Influence Program Implementation Research Articles

“Placing community in the driver's seat”: Key strategies and critical enablers of an equitable place-based COVID-19 vaccination response

Addressing health inequities requires both national and local-level action. In the case of COVID-19, locally-led place-based programs were instrumental in addressing vaccination inequities that resulted from implementation gaps in national and state-level universal COVID-19 vaccination programs. To prepare for future pandemics, understanding which local strategies are effective and the conditions that enable their effectiveness is crucial. We conducted a case study using qualitative interviews (n = 22) and document analysis to identify key strategies employed to increase vaccination uptake among priority populations in a regional community in Victoria, Australia, and the conditions perceived to enable or constrain the success of those strategies. Interviewees included Aboriginal and migrant community members (n = 12) and representatives from organisations that designed and implemented the COVID-19 vaccination program (n = 10). Strategies perceived to be effective by local migrant and Aboriginal communities included the location of outreach clinics (places considered physically, cultural and political accessible and safe), communication via trusted community leaders, practical supports such as translation services and transport, and empowering community in clinical interactions. Conditions perceived to influence program implementation and outcomes related to four themes: (i) shared vision and strong bonds of local partners, (ii) placing community in the driver's seat, (iii) rebalancing power through leadership grit and guts, and (iv) equity-enabling service and funding models. Our study supports strengthening of national and state government investment and engagement with local partnerships to place equity and community at the centre of future pandemic and public health responses.

Empowering pharmacy technicians as vaccine champions: A pilot study in independent community pharmacies

BackgroundIncreasing vaccine uptake in communities has been essential, even before coronavirus disease 2019. The use of "vaccine champions" or "VaxChamps" has shown promise. VaxChamps, who are often community members with specialized training but no special credentials, advocate for vaccination by sharing their experiences and knowledge. Pharmacy technicians’ scope of practice, coupled with their frequent interactions with pharmacy patients, make them ideal vaccine champions and a natural fit for the VaxChamp program. This study assessed the implementation and impact of the VaxChamp program in North Dakota community pharmacies. ObjectivesTo describe the development and implementation of the VaxChamp program in community pharmacies and evaluate its effect on vaccination rates and vaccine-related tasks within each pharmacy’s organizational context. MethodsThe VaxChamp program involved training one technician per participating pharmacy to spend 5 hours per week on vaccine-related tasks. Data collection included pre-post surveys, monthly reports, and semi-structured interviews with VaxChamps and pharmacists-in-charge from 6 pharmacies. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed using inductive methods to identify key themes. ResultsThe 6 participating pharmacies varied in location and staffing. Most had prior vaccine administration experience. VaxChamps’ roles ranged from administrative tasks to direct vaccine administration, depending on the pharmacy’s staffing and workflow. Vaccination rates for pneumococcal and hepatitis B vaccines increased in several pharmacies, while shingles vaccination rates declined. The presence of advanced pharmacy practice experience students often influenced VaxChamps’ responsibilities, underscoring the need for clear role delineation. ConclusionIntegrating pharmacy technicians as VaxChamps in community pharmacies is a promising strategy to increase vaccination rates and enhance public health. Future research should explore ways to better integrate technicians into comprehensive immunization strategies and address the contextual factors that influence program implementation.

Assessment of Standardized Care Plans for People with Chronic Diseases in Primary Care Settings.

Aging populations are driving a shift in emphasis toward enhancing chronic disease care, reflected in Catalonia's regional plan which prioritizes standardized nursing care plans in primary care settings. To achieve this, the ARES-AP program was established with a focus on harmonizing standards and supporting routine nursing clinical decision-making. This study evaluates nurses' perceptions of ARES-AP's standardized care plans for chronic diseases. A mixed-methods approach based on an ad hoc questionnaire (n = 141) and a focus group (n = 14) was used. Quantitative data were statistically analysed, setting significance at p < 0.05. Qualitative data were explored via content analysis. ARES-AP training was assessed positively. The resources for motivational interviewing and care plans for the most prevalent chronic diseases were rated very positively. This study identified key factors influencing program implementation, including facilitators such as structured information and nursing autonomy, barriers such as resistance to change, motivators such as managerial support, and suggested improvements such as technological improvements and time management strategies. This study identifies areas for improvement in implementing standardized nursing care plans, including additional time, motivation, enhanced IT infrastructure, and collaboration among primary care professionals. It enhances understanding of these plans in primary care, especially in managing chronic diseases in aging populations. Further research should assess the program's long-term impact on chronic patients. This study was not registered.

