Aspects Of Program Implementation Research Articles

A scoping review of the implementation and cultural adaptation of school-based mental health promotion and prevention interventions in low-and middle-income countries.

Effective school-based mental health promotion and prevention interventions in low-and middle-income countries (LMICs) can positively impact the mental health and well-being of large numbers of young people. This scoping review aimed to investigate the implementation of effective mental health promotion and prevention interventions in LMIC schools. A scoping review of the international literature was conducted and followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. Medline, PsycInfo, Scopus, Embase, CINAHL and Cochrane were searched for peer-reviewed literature published from 2014 to 2022. PsycExtra, Google Scholar and the websites of key organisations were searched for relevant grey literature. Study selection focussed on mental health promotion interventions, including the development of social and emotional skills and mental health literacy, and prevention interventions, including anti-bullying and skill-based interventions for "at-risk" students. Twenty-seven studies evaluating 25 school-based interventions in 17 LMICs were included in the review. Fifteen interventions were developed in the implementing country and 10 were adapted from high-income countries (HICs) or other settings. Findings from the studies reviewed were generally positive, especially when interventions were implemented to a high quality. Universal life-skills interventions were found to increase social and emotional skills, decrease problem behaviours and positively impact students' mental health and well-being. Mental health literacy interventions increased mental health knowledge and decreased stigma among students and school staff. Outcomes for externally facilitated anti-bullying interventions were less positive. All 19 effective studies reported on some aspects of programme implementation, and 15 monitored implementation fidelity. Eleven studies outlined the programme's underpinning theoretical model. Only four studies reported on the cultural adaptation of programmes in detail. Including young people in the adaptation process was reported to facilitate natural cultural adaptation of programmes, while input from programme developers was considered key to ensuring that the core components of interventions were retained. The review findings indicate increasing evidence of effective mental health interventions in LMIC schools. To facilitate the sustainability, replication and scaling-up of these interventions, greater attention is needed to reporting on intervention core components, and the processes of implementation and cultural adaptation in the local setting.

Implementasi Desentralisasi Fiskal dalam Kebijakan Transfer Dana ke Daerah Pada Realisasi Anggaran Pendapatan dan Belanja Negara Tahun 2021

Fiscal decentralization has been officially implemented in Indonesia since the beginning of the reform, to be precise since January 2001, and implemented to create regional self-reliance. With the regional autonomy policy and fiscal decentralization, every region in Indonesia receives a large delegation of authority. In 2020, the Covid-19 Pandemic rocked the Indonesian economy. Economic growth continued to decline and had a negative impact on the people's economy, in addition to influencing the Transfer to Regions and Village Fund (TKDD) policies. Regional Governments are given the authority to prioritize the use of budget allocations for specific programs (refocusing), change allocations, and use the Regional Revenue and Expenditure Budget (APBD). Merilee S. Grindle's theory of implementation is the rationale for this research, focusing on aspects of the desired degree of change, location of decision-making, program implementation, and level of compliance and responsiveness. Regarding the desired degree of change, regional governments must reallocate budgets and refocus programs according to the central government's regulations. Aspects of program implementation, budget reallocation, and refocusing programs in several regions were successfully carried out. Aspects of the location of decision-making appropriate policies by prioritizing the health, social, economic, and regional financial sectors. While the aspects of compliance and responsiveness show that the policy has yet to be realized optimally, several problems were found in its implementation.

The Importance of Implementation Fidelity for Teacher-Related Changes Within the Olweus Bullying Prevention Program

Although teachers are key figures of a program’s effectiveness, most intervention studies to date have not explored how anti-bullying programs are associated with changes at teacher level. Moreover, teacher data also informs about aspects of program implementation, which are essential in program evaluations. Therefore, the aim of this study was to gain insight into the perspectives of teachers working with the Olweus Bullying Prevention Program (OBPP). A scientific evaluation of the OBPP was carried out in 21 German schools. In addition to annual student surveys, regular teacher surveys were conducted. Ordered logistic regressions and linear regressions were used to estimate the variables. As we expected a dosage-response effect, we divided the schools by level of implementation (non-completer, completer, and certified Olweus schools). At baseline, 615 teachers took part in the assessment (68.26%), and 388 teachers at postline 2 years later (47.32%). A positive change in teachers’ intention to intervene in bullying could be found across all schools (p < .001), which was only significant for completer (p < .001) and certified schools (p = .004) when differentiated by implementation level. Teachers’ level of job strain did not change at all (non-significant model fit), while an improvement in school climate only emerged for certified schools (p = .003). The moderating effect of the implementation level turned out to be independent of different school characteristics. The self-reported changes at the teacher level depended on the level of program implementation. Therefore, it is essential to record data about the intensity of program activities when evaluating a program.Trial registration number: DRKS00008202 (date of registration: 08/04/2015).

