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Measuring capacity to use evidence-based interventions in community-based organizations: A comprehensive, scoping review. J Clin Transl Sci 2022; 6:e92. [PMID: 36003212 PMCID: PMC9389281 DOI: 10.1017/cts.2022.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction: Community-based organizations (CBOs) are well-positioned to incorporate research evidence, local expertise, and contextual factors to address health inequities. However, insufficient capacity limits use of evidence-based interventions (EBIs) in these settings. Capacity-building implementation strategies are popular, but a lack of standard models and validated measures hinders progress in the field. To advance the literature, we conducted a comprehensive scoping review. Methods: With a reference librarian, we executed a comprehensive search strategy of PubMed/Medline, Web of Science Core Collection, and EBSCO Global Health. We included articles that addressed implementation science, capacity-building, and CBOs. Of 5527 articles, 99 met our inclusion criteria, and we extracted data using a double-coding process Results: Of the 99 articles, 47% defined capacity explicitly, 31% defined it indirectly, and 21% did not define it. Common concepts in definitions were skills, knowledge/expertise, and resources. Of the 57 articles with quantitative analysis, 48 (82%) measured capacity, and 11 (23%) offered psychometric data for the capacity measures. Of the 99 studies, 40% focused exclusively on populations experiencing inequities and 22% included those populations to some extent. The bulk of the studies came from high-income countries. Conclusions: Implementation scientists should 1) be explicit about models and definitions of capacity and strategies for building capacity, 2) specify expected multi-level implementation outcomes, 3) develop and use validated measures for quantitative work, and 4) integrate equity considerations into the conceptualization and measurement of capacity-building efforts. With these refinements, we can ensure that the necessary supports reach CBO practitioners and critical partners for addressing health inequities.
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Porteny T, Alegría M, del Cueto P, Fuentes L, Markle SL, NeMoyer A, Perez GK. Barriers and strategies for implementing community-based interventions with minority elders: positive minds-strong bodies. Implement Sci Commun 2020; 1:41. [PMID: 32885198 PMCID: PMC7427860 DOI: 10.1186/s43058-020-00034-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 04/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By 2040, one out of three older adults in the USA are expected to belong to a racial/ethnic minority group. This population has an increased risk of mental and physical disability with significant barriers to access care. Community-based organizations (CBOs) often provide programming to serve minority and immigrant elders. Limited resources and other barriers such as lack of trained staff make it difficult to implement evidence-based interventions (EBIs) in CBOs for long-term adoption. Yet little is known about what factors can facilitate adoption of EBIs in CBOs serving minority elders. METHODS Positive-Minds-Strong Bodies (PM-SB), an evidence-based intervention offered in four languages, aims to reduce mental and physical disability for minority and immigrant elders through the efforts of community health workers and exercise trainers. The intervention consists of cognitive behavior therapy and exercise training sessions delivered over 6 months. During a recent clinical trial of this intervention, we elicited feedback from CBO staff to determine how best to facilitate the implementation and long-term sustainability of PM-SB within their agencies. We surveyed 30 CBO staff members, held four focus groups, and conducted 20 in-depth interviews to examine staff perspectives and to reveal factors or changes needed to facilitate long-term adoption in prospective CBOs. RESULTS Participants reported that staff motivation and implementation could be improved through the following changes: increasing patient compensation for treatment sessions, decreasing levels of organizational accountability, and reducing staff demands embedded in the intervention. Although most staff perceived that PM-SB improved their agency's ability to address the health and well-being of elders, capacity-building strategies such as a "train-the-trainer" initiative were identified as priorities to address staff turnover for sustainability. Adapting the intervention to get financial reimbursement also emerged as vital. CONCLUSIONS Augmenting financial incentives, streamlining procedures, and simplifying staff accountability were suggested strategies for facilitating the transition from a disability prevention clinical trial in minority and immigrant elders to a scalable implementation in routine services at CBOs. TRIAL REGISTRATION ClinicalTrials.gov, NCT02317432.