Program Plan Evaluation: A Participatory Approach to Bridge Plan Evaluation and Program Evaluation

Most program evaluation efforts concentrate on assessments of program implementation and program outcomes. However, another area of programs that has not received sufficient attention in the literature is evaluating the plan of the program. Since the quality of the plan and planning process can influence program implementation and outcomes, there is a need to expand program evaluation efforts to cover program plans, and thus bridge plan evaluation and program evaluation. This paper utilizes the program evaluation literature to illustrate two approaches to participatory program plan evaluation— ex-ante or proactive and ex-post or reactive—including a conceptual framework that identifies the requirements, barriers, and strategies for evaluating program plans. Concrete examples are provided to illustrate the application of these two approaches.

Abstract C109: Identifying implementation strategies to support cervical cancer screening programs in resource-limited countries through participatory action research

Abstract Background: Improving the adoption and integration of cervical cancer screening programs in resource-limited countries requires engaging with many local health system actors. We hypothesize that participatory design workshops co-developed by researchers, health system practitioners, and policy makers, facilitate rapid engagement to identify context-specific priorities and tailor strategies to improve implementation processes. Methods: With the Peruvian Ministry of Health (MOH), we co-designed a week-long workshop with health system actors (planners, providers, lab technicians) from the North District of Lima city. Through facilitated dialogue, participants engaged in self-reflection to map the cervical cancer screening and follow-up system, visualize system barriers, and identify potential solutions. As research partners, we analyzed findings from the workshop using the Consolidated Framework for Implementation Research, a framework from implementation science that identifies multilevel contextual factors that influence program implementation and guides the tailoring of strategies for improvement. Results: We identified three key context-specific challenges including 1) power hierarchies between specialists and midwives that obstruct the efficiency of screening services, 2) the complexities around communicating screening results, appointments, and referrals, are burdensome for patients and cause loss to follow up, and 3) implementation plans are not adequately matched to resources and workforce capacity. We identified feasible implementation strategies to address these challenges including 1) develop relationships between midwives and specialists through facilitated discussions to surface assumptions and align screening goals, 2) co-create counseling tools to help patients understand results and follow up steps for early detection and treatment of precancerous lesion that also reduce patients’ burden, and 3) Apply design workshops with key actors to develop an implementation plans to guide processes, acceptable adaptations, clinical workflows, and planning (ordering tests, supplies, training human resources, etc.) to align goals to prevention objectives and resources. Conclusions: Engaging with health systems actors through participatory action research is a strategy that enables collective learning, identifying context-specific priorities, and developing tailored implementation strategies that are likely to accelerate integration of sustainable cervical cancer screening programs globally. Citation Format: Margarita Correa-Mendez. Identifying implementation strategies to support cervical cancer screening programs in resource-limited countries through participatory action research [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C109.

Contributions and Partnership Strategies of External Stakeholders in the Implementation of the Alternative Learning System in Bontoc District: Insights from Teachers

The involvement and partnership of stakeholders have been identified as crucial factors influencing program implementation. This study focuses on examining the contributions and partnership strategies of external stakeholders involved in the implementation of the Alternative Learning System (ALS) program in Bontoc District, Mountain Province. Using a qualitative research design through interview, observation and focus group discussion, the study identified and described the contributions and partnership strategies of external stakeholders in the ALS program implementation, based on insights provided by the five ALS teachers in the district. Through thematic approach, the results show that external stakeholders play a significant role in the implementation of ALS programs in Bontoc District. They contribute through financial assistance and provision of learning spaces by the Municipal and Barangay Local Government Units, monetary and non-monetary donations from alumni, learning materials from the Provincial Local Government Unit (LGU), free skills trainings and certifications from Technical Education and Skills Development Authority (TESDA), and psychosocial support from parents. These contributions are the result of effective partnership strategies employed by the stakeholders, including resource sharing, collaboration with professional colleagues, engagement with alumni, and partnering with TESDA. ALS teachers recognize the value of these engagements in enhancing program implementation. However, they also acknowledge the need to strengthen partnerships with these stakeholders to fully leverage their potential for strengthening the ALS program implementation. Establishing networks and linkages with external stakeholders such as Non-Governmental Organizations (NGOs) and Higher Education Institutions (HEIs) is identified as a means to significantly enhance the curricular and instructional efficiency and effectiveness of the ALS program.

