Programs In Community Settings Research Articles

Implementation and outcomes of a statewide TBI screening program for underserved populations.

The purpose of this paper is to describe the implementation and outcomes of a unique traumatic brain injury (TBI) screening initiative serving the community, with a focus on underserved populations. Idaho's definition of underserved populations includes people living in rural/frontier areas, people experiencing homelessness or intimate partner violence, people with co-occurring disorders, and people with cultural and/or linguistically diverse backgrounds. The goals of screenings are to help participants gain awareness about the likelihood of having experienced a TBI, bridge the gap in TBI reporting, and provide needed support to underserved populations in a rural state. Our work represents a cross-sectional study. Beginning in 2014, TBI screenings were conducted by the Institute of Rural Health (IRH) within a public health university with several internal and external partners, as well as grant funding for work. Trained interprofessional health students and/or members of the IRH performed TBI screenings using the Ohio State University TBI Identification Method - Interview Form. Those who screened as likely experiencing a TBI received resources for care and follow-up telephone calls. Data was collected on the number of individuals screened and their results, and reported using descriptive statistics. From 2014-2022, a total of 1,333 individuals were screened at 23 different community events across Idaho. Over 30% of screened individuals reported a history of head or neck injury, primarily due to falls and being hit by objects. The majority of identified cases of traumatic brain injury were characterized by no loss of consciousness or less than 30 minutes of unconsciousness. Screenings targeting underserved populations showed higher TBI prevalence. Targeting underserved populations proved valuable in identifying TBI cases. The collaborative and interprofessional approach of this screening is unique and highlights the potential to address complex health issues effectively. These findings offer valuable insights for others implementing TBI screening programs in community settings.

IJCM_362A: Opportunistic Development of an Educational Intervention to Leverage Community Medicine Residents as Teachers for Community-Based Implementation of Attitudes, Ethics and Communication Module for Medical Students Using Life Skills Education Framework

Background: While undergraduate (UG) medical students often have inadequate opportunities to develop the Attitude, Ethics and Communication (AETCOM) competencies in real-world community settings, the Community Medicine (CM) residents have wider opportunities for community-based activities, but often lack opportunities to independently lead community-based intervention programs. Objective: This descriptive study involves the opportunistic development of a novel educational intervention aimed at integrating the fieldwork and teaching duties of a CM resident, facilitating the administration of the AETCOM module in real-world settings to benefit both UGs and the resident. Methodology: The intervention involved appointing a second-year CM resident as an independent near-peer teacher. This resident conceptualized, developed, and implemented a community-based learning (CBL) experience to administer the AETCOM module in community settings. The CBL included the resident facilitating a life skills education (LSE) session based on the World Health Organization Life Skills framework by engaging 30 third-year medical students with 50 children from the community in the Rural Health Training Centre field area. Kirkpatricks Level One of evaluation was conducted by collecting feedback through informal discussions between the resident, UGs, and faculty. Results: The medical students stated that the program provided an opportunity to learn CM beyond classroom in the community itself, sparking increased interest in the subject; practice teamwork and communication skills in real-world settings; discover their own strengths beyond academics. The resident reported gaining confidence in leadership skills via the opportunity to independently develop and implement a program, and also positively rated the chance to integrate work with teaching responsibilities. The faculty agreed to the benefits but reported apprehension about logistical challenges in routine implementation of such programs. Conclusion: Engaging residents-as-teachers to implement the AETCOM module through a LSE program in community settings is a novel approach to facilitate the development of relevant soft skills among medical students and residents.

Adaptations to a statewide walking program: Use of iterative feedback cycles between research and delivery systems improves fit for over 10 years.

