P45 Identifying Barriers and Facilitators to Implementing Policy, Systems, and Environmental Change Work in Cooperative Extension Using the Consolidated Framework for Implementation Research

Abstract

<h3>Background</h3> Following guidance provided in the 2014 National Framework for Health and Wellness, Cooperative Extension (CE) nutrition education programs in Louisiana shifted towards making policy, systems, and environmental (<i>P</i>SE) changes to promote healthy eating and increased physical activity according to the social-ecological model of behavior change. The transition to PSE work from an exclusive focus on direct nutrition education posed challenges for CE staff in Louisiana. In order to better understand barriers and facilitators to implementing PSE change work, we conducted qualitative semi-structured interviews with CE staff using constructs from the Consolidated Framework for Implementation Research (CFIR). <h3>Objective</h3> To identify CE staff's perceived barriers and facilitators to implementing PSE change interventions according to CFIR constructs. <h3>Study Design, Setting, Participants</h3> Qualitative semi-structured interviews were conducted with 5 Cooperative Extension staff using an interview guide with questions based on constructs from the Consolidated Framework for Implementation Research (CFIR). <h3>Measurable Outcome/Analysis</h3> Interviews were transcribed verbatim. Transcripts were independently coded by 2 researchers using codes defined a prori according to CFIR constructs. Coding differences were resolved through consensus. <h3>Results</h3> Though all 39 CFIR constructs were relevant, 16 emerged through interviews with CE agents as either barriers or facilitators to the implementation of PSE change work. The adaptability of PSE work and its relative advantage over traditional direct education emerged as major facilitators to its implementation. Major barriers to the implementation of PSE change work included the relative priority of PSE change work within CE agents' organizations, the complexity of PSE change work, and a lack of resources to support implementation. <h3>Conclusions</h3> Implementing PSE change work poses a challenge for CE staff who have traditionally conducted only direct nutrition education programs. Cooperative Extension programs should ensure PSE change work is presented as a priority to all staff within the organization. Training materials for PSE change work should prepare CE staff for the complexity of these interventions and emphasize their advantages over direct education.