Kasprzak Christina M, Canizares Andy, Lally Anne, Tirabassi Jill N, Vermont Leah N, Lev Samuel, Ammerman Alice S, Leone Lucia A
Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States.
Department of Anthropology, College of Arts and Sciences, University at Buffalo, Buffalo, NY, United States.
Front Health Serv. 2024 Feb 13;4:1288160. doi: 10.3389/frhs.2024.1288160. eCollection 2024.
The Veggie Van model is a mobile market model that is efficacious in increasing fruit and vegetable consumption for lower-income participants. The model is currently being evaluated for its effectiveness in a multi-state trial. Preliminary implementation data, collected through process measures surveys and implementation interviews, indicate that there are several barriers to implementation among partner organizations and implementation fidelity to the Veggie Van model was low. Consideration and planning for implementation ought to occur early and often throughout the research process order to ensure Veggie Van model effectiveness. This paper describes the step-by-step process for creating strategies to enhance implementation of Veggie Van model components.
Implementation mapping is a systematic process to develop implementation strategies through engagement with key stakeholders. We conducted a series of interviews ( = 31 representatives) with partner organizations ( = 8) to identify facilitators and barriers to Veggie Van model implementation. We then applied interview findings to an Implementation Mapping process to develop theory and practice-driven strategies to be integrated into existing implementation tools and technical assistance.
We identified implementation outcomes (e.g., staff implement the Veggie Van model component of nutrition education with fidelity) and performance objectives (e.g., offer nutrition education, in the form of food lessons and/or food demonstrations, at least bi-weekly) to achieve them. We conducted a secondary qualitative analysis of the findings from implementation interviews with partner organizations to identify behavioral determinants (e.g., attitudinal beliefs, social support) which were combined with the performance objectives to generate change objectives (e.g., view the Veggie Van model as advantageous to an organization and communities served). To achieve the change objectives, we developed implementation strategies that would be integrated into existing Veggie Van training resources including an online toolkit, webinars and trainings, an annual mobile market conference, and technical assistance.
The development of theory and practice-driven implementation strategies will enable us to improve our implementation tools, thereby improving fidelity to the Veggie Van model among organizations and increasing the likelihood of its effectiveness. Detailing the design of a multifaceted implementation strategy using Implementation Mapping also provides a model to design similar strategies for other community-based interventions.
“蔬菜车”模式是一种移动市场模式，对于增加低收入参与者的果蔬消费量很有效。目前正在一项多州试验中对该模式的有效性进行评估。通过过程措施调查和实施访谈收集的初步实施数据表明，合作伙伴组织在实施过程中存在若干障碍，并且对“蔬菜车”模式的实施保真度较低。为确保“蔬菜车”模式的有效性，在整个研究过程中应尽早且经常地进行实施方面的考量和规划。本文描述了制定策略以加强“蔬菜车”模式各组成部分实施的逐步过程。
实施映射是通过与关键利益相关者合作来制定实施策略的系统过程。我们与8个合作伙伴组织的31名代表进行了一系列访谈，以确定“蔬菜车”模式实施的促进因素和障碍。然后，我们将访谈结果应用于实施映射过程，以制定理论和实践驱动的策略，将其整合到现有的实施工具和技术援助中。
我们确定了实施成果（例如，工作人员忠实地实施营养教育的“蔬菜车”模式组成部分）和绩效目标（例如，至少每两周以食品课程和/或食品示范的形式提供营养教育）以实现这些成果。我们对与合作伙伴组织的实施访谈结果进行了二次定性分析，以确定行为决定因素（例如，态度信念、社会支持），这些因素与绩效目标相结合，以产生变革目标（例如，将“蔬菜车”模式视为对组织和所服务社区有利）。为实现变革目标，我们制定了实施策略，这些策略将被整合到现有的“蔬菜车”培训资源中，包括在线工具包、网络研讨会和培训、年度移动市场会议以及技术援助。
理论和实践驱动的实施策略的制定将使我们能够改进我们的实施工具，从而提高各组织对“蔬菜车”模式的保真度，并增加其有效性的可能性。使用实施映射详细设计多方面的实施策略也为设计其他基于社区的干预措施的类似策略提供了一个模型。