FitEx is an 8-week, group-based physical activity and fruit and vegetable consumption program co-created and implemented with the Cooperative Extension System. Effectiveness and delivery personnel perceptions of the program are promising; however, ongoing adaptations are required to continuously meet shifting needs of both researchers and delivery systems. We applied the APDER iterative cycles of implementation over 15 years to understand dynamic and ongoing adaptations as well as implications for FitEx sustainability. Each year, an IRPP between delivery (FitEx deliverers) and research (FitEx developers) systems shared feedback on program core elements and strategies for adaptation through regular team meetings, emails, and evaluations. While the core elements (delivering to groups, goal setting, feedback, and self-monitoring) of FitEx remained consistent, changes were made to address logistical factors, emergent research questions, and technological advancements. For example, program deliverers suggested decreasing training time and making program content available on demand rather than through traditional in-person training. Using APDER with a long-standing IRPP allowed the delivery system to provide feedback to program developers to co-create ongoing adaptations and data-driven decisions. Future work in response to shifting needs includes Fitbit integration and technological updates to the usability of the FitEx platform. Our aim is to report the 15+ years of applying the Assess, Plan, Do, Evaluate, Report (APDER) process with an integrated research-practice partnership (IRPP) for co-creation of ongoing adaptations of FitEx and to share methods for capturing relevant data for decision-making to integrate health promotion programs in community settings.

Evaluating the implementation of adult smoking cessation programs in community settings: Protocol for a scoping review

Background Morbidity and mortality due to tobacco smoking is a public health crisis predicted to rise in coming years with the growing global population. Smoking cessation programs are an important tool to support service users to quit smoking. Understanding implementation processes and associated contextual factors influencing uptake of smoking cessation programs may help enhance service delivery, service user engagement, and cessation outcomes. Objectives The objective of this review is to evaluate the implementation of smoking cessation programs for adult smokers aged 18 years or older. Rationale Whilst the effectiveness of smoking cessation programs has been thoroughly investigated, there is limited research examining the implementation of programs in practice. This scoping review will provide novel information by evaluating the implementation of smoking cessation programs including acceptability, fidelity, scalability, and sustainability. Inclusion criteria This review will include the implementation of smoking cessation programs for adults aged 18 years or older, who are daily smokers of tobacco-based cigarettes, accessing a community-based service for smoking cessation support. Methods A search of research databases Medline, CENTRAL, Embase, and Web of Science will be undertaken, in addition to searching for grey literature for potential studies for inclusion. Hand searches of included articles will also be performed. Data will be extracted into a spreadsheet and ordered into predetermined categories based on the inclusion criteria, intervention, implementation strategies and implementation outcomes. Implementation outcomes including acceptability, cost, and scalability will provide the framework for reporting outcomes. Conclusions This scoping review will evaluate the implementation of smoking cessation services to adults in the community. An evidence map highlighting current knowledge will be developed, contributing to the body of literature on community-based smoking cessation programs. Evidence gaps will be identified, providing direction for future research and service delivery internationally.

Abstract P165: Key Tenets for Lifestyle Programs Aiming to Improve Hypertension Control and Cardiovascular Health

Introduction: Promoting lifestyle changes, such as consuming a healthier diet, engaging in exercise, and quitting smoking can help control hypertension (HTN) and reduce the risk of adverse cardiac outcomes. To support public health practitioners and health care providers, the Centers for Disease Control and Prevention’s (CDC) Division for Heart Disease and Stroke Prevention (DHDSP) sought to develop a set of key tenets of lifestyle programs that support successful implementation and impact on HTN-related outcomes. Hypothesis: No a priori hypotheses. Methods: We conducted rapid evaluations of three lifestyle programs identified first through a broad call for nominations and then a panel of experts for final selections. We also performed a literature review to assess the landscape of lifestyle programs focused on managing HTN. To build upon these findings, a rigorous mixed-methods evaluation of a local YMCA’s (St. Louis Gateway Region) implementation of a Blood Pressure Self-Monitoring (BPSM) program was conducted to describe program characteristics and innovations and assess HTN outcomes. Results: The evaluation of a local YMCA included 333 participants with HTN (2018-2020) and reported a statistically significant average reduction of 2.6 mmHg in SBP from baseline to 16-week follow-up. Based on comprehensive findings from the project, DHDSP identified the following four key tenets for an effective program: 1) Implementing programs in community settings provides an opportunity to offer programming where people are already gathering and can build trust and commitment. Findings from rapid evaluation of a program held at churches and other community locations demonstrated increased BP control rates from 66.2% to 71.5% at 12-week follow-up. 2) A team-based approach with clinical and non-clinical staff allows for more impactful and effective implementation. Evaluation results demonstrated completion of a program with trained lifestyle coaches was associated with a decrease of 7.3 mmHg in SBP and 5.7 mmHg in DBP over a 16-week period. 3) Programs with shorter durations (between 3-24 weeks) allow for those not able to commit to a longer program to still benefit from learning to control BP and reduce other risk factors. Findings from rapid evaluation of a three-week program resulted in increased BP control from 28.4% to 61.3% by end of program period. 4) Targeting multiple lifestyle behaviors provide the opportunity to closely match participant needs with the type of activities that work best for them. Rapid evaluation of a 12-week program focused on exercise, diet, and reducing stress demonstrated an increase in BP control from 76.9% to 82.2%. Conclusion: Findings can be used as a resource to link patients to effective BP control and management programs that have implemented these key tenets. Strategies highlighted may also provide considerations for replication in other communities.