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Affiliation(s)
- Thalia Porteny
- Interfaculty Initiative in Health Policy, Graduate School of Arts and Science, Harvard University, 1350 Massachusetts Avenue, Suite 350, Cambridge, MA 02138-3654 USA
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114 USA
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215 USA
| | - Paola del Cueto
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114 USA
| | - Larimar Fuentes
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114 USA
| | - Sheri Lapatin Markle
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114 USA
| | - Amanda NeMoyer
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114 USA
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115 USA
| | - Giselle K. Perez
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215 USA
- Health Policy Research Center at the Mongan Institute, Massachusetts General Hospital, 100 Cambridge Street, Boston, MA 02114 USA
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Factors That Influence Linkages to HIV Continuum of Care Services: Implications for Multi-Level Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111355. [PMID: 29112126 PMCID: PMC5707994 DOI: 10.3390/ijerph14111355] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/26/2017] [Accepted: 11/02/2017] [Indexed: 01/17/2023]
Abstract
Worldwide, the human immunodeficiency virus (HIV) continuum of care involves health promotion providers (e.g., social workers and health educators) linking patients to medical personnel who provide HIV testing, primary care, and antiretroviral treatments. Regrettably, these life-saving linkages are not always made consistently and many patients are not retained in care. To design, test and implement effective interventions, we need to first identify key factors that may improve linkage-making. To help close this gap, we used in-depth interviews with 20 providers selected from a sample of 250 participants in a mixed-method longitudinal study conducted in New York City (2012–2017) in order to examine the implementation of HIV services for at-risk populations. Following a sociomedical framework, we identified provider-, interpersonal- and environmental-level factors that influence how providers engage patients in the care continuum by linking them to HIV testing, HIV care, and other support services. These factors occurred in four domains of reference: Providers’ Professional Knowledge Base; Providers’ Interprofessional Collaboration; Providers’ Work-Related Changes; and Best Practices in a Competitive Environment. Of particular importance, our findings show that a competitive environment and a fear of losing patients to other agencies may inhibit providers from engaging in linkage-making. Our results suggest relationships between factors within and across all four domains; we recommend interventions to modify factors in all domains for maximum effect toward improving care continuum linkage-making. Our findings may be applicable in different areas of the globe with high HIV prevalence.
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McKay VR, Dolcini MM, Catania JA. Impact of Human Resources on Implementing an Evidence-Based HIV Prevention Intervention. AIDS Behav 2017; 21:1394-1406. [PMID: 27150896 PMCID: PMC5097686 DOI: 10.1007/s10461-016-1425-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Evidence-based interventions (EBIs) often require competent staff, or human resources (HR), for implementation. The empirical evidence characterizing the influence of HR fluctuations on EBI delivery is limited and conflicting. Using the Interactive Systems Framework, we explored staff fluctuation and the subsequent influence on RESPECT, an HIV prevention EBI. We conducted interviews with staff in two waves (n = 53, Wave I; n = 37, Wave II) in a national sample of organizations delivering RESPECT (N = 29). We analyzed interviews qualitatively to describe changes among RESPECT staff and explore the subsequent influences on RESPECT implementation. Organizations reported downsizing, turnover, and expansion of staff positions. Staff changes had multiple influences on RESPECT implementation including clients reached, fidelity to specific RESPECT protocols, and overall sustainability of RESPECT over time. HR fluctuations are common, and our analyses provide an initial characterization of the relationship between HR fluctuation and EBI implementation. Given the prominent influence of HR on EBI implementation, the Interactive Systems Framework is a useful guiding tool for future examinations.
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Affiliation(s)
- Virginia R McKay
- Hallie E. Ford Center for Healthy Children and Families, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, 2631 SW Campus Way, Oregon State University, Corvallis, OR, 97330, USA.
