Process Evaluation of the Unplugged program to prevent drug use in schools in São Paulo and Santa Catarina

Objective: To evaluate the implementation process of the Prevention Program Unplugged in middle schools (6th to 9th grade) of Florianópolis (SC), São Paulo and São Bernardo do Campo (SP); to analyze the implementation fidelity of program Unplugged according to teachers that delivered the program; to assess the acceptability of the Unplugged program from the perspective of those involved in the process; to analyze the perception of teachers, students and school administrators about the implantation of the Unplugged program to understand the difficulties, facilities and capabilities of the program. Methods: Mixed methods were used in this process evaluation study. The program was implemented in 8 public schools in three Brazilian cities and delivered in 62 classes by 36 teachers to 1833 students from 6th to 9th grade, in 2013. In the quantitative phase, teachers filled out the fidelity check list (class by class) and students and teachers answered to the global satisfaction questionnaires after classroom program implementation. Qualitative data were collected through focus groups with semi-structured guide, categorized into five areas: Previous experience with prevention; joints; Implantation; Immediate results and future of the project, considering the aspects of fidelity, acceptability and feasibility of the program. The focus groups were conducted at the end of the implantation process. 14 focus groups were conducted with 100 subjects among teachers, stakeholders, school managers, coaches and students. Results: The program was delivered in appropriate proportions in schools and have been completed -12 lessons - in 94% of classes. Teachers realize an enrichment of their teaching skills with the application of Unplugged. We identified a good interaction and relationship between students and teachers. Teachers described most of the difficulties encountered in the process of program implantation. There was great emphasis on the lack of time to devote to the program, from the preparation of lessons to the application of them. Teachers and managers pointed out the importance of including the program in political-pedagogical project of the school. Most of students (77.9%) were satisfied or very satisfied with the program and suggested continuity (76.5%) in the next school year. The training of teachers to work with the methodology in the classroom and the dialogue between the coaches, stakeholders and the school staff appeared as an important aspect of the program implantation. Conclusions: According to the results, Unplugged is a program feasible to be implanted and expanded in Brazilian schools. However, to ensure continuity without compromising the academic curriculum content it will require logistical and process changes in the school environment. The study results helped to identify critical operational aspects, as well as the opportunities, difficulties and facilities to support the prevention of drug use as a public policy.Objetivo: Avaliar o processo de implantação do Programa de Prevenção ao Uso de Drogas Unplugged em escolas do ensino fundamental II (6º ao 9º ano) de Florianópolis (SC), São Paulo e São Bernardo do Campo (SP); analisar a fidelidade de implantação do Programa Unplugged de acordo com o registro de professores aplicadores do programa; avaliar a aceitabilidade do Programa Unplugged a partir da ótica dos envolvidos no processo; analisar a percepção de professores, alunos e gestores escolares sobre a implantação do Programa Unplugged para compreensão das dificuldades, facilidades e potencialidades do programa. Métodos: Através de métodos mistos de pesquisa fez-se um estudo de avaliação de processo de implantação do Programa Unplugged de prevenção ao uso de drogas. O programa foi aplicado em 8 escolas públicas de 3 cidades brasileiras e participaram 62 turmas, 36 professores e 1833 estudantes do 6º a 9º ano, no ano de 2013. Na fase quantitativa, os professores preencheram os formulários de fidelidade (aula a aula) e os alunos e professores responderam aos questionários de satisfação global após aplicação do programa em sala de aula. Os dados qualitativos foram coletados através dos grupos focais com roteiro semiestruturado, categorizados em 5 eixos: Experiência anterior com prevenção; Articulações; Implantação; Resultados imediatos e Futuro do Projeto, considerando-se os aspectos de fidelidade, aceitabilidade e viabilidade do programa. Os grupos focais foram realizados ao final do processo de implantação. Foram realizados 14 grupos focais com 100 sujeitos entre professores, gestores políticos, gestores escolares, multiplicadoras e estudantes. Resultados: O programa foi implantado em proporções adequadas nas escolas, tendo sido completado -12 aulas dadas- em 94% das turmas. Os professores avaliaram seu enriquecimento das habilidades de ensino com a aplicação do Unplugged. Identificou-se uma boa interação e relação entre estudantes e professores. A maior parte das dificuldades encontradas no processo de implantação do programa foi descrita pelos professores. Houve grande destaque para a falta de tempo para se dedicar ao programa, desde a preparação das aulas, como a aplicação das mesmas. Os professores e gestores apontaram a importância de incluir o programa no projeto-político pedagógico na escola. A maioria (77,9%) dos estudantes ficou satisfeita ou muito satisfeita com o programa e sugeriu continuidade (76,5%) no ano letivo seguinte. A formação dos professores para trabalhar com a metodologia em sala de aula e a interlocução entre as multiplicadoras, gestão local e a escola apareceu como um aspecto importante implantação do Programa. Conclusões: O Unplugged é um programa viável para expansão de implantação nas escolas brasileiras de acordo com os resultados. No entanto, para garantir continuidade no currículo escolar sem comprometer o conteúdo acadêmico, serão necessárias alterações de logísticas e de processo de trabalho no ambiente escolar. O resultado da pesquisa contribuiu para identificar aspectos operacionais críticos, bem como as potencialidades, dificuldades e facilidades para a sustentação do na prevenção ao uso de drogas como uma política pública.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)BV UNIFESP: Teses e dissertaçõe