Nutrition and Health Programming and Outreach in Grocery Retail Settings: A Community Coalition in Action.

Grocery stores can provide a conducive environment for interventions targeting healthy eating and access to health services, particularly in low-income communities. A wide array of organizations deliver nutrition and related programs in community settings, but rarely in a coordinated fashion. Collaboration of local health promotion organizations with grocery stores could increase consumers' access to and selection of healthy foods and related services. This evaluation of the In-Store Programming and Outreach Coalition (IPOC) uses thematic analysis of first-person accounts from coalition members. To our knowledge, this is the first study of such a coalition. We present perspectives from six stakeholders about the IPOC strengths, challenges, and recommendations for strengthening the delivery of in-store interventions. Themes identified include partnership, increased client reach and cross-referrals, conflicting work schedules, leadership, and recommendations to identify coalition leaders and expand services to other grocery stores. We conclude that grocery stores can offer a suitable setting for programming and community outreach through coalitions.

Eleven Reasons for Adaptation of Swedish Parenting Programs.

While questions about adaptation and fidelity are of great concern in many implementation projects, less attention has been paid to reasons for adaptations that remain when evidence-based interventions (EBIs) are used in clinical and community settings. This study aims to explore reasons for adaptations that can arise when using parenting programs in a community setting. Seventeen individual interviews with providers were conducted and analyzed thematically, resulting in 11 reasons for adaptations organized into four separate areas: characteristics of group leaders (supplementary skills and knowledge, preferred ways of working), characteristics of families (problem complexity, diverse or limited educational experience, non-parenting needs for support, colliding value systems), group incidents (criticism and challenges, excessive questions or discussions), and didactic challenges (lack of focus or engagement, limitations of the material, language differences). The study shows that factors triggering adaptation and fidelity decisions continuously reappear in the provision of parenting programs in community settings. Knowledge about reasons for adaptation can be used to inform decision-making during implementation planning, as well as the sustainment of implemented interventions.

Child sexual abuse prevention involving mothers: A Quasi‐experimental study with Protection Motivation Theory‐based intervention

Child sexual abuse (CSA) is a worldwide problem. The safety of children is everybody's responsibility. Parental and family involvement is crucial in the CSA prevention process. Parental lack of knowledge may increase the risk of abuse among children. Educating parents is crucial as children are mostly dependent on them. The role of mothers in educating children on CSA is of relevance as they are identified as more sensitive and responsible caregivers. The present study aimed to promote knowledge and attitude towards CSA prevention among mothers through a psychoeducation program. A pre- and posttest design (n = 67) was used with an intervention based on Protection Motivation Theory (PMT). A CSA knowledge and attitude scale was developed for the assessment of the participants for the study. There were significant changes in knowledge and attitude among the participants after the intervention. The prevention of CSA will be effective with knowledge gains after the PMT-based intervention. The intervention programs that involve mothers in CSA education have benefits. The findings of this study can be helpful to incorporate public health approaches to devise evidence-based parental programs in community settings.

