant noted:

What’s very hard is to schedule additional sessions that we may not know about ahead of time. It’s very hard to reserve time, um, no matter how great the buy-in, it’s just it is what it is here

While not all details relevant to rolling out and implementing a program were discussed during initial planning meetings (i.e., how delays due to inclement weather would be handled), participants generally emphasized how preplanning most aspects of implementation, along with maintaining flexibility during implementation, was critical to ensuring success. One participant described this process, stating:

[We] had three groups of [the program] being run, so I basically just told the advisors add an extra week to your program and the first week is going to be that survey. And then they just ran their four- or five-week program whatever it was um and that worked out really well and the advisors were okay with that

Communication between the research team and school staff related to coordinating and implementing the program was also discussed. Whereas there was a general acknowledgment of the study team’s responsiveness to school needs, several participants remarked on difficulties with having a full understanding of project-related needs when communicating over e-mail. Notably, the most consistent communication-related theme to emerge was the preference for having a single point of contact that they could reach out to with questions and concerns. One participant noted:

One of the challenges sometimes is that there are multiple members on the [program] team, and so sometimes emails were coming in from different members of the team who were unfamiliar and inadvertently overlapping um, coordination. So, it created a little bit of confusion on this end in that we might have, the advisors communicated: “I thought the plan was confirmed but I received another email from a different individual”, and sort of feeling like I’m replanning

3.2.2 |. Engaging school champions and administration

The construct engaging school champions and administration was conceptualized as the way in which the program team garnered support from a credible and trustworthy individual (i.e., teacher or school administrator) to help support, market, and engage others within the school during program implementation. School partners commonly remarked on the importance of gaining visible support from school leaders and administrators. Reporting on how successful implementation is both directly and indirectly influenced by the support given by school administration, one participant explained:

It always helps when upper administration buys in. Our administration is a strong advocate of this programming. I’ve also had a relationship with the [rape prevention] program for 7 years, and there was a news article that in some of our local papers that talked about the research study, and it named some schools that were participating. [Our administration] sent me an e-mail saying, “We have to get in on this!” And I was glad to send back “We’ve been in for years! We have an existing relationship; the research study component will be new to us as well but we’re already in! So great news!”

Broadly, engaging both school-specific champions and garnering support from school administration was seen as a critical step to increase staff and teacher buy-in and participation, decrease resistance or indifference to implementing the program, and ensure overall success with a program’s implementation process.

3.2.3 |. Reflecting and evaluating

The construct of reflecting and evaluating described the overall perceived usefulness of the program, and the quality of the implementation process, as well as capturing feedback on logistical aspects of the intervention that could improve. Overwhelmingly, participants provided positive feedback on the overall impact and reception of the intervention among students, teachers, and staff within schools. One participant commented:

Teachers, the advisors, reported that the students were engaged. The students reported that they were engaged and liked the program, they asked when you were coming back! Well, I’ll have to figure that out. Typically, 10th graders receive it once, in their 10th grade year and we don’t typically do a second session, but we get some feedback from students: “Are they coming back for the next level?” And we were like “we’ll explore that!”

The YVYV intervention was highly interactive and focused heavily on fostering student discussion. Notably, participants cited the level of student engagement with the intervention as particularly important to the perceived success of the program:

The [students] were like engaged and really working with the facilitator. So, it was nice to see that they weren’t just sitting there bored and not engaging with the facilitator. I was proud of them. Look at these kids

School partners also commented on the utility and helpfulness of the intervention content, specifically. As detailed by one participant:

I think it’s very good that they discuss these things. Um, for us, I think the benefits was giving them the definitions and defining them, um and also giving them the laws around it and then like you said, the description of risky situations, situations that are going to be high risk and walking the kids through that I think was very educational for them

Some participants also used results from the pre- and posttest surveys as evidence of implementation successfulness within their schools:

Based on their pre—the pre versus post, it sounded like they really understood more about being an active bystander and helping and assisting and feeling like they had more tools to assist and help in that. They themselves may not have experienced anything and I think that came through for most of our kids, but I think they felt more confident afterwards of helping

