Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Implementation Science
Published in: Implementation Science 1/2015

Open Access 01-12-2015 | Research

Facilitators and barriers to effective scale-up of an evidence-based multilevel HIV prevention intervention

Authors: Susan M Kegeles, Gregory Rebchook, Scott Tebbetts, Emily Arnold, The TRIP Team

Published in: Implementation Science | Issue 1/2015

Login to get access

Abstract

Background

Since the scale-up of HIV/AIDS prevention evidence-based interventions (EBIs) has not been simple, it is important to examine processes that occur in the translation of the EBIs into practice that affect successful implementation. The goal of this paper is to examine facilitators and barriers to effective implementation that arose among 72 community-based organizations as they moved into practice a multilevel HIV prevention intervention EBI, the Mpowerment Project, for young gay and bisexual men.

Methods

CBOs that were implementing the Mpowerment Project participated in this study and were assessed at baseline, and 6-months, 1 year, and 2 years post-baseline. Semi-structured telephone interviews were conducted separately with individuals at each CBO. Study data came from 647 semi-structured interviews and extensive notes and commentaries from technical assistance providers. Framework Analysis guided the analytic process. Barriers and facilitators to implementation was the overarching thematic framework used across all the cases in our analysis.

Results

Thirteen themes emerged regarding factors that influence the successful implementation of the MP. These were organized into three overarching themes: HIV Prevention System Factors, Community Factors, and Intervention Factors. The entire HIV Prevention System, including coordinators, supervisors, executive directors, funders, and national HIV prevention policies, all influenced implementation success. Other Prevention System Factors that affected the effective translation of the EBI into practice include Knowledge About Intervention, Belief in the Efficacy of the Intervention, Desire to Change Existing Prevention Approach, Planning for Intervention Before Implementation, Accountability, Appropriateness of Individuals for Coordinator Positions, Evaluation of Intervention, and Organizational Stability. Community Factors included Geography and Sociopolitical Climate. Intervention Factors included Intervention Characteristics and Adaptation Issues.