Treatment Programs for Substance Use Disorder


 Moderate to weak evidence suggests that patients with substance use disorders who received residential treatment were more likely than outpatients to complete treatment and be considered abstinent. Comparisons between residential treatment and outpatient programs for other outcomes were unclear.
 Strong- to weak-quality evidence showed that residential treatment services for patients with substance use disorders was effective in improving various outcomes including substance use, social, criminal activity, and mental health outcomes. However, residential treatment was likely associated with poorest survival outcomes after discharge compared to other treatments.
 Managed alcohol programs in hospital settings appeared to be effective and safe in preventing and treating alcohol withdrawal syndrome in surgical patients, trauma patients, or hospitalized patients. The level of evidence was not assessed.
 There was evidence that managed alcohol programs in community settings improved drinking patterns, alcohol-related harm, criminal activity, mental health, and social and physical well-being. The level of evidence was not assessed.
 The American Society of Addiction Medicine clinical practice guideline provides recommendations for the identification and management of alcohol withdrawal in inpatient and ambulatory settings. Patients’ current signs and symptoms, levels of risk for developing severe or complicated withdrawal or complications of withdrawal, and other dimensions should be taken into consideration in the assessment process to determine the appropriate level of care. Strength of recommendations was not assessed.
 The Canadian Coalition for Seniors’ Mental Health recommends that patients with cannabis use disorder should be considered for residential treatment if they are unable to effectively reduce or cease their cannabis use (level of evidence: Low; strength of recommendation: Strong).

Mixed-Methods Evaluation of the Initial Implementation of Advanced Home Visits in Chile.

Home visiting programs are evidence-based interventions that have a myriad outcomes for mothers and newborns. Chile offers these services as part of the Chile Crece Contigo, a nationwide program. However, implementing home visiting programs in community settings is difficult. In this study, we report clinic, provider, and participant engagement with the implementation of advanced home visits (ViDAs) in Chilean primary care clinics. ViDAs include a high number of visits, external supervision, and the use of technology. In this study, qualitative and quantitative data were collected to assess the initial implementation of the home visiting strategy. Qualitative data consisted of individual interviews and focus groups with directors of city health departments, clinic managers, and providers conducting home visits. Quantitative data included clinic, provider, and participant recruitment. City health departments were approached to authorize the participation of primary care clinics in the ViDAs program. Then, clinic directors were invited to approve the implementation of the home visiting program at their health centers. In total, 16 clinics, 42 practitioners, and 185 participants were recruited. A large amount of resources was needed to recruit clinics, providers, and participants. The intervention had low acceptability, low adoption, and a high implementation cost. Initial program implementation experienced several challenges. Identified facilitators and barriers both highlighted the need for community engagement at all levels for the successful implementation of an innovation in Chilean primary care clinics. In addition, this article provides recommendations for practitioners and researchers regarding the conduct of research in community-based settings.

Mindfulness and Self-Regulation in a Summer Camp Setting: An EBP Project

BackgroundGuidelines for pediatric mental/behavioral health promotion call for preventative mental health services. Previous studies have found mindfulness an effective approach to addressing self-regulation/behavior concerns. Behavioral and self-regulation concerns had been identified in a summer camp program held in a large urban setting. Camp directors sought methods to address concerns, nurture the whole child and improve the overall program. PurposeThe purposes of this evidence-based practice (EBP) project in a summer day-camp setting were to (1) implement an evidence-based mindfulness program for children and (2) evaluate the impact on child self-regulation skills and behavior. MethodologyTwo questions consistent with the purpose guided this project: 1) How can a mindfulness program be implemented in a summer camp setting 2) What impact does a mindfulness program have on self-regulation of school age participants in a camp setting? To achieve the purpose of this EBP project, an eight-week program guided by the Mindful Schools© curricula was implemented in a summer day camp program in a large urban setting. Descriptive statistics and qualitative methods were used for evaluation of the program. ResultsWe were able to show a decrease in emotional distress and assess the mindful strategies which most connected with a school age population. In addition, camp counselor responses illuminated the value of dyad instruction approach in which child and counselors engaged in the Mindful Schools© guided program. ConclusionsUse of an evidenced-based programs allows for sustainability of programs in community settings outside of schools setting to broaden the reach of mental health promotion in a pediatric population.