| | - M Margaret Dolcini
- Hallie E. Ford Center for Healthy Children and Families, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, 2631 SW Campus Way, Oregon State University, Corvallis, OR, 97330, USA
| | - Joseph A Catania
- Hallie E. Ford Center for Healthy Children and Families, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, 2631 SW Campus Way, Oregon State University, Corvallis, OR, 97330, USA
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Mckay VR, Dolcini MM, Conte KP, Catania JA. ADAPTATIONS TO AN HIV COUNSELING AND TESTING INTERVENTION FROM A COUNSELOR PERSPECTIVE. JOURNAL OF COMMUNITY PSYCHOLOGY 2014; 42:891-906. [PMID: 32341602 PMCID: PMC7184937 DOI: 10.1002/jcop.21659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Understanding the balance between fidelity and adaptation for evidence-based interventions has the potential to improve their translation from research to practice. The Translation into Practice study explores variation in program implementation within organizations utilizing the RESPECT program, an HIV counseling and testing intervention. Counselors (N = 70) were interviewed using a semistructured interview guide to examine both the influential factors on, and the subsequent adaptations to, RESPECT. Almost all counselors reported making adaptations (N = 69). Adaptations were made both to key characteristics (mean [M] = 2.24, standard deviation [SD] = 1.3) and to core components (M = 0.5, SD = 0.8). Counselors identified the environmental context and factors within the counseling context as common influences leading to adaptation. These findings suggest adaptations were a routine part of program usage. To improve implementation of the RESPECT program, further research is needed to assess the degree to which adaptations can be made to better meet the needs of agencies and clients without compromising fidelity.
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Cederbaum JA, Song A, Hsu HT, Tucker JS, Wenzel SL. Adapting an evidence-based intervention for homeless women: engaging the community in shared decision-making. J Health Care Poor Underserved 2014; 25:1552-70. [PMID: 25418227 PMCID: PMC4243536 DOI: 10.1353/hpu.2014.0188] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As interest grows in the diffusion of evidence-based interventions (EBIs), there is increasing concern about how to mitigate implementation challenges; this paper concerns adapting an EBI for homeless women. Complementing earlier focus groups with homeless women, homeless service providers (n = 32) were engaged in focus groups to assess capacity, needs, and barriers with implementation of EBIs. Deductive analyses of data led to the selection of four EBIs. Six consensus groups were then undertaken; three each with homeless women (n = 24) and homeless service providers (n = 21). The selected EBI was adapted and pretested with homeless women (n = 9) and service providers (n = 6). The structured consensus group process provided great utility and affirmed the expertise of homeless women and service providers as experts in their domain. Engaging providers in the selection process reduced the structural barriers within agencies as obstacles to diffusion.
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Affiliation(s)
- Julie A. Cederbaum
- University of Southern California School of Social Work, 669 W.34 Street, Los Angeles, California, USA
| | - Ahyoung Song
- University of Southern California School of Social Work, 669 W.34 Street, Los Angeles, California, USA
| | - Hsun-Ta Hsu
- University of Southern California School of Social Work, 669 W.34 Street, Los Angeles, California, USA
| | | | - Suzanne L. Wenzel
- University of Southern California School of Social Work, 669 W.34 Street, Los Angeles, California, USA
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Feldman MB, Silapaswan A, Schaefer N, Schermele D. Is there life after DEBI? Examining health behavior maintenance in the diffusion of effective behavioral interventions initiative. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2014; 53:286-313. [PMID: 24499926 DOI: 10.1007/s10464-014-9629-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The evidence-based interventions that are identified, packaged, and disseminated by the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention as part of the Diffusion of Effective Behavioral Interventions (DEBI) initiative-commonly referred to the "DEBIs"-currently represent a primary source of HIV prevention interventions for community-based providers. To date, little attention has focused on whether the intended outcomes of the DEBIs, i.e., reductions in HIV-related risk behaviors, are maintained over time. This review summarized evidence for the sustainability of the effects of the DEBIs on HIV sexual risk behavior and intravenous drug use from studies of original and adapted DEBIs. Evidence of intervention decay or a lack of any intervention effect was identified in several original and adapted versions of the DEBIs included in this review. Recommendations include modifications to current criteria for inclusion in the DEBI portfolio, in addition to the development of remediation strategies to address intervention decay. Further, theoretical models that specify the processes that underlie the maintenance of health behaviors over time should be used in developing HIV prevention interventions.