Conclusions

The entire ecological system in which an EBI occurs affects implementation. It is imperative to focus capacity-building efforts on getting individuals at different levels of the HIV Prevention System into alignment regarding understanding and believing in the program’s goals and methods. For a Prevention Support System to be maximally useful, it must address facilitators or barriers to implementation, address the right people, and use modalities to convey information that are acceptable for users of the system.
Literature
1.
Tabak RG, Khoong EC, Chambers DA, Brownson RC. Bridging research and practice: models for dissemination and implementation research. Am J Prev Med. 2012;43:337–50.CrossRefPubMedPubMedCentral
2.
Blase K, Fixsen D, Phillips E. Residential treatment for troubled children: developing service delivery systems. In: Paine S, Bellamy G, Wilcox B, editors. Human services that work: from innovation to standard practice. Baltimore: Paul H. Brookes Publishing; 1984. p. 149–65.
3.
Norton WE, Amico KR, Cornman DH, Fisher WA, Fisher JD. An agenda for advancing the science of implementation of evidence-based HIV prevention interventions. AIDS Behav. 2009;13:424–9.CrossRefPubMedPubMedCentral
4.
Fisher HH, Patel-Larson A, Green K, Shapatava E, Uhl G, Kalayil EJ. Evaluation of an HIV prevention intervention for African Americans and Hispanics: findings from the VOICES/VOCES Community-based Organization Behavioral Outcomes Project. AIDS Behav. 2011;15:1691–706.CrossRefPubMed
5.
Heitgerd JL, Kalayil EJ, Patel-Larson A, Uhl G, Williams WO, Griffin T, et al. Reduced sexual risk behaviors among people living with HIV: results from the Healthy Relationships Outcome Monitoring Project. AIDS Behav. 2011;15:1677–90.CrossRefPubMed
6.
Jemmott 3rd JB, Jemmott LS, Fong GT, Morales KH. Effectiveness of an HIV/STD risk-reduction intervention for adolescents when implemented by community-based organizations: a cluster-randomized controlled trial. Am J Public Health. 2010;100:720–6.CrossRefPubMedPubMedCentral
7.
Neumann MS, O'Donnell L, Doval AS, Schillinger J, Blank S, Ortiz-Rios E, et al. Effectiveness of the VOICES/VOCES sexually transmitted disease/human immunodeficiency virus prevention intervention when administered by health department staff: does it work in the “real world”? Sex Transm Dis. 2011;38:133–9.CrossRefPubMed
8.
Kelly JA, Heckman TG, Stevenson LY, Williams PN, Ertl T, Hays RB, et al. Transfer of research-based HIV prevention interventions to community service providers: Fidelity and adaptation. AIDS Educ Prev. 2000;12:87–98.PubMed
9.
McKleroy VS, Galbraith JS, Cummings B, Jones P, Harshbarger C, Collins C, et al. Adapting evidence-based behavioral interventions for new settings and target populations. AIDS Educ Prev. 2006;18:59–73.CrossRefPubMed
10.
Feldman MB, Silapaswan A, Schaefer N, Schermele D: Is There Life After DEBI? Examining Health Behavior Maintenance in the Diffusion of Effective Behavioral Interventions Initiative. Am J Community Psychol 2014.
11.
Dolcini MM, Canin L, Gandelman A, Skolnik H. Theoretical domains: a heuristic for teaching behavioral theory in HIV/STD prevention courses. Health Promot Pract. 2004;5:404–17.CrossRefPubMed
12.
Galbraith JS, Stanton B, Boekeloo B, King W, Desmond S, Howard D, et al. Exploring implementation and fidelity of evidence-based behavioral interventions for HIV prevention: lessons learned from the focus on kids diffusion case study. Health Educ Behav. 2009;36:532–49.CrossRefPubMed
13.
Miller RL, Forney JC, Hubbard P, Camacho LM. Reinventing Mpowerment for Black Men: Long-Term Community Implementation of an Evidence-Based Program. Am J Community Psychol. 2012;49:199–214.CrossRefPubMed
14.
Rebchook GM, Kegeles SM, Huebner D, Trip Research Team. Translating research into practice: the dissemination and initial implementation of an evidence-based HIV prevention program. AIDS Educ Prev. 2006;18:119–36.CrossRefPubMed
15.
Cunningham SD, Card JJ. Realities of replication: implementation of evidence-based interventions for HIV prevention in real-world settings. Implement Sci. 2014;9:5.CrossRefPubMedPubMedCentral
16.
Hamdallah M, Vargo S, Herrera J. The VOICES/VOCES success story: effective strategies for training, technical assistance and community-based organization implementation. AIDS Educ Prev. 2006;18:171–83.CrossRefPubMed
17.
Hitt JC, Robbins AS, Galbraith JS, Todd JD, Patel-Larson A, McFarlane JR, et al. Adaptation and implementation of an evidence-based prevention counseling intervention in Texas. AIDS Educ Prev. 2006;18:108–18.CrossRefPubMed