Contextual and Policy Influences on the Implementation of Prenatal Care Coordination.

Prenatal Care Coordination (PNCC) is a Medicaid fee-for-service that provides reimbursement for supportive services to mothers and infants at high risk of adverse outcomes. Services include health education, care coordination, referral to needed services, and social support. Currently, the implementation of PNCC programs is highly variable. We aimed to identify and describe the contextual factors that influence implementation of PNCC. Using a qualitative descriptive approach and theoretical reflexive thematic analysis techniques, we conducted observation and semistructured interviews with all PNCC staff at two PNCC sites in Wisconsin, representing diversity in region and patient population. We thematically analyzed interview data to examine how contextual factors influenced program implementation with the Consolidated Framework for Implementation Research as a sensitizing model. Observational field notes were used to triangulate interview data. Overall, participants endorsed the goals of PNCC and believed in its potential. However, participants asserted that the external policy context limited their impact. In response, they developed local strategies to combat barriers and work toward better outcomes. Our findings support the need to study the implementation of perinatal public and community health interventions and consider "health in all policies." Several changes would maximize PNCC's impact on maternal health: increased collaboration among policy stakeholders would reduce barriers; increased reimbursement would enable PNCC providers to better meet the complex needs of clients; and expansions in postpartum Medicaid coverage would extend the PNCC eligibility period. Nurses who provide PNCC have unique insights that should be leveraged to inform maternal-child health policy.

MCH Leadership Training Program: An Innovative Application of an Implementation Science Framework.

MCH training programs in schools of public health provide specialized training to develop culturally competent and skilled MCH leaders who will play key roles in public health infrastructure. Previous literature has reported on the effectiveness of MCH training programs (e.g., number of trainees, improvement in knowledge/skills); less attention has been devoted to understanding factors influencing program implementation during times of rapid change, while considering internal and external contexts (e.g., global pandemic, social unrest, uncertainty of funding, mental health issues, and other crises). This article describes a graduate-level MCH leadership training program and illustrates how an implementation science framework can inform the identification of determinants and lessons learned during one year of implementation of a multi-year program. Findings reveal how CFIR can be applicable to a MCH training program and highlight how constructs across domains can interact and represent determinants that serve as both a barrier and facilitator. Key lessons learned included the value of accountability, flexibility, learner-centeredness, and partnerships. Findings may apply to other programs and settings and could advance innovative training efforts that necessitate attention to the multi-level stakeholder needs (e.g., student, program, institution, community, and local/regional/national levels). Applying CFIR could be useful when interpreting process and outcome evaluation data and transferring findings and lessons learned to other organizations and settings. Integrating implementation science specifically into MCH training programs could contribute to the rigor, adaptability, and dissemination efforts that are critical when learning and sharing best practices to expand leadership capacity efforts that aim to eliminate MCH disparities across systems.

The influence of collective and individual sensemaking on how facilitators and teachers implement a professional development program

ABSTRACT This study takes a sociocultural approach in examining how mathematics professional development facilitators and teachers enacted a professional development program in a statewide network of trainings. Facilitators (N = 11) and teachers (N = 62) were surveyed before and after implementation to capture how facilitators understood and then implemented the program with teachers, and how teachers interpreted and then enacted the program with students. Differences in uptake (intended use) and implementation (actual use) were investigated in two separate analyses that looked for differences (1) across levels of iteration (i.e., from original program to facilitators to teachers) and (2) between groups of teachers who participated in the trainings. Results showed substantial variation across levels and between groups such that, although less true of some groups than others, intention to use the program was higher than actual use. Insights are offered into how collective and individual sensemaking processes influence program implementation.