Process evaluation of the implementation of the unplugged program for drug use prevention in brazilian schools

Background: Most Brazilian schools do not have a continuous program for drug use prevention. To address this gap, the Ministry of Health adapted the European evidence-based program Unplugged to improve the drug use prevention efforts of Brazilian public schools. The aim of this study was to evaluate the process of program implementation in three Brazilian cities among middle school students between 6th and 9th grade (11 to 14 years old). Methods: Mixed methods were used in this process evaluation study, including focus groups, fidelity forms, and satisfaction questionnaires. Study participants included 36 teachers, 11 school administrators, 6 coaches, 16 stakeholders, and 1267 students from 62 classes in 8 schools. Results: The 12 Unplugged lessons were all implemented in 94 % of the classes. However, only 57 % of the classes were completed as described in the program's manual. The decision to exclude activities because of time constraints was made without a common rationale. Teachers reported difficulties due to the amount of time necessary to plan the lessons and implement the activities. In addition, they mentioned that the lack of support from school administrators was an obstacle to proper program implementation. The majority of students and teachers responded positively to the program, reporting changes in the classroom environment and in personal skills or knowledge. Conclusions: The Unplugged program can be feasibly implemented in Brazilian public schools. However, it is necessary to reduce the number of activities per class and to restructure the format of the standard teaching schedule to ensure that the normal academic content is still taught while Unplugged is being implemented.Brazilian Ministry of Health through the UNODC (United Nations Office for Drugs and Crime) Technical Cooperation Agreement [PRODOC BRA/K47]Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, 4° andar, São Paulo, SP, BrazilDepartment of Psychology, Universidade Federal de Santa Catarina, School of Psychology, Florianopolis, BrazilDepartment of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, 4° andar, São Paulo, SP, BrazilUNODC: Technical Cooperation Agreement, PRODOC BRA/K47.Web of Scienc

A secondary analysis of the #Tamojunto cluster-randomized trial

Aims: To investigate the mediating effects of normative beliefs of drug use on the effects of the #Tamojunto school-based prevention program (Unplugged). Design: Secondary analysis of a cluster randomized controlled trial. Setting: Brazil. Participants: A total of 6,391 adolescents (12.68 y.o) from 72 public schools in 6 Brazilian cities. Intervention: Schools were assigned to an experimental condition (#Tamojunto curriculum) or a control condition (no prevention program). Measurements: Baseline data were collected prior to program implementation, and follow-up data were collected 9 and 21 months later. The substances examined were alcohol (including binge drinking), tobacco, marijuana and inhalants. Five in-parallel mediation models evaluated whether the positive and negative beliefs were mediators of the likely effects of the intervention on drug use. Findings: Lack of evidences regarding differences in normative beliefs or drug use were found between the intervention and control groups. However, there was a clear association between negative drug beliefs and lower consumption (i.e. OR = 0.78; 95% CI 0.70; 0.87, for cannabis use) as well as between positive drug beliefs and higher consumption (i.e. OR = 1.77; 95% CI 1.56; 2.02, for cannabis use) independent of the assigned group. Conclusions: These results suggest that there is a lack of evidence that the program impact the normative beliefs, as proposed by the theoretical model of the program, suggesting that modifications are needed to produce the intended effect of the program. Negative normative beliefs seem to be a potential protective factor for drug use, but the program’s effect itself on drug use via normative beliefs was not found to be statistically significant. Program activities intended to affect normative beliefs should be improved