18.
Prather C, Fuller TR, King W, Brown M, Moering M, Little S, et al. Diffusing an HIV prevention intervention for African American Women: integrating afrocentric components into the SISTA Diffusion Strategy. AIDS Educ Prev. 2006;18:149–60.CrossRefPubMed
19.
Wingood GM, DiClemente RJ. Enhancing adoption of evidence-based HIV interventions: promotion of a suite of HIV prevention interventions for African American women. AIDS Educ Prev. 2006;18:161–70.CrossRefPubMed
20.
Pangea Global AIDS Foundation. Report from the Expert Consultation on Implementation Science Research: A Requirement for Effective HIV/AIDS Prevention and Treatment Scale-Up. Cape Town, South Africa: Sponsored by Office of AIDS Research, National Institutes of Health, U.S. Department of Health and Human Services in collaboration with Pangaea Global AIDS Foundation; 2009.
21.
22.
Herbst JH, Beeker C, Mathew A, McNally T, Passin WF, Kay LS, et al. The effectiveness of individual-, group-, and community-level HIV behavioral risk-reduction interventions for adult men who have sex with men: A systematic review. Am J Prev Med. 2007;32:S38–67.CrossRefPubMed
23.
Kegeles SM, Hays RB, Coates TM. The Mpowerment project: a community-level HIV prevention intervention for young gay men. Am J Public Health. 1996;86:1129–36.CrossRefPubMedPubMedCentral
24.
Kegeles SM, Hays RB, Pollack LM, Coates TJ. Mobilizing young gay and bisexual men for HIV prevention: A two-community study. AIDS. 1999;13:1753–62.CrossRefPubMed
25.
Collins C, Harshbarger C, Sawyer R, Hamdallah M. The diffusion of effective behavioral interventions project: development, implementation, and lessons learned. AIDS Educ Prev. 2006;18:5–20.CrossRefPubMed
26.
Smith A, Miles I, Le B, Finlayson T, Oster A, DiNenno E. Prevalence and Awareness of HIV Infection Among Men Who Have Sex With Men – 21 Cities, United States, 2008. MMWR. 2010;59:1201–7.
27.
28.
Millett GA, Crowley JS, Koh H, Valdiserri RO, Frieden T, Dieffenbach CW, et al. A way forward: the national HIV/AIDS strategy and reducing HIV incidence in the United States. J Acquir Immune Defic Syndr. 2010;55 Suppl 1:S144–7.CrossRefPubMed
29.
Centers for Disease Control and Prevention: High-Impact HIV Prevention: CDC’s Approach to Reducing HIV Infections in the United States. Atlanta, GA; 2011.
30.
Flaspohler P, Duffy J, Wandersman A, Stillman L, Maras MA. Unpacking prevention capacity: an intersection of research-to-practice models and community-centered models. Am J Community Psychol. 2008;41:182–96.CrossRefPubMed
31.
Wandersman A. Community science: bridging the gap between science and practice with community-centered models. Am J Community Psychol. 2003;31:227–42.CrossRefPubMed
32.
Hays RB, Rebchook GM, Kegeles SM. The Mpowerment Project: community-building with young gay and bisexual men to prevent HIV. Am J Community Psychol. 2003;31:301–12.CrossRefPubMed
33.
Mugavero MJ, Amico KR, Horn T, Thompson MA. The state of engagement in HIV care in the United States: from cascade to continuum to control. Clin Infect Dis. 2013;57:1164–71.CrossRefPubMed
34.
Kegeles SM, Rebchook G, Pollack L, Huebner D, Tebbetts S, Hamiga J, et al. An intervention to help community-based organizations implement an evidence-based HIV prevention intervention: the Mpowerment Project technology exchange system. Am J Community Psychol. 2012;49:182–98.CrossRefPubMed
35.
Bandura A. Social learning theory. Englewood Cliffs, New Jersey: Prentice-Hall; 1977.
36.
Rogers EM. Diffusion of innovations. 5th ed. New York: Free Press; 2003.
37.
Knowles MS, Holton EF, Swanson RA. The adult learner: The definitive classic in adult education and human resource development. 5th ed. Houston TX: Gulf Professional Publishing Co; 1998.
38.
Wandersman A, Duffy J, Flaspohler P, Noonan R, Lubell K, Stillman L, et al. Bridging the gap between prevention research and practice: the interactive systems framework for dissemination and implementation. Am J Community Psychol. 2008;41:171–81.CrossRefPubMed
39.
Richie J, Spencer L. Qualitative data analysis for applied policy research. In: Huberman A, Miles M, editors. The Qualitative Researcher’s Companion. London: Sage; 2002. p. 173–94.
40.
Mihalic SF, Irwin K. Blueprints for violence prevention: From research to real-world settings–Factors influencing the successful replication of model programs. Youth Violence and Juvenile Justice. 2003;1:307–29.CrossRef