Development and Evaluation of a Classified and Tailored Community-Based Exercise Program According to the Mobility Level of People with Stroke Using the Knowledge to Action Framework.

Attempts to classify the mobility levels of people with stroke (PWS) for a tailored exercise program in community settings have been few. We developed and evaluated a classified and tailored community-based (CTC) exercise program according to the mobility level of PWS. Forty-two PWS were classified into the Supine and Sitting, Sitting and Standing, and Standing and Gait groups, based on a newly developed classification model and participated in a group-based CTC exercise program for 1 h/day twice/week for 10 weeks. The health outcome measures were blood pressure, lipid profile, glucose control, body composition, ventilatory capacity, and physical and psychological function. The rate of agreement on classification results among the physiotherapists was analysed. For all participants, significant improvements were noted in the blood pressure, lipid profile, body composition, ventilatory capacity, and physical and psychological function. The lower mobility groups showed significant improvements in a greater number of health outcomes than the higher mobility group. The physiotherapists’ agreement regarding the classification results was 91.16 ± 5.14%, verifying the model’s possible high relevance to the community. The effective improvement in participant health implied that the CTC exercise program was well tailored to the participants’ mobility levels, particularly the lower mobility groups.

Parents Matter: Empowering Parents to Inform Other Parents of Post-Year 10 Pathway Options in Disadvantaged Communities

The research, focused on parents with children in years 5-10 in three low-socioeconomic rural and regional communities, drew on an understanding of educational aspiration as culturally and socio-spatially embedded to develop practical strategies for parents to engage with their children as they made education and career pathways choices. It draws from principles of community-based participatory research to address the gap between parental aspirations for their children and parental knowledge by linking parents to expert knowledge and quality resources, building their confidence to discuss post-year 10 options and support their children's choices. This paper reports results from the evaluation of a successful 'initiative' to support parents and families in rural/regional Tasmania to access information about their children's options for post school education and contribute to their aspirations for further study. This research highlights the challenges in engaging parents in disadvantaged communities around education. Establishing trust takes time. Parents are well placed to deliver parent information programs that engage other parents in their children's education and career journeys. Programs must understand the community they are operating in and walk alongside its parents to design programs. Those aiming to increase parents' ability to support children's education should deliver targeted programs in community settings that respond to the context and needs of that community. Facilitators should act as bridges between community, industry, schools and parents to address the gap between parental aspirations and parental knowledge.

Implementation Science of Mindfulness in Intellectual and Developmental Disabilities

Implementation science deals with the translation of evidence-based knowledge into practice in the real world. Mindfulness-based programs for people with intellectual and developmental disabilities (IDD) emerged about 20 years ago. Efficacy and effectiveness studies provide the evidence-base for these programs and the field of IDD is moving towards large scale implementation of these programs. This article presents a model for implementing mindfulness-based programs in community settings, including family and group homes, schools, vocational settings, and congregate care facilities. The model is based on the 3-tier positive behavior support (PBS) system commonly used in school, family, and agency settings. Specific mindfulness-based programs can be linked to each of the three tiers to improve the quality of life of people with IDD.

Cost-effectiveness of a mindfulness-based mental health promotion program: economic evaluation of a nonrandomized controlled trial with propensity score matching