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Pinto RM, Wall MM, Spector AY. Modeling the Structure of Partnership Between Researchers and Front-Line Service Providers: Strengthening Collaborative Public Health Research. JOURNAL OF MIXED METHODS RESEARCH 2014; 8:83-106. [PMID: 25309155 PMCID: PMC4193907 DOI: 10.1177/1558689813490835] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Partnerships between HIV researchers and service providers are essential for reducing the gap between research and practice. Community-Based Participatory Research principles guided this cross-sectional study, combining 40 in-depth interviews with surveys of 141 providers in 24 social service agencies in New York City. We generated the Provider-Researcher Partnership Model to account for provider- and agency-level factors' influence on intentions to form partnerships with researchers. Providers preferred "balanced partnerships" in which researchers and providers allocated research tasks and procedures to reflect diverse knowledge/skill sets. An organizational culture that values research can help enhance providers' intentions to partner. Providers' intentions and priorities found in this study may encourage researchers to engage in and policy makers to fund collaborative research.
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Affiliation(s)
| | | | - Anya Y. Spector
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University
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Gelaude DJ, Sovine ML, Swayzer R, Herbst JH. HIV Prevention Programs Delivered by Community-Based Organizations to Young Transgender Persons of Color: Lessons Learned to Improve Future Program Implementation. Int J Transgend 2013. [DOI: 10.1080/15532739.2013.824846] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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10
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Pinto RM, Spector AY, Yu G, Campbell ANC. Transdisciplinary collaboration and endorsement of pharmacological and psychosocial evidence-based practices by medical and psychosocial substance abuse treatment providers in the United States. DRUGS-EDUCATION PREVENTION AND POLICY 2013; 20:408-416. [PMID: 26778896 DOI: 10.3109/09687637.2013.783792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS To examine the relative contribution of providers' professional affiliation (medical vs. non-medical), involvement in research, and training needs for associations with endorsement of the following evidence-based practices (EBPs): (1) pharmacological - buprenorphine treatment and (2) psychosocial - Cognitive Behavioural Therapy (CBT). METHODS Secondary analysis from a 2008 survey of a national sample (n = 571) of substance abuse treatment providers (medical, social workers, psychologists and counsellors) affiliated with the United States National Institute on Drug Abuse's National Drug Abuse Treatment Clinical Trials Network. Multivariate linear regression models to analyze cross-sectional survey data. FINDINGS Results demonstrated that medical providers and providers with previous research involvement more strongly endorsed the effectiveness of buprenorphine over CBT. Compared to medical providers, psychosocial providers more strongly endorsed CBT. There was a positive association between needing training in rapport with patients and endorsement of buprenorphine and a negative association with CBT. There was a positive association between needing training in behavioural management and needs assessment and endorsement of CBT. CONCLUSIONS Results underscore the importance of providers' involvement in research and the need for training medical and non-medical providers in practice areas that can purposely enhance their use of pharmacological and psychosocial EBPs.
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Affiliation(s)
- Rogério M Pinto
- Department of Social Work, Columbia University, New York City, NY, USA
| | - Anya Y Spector
- Department of Social Work, Columbia University, New York City, NY, USA; New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York City, NY, USA
| | - Gary Yu
- Department of Social Work, Columbia University, New York City, NY, USA
| | - Aimee N C Campbell
- New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York City, NY, USA
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Campbell ANC, Tross S, Calsyn DA. Substance use disorders and HIV/AIDS prevention and treatment intervention: research and practice considerations. SOCIAL WORK IN PUBLIC HEALTH 2013; 28:333-48. [PMID: 23731423 PMCID: PMC3694750 DOI: 10.1080/19371918.2013.774665] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Social workers are often on the front lines of the HIV/AIDS epidemic delivering prevention education and interventions, offering or linking individuals to HIV testing, and working to improve treatment access, retention, and adherence, especially among vulnerable populations. Individuals with substance use disorders face additional challenges to reducing sexual and drug risk behaviors, as well as barriers to testing, treatment, and antiretroviral therapy adherence. This article presents current data on HIV transmission and research evidence on prevention and intervention with substance abusers and highlights how individual social workers can take advantage of this knowledge in practice and through adoption and implementation within organizations.
