Realist evaluation of a theory-based life skills programme aiming to prevent addictive behaviours in adolescents: the ERIEAS study protocol

Judith Martin-Fernandez, Aurelie Affret, Emma Martel, Romain Gallard, Laurence Merchadou, Laetitia Moinot, Monique Termote, Vincent Dejarnac, François Alla, Linda Cambon, Judith Martin-Fernandez, Aurelie Affret, Emma Martel, Romain Gallard, Laurence Merchadou, Laetitia Moinot, Monique Termote, Vincent Dejarnac, François Alla, Linda Cambon

Abstract

Introduction: Adolescence is a sensitive life stage during which tobacco, alcohol and cannabis are used as ways to learn and adopt roles. There is a great deal of interest in substance use (SU) prevention programmes for young people that work to change representations of these products and help with mobilisation of life skills. Unfortunately, few existing programmes are evidence-based.In France, a programme called Expériences Animées (EA, Animated Experiences) has been developed, inspired by life skills development programmes that have been proven to be successful. The EA programme uses animated short movies and talks with high school and secondary school pupils about the use of psychoactive substances and addictions. By allowing life skills mobilisation and modifying representations and beliefs about SU, it is aimed at delaying initiation of use of psychoactive substances, preventing adolescents from becoming regular consumers, reducing the risks and harms related to the use of these substances and opening the way for adapted support measures.We are interested in understanding how, under what circumstances, through which mechanisms and among which adolescents the EA programme works. Therefore, we have developed the ERIEAS study ('Evaluation Réaliste de l'Intervention Expériences Animées en milieu Scolaire'; Realist Evaluation of the EA Intervention in Schools).

Methods and analysis: EA will be conducted in 10 schools. A multi-case approach will be adopted with the aim of developing and adjusting an intervention theory. The study comes under the theory-driven evaluation framework. The investigation methodology will include four stages: (i) elaboration of a middle-range theory; (ii) data collection for validating/adjusting the theory; (iii) data analysis; and (iv) refinement and adjustment of the middle-range theory and definition of the programme's key functions.

Ethics and dissemination: The study will provide evidence-based results to health authorities to help in the rollout of health promotion strategies in schools. It will provide knowledge about the strategic configurations most suitable for leading to life skills mobilisation and change young people's representations about SU. The project will be carried out with full respect of current relevant legislation (eg, the Charter of Fundamental Rights of the European Union) and international conventions (eg, Helsinki Declaration). It follows the relevant French legislation of the research category on interventional research protocol involving the human person. The protocol was approved by the Comité et Protection des Personnes (CPP), that is, Committee for the Protection of Persons CPP SUD-EST VI n°: AU 1525 and was reported to the Agence Française de Sécurité Sanitaire des Produits de Santé (ANSM) that is, the French National Agency for the Safety of Health Products. It is in conformity with reference methodology MR003 of Bordeaux University Hospital (CNIL n° 2 026 779 v0).Trial registration detailsThis research has been registered on ClinicalTrials.gov (No. NCT04110626).The research project is registered in the European database ID-RCB (No. 2019-A01003-54).

Keywords: addictions; life skills; preventive medicine; realist evaluation.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
The realistic approach and the way to refine middle range theories applied to ERIEAS study.
Figure 2
Figure 2
Stages of the ERIEAS study. Ce, contextual factors not linked to the intervention, that is, external factors; Ci, contextual factors linked to the Intervention;CMO, context-mechanism-outcome; QUAL, qualitative; QUAN, quantitative.
Figure 3
Figure 3
Different modalities of data collection and their links with the middle-range theories. Ce, contextual factors not linked to the intervention, that is, external factors; Ci, contextual factors linked to the Intervention;CMO, context-mechanism-outcome; DCE, Discrete Choice Experiment.
Figure 4
Figure 4
Timeline of the data collection. Ce, contextual factors not linked to the intervention, that is, external factors; Ci, contextual factors linked to the Intervention;estab., establishments; CMO, context-mechanism-outcome; DCE, Discrete Choice Experiment; prof., professor.

