Implementation Support for Prevention Program Delivery by College Peer Educators

Several interventions for mental health problems are efficacious and effective, but few are
routinely offered to college students, who represent 59% of young adults. This is regrettable
because college students are at high risk for mental health problems (e.g., depression,
substance abuse, eating disorders), and college counseling centers lack sufficient clinicians
to offer individual therapy to all afflicted students and are not well positioned to deliver
prevention programs. One solution for this service shortfall is to have peer educators
deliver scripted group-based prevention programs, which can more efficiently reduce the
burden of mental illness than individual therapy. Targeting college students is a
cost-effective tactic for delivering prevention programs and has vast potential reach because
85% of colleges have peer educator programs. Peer educators have effectively delivered
several prevention programs, sometimes producing larger effects than clinicians. This study
will investigate 3 levels of implementation support (training, training with technical
assistance, and training with technical assistance and quality assurance) and the impacts of
differing levels of implementation support on program outcomes across 57 college campuses
nationwide. Specifically we have five aims for this study:

Aim 1: Test whether greater implementation support is associated with graded increases in
fidelity and competence in delivering the scripted prevention program. This will be assessed
by an established procedure for reliably rating fidelity and competence of audio-recorded
intervention sessions.

Aim 2: Test whether greater implementation support, which should increase fidelity and
competence of intervention delivery, is associated with graded increases in student
attendance of intervention sessions (recorded by the peer educators) and effectiveness of the
prevention program (measured by pre-to-post changes in core outcomes assessed with anonymous
surveys completed by group participants) and compared to parallel pre-to-post change data
collected from students at the colleges before implementation is initiated.

Aim 3: Test whether greater implementation support is associated with graded increases in
program reach (% of female students at each college who complete the prevention program
during the 1-year implementation period) and sustainability (% of female students at each
college who complete the prevention program during the subsequent 2-year sustainability
monitoring period).

Aim 4: Test whether Consolidated Framework for Implementation of Research (CFIR) indices of
perceived intervention factors, outer and inner setting factors, peer educator attributes,
and process factors after the initial training correlate with fidelity, competence,
attendance, effectiveness, and reach over the 1-year implementation period and with
sustainability. We will test whether at the end of the initial implementation period the 3
conditions differ on relevant CFIR indices and on the progress and speed of implementation.

Aim 5: Compare the prevention program delivery cost in the 3 implementation conditions, and
the relative cost-effectiveness of each condition in terms of attaining fidelity, competence,
attendance, and effectiveness, reach, and sustainability, plus cost-savings from and
reductions in waitlists and eating disorder prevalence at clinics.

Inclusion Criteria:

- College undergraduate Student Peer Educators with an interest in promoting body
satisfaction

Exclusion Criteria:

- Undergraduate college students who are not Peer Educators

- Undergraduate college students from a college or university that does not have a
formal Peer Education Program