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Affiliation(s)
- Aimee N C Campbell
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY 10032, USA.
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Herbst JH, Glassman M, Carey JW, Painter TM, Gelaude DJ, Fasula AM, Raiford JL, Freeman AE, Harshbarger C, Viall AH, Purcell DW. Operational research to improve HIV prevention in the United States. J Acquir Immune Defic Syndr 2012; 59:530-6. [PMID: 22217681 PMCID: PMC4676559 DOI: 10.1097/qai.0b013e3182479077] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The HIV/AIDS epidemic in the United States continues despite several recent noteworthy advances in HIV prevention. Contemporary approaches to HIV prevention involve implementing combinations of biomedical, behavioral, and structural interventions in novel ways to achieve high levels of impact on the epidemic. Methods are needed to develop optimal combinations of approaches for improving efficiency, effectiveness, and scalability. This article argues that operational research offers promise as a valuable tool for addressing these issues. We define operational research relative to domestic HIV prevention, identify and illustrate how operational research can improve HIV prevention, and pose a series of questions to guide future operational research. Operational research can help achieve national HIV prevention goals of reducing new infections, improving access to care and optimization of health outcomes of people living with HIV, and reducing HIV-related health disparities.
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Affiliation(s)
- Jeffrey H Herbst
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA.
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13
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Owczarzak J. Evidence-based HIV prevention in community settings: provider perspectives on evidence and effectiveness. CRITICAL PUBLIC HEALTH 2012. [DOI: 10.1080/09581596.2011.566918] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hatcher A, de Wet J, Bonell CP, Strange V, Phetla G, Proynk PM, Kim JC, Morison L, Porter JDH, Busza J, Watts C, Hargreaves JR. Promoting critical consciousness and social mobilization in HIV/AIDS programmes: lessons and curricular tools from a South African intervention. HEALTH EDUCATION RESEARCH 2011; 26:542-555. [PMID: 20965911 DOI: 10.1093/her/cyq057] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The development of critical consciousness is seen as a key stage in communities increasing levels of dialogue about priority problems and effecting structural change for health. However, relatively little research identifies concrete methods for programmes to build critical consciousness. We examined how a South African structural intervention used critical consciousness as a tool for prevention of intimate partner violence and HIV infection. We collected qualitative data in the form of in-depth interviews with managers, trainers, and participants of the Intervention with Microfinance for AIDS and Gender Equity intervention (IMAGE) in rural South Africa. The data were analysed through a coding structure developed in QSR NVivo. We draw practical lessons from IMAGE to guide other HIV programmes aiming to promoting critical consciousness and social mobilization. This research suggests that specific curricular tools can work towards critical consciousness and that mobilization efforts in future programmes can be strengthened by including individual and collective efforts by participants.
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Affiliation(s)
- Abigail Hatcher
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA 94105, USA.
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Bowen SAK, Saunders RP, Richter DL, Hussey J, Elder K, Lindley L. Assessing levels of adaptation during implementation of evidence-based interventions: introducing the Rogers-Rütten framework. HEALTH EDUCATION & BEHAVIOR 2010; 37:815-30. [PMID: 21051771 DOI: 10.1177/1090198110366002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most HIV-prevention funding agencies require the use of evidence-based behavioral interventions, tested and proven to be effective through outcome evaluation. Adaptation of programs during implementation is common and may be influenced by many factors, including agency mission, time constraints, and funding streams. There are few theoretical frameworks to understand how these organizational and program-related factors influence the level of adaptation. This study used constructs from both Rogers's diffusion theory and Rütten's framework for policy analysis to create a conceptual framework that identifies determinants hypothesized to affect the level of adaptation. Preliminary measures of these constructs were also developed. This framework and its measures assess organizational and program-related factors associated with adaptation and could serve as a model to assess implementation and adaptation in fields outside of HIV prevention.
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Affiliation(s)
- Shelly-Ann K Bowen
- Bureau of Community Health and Chronic Disease Prevention, South Carolina Department of Health and Environmental Control, Columbia, USA.
