Scaling Effective Behavioral Interventions With MPC Avatar-Based Virtual Training

This project will establish the efficacy of MPC: VISTA, an online simulation-based training, in improving the knowledge, teaching skill, and confidence of educators who deliver Making Proud Choices!, an evidence-based teen pregnancy and HIV/STI prevention curriculum. A randomized controlled trial is being conducted to assess the impact of the training on educator knowledge, self-efficacy, and teaching fidelity, and on the knowledge and attitudes of the students those educators go on to teach.

Participants will be educators and health educators in training, aged 18 and older, who work with or plan to work with adolescents and have no prior experience teaching Making Proud Choices! and no prior training in Making Proud Choices! or related curricula. Educators with more than three years of general sex education teaching experience, or who are or have been enrolled in another Making Proud Choices! study, will also be excluded.

Participants are primarily being recruited through educator training programs, professional listservs, purchased email lists, social media, and direct outreach through existing networks. It is also likely that participants will refer other eligible educators to the study.

The study design is a three-arm randomized waitlist-controlled trial with pre- and post-training assessment. After completing baseline activities, a survey and a video-recorded teaching skill assessment, participants will be randomly assigned to one of three groups (approximately 55 each). The treatment group will receive immediate access to MPC: VISTA, a self-paced online training completed over about 8 hours within 6 weeks. The live virtual training group will receive a live, instructor-led Training of Educators lasting approximately 7 hours, also within 6 weeks. The waitlist group will continue their normal professional activities during this period with no formal training. All participants will then complete a post-training survey and a second video-recorded teaching skill assessment. At the conclusion of the study, the live virtual training and waitlist groups will be given free access to MPC: VISTA.

A subset of treatment group educators with access to students will go on to teach Making Proud Choices! to their own classes. Their students will complete a survey before and after the full course of instruction to assess change in knowledge and attitudes about safer sex practices.

• MPC VISTA (Other): An online training for health educators to develop classroom teaching skills when facilitating the Making Proud Choices! curriculum.
• Live Virtual Training (Other): A live training facilaited online.

Primary outcomes

• Educator Knowledge of Making Proud Choices! Content and Related Sexual Health Facts [Baseline (T1), 6 week (T2)]: Educator knowledge of Making Proud Choices! (MPC) curriculum content and related sexual health facts, including HIV/STI transmission and prevention, pregnancy, and condom use. Assessed via a study-developed multiple-choice/scenario-based test scored as the number of items answered correctly. The survey contains 11 items.
• Student Knowledge, Attitudes, and Beliefs About Safer Sex Practices [Baseline (T1) and after the final session of Making Proud Choices - approximately 8 weeks apart (T2)]: Composite of student-level knowledge and belief domains assessed via a study survey: HIV/STI, pregnancy, condom, and contraception knowledge (11 items, scored as percent correct); and 8 attitude/belief subscales covering condom-related beliefs (hedonistic, prevention, availability-control), negotiation/refusal self-efficacy, beliefs about sex and future goals, attitudes toward abstinence/safer sex, and attitudes toward consent (each rated on a 1-5 agreement scale, higher = more protective attitude). Domains are analyzed separately rather than combined into a single score, consistent with the original Making Proud Choices! evaluation measures on which most items are based.
• Educator Teaching Skill Demonstrated via Response to Virtual Classroom Vignettes [Before randomization (baseline) and after completion of the training period (post-training), within approximately 6 weeks of randomization]: Educator teaching skill assessed via an asynchronous video assessment. Educators watch short video vignettes depicting realistic Making Proud Choices! classroom moments (e.g., a values-based student question, activity facilitation and debrief) and record a real-time video response demonstrating what they would say and do, as though teaching that moment live (a 'teachback'). Responses are scored by trained raters using a structured coding rubric. The rubric will assign points across a defined set of teaching-skill criteria per vignette; higher total scores will indicate stronger demonstrated teaching skill.

Secondary outcomes

• Educator Perceptions of MPC: VISTA's Relative Advantage, Compatibility, Ease of Use, and Result Demonstrability [Immediately following completion of training (post-training only); treatment (MPC: VISTA) arm only]: Technology adoption measure (adapted from Moore \& Benbasat, 1991) assessing educators' perceptions of MPC: VISTA across 4 subscales: relative advantage, compatibility, ease of use, and result demonstrability (3 items each, 12 items total), rated on a 1 (strongly disagree) to 7 (strongly agree) scale. Each subscale score is the mean of its 3 items (range 1-7), with higher scores indicating a more favorable perception of the training. Administered only to educators randomized to the MPC: VISTA arm, at post-training only.
• Training Usability of MPC: VISTA [Immediately following completion of training (post-training only); treatment (MPC: VISTA) arm only]: Post-Study System Usability Questionnaire (PSSUQ; Lewis, 1995), 19 items rated on a 1 (strongly disagree) to 7 (strongly agree) scale, with an 'N/A' option. Produces an overall usability score and 3 subscale scores: system usefulness (7 items), information quality (6 items), and interface quality (6 items). Each score is the mean of its items (range 1-7), with higher scores indicating greater perceived usability. Administered only to educators randomized to the MPC: VISTA arm, at post-training only.
• Educator Teaching Skill Demonstrated in Simulated MPC Classroom Scenarios [Baseline (t1), 6 weeks post (t2)]: Educator teaching skill assessed via 3 written classroom scenarios depicting realistic Making Proud Choices! facilitation moments (a values-based student question and two activity-facilitation/debrief situations). For each scenario, the educator describes what they would say and do.