BackgroundMental health promotion programs have been shown to reduce the burden associated with mental distress and prevent the onset of mental disorders, but evidence of cost-effectiveness is scarce.ObjectiveTo evaluate the cost-effectiveness of a mindfulness-based mental health prevention program provided by health coaches in a multi-site field setting in Germany.MethodsThe single-study based economic evaluation was conducted as part of a nonrandomized controlled trial, comparing the effects of a group-based prevention program to usual care based on propensity score matching. Participants (N = 1166) were recruited via a large statutory health insurance fund. Health outcome was assessed with the Hospital Anxiety and Depression Scale (HADS). Cost outcomes were actually incurred costs compiled from the health insurance’ records. Incremental cost-effectiveness ratios (ICER) were analyzed from a societal and a health care perspective for a 12-month time horizon with sampling uncertainty being handled using nonparametric bootstrapping. A cost-effectiveness acceptability curve was graphed to determine the probability of cost-effectiveness at different willingness-to-pay ceiling ratios.ResultsFrom a societal perspective, prevention was cost-effective compared to usual-care by providing larger effects of 1.97 units on the HADS (95% CI [1.14, 2.81], p < 0.001) at lower mean incremental total costs of €-57 (95% CI [− 634, 480], p = 0.84), yielding an ICER of €-29 (savings) per unit improvement. From a health care perspective, the incremental health benefits were achieved at additional direct costs of €181 for prevention participants (95% CI [40, 318], p = 0.01) with an ICER of €91 per unit improvement on the HADS. Willingness-to-pay for the prevention program to achieve a 95% probability of being cost-effective compared to usual-care, was estimated at €225 per unit improvement on the HADS score from a societal, and €191 from a health care perspective respectively. Sensitivity analyses suggested differential cost-effect-ratios depending on the initial distress of participants.LimitationsDue to the complexity of the field trial, it was not feasible to randomize participants and offer an active control condition. This limitation was met by applying a rigorous matching procedure.ConclusionsOur results indicate that universal mental health promotion programs in community settings might be a cost-effective strategy to enhance well-being. Differences between the societal and health care perspective underline the call for joint funding in the dissemination of preventive services.Trial registrationGerman Clinical Trials Registration ID: DRKS00006216 (2014/06/11, retrospective registration).

Developmental screening and early intervention in a childcare setting for young children at risk for autism and other developmental delays: A feasibility trial.

Efforts to decrease disparity in diagnosis and treatment for under-resourced children with developmental delays, such as autism spectrum disorder, have led to increased interest in developing programs in community settings. One potential setting that has already demonstrated feasibility in conducting universal screening is the childcare setting. The current study conducted developmental screening in a total of 116 children ages 16-80 months of age in an urban low-income community childcare center. Parents of 20 children who screened positive were enrolled in the intervention phase of the study, where children received a staff-delivered targeted early intervention or a waitlist control condition. Given the small and imbalanced sample sizes, confidence intervals from mixed effect models were used to measure changes across time for each group. Of the children who received treatment, there was an average increase in child initiated joint engagement, symbolic play, and language use. This study provides initial feasibility data for the implementation of a screening and early intervention program to service a predominantly low-resource and ethnically diverse population within the childcare system in a large metropolitan city. Autism Res 2019, 12: 1423-1433. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Identifying and delivering treatment services for young children with developmental delays, such as autism spectrum disorder, may be most successful in community settings, especially for those children from under-resourced areas. This study found preliminary evidence that the childcare setting is a good place to conduct screening and deliver early interventions for children at risk for autism and other developmental delays.

Operationalizing the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework to evaluate the collective impact of autonomous community programs that promote health and well-being

BackgroundThe RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is a useful tool for evaluating the impact of programs in community settings. RE-AIM has been applied to evaluate individual programs but seldom used to evaluate the collective impact of community-based, public health programming developed and delivered by multiple autonomous organizations. The purposes of this paper were to (a) demonstrate how RE-AIM can be operationalized and applied to evaluate the collective impact of similar autonomous programs that promote health and well-being and (b) provide preliminary data on the collective impact of Canadian spinal cord injury (SCI) peer mentorship programs on the delivery of peer mentorship services.MethodsCriteria from all five RE-AIM dimensions were operationalized to evaluate multiple similar community-based programs. For this study, nine provincial organizations that serve people with SCI were recruited from across Canada. Organizations completed a structured self-report questionnaire and participated in a qualitative telephone interview to examine different elements of their peer mentorship program. Data were analyzed using summary statistics.ResultsHaving multiple indicators to assess RE-AIM dimensions provided a broad evaluation of the impact of Canadian SCI peer mentorship programs. Peer mentorship programs reached 1.63% of the estimated Canadian SCI population. The majority (67%) of organizations tracked the effectiveness of peer mentorship through testimonials and reports. Setting-level adoption rates were high with 100% of organizations offering peer mentorship in community and hospital settings. On average, organizations allocated 10.4% of their operating budget and 9.8% of their staff to implement peer mentorship and 89% had maintained their programming for over 10 years. Full interpretation of the collective impact of peer mentorship programs was limited as complete data were only collected for 52% of survey questions.ConclusionsThe lack of available organizational data highlights a significant challenge when using RE-AIM to evaluate the collective impact of multiple programs that promote health and well-being. Although researchers are encouraged to use RE-AIM to evaluate the collective impact of programs delivered by different organizations, documenting limitations and providing recommendations should be done to further the understanding of how best to operationalize RE-AIM in these contexts.

