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Michelle Kegler, DrPH, MPH Michelle Carvalho, MPH, CHES

Moving from Research to Reality: Working with Partners to Implement and Adapt Evidence-Based Programs. Michelle Kegler, DrPH, MPH Michelle Carvalho, MPH, CHES. Mini-Grants as a Strategy for Dissemination.

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Michelle Kegler, DrPH, MPH Michelle Carvalho, MPH, CHES

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  1. Moving from Research to Reality: Working with Partners to Implement and Adapt Evidence-Based Programs Michelle Kegler, DrPH, MPH Michelle Carvalho, MPH, CHES

  2. Mini-Grants as a Strategy for Dissemination • Mini-grants are common in health promotion initiatives & have potential for creating demand for evidence-based interventions • Mini-grants can be combined with dissemination strategies shown to work • Training workshops (Rohrbach 2006; Elliot 2004) • Increases adoption, capacity, fidelity, maintenance • Technical Assistance (Pentz 2006; Shepherd 2008; Rohrbach 2006) • Ongoing support, feedback, coaching • Incentives (Basen-Engquist ,1994; Glanz, 2002) • stipends, equipment, materials

  3. Interactive Systems Framework Wandersman, A., Duffy, J., Flaspohler, P., Noonan, R., Lubell, K., Stillman, L., et al. (2008). Bridging the Gap Between Prevention Research and Practice: The Interactive Systems Framework for Dissemination and Implementation. American Journal of Community Psychology, 41(3), 171-181.

  4. Mini-grants Programto Disseminate EBPs • A “push-pull method” (i.e. funds + TA) increases demand while building capacity* • 2 cohorts: 2007 & 2008 (12-18 month period) • 12 SW GA community organizations awarded • Received up to $4000 & technical assistance (TA) • Implemented 5 RTIPs programs (nutrition or PA) *Orleans, C., Gruman, J., & Anderson, N. (2002). Designing for Dissemination: The Larger Challenge of Translation: An Extraordinary Opportunity for Cancer Control. Designing for Dissemination Collaborative Meeting, Washington, D.C.

  5. 12 Awarded Sites & 5 Programs

  6. Engaging Community Expertise Emory PRC Community Advisory Board (CAB) roles: • Prioritized behavioral risk factors: • nutrition, physical activity, tobacco prevention/cessation • Helped to develop mini-grants and TA process • Facilitated promotion of program to community • Joint EPRC/CAB review committee selected grantees • Currently co-authoring presentations and publications

  7. Program Core Elements Core elements for each program were identified based on: • underlying theory & process evaluation findings • published articles describing the program • available program materials • program description on NCI’s Research Tested Intervention Programs (RTIPs) website

  8. * Collected in both cohorts (Other tools in 1st cohort only)

  9. Project Report Form Documented progress on core elements

  10. Interview/Focus Group Guides

  11. Fidelity Findings • 95% of core elements conducted across all sites • 9 of 12 (75%) sites conducted all core elements • 3 (of 7) sites in 1st cohort did not conduct all core elements • All 5 sites in 2nd cohort conducted all core elements

  12. Participation and Reach of Core Elements Implemented by 2007 Mini-Grant Recipients Reach = proportion of the site population that participated in a given event: Categories: Low (<1/3), Medium (1/3 to 2/3), High (>2/3).

  13. Contextual Factors(related to implementation) * Mentioned in both cohorts Blue text = barrier that prevented completion of core element(s) - 1st cohort

  14. Fidelity-Adaptation Continuum HIGH FIDELITY ADAPTATION EXAMPLES MINOR ADAPTATION NEEDS EVALUATION LOW FIDELITY MAJOR ADAPTATION • Added/customized materials • Added activities • Shifted primary audience • Held concurrent physical activity & weight loss events • Changed delivery format/process steps • Expanded audience (to community) • Shifted focus to other behaviors • Did not complete all core elements

  15. Reasons for Adaptations • Expand program reach (broader community) • Generate/maintain engagement • Strengthen/reinforce program message • Fit program to organization’s infrastructure/activities • Reach specific audiences (esp. underserved) Added content to reach specific audiences (teen parents) “You got to think about being also sensitive to the age of the parent. If you have [a parent] that’s maybe 14…give them something that can be kinda fun…” - Site coordinator

  16. Limitations • Small number of sites (n=12) in rural SW GA • Limited measurement of fidelity & implementation quality • Time span 12-18 months – more time needed to learn about maintenance • Self report/social desirability • Data reflects information from only 5 intervention programs • Data may not be generalizable to other settings, populations, regions and programs

  17. 2010-12 Mini-grants Cohort • Mini-grants period will span 2 years • 4 sites funded at $8000 each • Structured and proactive TA and training • RTIPs programs: • CATCH: Coordinated Approach to Child Health • Family Matters • Body & Soul • Process evaluation focused on TA and training

  18. Map of the Adaptation Process Developed a structured TA model derived from the Map of the Adaptation Process (Mckleroy et al., 2006) Focus on objectives of each key step:

  19. EBI Training Topics (pre-award)

  20. TEACH model: Translating Evidence into Action through Collaboratives for Health

  21. TEACH Evaluation Questions Kept the original evaluation questions and added capacity questions related to the impact of TEACH: • Do attitudes toward EBAs become more positive as a result of the TEACH process? • Does self-efficacy for EBA behaviors increase as a result of the TEACH process? • Does organizational capacity for EBAs increase as a result of the TEACH process?

  22. Process Evaluation Plan • Baseline survey (n=17) – 80 items • Follow-up at 3, 6, and 24 months • TA tracking Access database • Project Report Forms • Qualitative interviews w/ coordinators at 24 months

  23. *Levinger and Bloom, 2000; Weiss et al., 2002; Preskill and Tores, 1998; Caplan, 1971; Kenny and Sofaer, 2000; Schminke et al, 2002)

  24. Next Steps • 2 manuscripts in progress: • Process evaluation of a mini-grants program to disseminate evidence-based nutrition programs to rural churches and work sites • Balancing fidelity and adaptation: Case Studies in implementing evidence-based chronic disease prevention programs • Conduct process evaluation of current mini-grants program (TA, training, fidelity, adaptations) • Dissemination research grant proposals

  25. Acknowledgements • JK Veluswamy • Margaret Clawson • Megan Brock • NidiaBanuelos • Alma Nakasone • Amanda Wyatt • Ana Iturbides • Sally Honeycutt • Cam Escoffery • Kirsten Rodgers • Karen Glanz • Johanna Hinman • Jenifer Brents The CPCRN is part of the Prevention Research Centers Program. It is supported by the Centers for Disease Control and Prevention and the National Cancer Institute (Cooperative agreement # 1U48DP0010909-01-1)

  26. QUESTIONS?

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