scholarly journals An Approach to Adapting a Community-Based Cancer Control Intervention to Organizational Context

2020 ◽  
Vol 21 (2) ◽  
pp. 168-171 ◽  
Author(s):  
Cheryl L. Knott ◽  
Janice Bowie ◽  
C. Daniel Mullins ◽  
Sherie Lou Zara Santos ◽  
Jimmie Slade ◽  
...  

There has been increasing attention in implementation science to optimizing the fit of evidence-based interventions to the organizational settings where they are delivered. However, less is known about how to maximize intervention–context fit, particularly in community-based settings. We describe a new strategy to customize evidence-based health promotion interventions to community sites. Specifically, leaders in African American churches completed a memorandum of understanding where they were asked to identify two or more health promotion implementation strategies from a menu of 20 and select a planned implementation time frame for each. In a pilot phase with three churches, the menu-based strategy and protocols were successfully implemented and finalized in preparation for a subsequent randomized trial. The three pilot churches identified between two and nine strategies (e.g., form a health ministry, allocate space or budget for health activities, include health in church communications/sermons). The selected strategies varied widely, reinforcing the need for interventions that can be customized to fit the organizational context. Despite the challenges of integrating health promotion activities into non–health focused organizations, this approach has promise for fostering sustainable health activities in community settings.

Author(s):  
Byron J. Powell ◽  
Krystal G. Garcia ◽  
Maria E. Fernandez

Implementation strategies are methods or techniques that can be used to enhance the adoption, implementation, scale-up, and sustainment of evidence-based cancer control practices into routine care. This chapter defines implementation strategies, presents several taxonomies of implementation strategies that can be used to address multilevel implementation barriers, describes guidelines for reporting and specifying implementation strategies to ensure the efficient generation of knowledge and the replication of effective strategies in research and practice, briefly overviews the state of evidence for strategies, and suggests ways in which they can be carefully developed and applied to address the needs of specific contexts. The chapter concludes by presenting several research priorities related to implementation strategies.


2020 ◽  
Author(s):  
Jessica Haughton ◽  
Michelle L. Takemoto ◽  
Jennifer Schneider ◽  
Steven P. Hooker ◽  
Borsika Rabin ◽  
...  

Abstract Background: Community engagement is critical to the acceleration of evidence-based interventions into community settings. Harnessing the knowledge and opinions of community leaders increases the likelihood of successful implementation, scale up, and sustainment of evidence-based interventions. Faith in Action (Fe en Acción) is an evidence-based promotora-led physical activity program designed to increase moderate-to-vigorous physical activity among churchgoing Latina women.Methods: We conducted in-depth interviews using a semi-structured interview guide based on the Consolidated Framework for Implementation Research (CFIR) at various Catholic and Protestant churches with large Latino membership in San Diego County, California to explore barriers and facilitators to implementation of Faith in Action and identify promising implementation strategies for program scale-up and dissemination. We interviewed 22 pastors and church staff and analyzed transcripts using an iterative-deductive team approach. Results: Pastors and church staff described barriers and facilitators to implementation within three domains of CFIR: characteristics of individuals (lack of self-efficacy for and knowledge of physical activity; influence on churchgoers’ behaviors), inner setting (church culture and norms, alignment with mission and values, competing priorities, lack of resources), and outer setting (need for buy-in from senior leadership). From the interviews, we identified four promising implementation strategies for the scale-up of faith-based health promotion programs: 1) health behavior change training for pastors and staff; 2) tailored messaging; 3) developing community collaborations; and 4) gaining denominational support.Conclusions: While churches can serve as valuable partners in health promotion, specific barriers and facilitators to implementation must be recognized and understood. Addressing these barriers through targeted implementation strategies at the adopter and organizational level can facilitate improved program implementation and lead the way for scale-up and dissemination.


2020 ◽  
Author(s):  
Jessica Haughton ◽  
Michelle L. Takemoto ◽  
Jennifer Schneider ◽  
Steven P. Hooker ◽  
Borsika Rabin ◽  
...  

Abstract Background Stakeholder engagement is critical to the acceleration of evidence-based interventions into community settings. Harnessing the knowledge and opinions of community stakeholders increases the likelihood of successful implementation, scale up, and sustainment of evidence-based interventions. Faith in Action ( Fe en Acción ) is an evidence-based promotora -led physical activity program designed to increase moderate-to-vigorous physical activity among churchgoing Latina women. Methods We conducted in-depth interviews using a semi-structured interview guide based on the Consolidated Framework for Implementation Research (CFIR) at various Catholic and Protestant churches with large Latino membership in San Diego County, California to explore barriers and facilitators to implementation of a Faith in Action and to identify promising implementation strategies for program scale-up and dissemination. We interviewed 22 pastors and church staff and analyzed transcripts using an iterative-deductive team approach. Results Stakeholders described barriers and facilitators to implementation within three domains of CFIR: characteristics of individuals (lack of self-efficacy for and knowledge of PA; influence on churchgoers’ behaviors), inner setting (church culture and norms, alignment with mission and values, competing priorities, lack of resources), and outer setting (need for buy-in from senior leadership). From the interviews, we identified four promising implementation strategies for the scale-up of faith-based health promotion programs: 1) health behavior change training for pastors and staff; 2) tailored messaging; 3) developing community collaborations; and 4) gaining denominational support. Conclusions While churches can serve as valuable partners in health promotion, specific barriers and facilitators to implementation must be recognized and understood. Addressing these barriers through targeted implementation strategies at the adopter and organizational level can facilitate improved program implementation and lead the way for scale-up and dissemination.