Discussions of highlights or aspects of the program that were particularly beneficial were also included. As in the comments below, many school partners acknowledged program facilitation, or delivery of the programmatic content, to be an overall highlight of successful implementation:

I have absolutely no complaints. I thought the facilitation went well, they were engaging, at the same time they did manage to keep all the kids under control

[Students] were engaged in the process and liked being there and part. I understood that there was overall active participation from the students, the teachers being present helps with that. So yes, we [had] a positive experience

Whereas most participant feedback focused on positive aspects of implementation, programmatic challenges, including scheduling, time expectations, and resources needed were noted as barriers to successful implementation. For example, in YVYV, teachers were asked to stay in the classroom to support any behavior management concerns, and as one participant pointed out:

I think it would’ve been easier if we could just leave them with the [program team] to run the classes, but I know behavior management, classroom management can be tricky, so um most of the time I think we were able to figure it out, but I would say logistically that was one of the trickier things is location, and appropriate staff

Finally, the importance of incentives was also commonly mentioned by school partners, specifically as it related to getting buy-in and participation from teachers and other staff within the schools. Specifically, in this study, teachers were provided with lunch during the Lunch and Learn training, and students and teachers were provided with a gift card for survey completion. School partners noted that these incentives sent the message that the project team valued and appreciated individuals’ efforts in supporting this project. It is important to acknowledge the many competing demands and burdens placed upon teachers, who often are asked to complete a range of tasks outside of their typical job description to ensure student success. Although it is possible that teachers and other staff within schools may have participated in this project without external incentives, those interviewed commonly provided feedback related to how helpful it was to have incentives for program implementation. One participant exemplified this by stating:

There was, a wonderful lunch and learn, [with] donuts and coffee, and pastries and things along those lines. It was well received. We are a school that likes to eat. So always appreciated

Of note, for the purpose of this analysis, incentives were coded under reflecting and evaluating rather than resources, given that participants viewed this as part of the intervention implementation process that would facilitate future implementation—rather than a resource that the school had available to them to support implementation either during the study or in the future. Overall, feedback contained within the reflecting and evaluating domain contained critical information on the perceived effectiveness and usefulness of the program, as well as situational, contextual, and program-related facilitators and barriers to the successful implementation of the intervention.

3.3 |. Inner setting—The implementation climate

The inner setting domain reflects where the implementation takes place, such as the school setting, and may involve multiple layers, such as classrooms, administrative offices, teacher groups, and others. The inner setting is considered an active force in any implementation effort, with several interacting features based on the size of the school, its culture, and population. One inner setting construct—implementation climate—was coded in this analysis. Implementation climate relates to the overall culture and internal climate that exists within the schools, particularly as it relates to the perceived success of implementing a violence prevention program for high school students. Numerous subconstructs under implementation climate were coded, including resources to support implementation, tension for change, and learning climate, which collectively characterizes the school’s readiness, motivation, and ability to implement the program.

3.3.1 |. Resources to support implementation

The resources to support implementation subconstruct were used to characterize a school’s readiness for implementation related to its current resources, including physical space, personnel, equipment, time, and other tangible and nontangible resources that are needed to ensure that project roll-out is feasible. Participants primarily cited logistical challenges related to program implementation that created physical space limitations. Reflecting on resource-related challenges that occurred during program implementation, one participant stated:

[There was confusion with] room locations, getting the desks… We were like trying to figure out where to put [the students], and um, making sure that the projectors, the speakers, it was just stuff you know, logistics, but it wasn’t like horrible

Despite several participants presenting resource-related concerns that resulted during project implementation related to finding available rooms for program implementation, other participants did not recall any issues related to shortages of space during program administration.

