Risks and challenges of scaling up the intervention – an analysis of the program dissemination process

Background: The Riscos & Desafios (R&D) Prevention Program is a validated, co-curricular, comprehensive and multi-component competence enhancement based preventive intervention. It is composed of a set of 8 two-hour weekly sessions to be implemented in group format and is aimed at students attending higher education. Since its validation, the program has been implemented in an increasing number of higher education institutions, filling the previously identified gap in preventive intervention specifically targeted at this group. The present work aims to provide an account of the process of dissemination of the R&D Program, presenting its increasing scope not only regarding the final target group but also to the strategic target group, as well as the evaluation of the Program implementation in different contexts since 2021/22 school year. The qualitative and quantitative analysis presented is done with the instruments of the R&D’s Program protocol. 
Methods: This is a mixed-method study that focus on the implementation of the Riscos & Desafios Program. The analysis was done with the instruments of the R&D’s Program protocol, followed by univariate analysis of frequency. Also, an inductive analysis of qualitative data of student’s and faciliator´s reflexive reports was carried out. 
Results: There was growth at the level of partner institutions, which reflects the geographic expansion of the program. At the end of the implementations, 374 post-program student questionnaires and 33 facilitators evaluation questionnaires were obtained. The majority of students rated the program as very good, which was reinforced by the positive evaluation carried out by the facilitators. 
Conclusions: In the last two years, the intervention was extended to different territories at national level, which resulted in greater coverage. It is important to reflect on the implementation process in different partner institutions considering the fidelity of implementations and the specificities of each context/target group. The results indicated the suitability of the Program to different higher education institutions, degrees, graduations and formats. These data corroborate the evaluation of efficacy of the Riscos & Desafios Program and support the continuity of its implementation and the importance of investing on health promotion and prevention of addictive behaviors through structured programs aimed at university students.