Center for Nutrition & Health Impact, Omaha, NE, USA.
Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA.
Int J Behav Nutr Phys Act. 2024 Nov 26;21(1):132. doi: 10.1186/s12966-024-01685-5.
Implementation strategies have predominantly been operationalized and studied in clinical settings. Implementation strategies are also needed to improve evidence-based intervention (EBI) integration in community settings, but there is a lack of systematic characterization of their use, which limits generalizability of findings. The goals of this study were to determine which implementation strategies are most used to deliver primary prevention EBIs in community settings, develop a compilation and pragmatic strategy selection process with accompanying guidance tools, and understand practitioners' preferences for dissemination.
Purposive and snowball sampling was used to recruit community setting researchers and practitioners delivering primary prevention EBIs (nutrition, physical activity, tobacco prevention) in community settings: education, social services, city planning and transportation, workplaces, recreation/sport, faith-based, and other public health organizations. Semi-structured interviews were conducted using a guide based on the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework. Participants were asked to describe barriers experienced and strategies used to overcome them within each RE-AIM dimension. Practitioners were also asked about preferred dissemination strategies, prompted by Diffusion of Innovations theory concepts of sources (who provides information) and channels (how information is provided). A rapid deductive approach was used to analyze findings with a coding matrix aligned with the interview guide.
Researchers (n = 10) and practitioners (n = 8) across all targeted settings and intervention outcomes completed interviews. Interviewees shared unique implementation strategies (N = 40) which were used to overcome barriers related to multiple RE-AIM dimensions, most commonly implementation (n = 29) and adoption (n = 27). Most frequently mentioned implementation strategies were conduct pragmatic evaluation (n = 31), provide training (n = 26), change adaptable program components (n = 26), and leverage funding sources (n = 21). Webinars (n = 6) and listservs/newsletters (n = 5) were the most mentioned dissemination channels; national public health organizations (n = 13) were the most mentioned sources.
Results reflect commonly used implementation strategies in community settings (e.g., training, technical assistance) and add novel strategies not reflected in current taxonomies. Dissemination preferences suggest the need to involve broad-reaching public health organizations. The resultant compilation (Implementation Strategies Applied in Communities) and strategy selection process provide resources to assist researchers and practitioners in applying strategies and improving EBI delivery in community settings.
实施策略主要在临床环境中进行操作和研究。为了改善社区环境中基于证据的干预措施（EBI）的整合，也需要实施策略，但目前缺乏对其使用情况的系统描述，这限制了研究结果的推广。本研究的目的是确定在社区环境中最常用于提供初级预防 EBI 的实施策略，制定一个编译和实用的策略选择过程，并提供伴随的指导工具，并了解从业者对传播的偏好。
采用目的性和滚雪球抽样方法招募在社区环境中提供初级预防 EBI（营养、体育活动、烟草预防）的社区环境研究人员和从业者：教育、社会服务、城市规划和交通、工作场所、娱乐/体育、信仰和其他公共卫生组织。半结构式访谈采用基于普及度、有效性、采用、实施、维持（RE-AIM）框架的指南进行。参与者被要求描述在每个 RE-AIM 维度中遇到的障碍和克服这些障碍所使用的策略。根据创新扩散理论的来源（谁提供信息）和渠道（如何提供信息）的概念，从业者也被要求描述首选的传播策略。采用快速演绎方法对研究结果进行分析，并使用与访谈指南一致的编码矩阵。
完成访谈的研究人员（n=10）和从业者（n=8）来自所有目标环境和干预结果。受访者分享了独特的实施策略（n=40），这些策略用于克服与多个 RE-AIM 维度相关的障碍，最常见的是实施（n=29）和采用（n=27）。最常提到的实施策略是进行实用评估（n=31）、提供培训（n=26）、改变可适应的项目组成部分（n=26）和利用资金来源（n=21）。网络研讨会（n=6）和列表服务器/通讯（n=5）是最常提到的传播渠道；国家公共卫生组织（n=13）是最常提到的来源。
结果反映了社区环境中常用的实施策略（例如，培训、技术援助），并增加了当前分类法中未反映的新策略。传播偏好表明需要涉及广泛的公共卫生组织。由此产生的编译（在社区中应用的实施策略）和策略选择过程提供了资源，以帮助研究人员和从业者应用策略，并改善社区环境中 EBI 的提供。