2020 ◽  
Author(s):  
Jessica Haughton ◽  
Michelle L. Takemoto ◽  
Jennifer Schneider ◽  
Steven P. Hooker ◽  
Borsika Rabin ◽  
...  

Abstract Background: Stakeholder engagement is critical to the acceleration of evidence-based interventions into community settings. Harnessing the knowledge and opinions of community stakeholders increases the likelihood of successful implementation, scale up, and sustainment of evidence-based interventions. Faith in Action ( Fe en Acción ) is an evidence-based promotora -led physical activity program designed to increase moderate-to-vigorous physical activity among churchgoing Latina women.Methods: We conducted in-depth interviews using a semi-structured interview guide based on the Consolidated Framework for Implementation Research (CFIR) at various Catholic and Protestant churches with large Latino membership in San Diego County, California to explore barriers and facilitators to implementation of a Faith in Action and to identify promising implementation strategies for program scale-up and dissemination. We interviewed 22 pastors and church staff and analyzed transcripts using an iterative-deductive team approach.Results: Stakeholders described barriers and facilitators to implementation within three domains of CFIR: characteristics of individuals (lack of self-efficacy for and knowledge of PA; influence on churchgoers’ behaviors), inner setting (church culture and norms, alignment with mission and values, competing priorities, lack of resources), and outer setting (need for buy-in from senior leadership). From the interviews, we identified four promising implementation strategies for the scale-up of faith-based health promotion programs: 1) health behavior change training for pastors and staff; 2) tailored messaging; 3) developing community collaborations; and 4) gaining denominational support.Conclusions: While churches can serve as valuable partners in health promotion, specific barriers and facilitators to implementation must be recognized and understood. Addressing these barriers through targeted implementation strategies at the adopter and organizational level can facilitate improved program implementation and lead the way for scale-up and dissemination.


Author(s):  
Marian Kelly ◽  
Rachel Laxer ◽  
Daniel Harrington

Introduction: The Healthy Kids Community Challenge (HKCC) was a community-based, multi-stakeholder obesity prevention program aimed at children and youth in Ontario, which was funded and coordinated by the Ministry of Health and Long-term Care from 2015-2018. This project contributed to the process evaluation of the HKCC, which is being carried out by Public Health Ontario. The objective of my research was to identify and understand the barriers and facilitators to implementation of the HKCC, from the perspective of members of the Local Steering Committees (LSCs), who were directly involved in implementation. Methods: 10 questions from the 2018 LSC Survey were coded and thematically analyzed, using NVivo 11.0 software, according to the themes presented within Durlak and Dupre’s Ecological Framework for Effective Implementation. Themes were summarized according to barriers, challenges, factors associated with implementation, strategies communities used to engage partners and reach vulnerable populations, as well as positive experiences. The findings were presented in a report which featured a rich, qualitative account, accompanied by direct quotations and code frequency charts. Results: A number of perceived barriers to implementation were identified, including program structure (i.e., tight timelines, short duration), low SES (i.e., barriers related to lack of time, transportation and access to childcare, as well as difficulty accessing HKCC information) and geography and transportation (i.e., to access programming). Some important perceived facilitators of implementation included: funding, partnerships, HKCC messaging, and an inclusive, accessible approach to planning events. Participants expressed interest in sustaining programs and partnerships beyond the HKCC funding period, although the loss of provincial funding was identified as a challenge. Participants also noted potential for sustainability, particularly related to increased cross-sectoral collaboration and increased capacity for community-based health promotion. Implications: The results could be used to improve implementation of future community-based, multi-stakeholder health promotion programs. They might also offer insight into how to tailor the implementation process of large-scale community-based health promotion programs to local contexts.