3.3.2 |. Tension for change

The tension for change subconstruct captured specific challenges, priorities, and incidents that prompted administrators to acknowledge a need to address these issues, while also serving as catalysts within a specific school to implement YVYV. The extent to which participants believed that problematic behaviors related to sexual violence existed in the school varied. Participants often commented on behavioral precursors to sexual violence, such as bullying, that prompted change and motivated schools to address the prevention of harm within the school. One participant acknowledged the importance of addressing behaviors that were inconsistent with the school’s values and mission, stating:

One of the things that we’ve been trying to work on, kind of as a school is, see something say something. So, whether it’s bullying, whether it’s vandalism, um whether it’s something simply as simple as you know um, not pushing your chair in at the cafeteria, or not picking up trash, that just you know doesn’t show pride in the school

Although less common, some participants did discuss prior instances of sexual violence that had occurred within their school that increased teachers’ interest in implementing the program. Recalling related incidents that had occurred over the past year, one participant mentioned:

Yeah it was just something we had had a few incidents last year around sexual assault unfortunately in the school, so it was a big thing the social work team had to just hone in on

Taken together, most of the tension within schools prompting change often occurred before actual instances of sexual violence; however, when sexual violence did occur, schools acknowledged the problematic nature of these behaviors and were motivated to implement interventions to prevent further occurrences.

3.3.3 |. Learning climate

The final subconstruct participants discussed was the learning climate, which captured how the collaboration between the YVYV program team and school staff created an atmosphere within schools to effectively deliver the intervention in an engaging way to students. Several participants described the readiness of students to engage with the material, given that it was largely reinforcing and building upon other educational content delivered during the prior school year. In discussing how this collaboration may have led to positive outcomes and increased engagement with programmatic content among students, one school partner stated:

…having an outside agency, I think kind of reinforces things for kids a little bit more, almost teachers are almost like parents like we don’t know what we’re talking about either *chuckles*. But you know we have people that are experts in the field that come out, the kids respond better to that I believe

School partners acknowledged the sensitive nature of discussing sexual violence and the range of emotions and reactions that conversations related to this topic elicited among students. School partners reported having initial concerns before program rollout regarding how potential student disclosures of experiences of sexual violence would be handled or whether students feel compelled to disclose their own personal experiences as a part of the program. However, during the interview, participants acknowledged that these fears were unfounded, as the structure of program implementation allowed school staff and the research team to respond effectively to disclosures. The YVYV program team included staff with a long history of implementing sexual assault prevention in schools, and a detailed protocol was given to each school contact regarding how disclosures would be handled. YVYV program staff also remained in the school for 30 min—or as long as needed—following each program session to address student questions and manage disclosures that arose. These procedures appeared to be effective in addressing student disclosures of violence. For example, reflecting on how disclosures of victimization were handled, one participant recalled:

One of the facilitators came to me [to tell me] like this was disclosed and it was a student who was already on my radar so I had already had the full history of the disclosure. But I did bring her in and talk about her disclosure because she felt you know it was a safe space which you know was really good. And I was really excited that she felt she could trust the facilitator and she could trust the group she was in to disclose information

A clear and rigorous protocol for addressing student disclosures that could occur during YVYV was seen as a strength of the program’s implementation.

4 |. DISCUSSION

Results from the present study advance our scientific understanding of factors that influence the successful implementation of sexual violence prevention programs within high schools. Using CFIR as a guiding framework to assess postimplementation success and areas for improvement, numerous factors were identified as facilitators and barriers to the successful implementation of the YVYV program. School partner responses primarily centered around intervention characteristics, the process of implementation, including partner reflections on the planning and execution of implementation, as well as inner setting characteristics within schools that influenced the implementation-related outcomes.

Congruent with CFIR’s intervention characteristics domain, school partners first discussed their overall perceptions of the intervention. Comments were specific to the content presented, the mastery of facilitators and presenters, the engagement of students, and the advantage of having external presenters rather than teachers deliver the intervention. While school partner perceptions of the need to provide sexual violence prevention programming within their own schools varied, there was unanimous agreement that the YVYV program was effective at engaging students (from their perspective). The YVYV facilitators were extensively trained and received ongoing supervision to ensure fidelity to the program manual. These training and supervision procedures may contribute to the high perceived quality of the YVYV program.