Creating relationship‐based practice in youth employment services—Converting policy intentions to practical program design

AbstractRelationship‐based practice refers to approaches within human services which centralise inter‐personal relationships—either those between clients and workers or between clients and their own network—as a way to achieve positive service outcomes. Relationship‐based practice is increasingly recognised as a critical component in many areas of human services, particularly youth services. Despite increasing policy intentions for programs to adopt a relationship‐based approach, it is not always clear how services can implement this in practice. While relationship‐based skill training can be offered to individual workers, a question remains as to what can be done at an organisational and policy level to cultivate relationship‐based practice. Within this context, this paper explores how programs can be designed to foster relationship‐based practice. The paper draws on the evaluation of an intensive and tailored service for addressing long‐term youth unemployment in Australia: the your job your way pilot program run by yourtown. A key success of the program was strong relationship‐based practice, and this paper explores five features of the program's design that enabled this: (1) small caseloads, (2) intensive support, (3) staff with complementary skills and a professional and ‘youth friendly’ demeanour, (4) staff discretion about some aspects of program implementation, and (5) support delivered through social and group activities. The paper draws implications for how service provider organisations and governments can cultivate relationship‐based practice in human services.

Tracking Adaptation and Fidelity When Embedding COPE, Evidence-Based Dementia Care, in PACE Sites

One essential question in moving dementia care interventions to practice is, “What is the optimal balance between fidelity to, and adaptation of, a proven program in “real world” settings?" We present a protocol for measuring the adaptation/fidelity and implementation of an evidence-based dementia care program (Care of Persons in their Environment, COPE) in PACE settings. During pre-implementation, science-based elements of COPE were documented including the theory of change, logic model and core components. Possible adaptations to COPE in its delivery were identified and included program structure (sequence of sessions), content (assessments), and delivery methods (online). During implementation, documentation of implementation strategies is captured using an evidence-informed checklist derived from the Expert Recommendations for Implementing Change (ERIC) workgroup. Ongoing documentation of fidelity/adaptation aspects of program implementation is conducted using the FRAME framework. Understanding methods and measures deployed in adaptation and implementation of evidence-based dementia programs can help guide future translation efforts.

Can an electronic monitoring system capture implementation of health promotion programs? A focussed ethnographic exploration of the story behind program monitoring data

BackgroundThere is a pressing need for policy makers to demonstrate progress made on investments in prevention, but few examples of monitoring systems capable of tracking population-level prevention policies and programs and their implementation. In New South Wales, Australia, the scale up of childhood obesity prevention programs to over 6000 childcare centres and primary schools is monitored via an electronic monitoring system, “PHIMS”.MethodsVia a focussed ethnography with all 14 health promotion implementation teams in the state, we set out to explore what aspects of program implementation are captured via PHIMS, what aspects are not, and the implications for future IT implementation monitoring systems as a result.ResultsPractitioners perform a range of activities in the context of delivering obesity prevention programs, but only specific activities are captured via PHIMS. PHIMS thereby defines and standardises certain activities, while non-captured activities can be considered as “extra” work by practitioners. The achievement of implementation targets is influenced by multi-level contextual factors, with only some of the factors accounted for in PHIMS. This evidences incongruencies between work done, recorded and, therefore, recognised.ConclusionsWhile monitoring systems cannot and should not capture every aspect of implementation, better accounting for aspects of context and “extra” work involved in program implementation could help illuminate why implementation succeeds or fails. Failure to do so may result in policy makers drawing false conclusions about what is required to achieve implementation targets. Practitioners, as experts of context, are well placed to assist policy makers to develop accurate and meaningful implementation targets and approaches to monitoring.

Community activism as a strategy to reduce intimate partner violence (IPV) in rural Rwanda: Results of a community randomised trial.

