Organizational contexts, implementation process, and capacity outcomes of multicultural, multilingual Home-Based Programs in public initiatives: A Mixed-Methods study

A strategy to implement the American College of Sports Medicine's Exercise is Medicine® (EIM) initiative in a community oncology clinic

PURPOSE

Despite proven benefits, few cancer patients exercise during chemotherapy. The American College of Sports Medicine's Exercise is Medicine® (EIM) initiative describes a model to integrate exercise into oncology care, based upon assessing patients' ability to exercise safely, advising on exercise benefits, and referring patients to exercise. We developed and tested a strategy to implement EIM in a community-based oncology clinic, to assess-advise-refer 20 patients undergoing chemotherapy to a 3-month online exercise class, and measured implementation outcomes.

METHODS

Using a community-based provider participation in research (CBPPR) model, researchers and staff co-designed and tested a 4-level implementation strategy, with a goal of assessing-advising-referring 20 cancer patients to exercise. Surveys and interviews were conducted with 12 (100%) staff at baseline and post-implementation on acceptability/appropriateness/feasibility, perceptions of individual implementation roles, and organizational strengths/conditions. Data were analyzed using correlations, t-tests, and content analysis.

RESULTS

The proposed strategy was revised in collaboration with staff who requested assistance for recruitment and data collection. EIM was successfully implemented with 41 (92%) patients assessed, 37 (90%) advised, and 22 (60%) referred to exercise classes. Barriers to implementation were staff shortages and time constraints; facilitators included research team supports. Staff's perceived organizational strengths were positively correlated with exercise promotion acceptability, appropriateness, and feasibility. There were no statistically significant changes in implementation outcomes (acceptability/appropriateness/feasibility) post-implementation.

CONCLUSIONS

Using a collaborative model, EIM was successfully implemented in a community oncology clinic; however, the clinic required significant support from the research team. Adaptations to the EIM process may be required to improve implementation outcomes.

Unexpected capacity-building experiences of multicultural, multilingual participants in a public health initiative

AIMS

This study of a levy-voter funded public health initiative program (1) identifies capacity-building concerns, (2) summarizes those concerns at the community-based organization (CBO) level, and (3) documents the desired CBO capacity-building outcome.

PARTICIPANTS

Nineteen participants from nine CBOs were included, representing 95% of participants (19/20) and 90% of CBOs (9/10) from the initiative's program population.

METHODS

Interviews were conducted. A focus group validated data. Demographic surveys were completed.

METHODOLOGY AND ANALYSIS

Data were analyzed using demographic and inductive content analyses. Fifteen capacity-building unexpected concerns were identified. Participants from eight out of nine (88.8%) CBOs shared at least ten concerns. Seven CBO capacity-building outcomes were identified.

RESULTS

Capacity-building providers helped participants mitigate the Initiative's capacity-building testing of the National Implementation Research Network (NIRN) model. Participants' NIRN processes were Western and mainstream. Participants wanted community-designed processes and the funder to understand CBO clients' backgrounds, cultures, and languages. The contract money did not match the needed capacity-building processes, time, and workload.

DISCUSSION

The funder's pre-selected the NIRN Western majority approach did not fit. Participants wanted to lead. Capacity-building only for home-based program development was less desired. Social justice leadership could have made a difference.