RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
Malone Quantitative, Durham, North Carolina, USA.
Prev Sci. 2019 Nov;20(8):1200-1210. doi: 10.1007/s11121-019-01037-x.
Implementation support interventions have helped organizations implement programs with quality and obtain intended outcomes. For example, a recent randomized controlled trial called Preparing to Run Effective Programs (PREP) showed that an implementation support intervention called Getting To Outcomes (GTO) improved implementation of an evidence-based substance use prevention program (CHOICE) run in community-based settings. However, more information is needed on how these interventions affect organizational barriers and facilitators of implementation. This paper aims to identify differences in implementation facilitators and barriers in sites conducting a substance use prevention program with and without GTO. PREP is a cluster-randomized controlled trial testing GTO, a two-year implementation support intervention, in Boys & Girls Clubs. The trial compares 15 Boys & Girls Club sites implementing CHOICE (control group), a five-session evidence-based alcohol and drug prevention program, with 14 Boys & Girls Club sites implementing CHOICE supported by GTO (intervention group). All sites received CHOICE training. Intervention sites also received GTO manuals, training, and onsite technical assistance to help practitioners complete implementation best practices specified by GTO (i.e., GTO steps). During the first year, technical assistance providers helped the intervention group adopt, plan, and deliver CHOICE, and then evaluate and make quality improvements to CHOICE implementation using feedback reports summarizing their data. Following the second year of CHOICE and GTO implementation, all sites participated in semi-structured interviews to identify barriers and facilitators to CHOICE implementation using the Consolidated Framework for Implementation Research (CFIR). This paper assesses the extent to which these facilitators and barriers differed between intervention and control group. Intervention sites had significantly higher average ratings than control sites for two constructs from the CFIR process domain: planning and reflecting and evaluating. At the same time, intervention sites had significantly lower ratings on the culture and available resources constructs. Findings suggest that strong planning, evaluation, and reflection-likely improved with GTO support-can facilitate implementation even in the face of perceptions of a less desirable implementation climate. These findings highlight that implementation support, such as GTO, is likely to help low-resourced community-based organizations improve program delivery through a focus on implementation processes. TRIAL REGISTRATION: This project is registered at ClinicalTrials.gov with number NCT02135991 (URL: https://clinicaltrials.gov/show/NCT02135991). The trial was first registered May 12, 2014.
实施支持干预措施有助于组织以高质量实施项目并获得预期成果。例如，最近一项名为“准备有效实施项目”（PREP）的随机对照试验表明，一种名为“达成成果”（GTO）的实施支持干预措施可改善在社区环境中实施的基于证据的药物使用预防计划（CHOICE）。然而，我们需要更多信息来了解这些干预措施如何影响实施的组织障碍和促进因素。本文旨在确定在实施 GTO（为期两年的实施支持干预措施）和未实施 GTO 的情况下，实施促进因素和障碍方面的差异。PREP 是一项测试 GTO 的集群随机对照试验，GTO 是一种两年的实施支持干预措施，在男孩女孩俱乐部进行。该试验比较了 15 个实施 CHOICE（对照组）的男孩女孩俱乐部，CHOICE 是一个五节的基于证据的酒精和药物预防计划，以及 14 个实施 CHOICE 并得到 GTO 支持的男孩女孩俱乐部（干预组）。所有站点都接受了 CHOICE 培训。干预组还获得了 GTO 手册、培训和现场技术援助，以帮助从业人员完成 GTO 规定的实施最佳实践（即 GTO 步骤）。在第一年，技术援助提供者帮助干预组采用、计划和提供 CHOICE，然后使用总结他们数据的反馈报告评估并改进 CHOICE 实施的质量。在实施 CHOICE 和 GTO 的第二年之后，所有站点都参加了半结构化访谈，以使用实施研究综合框架（CFIR）确定实施 CHOICE 的障碍和促进因素。本文评估了这些促进因素和障碍在干预组和对照组之间的差异程度。干预组在 CFIR 过程领域的两个结构上的平均评分明显高于对照组：计划和反思以及评估。同时，干预组在文化和可用资源结构上的评分明显较低。研究结果表明，在面对不太理想的实施环境的情况下，强有力的计划、评估和反思——可能得益于 GTO 的支持——可以促进实施。这些发现强调了实施支持（如 GTO）可能有助于资源匮乏的社区组织通过关注实施过程来提高项目交付。试验注册：该项目在 ClinicalTrials.gov 注册，编号为 NCT02135991（网址：https://clinicaltrials.gov/show/NCT02135991）。该试验于 2014 年 5 月 12 日首次注册。