2018 ◽  
Vol 2 (S1) ◽  
pp. 13-13
Author(s):  
Rosemary Nabaweesi ◽  
Mary Aitken ◽  
Keneshia Bryant-Moore ◽  
Geoffrey M. Curran

OBJECTIVES/SPECIFIC AIMS: This abstract describes a recently-funded 2 year study that aims to: (1) explore the community advisors’ perspectives of the safe sleep intervention’s acceptability, feasibility, and adaptability using focus groups and key informant interviews. (2) Adapt the selected safe sleep interventions (SSI) and identify promising implementation strategies to support it through an evidence-based quality improvement process with a multistakeholder group. METHODS/STUDY POPULATION: Background sudden unexpected infant death (SUID) is the leading cause of post-neonatal infant death in the United States. Sudden infant death syndrome (SIDS), accidental suffocation and strangulation in bed account for over 50% of SUID, leading to recommendations for supine sleep position and safer sleep environments for infants. However, despite significant reductions in SIDS after “back to sleep” and “safe to sleep” campaigns, significant racial and urban-rural disparities persist. In 2015, the rural-urban crude death rate ratio was 4:1 and Black infants are twice as likely to die from SUID as White infants. Adherence to safe sleep recommendations is highly variable and a number of hospital and community-based interventions have been suggested to improve knowledge and change parent behavior. Hospital programs to promote safe sleep education and policies may serve to educate families about safe sleep, but may not be uniformly available in rural and underserved areas. The AAP evidence-based safe sleep guidelines have demonstrated reductions in SIDS and SUID when child caregivers adhere to them. Community-based SSI, including safety baby showers, promote safe sleep practices, but barriers may exist for participation, especially in rural areas. Partnering with community groups serving a high risk area, we will explore the barriers and facilitators to more widespread safety baby shower (SBS) delivery/adoption in rural underserved communities (RUC). Observation of the evidence-based SBS as it is currently delivered, focus groups and key informant interviews will be conducted with program leaders and participants. Based on this knowledge and using an evidence-based development process, we will adapt the SBS and identify implementation strategies to support its uptake in RUC. RESULTS/ANTICIPATED RESULTS: We expect to develop a modified safe sleep intervention that reaches more expectant and new mothers is more efficient at delivering safe sleep guidelines to rural community members and can be more readily adopted and implemented by RUC. Supporting implementation strategies will be identified during the formative evaluation. DISCUSSION/SIGNIFICANCE OF IMPACT: Developing a safe sleep intervention adapted for the local context through a collective decision-making process between intervention experts and local community advisors will potentially improve safe sleep guideline delivery and adherence in RUC. The next study will pilot test the effectiveness of the adapted safe sleep intervention with identified supporting implementation strategies.


2001 ◽  
Vol 28 (3) ◽  
pp. 290-305 ◽  
Author(s):  
Meg Montague ◽  
Ron Borland ◽  
Craig Sinclair

The Anti-Cancer Council of Victoria has been running sun protection programs for more than 20 years: Slip! Slop! Slap! from 1980 to 1988 and SunSmart from 1988 to the present. The Victorian Health Promotion Foundation has provided funding for the SunSmart program for the past 13 years. These programs have played an important role in changing the whole society’s approach to the sun and have resulted in marked reductions in sun exposure. This article describes the social, political, economic, and organizational context within which these programs developed. Then 10 areas are discussed that illustrate a critical aspect of the development and implementation of this successful systemwide health promotion program. These areas focus on key aspects of the context within which the program operates and on issues that derive from the experience of implementing program strategies. In summary, the success of the two programs is described as having been built on two key foundations: the vital integration of research and evaluation, on one hand, and a strong basis of consistency and continuity, on the other.


Author(s):  
Bernd Schulte ◽  
Christina Lindemann ◽  
Angela Buchholz ◽  
Anke Rosahl ◽  
Martin Härter ◽  
...  

Abstract. Background: The German Guideline on Screening, Diagnosis and Treatment of Alcohol Use Disorders aims to increase the uptake of evidence-based interventions for the early identification, diagnosis, prevention and treatment of alcohol-related disorders in relevant healthcare settings. To date, dissemination has not been accompanied by a guideline implementation strategy. The aim of this study is to develop tailored guideline implementation strategies and to field-test these in relevant medical and psycho-social settings in the city of Bremen, Germany. Methods: The study will conduct an impact and needs assessment of healthcare provision for alcohol use orders in Bremen, drawing on a range of secondary and primary data to: evaluate existing healthcare services; model the potential impact of improved care on public health outcomes; and identify potential barriers and facilitators to implementing evidence-based guidelines. Community advisory boards will be established for the selection of single-component or multi-faceted guideline implementation strategies. The tailoring approach considers guideline, provider and organizational factors shaping implementation. In field tests quality outcome indicators of the delivery of evidence-based interventions will be evaluated accompanied by a process evaluation to examine patient, provider and organizational factors. Outlook: This project will support the translation of guideline recommendations for the identification, prevention and treatment of AUD in routine practice and therefore contributes to the reduction of alcohol-related burden in Germany. The project is running since October 2017 and will provide its main outcomes by end of 2020. Project results will be published in scientific journals and presented at national and international conferences.


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