Binge drinking in Brazilian adolescents: results of a national household survey

This study aimed to estimate the prevalence of binge drinking and other alcohol consumption patterns and analyze the sociodemographic characteristics associated with binge drinking among Brazilian adolescents aged 15 to 17 years. A cross-sectional household survey including 2,315 adolescents from the 2019 Brazilian National Health Survey who answered a questionnaire on alcohol consumption (weekly frequency, average amount consumed in a drinking day, and binge drinking). A descriptive analysis of alcohol consumption by sociodemographic characteristics and a multivariable logistic regression model were performed. The prevalence of binge drinking (past 30 days) was 8.1% (95%CI: 6.2-10.3). Adolescents who did not attend school (OR = 2.8; 95%CI: 1.6-5.0) had greater odds of binge drinking than adolescents attending school. Higher socioeconomic status (measured via wealth score) was also associated with higher odds of binge drinking compared with lower socioeconomic status (e.g., 5th quintile vs. 1st quintile: OR = 2.9; 95%CI: 1.1-7.7). Girls had lower odds of binge drinking (OR = 0.5; 95%CI: 0.2-0.8) than boys. The prevalence of binge drinking among adolescents, especially boys, who did not attend school and had higher socioeconomic status was high. Monitoring alcohol consumption patterns in adolescents may provide important information on policies or actions to prevent binge drinking

Percepções da comunidade escolar sobre a implantação do programa unplugged em escolas

Resumo O objetivo do presente estudo foi investigar as percepções da comunidade escolar sobre o programa Unplugged, implantado pelo Ministério da Saúde em escolas públicas brasileiras de ensino fundamental II. A metodologia utilizada foi a qualitativa e envolveu coleta de dados através de 11 grupos focais de professores (n=13), alunos (n=54) e administradores escolares (n=11) em 8 escolas de 3 cidades brasileiras. Análise de conteúdo permitiu a identificação de 3 eixos temáticos. As facilidades identificadas estiveram relacionadas com o suporte técnico para implantação da metodologia, como a formação e supervisão recebida, além do suporte dos administradores das escolas. As dificuldades apontadas estiveram relacionadas ao tempo das aulas, a obtenção de materiais de suporte para as aulas e ao cumprimento adequado do currículo regular. Como potencialidade, identificou-se a melhoria das relações de convivência. Os resultados aqui alcançados permitem o aprimoramento da implantação do programa Unplugged nas escolas brasileiras

Resistências e desafios na formação interprofissional em álcool e outras drogas

Este artigo objetiva refletir acerca dos desafios nos espaços de formação para a qualificação das práticas cotidianas de estudantes e profissionais que atuam no campo da saúde mental, álcool e outras drogas. Os atuais retrocessos aos quais as políticas sobre drogas vêm sofrendo, perpassam o pensamento de que vivemos com crenças normativas e interpretações equivocadas sobre a questão das pessoas que fazem uso de drogas se afastando cada vez mais dos princípios e diretrizes da Reforma Psiquiátrica, da Redução de Danos, dos Direitos Humanos e da Bioética. A Educação Interprofissional em Saúde e as Metodologias Ativas são estratégias enriquecedoras que podem modificar percepções, atuações e análises críticas em relação ao tema. O trabalho interprofissional precisa estar atrelado às questões clínicas, éticas e sociais que deveriam de fato compor a formação de estudantes e profissionais

School community perceptions on implementation of the unplugged program in schools

<p></p><p>Abstract The aim of the present study was to investigate the perceptions of the school community about the Unplugged program, implemented by the Ministry of Health in Brazilian public elementary school. The methodology used was qualitative and involved data collection through 11 focus groups of teachers (n = 13), students (n = 54) and school administrators (n = 11) in 8 schools in 3 Brazilian cities. The content analysis allowed the identification of 3 thematic axes. The facilities identified were related to the technical support for the implementation of the methodology, such as the training and supervision received, and the support of the school administrators. The difficulties pointed out were related to class time, obtaining support materials for classes and adequate fulfillment of the regular curriculum. As potentiality, the improvement of the relations of coexistence was identified. The results obtained here allow the improvement of the implementation of the Unplugged program in Brazilian schools.</p><p></p

Drug use prevention: implementation and evaluation of programs in Brazil

A presente publicação reúne um conjunto de capítulos que descrevem em detalhes os percursos da adaptação cultural e os resultados da avaliação de três programas de prevenção sugeridos pelo Escritório das Nações Unidas para Drogas e Crime (UNODC) e adaptados pelo Ministério da Saúde: #Tamojunto, Elos – Construindo Coletivos e Famílias Fortes. A implantação piloto destes programas em diferentes cidades do País exemplifica uma experiência brasileira ímpar na formulação de políticas públicas de prevenção ao uso de álcool e outras drogas nas escolas e nas comunidades integrada à produção de conhecimento científico.Ministério da SaúdeTED 89-201