McKay Virginia R, Margaret Dolcini M, Hoffer Lee D
Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA.
School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA.
Transl Behav Med. 2017 Dec;7(4):821-831. doi: 10.1007/s13142-017-0493-1.
Evidence-based intervention (EBI) de-adoption and its influence on public health organizations are largely unexplored within public health implementation research. However, a recent shift in support for HIV prevention EBIs by the Centers for Disease Control and Prevention provides an opportunity to explore EBI de-adoption. The current mixed-method study examines EBI de-adoption and the subsequent impact on a community-based organization (CBO) dedicated to HIV prevention. We conducted a case study with a CBO implementing RESPECT, an HIV prevention EBI, over 5 years (2010-2014), but then de-adopted the intervention. We collected archival data documenting RESPECT implementation and conducted two semi-structured interviews with RESPECT staff (N = 5). Using Fixsen and colleagues' implementation framework, we developed a narrative of RESPECT implementation, delivery, and de-adoption and a thematic analysis to understand additional consequences of RESPECT de-adoption. Discontinuation of RESPECT activities unfolded in a process over time, requiring effort by RESPECT staff. RESPECT de-adoption had wide-reaching influences on individual staff, interactions between the staff and the community, the agency overall, and for implementation of future EBIs. We propose a revision of the implementation framework, incorporating EBI de-adoption as a phase of the implementation cycle. Furthermore, EBI de-adoption may have important, unintended consequences and can inform future HIV prevention strategies and guide research focusing on EBI de-adoption.
基于证据的干预措施（EBI）的弃用及其对公共卫生组织的影响在公共卫生实施研究中基本上未得到探讨。然而，疾病控制与预防中心最近对艾滋病毒预防EBI的支持转变为探索EBI的弃用提供了一个机会。当前的混合方法研究考察了EBI的弃用以及随后对一个致力于艾滋病毒预防的社区组织（CBO）的影响。我们对一个在5年（2010 - 2014年）期间实施艾滋病毒预防EBI“尊重”（RESPECT）但随后弃用该干预措施的CBO进行了一项案例研究。我们收集了记录RESPECT实施情况的档案数据，并对RESPECT工作人员（N = 5）进行了两次半结构化访谈。使用菲克森及其同事的实施框架，我们梳理了RESPECT的实施、提供和弃用过程，并进行了主题分析，以了解RESPECT弃用的其他后果。RESPECT活动的终止是一个随着时间推移的过程，需要RESPECT工作人员付出努力。RESPECT的弃用对工作人员个人、工作人员与社区之间的互动、整个机构以及未来EBI的实施都产生了广泛影响。我们提议对实施框架进行修订，将EBI的弃用纳入实施周期的一个阶段。此外，EBI的弃用可能会产生重要的意外后果，并可为未来的艾滋病毒预防策略提供参考，指导聚焦于EBI弃用的研究。