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Convey MR, Dickson-Gomez J, Weeks MR, Li J. Altruism and peer-led HIV prevention targeting heroin and cocaine users. QUALITATIVE HEALTH RESEARCH 2010; 20:1546-57. [PMID: 20639354 PMCID: PMC3566981 DOI: 10.1177/1049732310375818] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Peer-delivered HIV prevention and intervention programs play an important role in halting the spread of HIV. Rigorous scientific analysis of the aforementioned programs has focused on the immediate reduction of risk-related behaviors among the target populations. In our longitudinal study of the Risk Avoidance Partnership Peer Intervention for HIV, we assessed the long-term behavioral effects of a peer-led HIV intervention project with active drug users. Initial analysis of the qualitative data highlights the role of altruism as a motivator in sustaining peer educators beyond the immediate goals of the project. We contend that altruism found in volunteers is an important factor in maintaining long-term participation in HIV intervention programs and initiatives using peer educators.
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Affiliation(s)
- Mark R Convey
- Institute for Community Research, 2 Hartford Square West, Hartford, CT 06106, USA.
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Williams JK, Wyatt GE, Wingood G. The four Cs of HIV prevention with African Americans: crisis, condoms, culture, and community. Curr HIV/AIDS Rep 2010; 7:185-93. [PMID: 20730512 PMCID: PMC2938440 DOI: 10.1007/s11904-010-0058-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
HIV/AIDS continues to be a devastating epidemic with African American communities carrying the brunt of the impact. Despite extensive biobehavioral research, current strategies have not resulted in significantly decreasing HIV/AIDS cases among African Americans. The next generation of HIV prevention and risk reduction interventions must move beyond basic sex education and condom use and availability. Successful interventions targeting African Americans must optimize strategies that integrate socio-cultural factors and address institutional and historical barriers that hinder or support HIV risk reduction behaviors. Community-based participatory research to decrease the HIV/AIDS disparity by building community capacity and infrastructure and advocating for and distributing equitably, power and resources, must be promoted. Recommendations for paradigm shifts in using innovative theories and conceptual frameworks and for training researchers, clinicians, grant and journal reviewers, and community members are made so that culturally congruent interventions may be tested and implemented at the community level.
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Affiliation(s)
- John K. Williams
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza, C8-871C, Los Angeles, CA 90024-1759 USA
| | - Gail E. Wyatt
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza, C8-871C, Los Angeles, CA 90024-1759 USA
| | - Gina Wingood
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322 USA
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Margaret Dolcini M, Gandelman AA, Vogan SA, Kong C, Leak TN, King AJ, Desantis L, O'Leary A. Translating HIV interventions into practice: community-based organizations' experiences with the diffusion of effective behavioral interventions (DEBIs). Soc Sci Med 2010; 71:1839-46. [PMID: 20926169 DOI: 10.1016/j.socscimed.2010.08.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2009] [Revised: 07/23/2010] [Accepted: 08/16/2010] [Indexed: 12/01/2022]
Abstract
Efficacious behavioral interventions developed to address the spread of HIV/STIs are currently being disseminated in the USA through a national diffusion program (DEBI) spearheaded by the Centers for Disease Control and Prevention (CDC). Understanding how interventions are translated to real world settings is necessary to further scientific knowledge of this process and to facilitate future translation efforts in public health. Prior studies have begun to elucidate how agencies translate behavioral interventions into practice, but further work is needed. Guided by the ADAPT framework, we examined agencies' assessment, preparation, and implementation of interventions. Our qualitative interview-based study focused on six community-based agencies in California (United States) funded to implement three group-level HIV interventions. Findings showed considerable variation in the extent to which agencies engaged in assessment and broad-based preparation and in the ease with which agencies implemented the interventions. The findings provide insight into the process that agencies undergo in the translation of effective behavioral interventions and illustrate how agencies can inform logic models that guide translation. We also identify relevant dimensions of existing models, including the ADAPT framework and Rogers's (1995, 2005) diffusion of innovations in organizations, that have value for agencies that are translating research to practice.