BackgroundThere is considerable interest in community organising and activism as a strategy to shift patriarchal gender norms, attitudes and beliefs and thus reduce intimate partner violence (IPV). Yet there is limited insight into how activism actually translates into reduced violence, including how aspects of programme implementation or cultural context may affect impact. This study evaluates the community activism/mobilisation portion of Indashyikirwa, a multi-component, IPV prevention programme implemented in rural Rwanda. The activism part of Indashyikirwa was based on SASA!, a promising program model from Uganda with demonstrated effectiveness.MethodsWe implemented two separate cross-sectional surveys as part of a larger community randomised controlled trial to assess the impact of the community portion of Indashyikirwa on preventing physical and/or sexual IPV and other secondary outcomes at a community level. The survey consisted of a random household-based sample of 1400 women and 1400 men at both waves. Surveys were conducted before community-level activities commenced and were repeated 24 months later with a new cross-sectional sample. Longitudinal, qualitative data were collected as part of an embedded process evaluation.ResultsThere was no evidence of an intervention effect at a community level on any of the trial’s primary or secondary outcomes, most notably women’s experience of physical and/or sexual IPV from a current male partner in the past 12 months (adjusted odds ratio (aOR) = 1.25; 95% confidence interval (CI) = 0.92-1.70, P = 0.16), or men’s perpetration of male-to-female physical and/or sexual IPV (aOR = 1.02; 95% CI = 0.72-1.45, P = 0.89). Process evaluation data suggest that delays due to challenges in adapting and implementing SASA!-style activites in rural Rwanda may account for the trial’s failure to measure an effect. Additionally, the intervention strategy of informal activism was not well suited to the Rwandan context and required considerable modification.ConclusionsFailure to reduce violence when implementing an adaptation of SASA! in rural Rwanda highlights the importance of allowing sufficient time for adapting evidence-based programming (EBP) to ensure cultural appropriateness and fidelity. This evaluation held little chance of demonstrating impact since the project timeline forced endline evaluation only months after certain elements of the programme became operational. Donors must anticipate longer time horizons (5 to 7 years) when contemplating evaluations of novel or newly-adapted programmess for reducing IPV at a population level. These findings also reinforce the value of including embedded process evaluations when investing in rigorous trials of complex phenomena such as community activism.Trial registrationClinicalTrials.gov, NCT03477877

Evaluation of results-based financing in the Republic of the Congo: a comparison group pre–post study

Results-based financing (RBF) has been advocated and increasingly scaled up in low- and middle-income countries to increase utilization and quality of key primary care services, thereby reducing maternal and child mortality rates. This pilot RBF study in the Republic of the Congo from 2012 to 2014 used a quasi-experimental research design. The authors conducted pre- and post-household surveys and gathered health facility services data from both intervention and comparison groups. Using a difference-in-differences approach, the study evaluated the impact of RBF on maternal and child health services. The household survey found statistically significant improvements in quality of services regarding the availability of medicines, perceived quality of care, hygiene of health facilities and being respected at the reception desk. The health facility survey showed no adverse effects and significantly favourable impacts on: curative visits, patient referral, children receiving vitamin A, HIV testing of pregnant women and assisted deliveries. These improvements, in relative terms, ranged from 42% (assisted deliveries) to 155% (children receiving vitamin A). However, the household survey found no statistically significant impacts on the five indicators measuring the use of maternal health services, including the percentage of pregnant women using prenatal care, 3+ prenatal care, postnatal care, assisted delivery, and family planning. Surprisingly, RBF was found to be associated with a reduction of coverage of the third diphtheria, pertussis, and tetanus immunization among children in the household survey. From the health facility survey, no association was found between RBF and full immunization among children. Overall, the study shows a favourable impact of an RBF programme on most, but not all, targeted maternal and child health services. Several aspects of programme implementation, such as timely disbursement of incentives, monitoring health facility performance, and transparency of using funds could be further strengthened to maximize RBF's impact.

PROTOCOL: Strategies for scaling up the implementation of interventions in social welfare: protocol for a systematic review.

PROTOCOL: Strategies for scaling up the implementation of interventions in social welfare: protocol for a systematic review.

