Evaluation of Mentorship Approach to Improve the Quality of Community-Based Interventions (CBI) for Drug Abuse Prevention in Iran

Community based participatory interventions (CBPIs) have shown evidences of effectiveness in many studies conducted around the world. Also, it could result in reducing health inequity and empowering people at the local level. CBPI for drug abuse prevention was one of the prominent initiatives of the State Welfare Organization in Iran, which was established more than one decade ago. However, there have been concerns as regards optimal function of CBPIs in Iran. Therefore, a new intervention was developed to promote the quality of CBPIs activities in Iran through mentorship method. In this method a group of experienced facilitators who were able to pass the application requirements including a knowledge-skilled based exam of a guideline prepared for the training purposal, were invited to participate in a two-day workshop and training course. These facilitators were considered as mentors who were responsible to transfer their acquired knowledge and skills to other facilitators in an applied and accompaniment method during six months by two visits to each team under their supervision for at least twice a month. This project was piloted in seven provinces of Iran. The objective of the present study was to evaluate this pilot project in different provinces in Iran.

the research design of the study was prospective interventional trial. The study was conducted from July 2017 to May 2018 in seven different provinces of Iran namely Tehran, West Azerbaijan, Booshehr, Kerman, Sistan and Balouchestan, Hormozgan and Ilam provinces, from different parts of the country.Fifteen CBPIs teams were selected from each province (105 teams) as intervention groups and equal numbers of teams were selected as control groups (105 teams).  The facilitator educational level, neighborhood socioeconomic status, and the work experience of the control and intervention groups were similar between the intervention and control group.The intervention group included self-study of a community base participatory intervention guideline, participating in a test from the content of the self-study book, and for those who passed the test, a three-day training of trainers (mentors) workshop. Then each mentor transferred this knowledge to three intervention CBPI teams at the providence of residence of the mentor thorough accompaniment and applied training during six months.Data collection tool was designed based on the seven stages of a community based participatory intervention, as described in the self-study CBPI guideline namely assessment of the community before entering the community, communicating with the key individuals in the community, forming the team, participatory need assessment and prioritizing the needs, participatory project planning, implementation, and evaluation of the planned project. Process of entering a community, establishing relationship with the stakeholders in the community, forming team, participatory need assessment, setting priority, planning a project, implementation of the project, monitoring and evaluation of the project, and documentation of the whole process were the main variables enlisted in the data collection form. The data collection tools were data collection forms having been combined with qualitative questions, closed questions, observing the teams’ documents, and evaluating and grading them by an expert throughout the study before and after the intervention.The data were collected at the baseline and end of intervention. Statistical Package for the Social Sciences (SPSS) software version 19 was used to analyze the data. Paired t test, t test and chi square test were used to compare variables at the baseline and end of the intervention between and within case and control groups.

Totally 113 teams as intervention group and 75 teams as control group participated in the study. 178 teams were from urban areas, and 47 teams were from rural areas. The reason for not having equal intervention and control team was that in some provinces, CBPIs was initiated for the first time and there was no control group to compare. The result of the study showed that there was no significant difference in any of the baseline data related to CBPIs work experience, number of training courses passed by the facilitator, facilitator being resident of the local community, and the time span from formation of team between the case and the control groups (P>0.05). There was significant improvement (p<0.05) in the mean number of meetings of the teams per month (1.42 meetings per month vs. 2.05 meetings per month), number of teams that assessed the assets of community (79 teams, vs. 85 teams), using experts view as the source of information for need assessment (18 vs. 4) and using community gathering as a method for need assessment (27community gathering vs. 53community gathering), developing community-based project proposal (35 proposal vs. 70 proposal), not using experts for planning and implementing the project (10 projects vs. 4 projects), having a checklist for monitoring and evaluation of the community-based projects (22projects vs. 48 projects) and documentation of evaluation (7 documentations vs. 22 documentations) in the intervention group comparing after intervention with the  preintervention situation.

CBPI program has been stablished more than a decade in Iran; however, the performance of this program was not satisfactory, and mostly was directed towards educational and training events at the community level. Therefore, a project (mentorship program) was developed to improve the quality of the CBPI program, as described in the intervention section of the methodology of this study. This study describes the evaluation result of this pilot project. The results of this study showed that the mentorship program was effective in promoting the quality of CBPI activities in Iran. CBPI are among one of the proposed interventions that could result in community progress and social harm reduction, and it is supported by strong evidences from international organizations and national organizations. Many studies have shown that community based participatory interventions could have a positive impact on reducing high risk behaviors among the local communities. Besides, CBPI can increase social capital, social support, social cohesion, trust, awareness, and participation of the local community that even are not a member of CBPI teams. The level of the empowerment of the local communities with CBPI programs is also higher, and it can sensitize the local community regarding their problems and challenges.Ethical ConsiderationsAuthors’ Contributions: Zahra Esfahani contributed in designing the methodology, supervising the research and data collection.Roksana Mirkazemi, Conducted the evaluation and wrote the manuscriptDr. Farideh Barati, contributed in designing the methodology, supervising the research and data collection.Dr. Mohsen Roshan-Pajoh, contributed in designing the methodology, supervising the research and data collection.Dr. Hasan Rafiee, contributed in designing the methodology, reviewing the report and the manuscriptDr. Abolfazl Vatanparast, contributed in designing the methodologyDr. Kamalledin-Moaddab, contributed in designing the methodologyMahbobe Shoja_Eddin, contributed in designing the methodologyShidrokh Ghaemi, contributed in data collection, report and manuscript wrtingFunding: State Welfare Organization funded this studyConflict of Interest: Except for Roksana Mirkazemi and Shidrokh Ghaemi that were the external evaluators, other authors were affiliated with Welfare Organization, although did not interfere in evaluation.Ethic Approval: NA