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Affiliation(s)
- M Margaret Dolcini
- Department of Public Health, College of Health and Human Sciences, 304 Waldo Hall, Oregon State University, Corvallis, OR 97331-6406, United States.
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Berkley-Patton J, Goggin K, Liston R, Bradley-Ewing A, Neville S. Adapting effective narrative-based HIV-prevention interventions to increase minorities' engagement in HIV/AIDS services. HEALTH COMMUNICATION 2009; 24:199-209. [PMID: 19415552 PMCID: PMC2746743 DOI: 10.1080/10410230902804091] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Disparities related to barriers to caring for HIV-positive and at-risk minorities continue to be a major public health problem. Adaptation of efficacious HIV-prevention interventions for use as health communication innovations is a promising approach for increasing minorities' utilization of HIV health and ancillary services. Role-model stories, a widely-used HIV-prevention strategy, employ culturally tailored narratives to depict experiences of an individual modeling health-risk reduction behaviors. This article describes the careful development of a contextually appropriate role model story focused on increasing minorities' engagement in HIV/AIDS health and related services. Findings from interviews with community members and focus groups with HIV-positive minorities indicated several barriers and facilitators related to engagement in HIV health care and disease management (e.g., patient-provider relationships) and guided the development of role-model story narratives.
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Affiliation(s)
- Jannette Berkley-Patton
- Department of Psychology, University of Missouri-Kansas City, 4825 Troost, Suite 211, Kansas City, MO 64110-2499, USA.
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20
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Reviewing self-reported impacts of community health assessment in local health jurisdictions. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2009; 15:18-23. [PMID: 19077590 DOI: 10.1097/phh.0b013e3181903c57] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nationally, little is known about the characteristics of community health assessment (CHA) that contribute to the use of CHA findings in public health program and policy decisions. METHODS To begin identifying these characteristics, the Washington State Department of Health partnered with local health jurisdictions to establish an on-line system for reporting the impacts of CHA projects (eg, use of a CHA to identify health priorities, create an action plan, form a partnership, or develop or modify a health strategy, program, or service). A qualitative review was conducted of 90 reports of CHA impacts submitted by local health jurisdictions. FINDINGS Common characteristics of CHAs with reported impacts include (1) a focus on a specific subpopulation or health topic; (2) involvement of community and public health agency stakeholders in planning and conducting the CHA; (3) use of multiple data collection methods, sources of data, and approaches to dissemination; and (4) primary data collection at the local level. CONCLUSIONS Although the Washington State CHA Impact Tracking System is an important first step toward understanding characteristics of CHA connected to the use of the results, additional studies are needed to identify evidence-based practices in this field.
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Veniegas RC, Kao UH, Rosales R, Arellanes M. HIV prevention technology transfer: challenges and strategies in the real world. Am J Public Health 2009; 99 Suppl 1:S124-30. [PMID: 19218184 DOI: 10.2105/ajph.2007.124263] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined implementation of evidence-based interventions for HIV prevention at community-based organizations in Los Angeles County, CA. METHODS We conducted 2 waves of interviews with 34 organization staff members. We analyzed activities reported by staff in the phases (preimplementation, implementation, and maintenance and evolution) and activities defined by the technology transfer model for evidence-based HIV prevention interventions. RESULTS Staff members were able to select, adapt, and implement evidence-based HIV prevention interventions despite challenges in each phase of technology transfer. Preimplementation challenges included lack of information and poor fit between the interventions and organizations' clients. Implementation challenges included retention of participants across intervention sessions and staff turnover. A challenge in the maintenance and evolution phase was enhancing staff skills in outcome monitoring and cost analyses. CONCLUSIONS Technical assistance must be matched to the specific challenges found in each phase of technology transfer. Successful transfer of evidence-based HIV prevention interventions will depend on their continued uptake and use by organization staff. This study highlights directions for improving communications regarding appropriate modifications to these interventions and for organizational planning to continue adapted interventions.
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Affiliation(s)
- Rosemary C Veniegas
- Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, CA 90024, USA.
