Willging Cathleen Elizabeth, Shattuck Daniel, Ramos Mary M, Richard Bonnie O, Lawyer Adrien, Dickson Elizabeth, Aarons Gregory A
Southwest Center, Pacific Institute for Research and Evaluation, Albuquerque, NM, United States.
Department of Anthropology, University of New Mexico, Albuquerque, NM, United States.
Front Health Serv. 2025 Jun 3;5:1499508. doi: 10.3389/frhs.2025.1499508. eCollection 2025.
Reducing adolescent suicide in the United States is a public health priority, and lesbian, gay, bisexual, transgender, and queer (LGBTQ+) youth are at elevated risk. The Centers for Disease Control and Prevention has identified six evidence-informed school-based practices (EIPs) that enhance health equity and potentially reduce suicide-related behavior for LGBTQ+ students. Guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, we conducted a five-year, community-engaged cluster randomized controlled trial in 42 New Mexican high schools to study the implementation of these six EIPs. This paper assesses the effectiveness, utility, and benefits of the study's implementation strategy-the Dynamic Adaptation Process (DAP), a participatory and multifaceted implementation approach.
Our convergent parallel mixed-method analysis focused on 22 New Mexico high schools randomized into an implementation condition. Data sources included annual structured assessments of EIP implementation, individual and small-group qualitative interviews with school professionals, periodic debriefs and interviews with implementation coaches, and coach activity logs. We analyzed quantitative data using linear regressions and qualitative data using deductive coding techniques, integrating the results through a joint display.
The schools experienced statistically significant changes compared to their baseline in adopting safe spaces, prohibitions on bullying and harassment based on LGBTQ+ identity, inclusive health education materials, staff professional development, and facilitation of students' access to LGBTQ+ affirming healthcare. We attribute these changes to the impact of the DAP. The DAP facilitated collaboration among school professionals and community organizations to shift knowledge and attitudes and execute contextually responsive implementation strategies. It also fostered relationship-building and leadership, encouraging school leaders to legitimate implementation efforts and champion health equity for LGBTQ+ students.
Participatory implementation science models like the DAP can help prioritize health equity for marginalized populations by enabling the uptake of practices likely to contribute to well-being. This mixed-methods study provides a rich example for future research tackling health disparities for LGBTQ+ people in schools and other complex systems.
降低美国青少年自杀率是一项公共卫生重点工作，而女同性恋、男同性恋、双性恋、跨性别及酷儿（LGBTQ+）青年面临的风险更高。疾病控制与预防中心已确定了六种基于证据的校内实践措施（EIPs），这些措施可促进健康公平，并有可能减少LGBTQ+学生的自杀相关行为。在探索、准备、实施、维持（EPIS）框架的指导下，我们在新墨西哥州的42所高中开展了一项为期五年的社区参与式整群随机对照试验，以研究这六种EIPs的实施情况。本文评估了该研究实施策略——动态适应过程（DAP）的有效性、实用性和益处，DAP是一种参与性和多方面的实施方法。
我们采用收敛平行混合方法分析，重点关注随机分配到实施条件的新墨西哥州22所高中。数据来源包括对EIP实施情况的年度结构化评估、与学校专业人员进行的个人和小组定性访谈、与实施教练的定期汇报和访谈，以及教练活动日志。我们使用线性回归分析定量数据，使用演绎编码技术分析定性数据，并通过联合展示整合结果。
与基线相比，这些学校在采用安全空间、禁止基于LGBTQ+身份的欺凌和骚扰、提供包容性健康教育材料、开展员工专业发展以及促进学生获得认可LGBTQ+的医疗保健方面经历了具有统计学意义的变化。我们将这些变化归因于DAP的影响。DAP促进了学校专业人员和社区组织之间的合作，以转变知识和态度，并执行因地制宜的实施策略。它还促进了关系建设和领导力发展，鼓励学校领导认可实施工作，并为LGBTQ+学生倡导健康公平。
像DAP这样的参与式实施科学模型可以通过促使采用可能有助于福祉的实践措施，帮助将健康公平作为边缘化人群的优先事项。这项混合方法研究为未来解决学校及其他复杂系统中LGBTQ+人群健康差距的研究提供了一个丰富的范例。