Health promotion in schools: a scoping review of systematic reviews

Purpose – Schools are an important setting for a wide variety of activities to promote health. The purpose of this paper is to map the different types of health promotion programmes and activities in schools, to estimate the amount of published evaluations of health promotion within UK schools, and to identify any provisional “candidate programme theories” to inform a planned theory-driven systematic review. Design/methodology/approach – Review of reviews: in total, 67 published systematic reviews of health promotion in schools were identified, from which a sub-sample of 28 systematic reviews (on 14 health topics) were retrieved for more detailed reading. Findings – Key dimensions of programme design and delivery fell mainly under the following categories: the problem and age-group of children targeted, who delivers the programme and how, and the scale and theoretical underpinning of the programme. Candidate programme theories spanned both effectiveness factors and aspects of programme implementation. Research limitations/implications – Few detailed “candidate theories” emerged for explaining how and why health promotion can more successfully implemented in different schools. Practical implications – There are five or more systematic reviews of studies of health promotion programmes in schools which target: smoking prevention; physical activity; sexual health; emotional and behavioural health and well-being; mental health; substance abuse; obesity/overweight. This suggests probable duplication of health problem-specific systematic reviews. Originality/value – The findings highlight the considerable diversity of health promotion in schools, and specifies key dimensions of this diversity. They underline the need to understand better how, why, and in what circumstances health promotion can be successfully implemented in different schools and education systems.

Process evaluation outcomes from a global child obesity prevention intervention.

BackgroundWhile it is acknowledged that child obesity interventions should cover multiple ecological levels (downstream, midstream and upstream) to maximize their effectiveness, there is a lack of evaluation data to guide the development and implementation of such efforts. To commence addressing this knowledge gap, the present study provides process evaluation data relating to the experiences of groups implementing the EPODE approach to child obesity prevention in various locations around the world. The aim of this exploratory study was to investigate the barriers and facilitators to program implementation in program sites around the world to assist in developing strategies to enhance program outcomes.MethodsAn online survey that included open-ended questions was distributed to the 25 EPODE programs in operation at the time of the survey (May 2012). The survey items asked respondents to comment on those aspects of program implementation that they found challenging and to suggest areas for future improvement. Eighteen programs representing 14 countries responded to the request to participate in the survey, yielding a 72% response rate. The responses were analyzed via the constant comparative method using NVivo qualitative data analysis software.ResultsThe main concerns of the various EPODE programs were their ability to secure ongoing funding and their access to evidence-based intervention methods and policy advice relating to relationships with third parties. These issues were in turn impacted by other factors, including (i) access to user-friendly information relating to the range of intervention strategies available and appropriate evaluation measures; (ii) assistance with building and maintaining stakeholder relationships; and (iii) assurance of the quality, independence, and transparency of policies and practices.ConclusionsThe findings are facilitating the ongoing refinement of the EPODE approach. In particular, standardized and tailored information packages are being made available to advise program members of (i) the various evaluation methods and tools at their disposal and (ii) methods of acquiring private partner support. Overall, the study results relating to the types of issues encountered by program members are likely to be useful in guiding the future design and implementation of multi-level initiatives seeking to address other complex and intractable health-related problems.

Measuring Implementation of a School-Based Violence Prevention Program

When school-based prevention programs are put into practice, evaluation studies commonly only consider one indicator of program implementation. The present study investigates how two different aspects of program implementation – fidelity and participant responsiveness – jointly influence proximal outcomes of the school-based violence prevention program ViSC. The program was implemented in 20 schools across Austria. Trainers conducted in-school teacher trainings with varying implementation fidelity to the program schedule. In a two-wave evaluation study, 370 teachers provided data about their participant responsiveness and the program’s proximal outcomes. The latter comprised their self-efficacy to stop violence among students and their behavior in bullying situations. Multilevel analyses showed that teachers’ self-efficacy was significantly more enhanced in schools where the ViSC program had been implemented with high fidelity. Furthermore, only teachers with high participant responsiveness significantly changed their behavior in bullying situations. Implications for program developers and suggestions for further research on implementation are discussed.

Implementation of the extension phase of the project P.A.T.H.S. in Hong Kong: observations based on the Co-Walker Scheme

The implementation quality of the Tier 1 Program (Secondary 1 Program) of the Project P.A.T.H.S. in the second year of the Extension Phase was examined in this study, with classroom observations of 218 units in 172 schools. Results demonstrated that the overall level of program adherence was generally high with an average of over 90%. Different aspects regarding program delivery were significantly correlated, suggesting that different aspects of program implementation were intimately related. Regarding predictors of global implementation quality, analyses indicated that overall implementation quality was significantly predicted by interactive delivery method, achievement of objectives, time management, and lesson preparation; success of implementation was predicted by student participation and involvement, interactive delivery method, achievement of objectives, and time management. The present study replicated the findings in previous studies.

