Introduction
RCL
The teen birth rate in the USA has declined 73% in the past three decades (Martin et al., To respond to the disparity in teen pregnancies and address the lack of Native-specific programming, the Johns Hopkins Center for American Indian health in partnership with a tribal community in the Southwestern United States developed the “Respecting the Circle of Life” (RCL) teen pregnancy prevention program (Chambers et al., Given that RCL is one of the first programs proven efficacious at reducing risk for teen pregnancy among Native youth through a rigorous trial, efforts are now being made to disseminate the program to tribal communities around the USA. These efforts to disseminate the RCL program, in addition to the burgeoning field of implementation science, have brought to light a need to conduct a process evaluation of the RCL trial. Process evaluations generally explore the implementation, delivery, and setting of an intervention. These evaluations help researchers better understand the results of the outcomes of intervention trials and guide program implementers in replication efforts (Saunders et al., It is important in a process evaluation to measure and ensure fidelity and quality of intervention delivery as this variable may moderate the relationship between an intervention and its outcomes (Carroll et al., The amount of intervention received by participants may significantly impact outcomes, and thus, it is important before scaling interventions to understand the relationship between intervention amount and outcomes. Assessing amount of intervention received can be calculated in many ways including minutes of intervention, minutes of “core” components of an intervention, or minutes of theoretical content received. The latter is of specific interest for programs with a strong theoretical grounding such as RCL (Chambers et al., The goal of this paper is to first describe the implementation of the RCL program as it was delivered through the randomized controlled trial conducted between 2015 and 2020. Second, we aim to explore dosage and how the specific construct of dosage, amount of intervention received, is related to the trial’s primary outcomes. As interest in replicating RCL in other tribal communities increases, it is imperative to provide the results of this analysis to determine how communities can enhance RCL’s effectiveness, feasibility, and sustainability during replication efforts (Neta et al., 