Abstract
BackgroundUse of technology is increasing in health promotion and has continued growth potential in intervention research. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this paper reports on the adoption, reach, and implementation of Project HEAL (Health through Early Awareness and Learning)—a community-based implementation trial of a cancer educational intervention in 14 African American churches. We compare adoption, reach, and implementation at the organizational and participant level for churches in which lay peer community health advisors (CHAs) were trained using traditional classroom didactic methods compared with a new online system.MethodsFifteen churches were randomized to one of two study groups in which two CHAs per church were trained through either classroom (“Traditional”; n = 16 CHAs in 8 churches) or web-based (“Technology”; n = 14 CHAs in 7 churches) training methods. Once trained and certified, all CHAs conducted a series of three group educational workshops in their churches on cancer early detection (breast, prostate, and colorectal). Adoption, reach, and implementation were assessed using multiple data sources including church-level data, participant engagement in the workshops, and study staff observations of CHA performance.ResultsThe project had a 41% overall adoption rate at the church level. In terms of reach, a total of 375 participants enrolled in Project HEAL—226 participants in the Traditional group (43% reach) and 149 in the Technology group (21% reach; p < .10). Implementation was evaluated in terms of adherence, dosage, and quality. All churches fully completed the three workshops; however, the Traditional churches took somewhat longer (M = 84 days) to complete the workshop series than churches in the Technology group (M = 64 days). Other implementation outcomes were comparable between both the Traditional and Technology groups (p > .05).ConclusionsOverall, the Project HEAL intervention had reasonable adoption, though reach could have been better. Implementation was strong across both study groups, suggesting the promise of using web-based methods to disseminate and implement evidence-based interventions in faith-based settings and other areas where community health educators work to eliminate health disparities.
Highlights
Use of technology is increasing in health promotion and has continued growth potential in intervention research
Guided by the RE-AIM framework [5], we report on adoption, reach, and implementation outcomes at the organizational and participant (CHA and workshop participant) levels from an implementation trial in which lay peer community health advisors (CHAs) were trained using traditional classroom didactic methods compared with a new webbased system
Project HEAL illustrated that use of a web-based portal for training lay, peer CHAs resulted in implementation outcomes comparable to use of a traditional classroom CHA training approach
Summary
Use of technology is increasing in health promotion and has continued growth potential in intervention research. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this paper reports on the adoption, reach, and implementation of Project HEAL (Health through Early Awareness and Learning)—a community-based implementation trial of a cancer educational intervention in 14 African American churches. Implementation research aims to close this gap by identifying and evaluating the processes necessary to ensure successful widespread translation of evidence-based interventions (EBIs) into real world settings [2,3,4]. Utilizing the the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework [1, 5, 6] to evaluate implementation outcomes can be an effective approach to delineating between intervention and implementation failure. Effective e-health interventions have been documented over a wide array of health topics including, but not limited to, smoking cessation, weight management, anxiety and depression, and asthma management [11]
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