The Complexity of Teen Pregnancy Prevention Program Implementation: A Multiple Case Study Investigation

Abstract

Implementing teen pregnancy prevention programs is a complex process affected by intervention, organization, community, and policy-level factors. Adolescent health programs implemented with fidelity to core components from highly trained facilitators in community or school environment can improve overall sexual health outcomes. Qualitative cross-case analysis is a valuable analytic technique used to systematically review diverse evidence types and can be used for theory-building or conceptual contributions to the literature. System Dynamics (SD) is a theoretical perspective and method used to understand feedback mechanisms and leverage points which influence system structure and behavior over time. The purpose of this dissertation was to investigate implementation practices among pregnancy prevention programs with adolescents in the United States integrating traditional and systems thinking research approaches. To do so, we conducted one scoping literature review on teen pregnancy prevention implementation practices, investigated the 2010-2014 Office of Adolescent Health (OAH) Teen Pregnancy Prevention (TPP) Program cohort grantees implementation practices using cross-case analysis strategies, and qualitatively modeled system dynamics and feedback mechanisms which influenced pregnancy prevention program implementation.

The scoping literature review documented 23 studies investigating theoretical, procedural, and empirical evidence related to teen pregnancy prevention program implementation. The cross-case analysis used 29 case evaluation reports from the 2010-2014 OAH TPP Program to evaluate theoretical frameworks, applied research measures, and contextual experiences which affected implementation among replication and innovative program models. The system dynamics model integrated existing and new evidence to deconstruct the endogenous factors and dominant feedback loops influencing teen pregnancy prevention program implementation.

Results from the three studies, the scoping literature review, cross-case analysis, and qualitative system dynamics map, assert important insights which can help researchers and practitioners understand the implementation process and enhance the evidence base in teen pregnancy prevention. Results suggest: (a) a foundation of literature describing theoretical, procedural, and empirical teen pregnancy prevention program implementation evidence exists; (b) a cross-case analysis investigating theoretical implementation frameworks, applied research performance measures, and exploratory perspectives and themes described replicated and innovative teen pregnancy prevention programs in the United States; and (c) a preliminary qualitative system dynamics model identified reinforcing feedback loop mechanisms and theorized causal relationships among factors affecting teen pregnancy prevention program implementation.