Leeman Jennifer, Draeger Lindy B, Lyons Kiira, Pham Lisa, Samuel-Hodge Carmen
School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Front Health Serv. 2022 Nov 23;2:934479. doi: 10.3389/frhs.2022.934479. eCollection 2022.
Tailoring implementation strategies for scale-up involves engaging stakeholders, identifying implementation determinants, and designing implementation strategies to target those determinants. The purpose of this paper is to describe the multiphase process used to engage stakeholders in tailoring strategies to scale-up the Med-South Lifestyle Program, a research-supported lifestyle behavior change intervention that translates the Mediterranean dietary pattern for the southeastern US.
Guided by Barker et al. framework, we tailored scale-up strategies over four-phases. In Phase 1, we engaged stakeholders from delivery systems that implement lifestyle interventions and from support systems that provide training and other support for statewide scale-up. In Phase 2, we partnered with delivery systems (community health centers and health departments) to design and pilot test implementation strategies (2014-2019). In Phase 3, we partnered with both delivery and support systems to tailor Phase 2 strategies for scale-up (2019-2021) and are now testing those tailored strategies in a type 3 hybrid study (2021-2023). This paper reports on the Phase 3 methods used to tailor implementation strategies for scale-up. To identify determinants of scale-up, we surveyed North Carolina delivery systems ( = 114 community health centers and health departments) and elicited input from delivery and support system stakeholders. We tailored strategies to address identified determinants by adapting the form of Phase 2 strategies while retaining their functions. We pilot tested strategies in three sites and collected data on intermediate, implementation, and effectiveness outcomes.
Determinants of scale-up included limited staffing, competing priorities, and safety concerns during COVID-19, among others. Tailoring yielded two levels of implementation strategies. At the level of the delivery system, strategies included implementation teams, an implementation blueprint, and cyclical small tests of change. At the level of the support system, strategies included training, educational materials, quality monitoring, and technical assistance. Findings from the pilot study provide evidence for the implementation strategies' reach, acceptability, and feasibility, with mixed findings on fidelity. Strategies were only moderately successful at building delivery system capacity to implement Med-South.
This paper describes the multiphase approach used to plan for Med-South scale-up, including the methods used to tailor two-levels of implementation strategies by identifying and targeting multilevel determinants.
为扩大规模量身定制实施策略涉及让利益相关者参与进来、确定实施的决定因素，并设计针对这些决定因素的实施策略。本文的目的是描述用于让利益相关者参与量身定制策略以扩大“南方医学生活方式项目”规模的多阶段过程，该项目是一项由研究支持的生活方式行为改变干预措施，将地中海饮食模式应用于美国东南部地区。
在巴克等人的框架指导下，我们分四个阶段量身定制扩大规模的策略。在第一阶段，我们让实施生活方式干预的交付系统以及为全州范围扩大规模提供培训和其他支持的支持系统中的利益相关者参与进来。在第二阶段，我们与交付系统（社区卫生中心和卫生部门）合作设计并试点测试实施策略（2014 - 2019年）。在第三阶段，我们与交付系统和支持系统合作，为扩大规模量身定制第二阶段的策略（2019 - 2021年），目前正在一项3型混合研究中测试这些量身定制的策略（2021 - 2023年）。本文报告了在第三阶段用于为扩大规模量身定制实施策略的方法。为了确定扩大规模的决定因素，我们对北卡罗来纳州的交付系统（114个社区卫生中心和卫生部门）进行了调查，并征求了交付系统和支持系统利益相关者的意见。我们通过调整第二阶段策略的形式同时保留其功能来量身定制策略以解决已确定的决定因素。我们在三个地点对策略进行了试点测试，并收集了关于中间、实施和有效性结果的数据。
扩大规模的决定因素包括人员配备有限、相互竞争的优先事项以及新冠疫情期间的安全担忧等。量身定制产生了两个层面的实施策略。在交付系统层面，策略包括实施团队、实施蓝图以及周期性的小规模变革测试。在支持系统层面，策略包括培训、教育材料、质量监测和技术援助。试点研究的结果为实施策略的覆盖范围、可接受性和可行性提供了证据，在保真度方面结果不一。这些策略在建设交付系统实施“南方医学”项目的能力方面仅取得了一定程度的成功。
本文描述了用于规划“南方医学”项目扩大规模的多阶段方法，包括通过识别和针对多层次决定因素来量身定制两个层面实施策略所使用的方法。