Cervical cancer screening in Serbia

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Transformation of the California Mental Health System: Stakeholder-Driven Planning as a Transformational Activity

This study describes strategies developed by California counties to transform their mental health systems under the 2004 Mental Health Services Act (MHSA). This voter initiative places a 1% tax on annual incomes over $1 million; tax monies are earmarked to transform county-operated mental health services into systems that are oriented more toward recovery. MHSA implementation itself can be considered "transformational" by balancing greater standardization of mental health service delivery in the state with a locally driven planning process. A qualitative content analysis of the three-year plans submitted by 12 counties to receive funds under MHSA was conducted to identify common themes, as well as innovative approaches. These 12 (out of 58) counties were chosen to represent both small and large counties, as well as geographic diversity, and they represent 62.3% of the state population. This analysis showed that the state guidelines and local planning process generated consistency across counties in establishing full-service partnerships with a "whatever it takes" approach to providing goal-directed services and supports to consumers and their families. There was, however, little convergence around the specific strategies to achieve this vision, reflecting both the local planning process and a relative lack of clear policy and guidance on evidence-based practices. There are many obstacles to the successful implementation of these ambitious plans. However, the state-guided, but stakeholder-driven, transformation in California appears to generate innovative approaches to recovery-oriented services, involve consumers and family members in service planning and delivery, and build community partnerships that create new opportunities for consumers to meet their recovery goals.

Transformation of the California Mental Health System: Stakeholder-Driven Planning as a Transformational Activity

Transformation of the California Mental Health System: Stakeholder-Driven Planning as a Transformational Activity

The Complexity of Measuring the Quality of Program Implementation With Observations

In the growing literature on the evaluation of program implementation, less has been said about evaluating program quality than about evaluating other aspects of program implementation. Furthermore, most articles and reports in the program-implementation evaluation literature have presented only brief descriptions of how implementation instruments have been developed. In this article, the authors describe a method for evaluating the quality of implementation of middle school inquiry-based science using data from observations scaled with paired comparison judgments. The authors show the complexities of developing and applying the method, describe how they tried it out, present the results of validity and reliability analyses, and describe the method's strengths and weaknesses.

HIVCORPS: USING VOLUNTEERS TO RAPIDLY EXPAND HIV HEALTH SERVICES ACROSS ZAMBIA

In 2004, we created HIVCorps, an international volunteer program to involve pre-medical, medical, and public health students in the scale-up of HIV care and prevention services in Zambia. In our first year, we used 27 American and Zambian volunteers to assist with the administrative and logistical aspects of program implementation. Ten volunteers were based in the capital Lusaka; the remaining 17 were stationed across five rural districts. Supervision was provided by local health care providers, district officials, and hospital administrators. In our setting, the use of volunteers has proven feasible and effective for program support. Depending on a program's immediate needs, use of many basic field personnel may be more beneficial than employment of one to two trained clinicians. Formal volunteer programs like HIVCorps should be developed alongside initiatives focused on deploying more specialized, experienced healthcare workers aboard.

Effectiveness of comprehensive tobacco control programmes in reducing teenage smoking in the USA

OBJECTIVETo describe the extent to which comprehensive statewide tobacco control programmes in the USA have made progress toward reducing teenage smoking.DATA SOURCESLiterature search of Medline for reviews of effectiveness of...

Implementing a comprehensive program for the prevention of conduct problems in rural communities: the Fast Track experience. The Conduct Problems Prevention Research Group.

Childhood conduct problems are predictive of a number of serious long-term difficulties (e.g., school failure, delinquent behavior, and mental health problems), making the design of effective prevention programs a priority. The Fast Track Program is a demonstration project currently underway in four demographically diverse areas of the United States, testing the feasibility and effectiveness of a comprehensive, multicomponent prevention program targeting children at risk for conduct disorders. This paper describes some lessons learned about the implementation of this program in a rural area. Although there are many areas of commonality in terms of program needs, program design, and implementation issues in rural and urban sites, rural areas differ from urban areas along the dimensions of geographical dispersion and regionalism, and community stability and insularity. Rural programs must cover a broad geographical area and must be sensitive to the multiple, small and regional communities that constitute their service area. Small schools, homogeneous populations, traditional values, limited recreational, educational and mental health services, and politically conservative climates are all more likely to emerge as characteristics of rural rather than urban sites (Sherman, 1992). These characteristics may both pose particular challenges to the implementation of prevention programs in rural areas, as well as offer particular benefits. Three aspects of program implementation are described in detail: (a) community entry and program initiation in rural areas, (b) the adaptation of program components and service delivery to meet the needs of rural families and schools, and (c) issues in administrative organization of a broadly dispersed tricounty rural prevention program.