Drew Alison L, Yang Huidi, Rhoades Kimberly A, Slep Amy M Smith, Heyman Richard E
Family Translations Research Group, New York University, New York, NY 10010, United States.
Mil Med. 2025 Aug 6. doi: 10.1093/milmed/usaf397.
The U.S. Department of Defense (DoD) requires the implementation of evidence-based behavioral health interventions (EBIs) to prevent harmful behaviors such as suicide, harassment, sexual assault, and partner and child abuse. However, EBI sustainment with fidelity over time is a tremendous challenge, and a failure to do so limits the potential impact of these EBIs. Although implementation science theories and empirical research have identified determinants of EBI sustainment in the civilian context, unique aspects of the military social ecology likely influence sustainment in this context. Building on our prior leader interviews, this study examines program implementers' perspectives on factors influencing military behavioral health EBI sustainment. The combined perspectives of leaders and implementers will inform a military-specific model for implementing and sustaining behavioral health EBIs that can then be empirically tested.
We conducted focus groups with 24 implementers representing 5 behavioral health EBIs currently implemented in the U.S. Military: 4 evidence-based sexual assault prevention programs and 1 longstanding, evidence-based suicide prevention program. We conducted a multi-step thematic analysis to identify supports and impediments to sustaining EBIs, organized by levels of the social ecology. Themes were organized using the Consolidated Framework for Implementation Research: outer setting (DoD, Congress, service, major command), inner setting (installation, service agency), characteristics of individuals (implementers, end users), and innovation characteristics. The New York University Institutional Review Board reviewed and approved the study (IRB-FY2020-4345), and the U.S. Army Medical Research and Development Command Human Research Protections Office provided concurrence.
Participants identified socioecological supports and impediments to sustaining EBIs in the military context and described how factors at the outer levels of the social ecology influence implementers' and end users' experiences. They noted the importance of (1) choosing EBIs that have been evaluated in a military context and have support from leaders in the outer and inner settings, and (2) implementation by an educated and trained workforce. Notably, aspects of military culture (e.g., hierarchical structure, frequent moves, mission focus, mandated participation) can both support and challenge the implementation of behavioral health EBIs.
Prevention implementers confirmed leadership-identified military-specific social-ecological factors influencing behavioral health EBI fidelity and sustainability, while providing unique, on-the-ground insights into implementer and end-user experiences. The study's results reinforce the need for implementation scientists to use a military-informed model to understand the determinants of sustained EBI implementation. Further evaluation of this model is warranted to document the relative contributions of these determinants and identify priorities for enhancements that can improve the sustainability of military behavioral health EBIs, ultimately improving the well-being of service members and supporting mission readiness.
美国国防部要求实施循证行为健康干预措施（EBIs），以预防自杀、骚扰、性侵犯以及伴侣和儿童虐待等有害行为。然而，随着时间的推移，持续保真地实施循证行为健康干预措施是一项巨大的挑战，而未能做到这一点会限制这些干预措施的潜在影响。尽管实施科学理论和实证研究已经确定了在 civilian 背景下循证行为健康干预措施持续实施的决定因素，但军事社会生态的独特方面可能会影响在这种背景下的持续实施。基于我们之前对领导者的访谈，本研究考察了项目实施者对影响军事行为健康循证行为健康干预措施持续实施因素的看法。领导者和实施者的综合观点将为实施和维持行为健康循证行为健康干预措施的特定军事模型提供信息，然后可以对其进行实证检验。
我们与 24 名实施者进行了焦点小组讨论，他们代表了目前在美国军队中实施的 5 种行为健康循证行为健康干预措施：4 种循证性侵犯预防项目和 1 个长期的循证自杀预防项目。我们进行了多步骤主题分析，以确定持续实施循证行为健康干预措施的支持因素和阻碍因素，并按社会生态层面进行组织。主题是使用实施研究综合框架进行组织的：外部环境（国防部、国会、军种、主要司令部）、内部环境（军事基地、军种机构）、个人特征（实施者、最终用户）以及创新特征。纽约大学机构审查委员会审查并批准了该研究（IRB-FY2020-4345），美国陆军医学研究与发展司令部人类研究保护办公室也表示同意。
参与者确定了在军事背景下持续实施循证行为健康干预措施的社会生态支持因素和阻碍因素，并描述了社会生态外部层面的因素如何影响实施者和最终用户的体验。他们指出了以下两点的重要性：（1）选择在军事背景下经过评估并得到外部和内部环境领导者支持的循证行为健康干预措施；（2）由受过教育和培训的工作人员进行实施。值得注意的是，军事文化的各个方面（例如等级结构、频繁调动、任务重点、强制参与）既可以支持也可以挑战行为健康循证行为健康干预措施的实施。
预防实施者确认了领导者所确定的影响行为健康循证行为健康干预措施保真度和可持续性的特定军事社会生态因素，同时提供了关于实施者和最终用户体验的独特的实地见解。该研究结果强化了实施科学家使用军事知情模型来理解循证行为健康干预措施持续实施决定因素的必要性。有必要对该模型进行进一步评估，以记录这些决定因素的相对贡献，并确定可提高军事行为健康循证行为健康干预措施可持续性的改进重点，最终改善军人的福祉并支持任务准备状态。