Results also revealed favorable opinions related to the overall design and packaging of the intervention, particularly revolving around the mixed-media presentations and the accompanying poster campaign. School partners frequently mentioned that the posters heightened student engagement, which they noted was likely due to the discussion generated from the messages shared. School partners also discussed the relative advantage of having an external community-based organization administer the program, rather than relying on school staff and administration, who may be seen as less credible in dealing with sensitive topics like sexual assault.

A “Lunch and Learn” training presentation was developed and delivered across all schools to prepare teachers and school staff for the four-session YVYV program and accompanying poster campaign. Along with other research-specific components related to evaluating the effectiveness of YVYV, there were multiple “moving parts” of this program that required a comprehensive understanding, time commitment, and need to coordinate by members of each school. Given the comprehensive nature of the intervention, it is not surprising that the relative complexity of implementing this program was discussed as a barrier to program implementation, specifically with regard to scheduling times to implement each intervention component in a school setting. This finding is consistent with the broader implementation science literature suggesting that intervention complexity, deficits in communication, and challenges in planning to deliver the intervention remain significant barriers to the successful implementation of health-based interventions (Muddu et al., 2020; Ware et al., 2018). While the program team met with school staff before implementation to discuss planning and execution, these results suggest that even more detailed guides and instructions regarding the timing and schedule of the intervention can be provided and discussed in-depth, as to better prepare the school to implement the program.

Although there was consensus among school partners regarding the challenges of scheduling time to implement a multicomponent sexual assault prevention program, no participants reported that the program dose was excessive, not needed, or ineffective. In fact, the program was well received, and there were no complaints or suggestions regarding any of the specific content shared or discussed within the program. This would suggest that schools are supportive of these more intensive prevention programs, which are recommended as opposed to a single-dose program (Orchowski et al., 2020). Nonetheless, schools do need assistance in rolling out these high-quality programs to students. Broadly, findings align with numerous studies examining implementation outcomes within schools that highlight the importance of garnering administrative support for successful program delivery and uptake (Langley et al., 2010). As highlighted by Edwards et al. (2023), ensuring that school champions are actively engaged in planning for the administration of a violence prevention program within a school can be critical to the success of the program rollout.

Results from the present study also converged around the importance of inner setting influences on implementation. In fact, numerous studies using CFIR disproportionately emphasize the role of inner setting characteristics as being particularly vital to implementation successfulness when compared to other domains (Clinton-McHarg et al., 2016; Ware et al., 2018). Distinct from logistical aspects of implementation captured under codes relating to intervention planning, logistics related to the availability of school resources to support the program—such as locating available classrooms with sufficient space for students and facilitators—were noted as a barrier to program facilitation by numerous school partners. From a logistical standpoint, it is especially important that intervention resources and spaces for program implementation are clearly delineated.

In contrast to the inner setting barriers to successful implementation noted above, numerous inner setting characteristics were also identified as facilitators to the implementation of YVYV. In general, participants discussed a need for more comprehensive interventions for 10th graders, as recent disclosures of sexual assault and other related maladaptive behaviors within this sample prompted schools to further explore opportunities to address the issue. Relatedly, results from the present study also revealed that the YVYV program supplemented and enhanced the existing curriculum that was introduced to students in some schools during their freshman year. Teachers and administrators were vastly supportive of the program and were highly invested in ensuring the program’s roll-out was a success, which aligns with prior work suggesting that school leadership is seen as a significant facilitator of successful implementation (Hudson et al., 2020). While speculative, the Lunch and Learn teacher training may have played an important role in readying the school community to engage with the YVYV program.

4.1 |. Practice and policy implications

One of the most significant barriers to successful implementation was related to scheduling times to implement each program session. To address this, having an established method of communication is an important aspect of the program implementation process that should be determined in advance of program roll-out. Given that the YVYV program included multiple sessions and components (i.e., teacher training, school-wide normative survey, four sessions of the intervention, data-based social norms poster campaign), detailed instructions should be provided regarding how the intervention will be rolled out, and in what order, so that school staff is better informed about the process of program implementation. Furthermore, working in a school setting can cause unpredictable schedule changes during the execution of interventions, such as fire and lockdown drills, and snow days, for example. When possible, it can be useful to plan program activities around planned fire and lockdown drills. Although it is not possible to prevent inclement weather from interfering with implementation efforts, having plans in place for how program activities will be adjusted in the event of weather-related school closures can help to navigate these occurrences.

