Paone & Associates, LLC , Minneapolis, MN , USA.
Front Public Health. 2015 Apr 27;2:237. doi: 10.3389/fpubh.2014.00237. eCollection 2014.
Reaching individuals who can benefit from evidence-based health promotion and disability prevention programs is a goal of federal, state, and local agencies as well as researchers, providers, community agencies, and other stakeholders. Implementation effectiveness at the organizational level must be achieved in order to reach these individuals and sustain the program. This mixed methods study examined eight organizations within two states that successfully implemented the Chronic Disease Self-Management Program (CDSMP) and sustained it from 4 to 10 years. There were two types of organizations: aging services and health care. Internal and external implementation factors and influences were explored. Additional examination of state activities (as a key external agent supporting CDSMP implementation) was conducted. The examination found agreement among the eight organizations regarding why they had adopted the CDSMP - citing the alignment between the program and their organizations' mission and purpose to improve health status and promote better self-care, and the demonstrated value (benefits) of the program. Organizations were also alike in that they described the importance of an internal champion and supportive senior leader. Organizations differed in how they experienced and valued peer support and collaborative networks. Organizations also differed in how they filled their CDSMP workshops. Internal drivers and capability were more often discussed as facilitating successful implementation than external factors. However, state activities and external support enabled successful adoption - particularly funding and training. The primary challenges identified by this set of organizations included difficulty in recruiting participants (filling workshops) and irregular or insufficient funding sources. These challenges were identified as significant and represented barriers to sustaining the program.
为联邦、州和地方机构以及研究人员、提供者、社区机构和其他利益相关者提供受益于循证健康促进和残疾预防计划的个人是一个目标。为了接触到这些个人并维持该计划，必须在组织层面实现实施效果。这项混合方法研究调查了两个州的八个成功实施慢性疾病自我管理计划 (CDSMP) 并持续实施 4 至 10 年的组织。这些组织有两种类型：老年服务和医疗保健。研究探讨了内部和外部实施因素和影响。还对州活动（作为支持 CDSMP 实施的关键外部机构）进行了额外的检查。检查发现，这八个组织在为什么采用 CDSMP 方面达成了一致意见 - 指出该计划与他们组织的使命和宗旨相契合，以改善健康状况并促进更好的自我护理，以及该计划的显著价值（收益）。组织还认为内部拥护者和支持性高级领导的重要性。组织在体验和重视同行支持和协作网络方面存在差异。组织在如何填补 CDSMP 研讨会方面也存在差异。内部驱动力和能力更常被讨论为成功实施的促进因素，而外部因素则较少。然而，州活动和外部支持使成功采用成为可能 - 特别是资金和培训。这组组织确定的主要挑战包括招募参与者（填补研讨会）的困难和资金来源不规律或不足。这些挑战被认为是重大的，代表了维持该计划的障碍。