P02-09 The dissemination of an effective school-based PA intervention programme: Sigue la Huella (Follow the footprint)

BackgroundA widespread dissemination of effective evidence-based physical activity (PA) interventions is needed whether a greater proportion of the population, who could potentially benefit from it, wants to be reached (Finch et al., 2016). ‘Sigue la Huella' (Follow the Footprint), is one of the few effective evidence-informed PA school-based interventions conducted on adolescents in Europe, with the support of the family and the community (Murillo et al., 2014). The main aim of this study is to describe and analyze the process of dissemination of this intervention program.MethodsThe ‘Sigue la Huella' was implemented at one secondary school situated in Jaca/Huesca (Spain). The Replicating Effective Programs (REP) framework was used, because provides a roadmap for disseminating effective interventions (Kilbourne et al., 2007). The intervention was delivered through workshops, ongoing technical assistance to the teachers, and the distribution of an instructional guide among the teachers and the school staff. A quasi-experimental design was adopted to examine the effect of ‘Sigue la Huella' after its dissemination process. PA was assessed using accelerometers at baseline and after the intervention of 14 weeks. In addition, we evaluated the dissemination process using the PRACTIS guide (Koorts et al., 2018).ResultsFrom an initial evaluation of the dissemination process, several key learnings emerged:To identify strategies for effective stakeholders engagement;To overcome some barriers such as the excess workload of the teachers in charge of disseminating the intervention program;For better measures to determine the success of dissemination approaches (e.g., reliable and valid indicators of organizational and policy change).ConclusionsThis study provides a comprehensive overview of the dissemination process of an effective school-based program identifying contextual barriers and facilitators that influence program implementation in new contexts and the direction of specific strategies to address those barriers.

Exploring the implementation and underlying mechanisms of centralized referral systems to access specialized health services in Quebec

BackgroundIn 2016, Quebec, a Canadian province, implemented a program to improve access to specialized health services (Accès priorisé aux services spécialisés (APSS)), which includes single regional access points for processing requests to such services via primary care (Centre de répartition des demandes de services (CRDS)). Family physicians fill out and submit requests for initial consultations with specialists using a standardized form with predefined prioritization levels according to listed reasons for consultations, which is then sent to the centralized referral system (the CRDS) where consultations with specialists are assigned. We 1) described the APSS-CRDS program in three Quebec regions using logic models; 2) compared similarities and differences in the components and processes of the APSS-CRDS models; and 3) explored contextual factors influencing the models’ similarities and differences.MethodsWe relied on a qualitative study to develop logic models of the implemented APSS-CRDS program in three regions. Semi-structured interviews with health administrators (n = 9) were conducted. The interviews were analysed using a framework analysis approach according to the APSS-CRDS’s components included in the initially designed program, Mitchell and Lewis (2003)’s logic model framework, and Chaudoir and colleagues (2013)’s framework on contextual factors’ influence on an innovation’s implementation.ResultsFindings show the APSS-CRDS program’s regional variability in the implementation of its components, including its structure (centralized/decentralized), human resources involved in implementation and operation, processes to obtain specialists’ availability and assess/relay requests, as well as monitoring methods. Variability may be explained by contextual factors’ influence, like ministerial and medical associations’ involvement, collaborations, the context’s implementation readiness, physician practice characteristics, and the program’s adaptability.InterpretationFindings are useful to inform decision-makers on the design of programs like the APSS-CRDS, which aim to improve access to specialists, the essential components for the design of these types of interventions, and how contextual factors may influence program implementation. Variability in program design is important to consider as it may influence anticipated effects, a next step for the research team. Results may also inform stakeholders should they wish to implement similar programs to increase access to specialized health services via primary care.

Unequal Retreats: How Racial Segregation Shapes Climate Adaptation

ABSTRACT Recent research on climate adaptation points to the need to take flood control seriously as a state-led process that organizes and responds to the racial and environmental spaces of cities. The present study advances that agenda by focusing on the federally funded retreat of homes and residents from flood-prone urban neighborhoods. While officially organized by rational engineering and technocratic calculations, its implementation cannot escape the racialized landscapes of U.S. cities. To illustrate, we review how a century of unequal environmental planning and housing policy has forged today’s racialized urban landscapes. Then, we turn to the federal government’s entrance into those landscapes via its policy of managed retreat that purchases flood-prone homes and returns them to nature. Here we draw on nationwide data to reveal the policy’s increasing urban orientation. We then present evidence from Houston to reveal how the racial composition and turnover of local neighborhoods influence program implementation and subsequent relocation. While not every city may experience the same racialized patterns as Houston, they will exhibit some patterns due to the powerful social and environmental force that race has long exerted in U.S. cities. Failing to account for that force will compromise efforts to adapt effectively to climate change.