References

    1. Gowing LR, Ali RL, Allsop S, et al. . Global statistics on addictive behaviours: 2014 status report. Addiction 2015;110:904–19. 10.1111/add.12899
    1. Brick J. Handbook of the Medical Consequences of Alcohol and Drug Abuse. Routledge, 2012.
    1. Barker D. Mothers, Babies, and Disease in Later Life. 2nd ed London, UK: BMJ Publishing Group, 1998.
    1. Schmits E, Mathys C, Quertemont E. A longitudinal study of cannabis use initiation among high school students: effects of social anxiety, expectancies, Peers and alcohol. J Adolesc 2015;41:43–52. 10.1016/j.adolescence.2015.02.009
    1. Meruelo AD, Castro N, Cota CI, et al. . Cannabis and alcohol use, and the developing brain. Behav Brain Res 2017;325:44–50. 10.1016/j.bbr.2017.02.025
    1. Lorenzetti V, Alonso-Lana S, Youssef GJ, et al. . Adolescent cannabis use: what is the evidence for functional brain alteration? Curr Pharm Des 2016;22:6353–65. 10.2174/1381612822666160805155922
    1. WHO Skills for health: Skills‐based health education including life skills: an important component of a child‐friendly/ health‐promoting school. Geneva: WHO, 2003: 1–88.
    1. Griffin KW, Botvin GJ. Evidence-Based interventions for preventing substance use disorders in adolescents. Child Adolesc Psychiatr Clin N Am 2010;19:505–26. 10.1016/j.chc.2010.03.005
    1. Faggiano F, Vigna-Taglianti FD, Versino E, et al. . School-Based prevention for illicit drugs use: a systematic review. Prev Med 2008;46:385–96. 10.1016/j.ypmed.2007.11.012
    1. Fanshawe TR, Halliwell W, Lindson N, et al. . Tobacco cessation interventions for young people. Cochrane Database Syst Rev 2017;11:CD003289. 10.1002/14651858.CD003289.pub6
    1. Stockings E, Hall WD, Lynskey M, et al. . Prevention, early intervention, harm reduction, and treatment of substance use in young people. Lancet Psychiatry 2016;3:280–96. 10.1016/S2215-0366(16)00002-X
    1. Botvin GJ, Griffin KW. Life skills training as a primary prevention approach for adolescent drug abuse and other problem behaviors. Int J Emerg Ment Health 2002;4:41–7.
    1. Vadrucci S, Vigna-Taglianti FD, van der Kreeft P, et al. . The theoretical model of the school-based prevention programme Unplugged. Glob Health Promot 2016;23:49–58. 10.1177/1757975915579800
    1. Groupement Romand d’Etudes des Addictions Programme In Medias: host a philosophical dialogue workshop, 2018. Available: [Accessed 16 Jul 2018].
    1. Botvin GJ, Griffin KW. Life skills training: empirical findings and future directions. J Prim Prev 2004;25:211–32. 10.1023/B:JOPP.0000042391.58573.5b
    1. Cambon L, Terral P, Alla F. From intervention to interventional system: towards greater theorization in population health intervention research. BMC Public Health 2019;19:339. 10.1186/s12889-019-6663-y
    1. Wong G, Westhorp G, Manzano A, et al. . RAMESES II reporting standards for realist evaluations. BMC Med 2016;14:96. 10.1186/s12916-016-0643-1
    1. Yin RK. Case Study Research: Design and Methods. 5th Revised ed Thousand Oaks, CA: SAGE Publications Inc, 2014.
    1. Kœnig G. Realistic evaluation and case studies: stretching the potential. Evaluation 2009;15:9–30.
    1. Chen H-T. Theory-driven evaluations. Newbury Park, CA: Sage Publications, 1990.
    1. Stame N. Theory-Based evaluation and types of complexity. Evaluation 2004;10:58–76. 10.1177/1356389004043135
    1. Weiss C. Theory-based evaluation: past, present, and future. New Dir Eval 1997;1997:41–55. 10.1002/ev.1086
    1. De Silva MJ, Breuer E, Lee L, et al. . Theory of change: a theory-driven approach to enhance the medical Research Council's framework for complex interventions. Trials 2014;15:267. 10.1186/1745-6215-15-267
    1. Mayne J. Addressing attribution through contribution analysis: using performance measures Sensibly | better evaluation. The Canadian Journal of Program Evaluation. 2001:1–24.
    1. Mayne J. Contribution analysis: coming of age? Evaluation 2012;18:270–80. 10.1177/1356389012451663
    1. Craig P, Cooper C, Gunnell D, et al. . Using natural experiments to evaluate population health interventions: new medical Research Council guidance. J Epidemiol Community Health 2012;66:1182–6. 10.1136/jech-2011-200375