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22
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Fernández ME, DeBor M, Candreia M, Flores B. Dissemination of a breast and cervical cancer early detection program through a network of community-based organizations. Health Promot Pract 2008; 11:654-64. [PMID: 19116426 DOI: 10.1177/1524839908325064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
ENCORE (plus) , a breast and cervical cancer outreach, education, and screening referral program, was implemented by the YWCA of the United States and funded by Avon's Breast Cancer Awareness Crusade. ENCORE (plus) was designed to address the educational and access needs of low socioeconomic status and minority women who experience substantial barriers to breast and cervical cancer screening. This article describes the dissemination of ENCORE (plus) to 78 YWCAs in 30 states. It illustrates the application of social cognitive theory and diffusion theory to increase program adoption, implementation, and maintenance among community organizations that have not traditionally provided public health related services. The article highlights elements of the program that enhanced its adoption and implementation and describes procedures for accelerating the diffusion of the program across the country.
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Affiliation(s)
- María E Fernández
- Center for Health Promotion and Prevention Research, University of Texas-Health Science Center at Houston, School of Public Health, 7000 Fannin Street, Houston, TX 77030, USA.
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Dworkin SL, Pinto RM, Hunter J, Rapkin B, Remien RH. Keeping the spirit of community partnerships alive in the scale up of HIV/AIDS prevention: critical reflections on the roll out of DEBI (Diffusion of Effective Behavioral Interventions). AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2008; 42:51-9. [PMID: 18612809 PMCID: PMC2735211 DOI: 10.1007/s10464-008-9183-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
DEBI, or the Diffusion of Effective Behavioral Interventions is the largest centralized effort to diffuse evidence-based prevention science to fight HIV/AIDS in the United States. DEBI seeks to ensure that the most effective science-based prevention interventions are widely implemented across the country in community-based organizations. Thus, this is a particularly timely juncture in which to critically reflect on the extent to which known principles of community collaboration have guided key processes associated with the DEBI rollout. We review the available evidence on how the dissemination of packaged interventions is necessary but not sufficient for ensuring the success of technology transfer. We consider additional principles that are vital for successful technology transfer, which were not central considerations in the rollout of the DEBI initiative. These issues are: (1) community perceptions of a top-down mode of dissemination; (2) the extent to which local innovations are being embraced, bolstered, or eliminated; and (3) contextual and methodological considerations that shape community preparedness. Consideration of these additional factors is necessary in order to effectively document, manage, and advance the science of dissemination and technology transfer in centralized prevention efforts within and outside of HIV/AIDS.
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Affiliation(s)
- Shari L Dworkin
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit #15, New York, NY 10032, USA.
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Jones KT, Gray P, Whiteside YO, Wang T, Bost D, Dunbar E, Foust E, Johnson WD. Evaluation of an HIV prevention intervention adapted for Black men who have sex with men. Am J Public Health 2008; 98:1043-50. [PMID: 18445795 PMCID: PMC2377294 DOI: 10.2105/ajph.2007.120337] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2007] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the efficacy of an HIV behavioral intervention adapted for Black men who have sex with men (MSM). METHODS We conducted serial cross-sectional surveys, 1 baseline measurement followed by initiation of an intervention and 3 follow-up measurements, among Black MSM in 3 North Carolina cities over 1 year. RESULTS We observed significant decreases in unprotected receptive anal intercourse at 4 months (by 23.8%, n=287) and 8 months (by 24.7%, n=299), and in unprotected insertive anal intercourse (by 35.2%), unprotected receptive anal intercourse (by 44.1%), and any unprotected anal intercourse (by 31.8%) at 12 months (n=268). Additionally, at 12 months, the mean number of partners for unprotected receptive anal intercourse decreased by 40.5%. The mean number of episodes decreased by 53.0% for unprotected insertive anal intercourse, and by 56.8% for unprotected receptive anal intercourse. The percentage of respondents reporting always using condoms for insertive and receptive anal intercourse increased by 23.0% and 30.3%, respectively. CONCLUSIONS Adapting previously proven interventions designed for other MSM can significantly reduce HIV risk behaviors of Black MSM.
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Affiliation(s)
- Kenneth T Jones
- Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE (MS E-37), Atlanta, GA 30333, USA.
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