Examining and evaluating university Clery Act programs: Sexual assault on university campuses

ABSTRACT The #metoo movement has drawn attention to the significant issue of sexual assault. The concern has been so considerable that the US Department of Education (DoE) mandated adherence to various crime prevention, reporting and support practices through the Jeanne Clery Disclosure of Campus Security Policy and Crime Statistics Act (Clery Act). As public affairs scholars and university professors, we are concerned with the well-being of our students and the effectiveness of programs within our universities and societies. And, more importantly, our students will be administrators in public organizations who are affected by the same oversight and efficacy issues that influence program implementation of federal policy such as the Clery Act. Using a content analysis of more than 20 years of Clery Act investigation documents (1996–2017) and interviews with Clery and Title IX coordinators, this study examines the Act as a mechanism for sexual assault prevention, reporting and survivor support.

Will college promise programs improve or reduce equity? Understanding the contextual conditions that influence program implementation

Although “free tuition” programs are politically popular, some worry that these programs will exacerbate inequity. Scholars note that program outcomes depend on implementation, but few have probed the contextual conditions that contribute to differences in implementation or the consequences of implementation for equity. To address this knowledge gap, we draw on conceptual models of implementation fidelity and case studies of last-dollar, free tuition programs at four community colleges. The consequences of an implemented program for equity depend on program content and coverage and are moderated by programmatic and organizational conditions. For the studied programs, implemented content includes the financial award and non-financial academic supports. Coverage is determined by eligibility requirements. Program content and coverage are moderated by programmatic characteristics, including program goals and placement in the organizational structure, program staffing, and recruitment strategies. Organizational conditions, including sources and availability of funding, availability of synergistic programs, capacity for data collection and evaluation, and perceptions of the community college also moderate implementation. The results inform understanding of how to implement programs at community colleges that increase equity in particular contexts.

Notes From the Field: Applying the Consolidated Framework for Implementation Research in a Qualitative Evaluation of Implementation of the Queensland Aboriginal and Torres Strait Islander Brief Intervention Training Program.

This paper describes the applicability of the Consolidated Framework for Implementation Research (CFIR) to the qualitative evaluation of the implementation of the Queensland Aboriginal and Torres Strait Islander Brief Intervention Training Program, the B.strong Program. Interviews were conducted with 20 B.strong Program trainees and four health service managers from eight purposively sampled Indigenous primary health care services in Queensland to collect their perceptions of the B.strong Program implementation. The 26 constructs of the CFIR were used to guide data collection and analysis. Additional constructs were developed for two program implementation aspects, "quality improvement" and "cultural suitability." Findings are presented from the application of the CFIR to the evaluation of the implementation of a brief intervention training program in the Australian Indigenous context. While demonstrating the applicability of the CFIR in this evaluation, this study also highlights that it may require modification, to ensure identification of the different contextual factors that influence program implementation.

Impacts of Community Resilience on the Implementation of a Mental Health Promotion Program in Rural Australia.

Mental health promotion programs are important in rural communities but the factors which influence program effectiveness remain unclear. The aim of this mixed-methods study was to assess how community resilience affected the implementation of a mental health promotion program in rural Tasmania, Australia. Four study communities were selected based on population size, rurality, access to local support services, history of suicide within the community, and maturity of the mental health promotion program. Data from self-report questionnaires (n = 245), including items of Communities Advancing Resilience Toolkit (CART) assessment, and qualitative (focus group and interview) data from key local stakeholders (n = 24), were pooled to explore the factors perceived to be influencing program implementation. Survey results indicate the primary community resilience strengths across the four sites were related to the ‘Connection and Caring’ domain. The primary community resilience challenges related to resources. Qualitative findings suggested lack of communication and leadership are key barriers to effective program delivery and identified a need to provide ongoing support for program staff. Assessment of perceived community resilience may be helpful in informing the implementation of mental health promotion programs in rural areas and, in turn, improve the likelihood of their success and sustainability.

