Résumés
Résumé
Malgré l’importante augmentation de la prévalence de la dépression durant l’adolescence, seulement une faible proportion des adolescents qui présentent des symptômes dépressifs élevés bénéficie des services de santé mentale en milieu scolaire. De plus, les programmes offerts à ces élèves souffrent souvent d’une implantation lacunaire, limitant ainsi leur efficacité potentielle. L’identification des facteurs qui influencent la fidélité de l’implantation est donc essentielle pour améliorer la qualité des services offerts. Guidés par le modèle d’évaluation basé sur la théorie des programmes (theory-driven evaluation), nous évaluons la qualité de l’implantation du programme Pare-Chocs et les facteurs qui l’ont influencée à l’aide des composantes du modèle d’action de Chen (2005). Une approche multi-méthodes a été utilisée pour obtenir des données quantitatives sur la fidélité d’implantation dans les six groupes et des données qualitatives sur les composantes du modèle d’action. Les résultats suggèrent que l’adhésion, le dosage et la participation étaient élevés. Les contraintes de temps et le peu de formation antérieure en lien avec la théorie du programme ont limité la fidélité de l’implantation tandis que la formation, la supervision et le manuel y ont contribué. Ces résultats confirment que les programmes de prévention disséminés dans les milieux scolaires peuvent être implantés avec un niveau de fidélité élevé, même si certains défis doivent être pris en considération lors de la planification de l’intervention pour contribuer à des effets plus importants du programme. De plus, la fidélité devrait être évaluée de manière systématique dans ce contexte.
Mots-clés :
- évaluation de l’implantation,
- fidélité,
- dépression,
- adolescents
Abstract
Despite the important increase in the prevalence of depression during adolescence, a low proportion of adolescent presenting elevated depressive symptoms receive school-based mental health services. Moreover, programs implemented in school settings often suffer of a less rigorous implementation, thus limiting their potential effectiveness. The identification of factors influencing implementation fidelity is essential to improve the quality of services. Guided by a theory-driven evaluation model, we assessed the quality of implementation of the Pare-Chocs program and the factors that affected this quality with the elements of action model of Chen (2005). Participants were 15 professionals that implemented Pare-Chocs with six groups of adolescents exhibiting high depressive symptoms. A mixed-method approach was used to collect quantitative data on implementation fidelity in the six groups and qualitative data on action model components. Our results suggest that adherence, dose and participant responsiveness were high. Time constraints and lack of previous education linked to program theory limited the fidelity of implementation, but training, supervision and program guide enhanced it. These findings confirm that prevention programs disseminated in school settings could be implemented with a high level of fidelity, although some challenge must be considered in treatment planning to contribute to higher program effects. Moreover, fidelity should be systematically evaluated in this setting.
Keywords:
- implementation evaluation,
- fidelity,
- depression,
- adolescents
Parties annexes
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