Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA.
Department of Sociology, Sungkyunkwan University, Seoul, South Korea.
Transl Behav Med. 2021 Mar 16;11(2):462-469. doi: 10.1093/tbm/ibaa049.
Cardiovascular disease is the second leading cause of death in the USA among Asian Americans and Pacific Islanders (AAPIs) over the age of 65. Healthy Eating Healthy Aging (HEHA), an evidence-based heart health program, can provide culturally appropriate nutrition education to decrease the risk of cardiovascular disease. Community-based organizations (CBOs) are optimal settings to implement community-based programs. However, there is inadequate research on how evidence-based interventions like HEHA are implemented in CBOs. This study examined processes that facilitated the implementation of HEHA among CBOs serving older AAPIs. Twelve representatives from CBOs that implemented the HEHA program were recruited to participate in a semistructured interview. All the participants were CBO directors or senior managers. A semistructured interview guide was created and informed by the Consolidated Framework for Implementation Research (CFIR) to capture how HEHA played into the five domains of CFIR: (a) intervention characteristics, (b) outer setting, (c) inner setting, (d) characteristics of the individuals, and (e) process. Data analysis captured themes under the CFIR domains. All five CFIR domains emerged from the interviews. Under intervention characteristics, three constructs emerged as facilitating the implementation of HEHA: (a) the participant's beliefs around the quality of the HEHA program and its ability to promote healthy eating, (b) HEHA's adaptability to different AAPI subgroups, and (c) perceptions of how successfully HEHA was bundled and assembled. Under outer setting, the participants described the community's need for healthy eating programs and how the HEHA program meets that need. Four constructs emerged under inner setting: (a) the CBO's structural characteristics and social standing in the community; (b) resources dedicated to the implementation and ongoing operations, including funding, training, education, physical space, and time; (c) the culture of the CBO; and (d) the participant's commitment and involvement in marketing, promotion, and implementation of HEHA. Under characteristics of individuals, participants' described their desire to learn the content of HEHA and deliver them successfully. Under process, participants described strategies to engage relevant individuals to facilitate HEHA implementation. The interviews with CBO representatives provided insights into CFIR domain constructs that facilitated the implementation of HEHA. CBOs are key settings for community health education. Understanding processes that lead to the successful implementation of evidence-based interventions among CBOs is critical for accelerating the dissemination and implementation of best practices.
心血管疾病是 65 岁以上美国亚裔和太平洋岛民（AAPI）的第二大死亡原因。健康饮食健康老龄化（HEHA）是一个基于证据的心脏健康计划，可以提供文化上适当的营养教育，降低心血管疾病的风险。社区组织（CBO）是实施基于社区的项目的最佳场所。然而，关于像 HEHA 这样的基于证据的干预措施如何在 CBO 中实施的研究还不够充分。本研究探讨了促进 CBO 为老年 AAPI 实施 HEHA 的过程。从实施 HEHA 计划的 12 名 CBO 代表中招募了他们来参加半结构化访谈。所有参与者都是 CBO 主任或高级经理。创建了一份半结构化访谈指南，并由实施研究综合框架（CFIR）通知，以捕捉 HEHA 如何融入 CFIR 的五个领域：（a）干预措施特征，（b）外部环境，（c）内部环境，（d）个体特征，和（e）过程。数据分析捕捉了 CFIR 领域下的主题。所有五个 CFIR 领域都来自访谈。在干预措施特征下，出现了三个构建，促进了 HEHA 的实施：（a）参与者对 HEHA 计划质量及其促进健康饮食能力的信念，（b）HEHA 对不同 AAPI 亚群的适应性，以及（c）对 HEHA 成功捆绑和组装的看法。在外设环境下，参与者描述了社区对健康饮食计划的需求以及 HEHA 计划如何满足该需求。在内部环境下出现了四个构建：（a）CBO 的结构特征和在社区中的社会地位；（b）用于实施和持续运营的资源，包括资金、培训、教育、物理空间和时间；（c）CBO 的文化；以及（d）参与者在营销、推广和实施 HEHA 方面的投入和参与。在个体特征方面，参与者描述了他们学习 HEHA 内容并成功提供的愿望。在流程下，参与者描述了吸引相关人员来促进 HEHA 实施的策略。对 CBO 代表的访谈提供了对促进 HEHA 实施的 CFIR 领域结构的见解。CBO 是社区健康教育的关键场所。了解导致 CBO 成功实施基于证据的干预措施的过程对于加速最佳实践的传播和实施至关重要。