Other outcomes

• Educator Fidelity to the Making Proud Choices! Curriculum [From the educator's first to final MPC module, an average of 8 weeks.]: Educator fidelity to the Making Proud Choices! (MPC) curriculum, assessed via educator self-report using a log completed after each of the 8 MPC modules, of whether they completed the module's core activities (yes / only in part / no).
• Educator Self-Efficacy for Teaching Sexual Health Content [Baseline and immediately following completion of the training period (post-training)]: Educator confidence and comfort teaching sexual health content, assessed via 3 measures: (1) the Sex Education Confidence Scale (SECS) knowledge subscale, 11 topics rated 1 (prefer not to answer) to 7 (very confident); (2) a 4-item measure of confidence teaching and discussing condom use, adapted from Jemmott, Jemmott \& Fong (1998), rated 1 (not at all) to 7 (extremely); and (3) a 6-item measure of confidence using core MPC facilitation strategies (e.g., brainstorming, roleplay, creating a safe environment), rated 1-7. Each measure is scored as the mean of its items, with higher scores indicating greater self-efficacy.
• Teachers' Sense of General Instructional Efficacy [Baseline and immediately following completion of the training period (post-training)]: General (non-MPC-specific) teaching self-efficacy, assessed via the 12-item Teachers' Sense of Efficacy Scale (Tschannen-Moran \& Woolfolk Hoy, 2001) covering classroom management, instructional strategies, and student engagement. Each item is rated 1 (none at all) to 5 (a great deal); the overall score is the mean of all 12 items (range 1-5), with higher scores indicating greater perceived teaching efficacy.
• Educator Use of Student-Centered Instructional Practices [Baseline and immediately following completion of the training period (post-training)]: Educator use of student-centered teaching practices, assessed via 2 sub-scales of the Measuring and Improving Student-Centered Learning (MISCL) toolkit: Student-Centered Instructional Practices (6 items, rated 1 \[not at all/less than monthly\] to 5 \[daily\]) and Student Agency (12 items, rated on a comparable frequency scale). Each subscale is scored as the mean of its items, with higher scores indicating more frequent use of student-centered practices.
• Educator Readiness for Online Learning [Baseline and immediately following completion of the training period (post-training)]: Educator readiness for online professional learning, assessed via the 18-item Teacher Readiness for Online Learning Measure (TROLM; Hsu et al., 2015), covering 4 domains: communication, institutional support, self-directed learning, and learning transfer. Each item is rated 1 (strongly disagree) to 5 (strongly agree); domain scores are the mean of their items (range 1-5), with higher scores indicating greater readiness for online learning.
• Educator Computer Proficiency and Comfort With E-Learning [Baseline and immediately following completion of the training period (post-training)]: Educator computer proficiency and comfort with online training, assessed via a single-item overall computer proficiency rating (6-point scale from 'unfamiliar' to 'expert') and a 6-item e-learning comfort measure covering navigating online courses, engaging with video content, completing interactive activities, troubleshooting technical problems, and preference for online versus in-person training, rated 1 (strongly disagree) to 5 (strongly agree). The e-learning comfort score is the mean of its 6 items, with higher scores indicating greater comfort.
• Student Satisfaction With and Perceived Learning From the MPC Program [Immediately after the final Making Proud Choices! session (post only)]: Student-reported satisfaction with the Making Proud Choices! program they received, assessed via a 5-item study survey.
• Student Perceptions of the Educator Who Delivered MPC [Immediately after the final Making Proud Choices! session (post only)]: Student ratings of the educator who delivered Making Proud Choices!, assessed via a 5-item study survey covering clarity, respect, honesty, comfort with the material, and engagement, each rated 1 (strongly disagree) to 5 (strongly agree). Score is the mean of the 5 items (range 1-5), with higher scores indicating more favorable perceptions of the educator. Collected only at the post-survey, from students in the Student Outcomes Sub-Study.
• Student-Perceived Classroom Climate and Psychological Safety During MPC [Immediately after the final Making Proud Choices! session (post only)]: Student-perceived classroom climate during Making Proud Choices! instruction, assessed via a 5-item study survey covering felt safety, honesty in discussion, peer respect, comfort asking questions (including about sensitive topics), and privacy, each rated 1 (strongly disagree) to 5 (strongly agree). Score is the mean of the 5 items (range 1-5), with higher scores indicating a more positive and psychologically safe classroom climate. Collected only at the post-survey, from students in the Student Outcomes Sub-Study.

Sex: All, ages: 18 Years to any, accepts healthy volunteers

Inclusion Criteria:

* Adult aged 18 or older
* Fewer than three years experience teaching sex ed
* Current educator, educator in training or preservice teacher
* Works with or plans to work with adolescents in school or community-based settings
* Access to a video call-capable device with reliable internet connection
* Able to commit to all study activities including pre- and post-assessment time points within the study timeline
* English-speaking and teaches in English
* No prior experience facilitating Making Proud Choices! or other Jemmott suite curriculum

Additional inclusion criteria for Student Outcomes Sub-Study participants only:

* Currently employed in an active teaching role with adolescents in a school or community-based setting
* Has or can obtain written site administrator approval to participate in the study and to deliver all 8 MPC modules to a student cohort during the study period
* Able to identify a student cohort of at least 10 students with parental consent with whom they will deliver the full curriculum within the study timeline

Exclusion Criteria:

* Substudy only: Teachers who work primarily with students with special needs or IEP and therefore would require adaptations to the curriculum. The adaptations would then mean that the teachers cannot maintain fidelity to the curriculum.

• Mia Barrett, MEd, Principal investigator, dfusion Inc

NIH grants: R44HD094406