    1. Pawson R, Tilley N. Realistic evaluation. SAGE Publications, 1997.
    1. Pawson R, Greenhalgh T, Harvey G, et al. . Realist review--a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy 2005;10 Suppl 1:21–34. 10.1258/1355819054308530
    1. Blaise P, Marchal B, Lefèvre P, et al. . Au-del des méthodes expérimentales: l’approche réaliste en évaluation., 2010. Available:
    1. Salter KL, Kothari A. Using realist evaluation to open the black box of knowledge translation: a state-of-the-art review. Implement Sci 2014;9:115. 10.1186/s13012-014-0115-y
    1. Pawson R. Evidence Based Policy: A Realist Perspective. SAGE Publications Ltd., 2006.
    1. Hawe P, Shiell A, Riley T. Complex interventions: how "out of control" can a randomised controlled trial be? BMJ 2004;328:1561–3. 10.1136/bmj.328.7455.1561
    1. Hawe P, Shiell A, Riley T. Theorising interventions as events in systems. Am J Community Psychol 2009;43:267–76. 10.1007/s10464-009-9229-9
    1. Cambon L, Minary L, Ridde V, et al. . Transferability of interventions in health education: a review. BMC Public Health 2012;12:497. 10.1186/1471-2458-12-497
    1. Cambon L, Minary L, Ridde V, et al. . A tool to analyze the transferability of health promotion interventions. BMC Public Health 2013;13:1184. 10.1186/1471-2458-13-1184
    1. Ridde V, Robert E, Guichard A, et al. . L’approche réaliste l’épreuve du réel de l’évaluation des programmes. Can J Program Eval 2011;26:37.
    1. Lacouture A, Breton E, Guichard A, et al. . The concept of mechanism from a realist approach: a scoping review to facilitate its operationalization in public health program evaluation. Implement Sci 2015;10:153. 10.1186/s13012-015-0345-7
    1. Rey G, Jougla E, Fouillet A, et al. . Ecological association between a deprivation index and mortality in France over the period 1997 - 2001: variations with spatial scale, degree of urbanicity, age, gender and cause of death. BMC Public Health 2009;9:33. 10.1186/1471-2458-9-33
    1. Ryan M, Bate A, Eastmond CJ, et al. . Use of discrete choice experiments to elicit preferences. Quality and Safety in Health Care 2001;10:i55–60. 10.1136/qhc.0100055
    1. Mandeville KL, Lagarde M, Hanson K. The use of discrete choice experiments to inform health workforce policy: a systematic review. BMC Health Serv Res 2014;14:367. 10.1186/1472-6963-14-367
    1. Giannotta F, Vigna-Taglianti F, Rosaria Galanti M, et al. . Short-Term mediating factors of a school-based intervention to prevent youth substance use in Europe. J Adolesc Health 2014;54:565–73. 10.1016/j.jadohealth.2013.10.009
    1. Creswell J, PlanoClarkv. Designing and conducting mixed methods research. 3rd ed SAGE Publications, 2017.
    1. Velasco V, Griffin KW, Botvin GJ, et al. . Preventing adolescent substance use through an evidence-based program: effects of the Italian adaptation of life skills training. Prev Sci 2017;18:394–405. 10.1007/s11121-017-0776-2
    1. Bardin L. L’ analyse de contenu. 2nd edn Paris: PUF, 2013.
    1. Chen HT. The bottom-up approach to integrative validity: a new perspective for program evaluation. Eval Program Plann 2010;33:205–14. 10.1016/j.evalprogplan.2009.10.002
    1. Moore GF, Audrey S, Barker M, et al. . Process evaluation of complex interventions: medical Research Council guidance. BMJ 2015;350:h1258. 10.1136/bmj.h1258
    1. Beck F, Godeau E, Legleye S, et al. . Drug consumptions by the young adolescents: epidemiological data. Médecine/sciences 2007;23:1162–8.
    1. OFDT Drogues et addictions, Données essentielles. Paris, 2019.
    1. European Monitoring Centre for Drugs and Drug Addiction European drug report 2019: trends and developments. Lisbon: Office for Official Publications of the European Communities, 2019.
    1. Spilka S, Godeau E, Le Nézet O, et al. . Usages d’alcool, de tabac et de cannabis chez les adolescents du secondaire en 2018. Tendances 2019;132.
    1. Le Nézet O, Janssen E, Brissot A, et al. . Les comportements tabagiques la fin de l’adolescence. Enquête Escapad 2017. Bull épidémiol hebd 2018;14.

Source: PubMed

3
Abonner