41.
Beyrer C, Baral S, Kerrigan D, El-Bassel N, Bekker LG, Celentano DD. Expanding the space: inclusion of most-at-risk populations in HIV prevention, treatment, and care services. J Acquir Immune Defic Syndr. 2011;57 Suppl 2:S96–9.CrossRefPubMedPubMedCentral
42.
Gandelman A, Dolcini MM. The influence of social determinants on evidence-based behavioral interventions-considerations for implementation in community settings. Transl Behav Med. 2012;2:137–48.CrossRefPubMed
43.
Fixsen DL, Naoom SF, Blase KA, Friedman RM, Wallace F: Implementation research: A synthesis of the literature. University of South Florida, Louis de la Parte Florida Mental Health Institute, the National Implementation Research Network; 2005.
44.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.CrossRefPubMedPubMedCentral
45.
Altschuld JW, Kumar DD, Smith DW, Goodway JD. School-based educational innovations: Case illustrations of context-sensitive evaluations. Fam Community Health. 1999;22:66–79.CrossRef
46.
Riley BL, Taylor SM, Elliott SJ. Determinants of implementing heart health: promotion activities in Ontario public health units: a social ecological perspective. Health Educ Res. 2001;16:425–41.CrossRefPubMed
47.
Shediac-Rizkallah MC, Bone LR. Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy. Health Educ Res. 1998;13:87–108.CrossRefPubMed
48.
Durlak JA, DuPre EP. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008;41:327–50.CrossRefPubMed
49.
O'Donnell L, Scattergood P, Adler M, Doval AS, Barker M, Kelly JA, et al. The role of technical assistance in the replication of effective HIV interventions. AIDS Educ Prev. 2000;12:99–111.PubMed
50.
Castaneda SF, Holscher J, Mumman MK, Salgado H, Keir KB, Foster-Fishman PG, et al. Dimensions of community and organizational readiness for change. Prog Community Health Partnersh. 2012;6:219–26.CrossRefPubMedPubMedCentral
51.
Fixsen DL, Blase KA, Naoom SF, Wallace F. Core Implementation Components. Res Social Work Prac. 2009;19:531–40.CrossRef
52.
Janssen R, Onorato I, Valdiserri R, Durham T, Seiler E, Jaffe H. Advancing HIV prevention: new strategies for a changing epidemic–United States, 2003. MMWR. 2003;52:329–32.
53.
Fagan AA, Hanson K, Hawkins JD, Arthur MW. Bridging science to practice: achieving prevention program implementation fidelity in the community youth development study. Am J Community Psychol. 2008;41:235–49.CrossRefPubMed
54.
Fetterman D, Kaftarian S, Wandersman A. Empowerment Evaluation: Knowledge and Tools for Self-Assessment and Accountability. Thousand Oaks, CA: Sage; 1996.
55.
Dworkin SL, Pinto R, Hunter J, Rapkin B, Remien RH. Keeping the spirit of community partnerships alive in the scale up of HIV/AIDS prevention: critical reflections on the roll out of DEBI (Diffusion of Effective Behavioral Interventions). Am J Community Psychol. 2010;42:51–9.CrossRef
56.
Goodman RM, Speers MA, McLeroy K, Fawcett S, Kegler M, Parker E, et al. Identifying and defining the dimensions of community capacity to provide a basis for measurement. Health Educ Behav. 1998;25:258–78.CrossRefPubMed
57.
Hoge MA, Tondora J, Marrelli AF. The fundamentals of workforce competency: implications for behavioral health. Adm Policy Ment Health. 2005;32:509–31.CrossRefPubMed
Metadata
Title
Facilitators and barriers to effective scale-up of an evidence-based multilevel HIV prevention intervention
Authors
Susan M Kegeles
Gregory Rebchook
Scott Tebbetts
Emily Arnold
The TRIP Team
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2015
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-015-0216-2

Other articles of this Issue 1/2015

Implementation Science 1/2015 Go to the issue

Short report

Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study

Study protocol

Development and preliminary evaluation of a rehabilitation consult for survivors of head and neck cancer: an intervention mapping protocol

Methodology

Developing standards for reporting implementation studies of complex interventions (StaRI): a systematic review and e-Delphi

Study protocol

Advancing implementation science through measure development and evaluation: a study protocol

Erratum

Erratum to: ‘Exploring the function and effectiveness of knowledge brokers as facilitators of knowledge translation in health related settings: a systematic review and thematic analysis’

Study protocol

Protocol for the evaluation of a social franchising model to improve maternal health in Uttar Pradesh, India