Enhancing trainer confidence and comfort: Evaluating the impact of evidence-based follow-up support in the Hawaiʻi keiki train-the-trainer program

Abstract

Problem Statement: The opioid epidemic in the United States has significantly impacted adolescent populations, with fentanyl-related overdoses on the rise. In Hawai‘i, this crisis has led to legislative measures supporting overdose education and naloxone distribution in public schools. The Hawai‘i Keiki Train-the-Trainer (TTT) program equips school staff with lifesaving overdose response skills. However, the program lacks continued support for trainers, potentially affecting their confidence and effectiveness in delivering training.Purpose: This quality improvement project aims to enhance the Hawai‘i Keiki TTT program by implementing a follow-up session 28 days after the initial training. The objective is to assess whether this additional support improves trainers' confidence and comfort in delivering first aid and naloxone training to Hawai‘i Department of Education (HIDOE) staff. Methods: A pre-post survey design was used to evaluate the impact of the follow-up session. Participants included Hawai‘i Keiki registered nurses (RNs), advanced practice registered nurses (APRNs), and health technicians. Surveys assessing self-reported confidence and comfort levels were administered before training, immediately after training, and after the follow-up session. Results: The follow-up intervention further reinforced confidence and comfort levels across all domains. Mean scores for the ability to respond appropriately to an opioid overdose rose from 3.55 post-training to 3.65 post-follow-up. Mean scores for explaining how to use naloxone nasal spray to HIDOE staff rose from 3.52 to 3.74, and overall preparedness to train others on opioid overdose prevention and naloxone administration increased from 3.40 to 3.70. Open-ended responses highlighted the value of interactive discussions, knowledge exchange, and scenario-based learning during the follow-up session. Trainers appreciated the clarity and usability of the training materials and requested additional follow-up support, including mentorship opportunities. Trainers noted that delivering more training would increase their confidence. Discussion: The study suggests the effectiveness of incorporating a follow-up session into the Hawai‘i Keiki TTT program. Reinforcement through the follow-up session enhanced trainers’ confidence and comfort levels in delivering first aid and naloxone training, beyond what was achieved through the initial training alone.