Social Interface Model: Theorizing Ecological Post-Delivery Processes for Intervention Effects

A scoping review of implementation science theories, models, and frameworks - an appraisal of purpose, characteristics, usability, applicability, and testability

BACKGROUND

A proliferation of theories, models, and frameworks (TMFs) have been developed in the implementation science field to facilitate the implementation process. The basic features of these TMFs have been identified by several reviews. However, systematic appraisals on the quality of these TMFs are inadequate. To fill this gap, this study aimed to assess the usability, applicability, and testability of the current TMFs in a structured way.

METHODS

A scoping review method was employed. Electronic databases were searched to locate English and Chinese articles published between January 2000 and April 2022. Search terms were specific to implementation science. Additionally, hand searches were administered to identify articles from related reviews. Purpose and characteristics such as the type of TMF, analytical level, and observation unit were extracted. Structured appraisal criteria were adapted from Birken et al.'s Theory Comparison and Selection Tool (T-CaST) to conduct an in-depth analysis of the TMFs' usability, applicability, and testability.

RESULTS

A total of 143 TMFs were included in this analysis. Among them, the most common purpose was to identify barriers and facilitators. Most TMFs applied the descriptive method to summarize the included constructs or the prescriptive method to propose courses of implementation actions. TMFs were mainly mid-range theories built on existing conceptual frameworks or demonstrated grand theories. The usability of the TMFs needs to be improved in terms of the provision of conceptually matched strategies to barriers and facilitators and instructions on the TMFs usage. Regarding the applicability, little attention was paid to the constructs of macro-level context, stages of scale-up and sustainability, and implementation outcomes like feasibility, cost, and penetration. Also, fewer TMFs could propose recommended research and measurement methods to apply the TMFs. Lastly, explicit hypotheses or propositions were lacking in most of the TMFs, and empirical evidence was lacking to support the claimed mechanisms between framework elements in testability.

CONCLUSIONS

Common limitations were found in the usability, application, and testability of the current TMFs. The findings of this review could provide insights for developers of TMFs for future theoretical advancements.

Testing Narrative Persuasion of a Culturally Grounded, School-Based "Dale Se REAL" Entertainment-Education Intervention and Peer Communication on Nicaraguan Adolescent Substance Use

Guided by narrative engagement theory and social cognitive theory, the present study investigates effects of narrative persuasion and peer communication on Nicaraguan adolescent substance use. Eighth-grade students in Nicaragua were recruited to participate in the culturally grounded, school-based prevention intervention Dale se REAL and to watch five entertainment-education intervention videos that teach drug refusal communication strategies. Using the cross-sectional survey (N = 224), a path analysis was run to examine the mediated moderation effects of narrative engagement (e.g., interest, realism, and identification with main characters) and peer communication about the intervention videos (e.g., frequency and valence of communication) on adolescent refusal self-efficacy and substance use behaviors. Results revealed that realism was significantly related to adolescent refusal self-efficacy and frequent peer communication moderated the association between refusal self-efficacy and the past 30-day marijuana use. Findings suggest that health communication scholars should take into consideration social factors and cultural contexts for adolescent substance use prevention research.

The Antecedents and Consequences of Interpersonal Communication during a School-based Health Intervention

School-based health interventions often have limited and inconsistent effects. Although interpersonal communication likely is important, hardly any studies have investigated interpersonal communication of students with their friends, classmates, and parents about the health programs and health behaviors in school-based health interventions. In a two-wave prospective study of 389 adolescents focusing on three health behaviors (i.e., alcohol use, snack intake, and exercise), we addressed two aims. Our first aim was to investigate how student evaluations of a school-based health intervention influenced interpersonal communication about health behaviors (i.e., valence and frequency of conversations). Findings showed that positively evaluating a school-based health intervention increased how often students talked about the intervention with friends, classmates, and parents, as well as how they discussed the three health behaviors. Our second aim was to investigate the influence of interpersonal communication with friends, classmates, and parents on predictors of health behaviors. We found for conversational frequency that frequently discussing health behaviors resulted in healthier (more positive) predictors of exercise, but also in unhealthier (more positive) predictors of snacking and drinking. Furthermore, findings showed that positively discussing exercising, and negatively discussing snacking and drinking, resulted in healthier predictors of these behaviors. Our findings show that it is important to understand the impact of post-intervention communication and that post-intervention communication with peers and parents about health behaviors are predictors of health behavior.

Challenging sustainability in school-based intervention in Nicaragua

Purpose

The current study identifies successes and limitations of sustaining Dale se Real (DsR) as a school-based educational intervention program related to drugs and violence for 7th and 8th grade students in Nicaragua, Central America. As evidence-based interventions are transported and imported across national borders, issues surrounding their adaptation and sustainability become important targets for investigation.

Design/methodology/approach

Interviews were conducted with nine key informants (e.g. school directors, implementers) from seven institutions, four of which sustained DsR and three of which did not. This study explores DsR's fit with the institutions' missions and routines, program adaptability, broader community support and sustainability planning.

Findings

Findings demonstrate two emerging views of sustainability within the Nicaraguan schools: a deficit approach and an empowerment approach. These two approaches imply different motivational structures for institutions and also led to the practical finding that developers and trainers need to provide structured or formal ways of empowering schools to continue implementing a program after staff no longer routinely contact them.

Originality/value

This study contributes a particular case on what facilitates and impedes sustainability of school-based interventions that can inform future intervention research in Latin American countries.

Is Parent-Adolescent Drug Talk Always Protective? Testing A New Scale of Drug Talk Styles in Relation to Adolescent Personal Norms, Parental Injunctive Norms, Substance Use Intentions, and Behaviors

According to parent-offspring drug talk (PODT) model, the specificity of drug talk styles is identified by the timing and directness of communication about substance use between parent and adolescent (e.g., situated direct, ongoing direct, situated indirect, and ongoing indirect talk style). Given the limitation of the original, single item measure for drug talk styles with a categorical response option, the current study proposed a new scale of drug talk styles and tested its concurrent validity. Using cross-sectional survey data (N = 2,035), confirmatory factor analysis was conducted to test the factor structure of the scale. Consistent with PODT model, the analysis yielded support for a four-factor structure for the drug talk styles. Next, a path analysis was employed to validate the scale. The findings suggested that situated direct talk was positively related to personal anti-substance-use norms and parental anti-substance-use injunctive norms but negatively related to smoking intention, as well as alcohol use in the past 30 days. Ongoing direct talk, however, was found to be positively associated with alcohol and marijuana use in the past 30 days. Research implications and future directions are discussed.