A Qualitative Analysis of College Counseling Center Staff Experiences of the Utility of Dialectical Behavior Therapy Programs on Campus

ABSTRACT Dialectical behavior therapy (DBT) is an evidence-based practice for suicidal and self-injuring behavior with growing popularity in college counseling centers (CCCs). With the exception of a single, quantitative study, no research to date investigates how DBT is used in CCCs or what factors influence program implementation. We conducted qualitative interviews with 15 CCC staff that were delivering DBT programs in order to inform a more richly detailed understanding of the process of developing and implementing a DBT program housed in a CCC.

Medicaid Investments To Address Social Needs In Oregon And California.

Health care organizations across the US are developing new approaches to addressing patients' social needs. Medicaid programs are uniquely placed to support these activities, given their central role in supporting low-income Americans. Yet little evidence is available to guide Medicaid initiatives in this area. We used qualitative methods to examine how Medicaid funding was used to support social interventions in sites involved in payment reforms in Oregon and California. Investments were made in direct services-including care coordination, housing services, food insecurity programs, and legal supports-as well as capacity-building programs for health care and community-based organizations. A mix of Medicaid funding sources was used to support these initiatives, including alternative models and savings. We identified several factors that influenced program implementation, including the local health system context and wider community factors. Our findings offer insights to health care leaders and policy makers as they develop new approaches to improving population health.

Does Culture Matter? An Exploratory Study of Culture in the Implementation of an Adaptive Sports Program

There is limited research surrounding the effectiveness of program implementation, and the research that does exist often considers culture as a minor contributing factor. In this study, culture is re-framed as a major contributing factor of program implementation using an international adaptive sports program as an example. The program was planned and implemented by a team of U.S. facilitators for a group of Thai students and professors in Thailand. The purpose of this study was to understand the cultural processes that influence program implementation in the context of adaptive sport. The research team conducted observations of the program delivery and semi-structured interviews with the U.S. program facilitators. Guided by Hofstede’s Cultural Dimensions, the findings consider how culture influenced program implementation. Building from existing program implementation models, this study proposes a modified model of program implementation in which culture is positioned as a factor influencing all aspects of program implementation.Subscribe to TRJ

Exploring the roots of antagony in the safe male circumcision partnership in Botswana.

BackgroundPartnerships in global health and development governance have been firmly established as a tool to achieve effective outcomes. Botswana implements Safe Male Circumcision (SMC) for HIV prevention through a North-South partnership comprising the local Ministry of Health, US Centers for Disease Control and Prevention (funded by PEPFAR) and Africa Comprehensive HIV/AIDS Partnership (funded by the Bill and Melinda Gates Foundation). The SMC partnership experienced significant antagony and the aim of this paper is to illuminate the actions and processes in the SMC program that contributed to that antagony.MethodsMethods used to gather data include observation of the partners’ planning and strategic meeting in 2012, in-depth interviews with lead officers at national level, focus group discussions with district officers and implementers, younger male officers and old community members as recipients of the service.ResultsThe findings reveal that the partnership experienced antagony during operational processes and as the ultimate outcome. Target setting, financial power of the North, superficial ownership given to the South, ignoring local traditional realities results in antagony. Three roots of antagony have been identified: 1. therapeutic domination–medical expertise given with arrogance; 2.iatrogenic violence–good intentions that cause unintended harm; 3. the Trojan horse–Reckless acceptance of the gift as well as deceptive power positioned under the pretext of benevolence.ConclusionThe three roots of antagony; therapeutic domination, iatrogenic violence and the Trojan horse, constitute attitudes, hidden intentions and unintended consequences that influence program implementation and cause harm at different levels. Examples of therapeutic domination and the Trojan horse have highlighted the need for vigilance at the stage of establishing a partnership, to prevent more powerful partners from developing and applying hidden agendas and to strengthen accountability from the local partner. Iatrogenic violence has highlighted the need for partnership interventions to prevent good partner intentions accidentally producing bad outcomes.