School partners also reported experiencing some difficulties related to administering the gender-specific session of YVYV. Given that sexual assault is a phenomenon that has well-documented gender-specific risk factors and concerns, YVYV includes gender-specific sessions for boys and girls within the curriculum. While facilitators allowed any student to join whichever group they felt would be most relevant to them personally, transgender and other gender-diverse participants were expected to join a group that may not have fully represented their identified gender. As such, creating more inclusive intervention sessions for transgender and gender-diverse student populations should be at the forefront while planning intervention modules. Addressing the needs of transgender and other gender-diverse youth in violence prevention is especially important given the high rates of victimization experienced by this population (Norris & Orchowski, 2020).

Additional inquiry is warranted to explore factors that contributed to YVVY’s positive reception by school partners. It is possible that the relative advantage of YVYV was related to its success in engaging students. The inclusion of a school-specific poster campaign, which provided schools with current data on the positive norms within their school, also may have contributed to its positive evaluation.

Finally, incentivizing participation during the planning and implementation phases was unanimously viewed as a facilitator for both staff and participants to encourage buy-in. The current study included student incentives for completing the school-wide survey, as well as teacher and student incentives associated with completing post-program surveys. Since this program was evaluated in the context of a federally funded research evaluation, these types of incentives may not be feasible in the future implementation of the program. Data nonetheless highlight the utility of using incentives to foster engagement in a multicomponent sexual assault prevention program, such as YVYV. Numerous studies have highlighted how rewards and recognition are known to be an important component of engaging with a program or organization (Potter et al., 2016; Rothman & Silverman, 2007), and teams that are implementing YVYV in the future, or other similar multicomponent sexual assault prevention programs, may benefit from considering ways to incentivize participants through recognition. Some methods of recognition, such as certificates that recognize completion of all sessions of a program, or a small raffle prize for individuals who complete a survey, may be integrated into the implementation of a program for a relatively low cost.

4.2 |. Limitations and future directions

Some important limitations should be noted. First, the present study was limited to a small number of participants who implemented the YVYV program as a part of a group-cluster trial in the Northeast United States. Numerous types of schools were involved in the evaluation, including charter schools, private schools, and public schools. In addition, the population of each of these schools varied greatly, including students from rural, urban, and suburban neighborhoods. Gender distribution and socioeconomic status of students within schools also varied. Although the school partners in this study provided a diverse set of insights and opinions, a larger sample of interviewees would permit exploration of how implementation processes varied across school types and by other characteristics spanning the socioecological model. Although it is unclear precisely why some school partners did not enroll in the interviews, time considerations were likely a barrier to participation. School partners also did not receive compensation for the interview, which could influence selection bias. The demographic characteristics of participants were also not recorded, which should be noted as a study limitation.

It is also important to note that the CFIR is one of many potential frameworks for understanding characteristics that influence program implementation. The Active Implementation Frameworks have been applied to facilitate the implementation of research-based interventions for children (Fixsen et al., 2005; Metz et al., 2015). An update to the CFIR framework is also underway (Damschroder et al., 2022). The interviews in the current study did not specifically delve into all domains of the CFIR model. Interviews did not demonstrate sufficient coverage of codes related to the outer setting domain, such as external policies that influenced program implementation, or an awareness of student needs or resources that might influence program implementation. Additionally, the domain of characteristics of individuals was not discussed in-depth since the interview was primarily conducted to understand school-level feedback, rather than school partner-specific personal beliefs and perspectives. It is not clear whether these domains are not as relevant to the process of implementing this violence prevention program or whether utilizing questions in the CFIR guide (cfirguide.org) would yield different results. Future studies may consider adapting the interview guide in an attempt to garner more feedback related to these domains.