Mentes Positivas en Acción: Feasibility Study of a Promotor-Delivered Cognitive Behavioral Stress Management Program for Low-Income Spanish-Speaking Latinas.

Purpose: Low-income Latino immigrants lack access to mental health providers. We explored the feasibility of training promotores to deliver a stress management program in community settings.Methods: We trained promotores to deliver an 8-week intervention program comprising evidence-based cognitive-behavioral stress management techniques. Trained promotores then delivered the program to Spanish-speaking Latino immigrants.Results: Promotores (n=10) improved their knowledge significantly after the training (p<0.001) and delivered the program demonstrating excellent fidelity. Participants who received the program (n=50) had significantly improved scores on immigration stress, perceived stress, and depressive symptoms (p<0.001).Conclusion: It is feasible to train Latino promotores to deliver an effective stress management program to low-income Latino immigrants in their communities. Results contribute to a growing literature on the value of such interventions in community settings. If it is found to be effective in future studies, the program could help fill a large need in the Latino community.

Redesigning Implementation Measurement for Monitoring and Quality Improvement in Community Delivery Settings.

The field of prevention has established the potential to promote child adjustment across a wide array of outcomes. However, when evidence-based prevention programs have been delivered at scale in community settings, declines in implementation and outcomes have resulted. Maintaining high quality implementation is a critical challenge for the field. We describe steps towards the development of a practical system to monitor and support the high-quality implementation of evidence-based prevention programs in community settings. Research on the implementation of an evidence-based parenting program for divorcing families called the "New Beginnings Program" serves as an illustration of the promise of such a system. As a first step, we describe a multidimensional theoretical model of implementation that links aspects of program delivery with improvements in participant outcomes. We then describe research on the measurement of each of these implementation dimensions and test their relations to intended program outcomes. As a third step, we develop approaches to the assessment of these implementation constructs that are feasible to use in community settings and to establish their reliability and validity. We focus on the application of machine learning algorithms and web-based data collection systems to assess implementation and provide support for high quality delivery and positive outcomes. Examples are presented to demonstrate that valid and reliable measures can be collected using these methods. Finally, we envision how these measures can be used to develop an unobtrusive system to monitor implementation and provide feedback and support in real time to maintain high quality implementation and program outcomes.

Scaling Up Diabetes Prevention Programs in North Carolina: Perceptions of Demand From Potential Program Recipients and Providers.

Purpose The purpose of this study was to assess factors that influence demand for the Diabetes Prevention Program (DPP) from the perspectives of potential program participants and providers. Methods A qualitative study guided by a conceptual framework was conducted with potential DPP participants and potential DPP providers. Five focus groups with potential participants (n = 37) and key informant interviews with potential providers (n = 14) were conducted in community settings across North Carolina. Results Although providers considered prediabetes to be an important health problem, potential DPP participants expressed less urgency related to a diagnosis of prediabetes. Potential participants felt that they were more likely to adopt diabetes prevention programs if affordable and convenient. For potential program providers, funding, collaboration, and staff support were key considerations for DPP adoption. Providers were supportive of DPP features; however, there was concern from both stakeholders on retention in a 16-week program. Both groups cited transportation, cost, and health insurance reimbursement as existing barriers to the uptake of these programs. Conclusion This qualitative study highlights important considerations for scaling up diabetes prevention programs in community settings, including what constraints agencies face in adopting programs, the perceived demand and programmatic needs for these services by customers, and the need for improving patient education on prediabetes. This implementation science study allows us to increase the potential to scale up and sustain diabetes prevention programs that fit available resources and customer needs.