The interviews in the current study took place postimplementation, revealing factors that could guide future program implementation. Implementation frameworks can be utilized to understand processes of program implementation at varying stages of program roll-out, including pre-, mid-, and postimplementation. Conducting interviews with school partners before the start of a violence prevention program can also be useful for identifying potential barriers to successful program implementation and garnering a sense of the resources that can be used to support program implementation.

It should be noted that lessons learned in the study regarding factors that influence program implementation may not apply to other programs with different components or program lengths. The study nonetheless highlights the utility of using CFIR to better understand factors that influence implementation of sexual assault prevention programs in school settings, which can help to facilitate the adoption and uptake of programs in the future.

It was notable that interview participants did not comment on whether the content of the YVYV program met their needs. While this may be expected, given that the interview focused on program implementation feedback, it would be useful to know more about whether the content of the program met the perceived needs of students and school staff. Given that YVYV continues to be implemented in schools outside of the context of this research study, this information could also be utilized to update the curriculum. Future studies may consider incorporating the opportunity to garner feedback on specific program components in exit interviews conducted with school staff. Interviews with students can also be utilized to garner information on the utility of specific program components, which can help to understand what makes a program successful.

5 |. CONCLUSION

Whereas it is critical to both evaluate and critique the underlying outcome-specific evidence of prevention programs used within schools, careful consideration related to mechanistic processes and contextual factors of implementation is often neglected when selecting programs for use (Lendrum & Humphrey, 2012). Thus, as the field of sexual assault prevention starts to develop more evidence-based interventions, it is essential to garner a better understanding of how these interventions can be disseminated across school settings. The current study highlights how CFIR can be utilized to understand barriers and facilitators to program implementation, which can help to support roll-out within schools in the future.

TABLE 2.

Codes relating to the process of Your Voice Your View (YVYV) implementation.

Code	N	Description	Example
Planning	97	The degree to which a scheme or method of behavior and tasks for implementing an intervention are developed in advance and the quality of those schemes or methods.	“It worked successfully in that it was embedded into the workshop plan, so we’d already reserved 4 h and the surveys bookended the sessions, and so because it was embedded it happened in the classroom setting so surveying 15 students and two YVYV staff members overseeing that, and I didn’t received feedback that said it didn’t go smoothly.”
Engaging school champions and administration	17	Individuals who dedicate themselves to supporting, marketing, and “driving through” an implementation, and overcoming indifference or resistance that the intervention may provoke in an organization. Garnering support from school administrators to ensure that top-down support for participating was visible and endorsed by school leaders.	“Recognition of the importance of what the program offers and what the buy-in to make room for it to happen is very important, is the only way we can be successful here and bring it in. So support from the top is definitely in place.”
Reflecting and evaluating	165	Quantitative and qualitative feedback about the progress and quality of implementation accompanied by regular personal and team debriefing about progress and experience.	“[Program] feedback was overall positive. There were some snafus in communication as can happen when you are attempting to coordinate programing.”

Note: N refers to the number of times the code was indicated across the eight transcripts.

APPENDIX A: INTERVIEW GUIDE

1. What do you think are the major problems students face in this high school outside of the academic realm?

2. What do you think are the major barriers your school faces when helping students with these problems?

3. What types of programs has your school tried?

   1. How have they worked?

4. What has worked best? Why?

5. What didn’t work? Why?

6. What do you think is needed?

7. Regarding the program—what kind of information or evidence are you aware of that shows whether students would benefit from such an intervention?

8. Do you currently see a need for this type of intervention?

9. How well do you think such an intervention would meet the needs of students?

10. Can you describe the planning you would do to get the intervention implemented?

11. Will you please describe the physical space needed?

12. What would motivate you personally to get a program like this off the ground?

13. What are your perceptions of the reasons students would choose to participate in an intervention like this?

14. What are the reasons students might decide not to participate?

15. Based on our conversation, would you recommend implementing this program?

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.