Characterizing implementation strategies using a systems engineering survey and interview tool: a comparison across 10 p
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METHODOLOGY
Open Access
Characterizing implementation strategies using a systems engineering survey and interview tool: a comparison across 10 prevention programs for drug abuse and HIV sexual risk behavior Sara J. Czaja1*, Thomas W. Valente2, Sankaran N. Nair3, Juan A. Villamar4 and C. Hendricks Brown4
Abstract Background: Although many behavioral interventions have proven to be efficacious, new methodologies are required beyond efficacy trials to understand how to adopt, implement with fidelity, and sustain behavioral interventions in community settings. In this paper, we present a new approach, based on systems engineering concepts and methods, for characterizing implementation strategies that are used to deliver evidence-based behavioral interventions in health and social service settings. We demonstrate the use of this approach with implementation strategies, used or being used for broader dissemination of 10 evidence-based prevention program projects focused on the prevention of drug or HIV sex risk behaviors. Results: The results indicate that there are wide variations in intervention approaches and that there are challenges in program implementation including maintaining program fidelity, serving community needs, and adequate resources. The results also indicate that implementation requires a committed partnership between the program developers, implementation researchers, and community partners. In addition, there is a need for adaptability within programs to meet community needs, resources, and priorities while maintaining program fidelity. Conclusions: Our methodological approach enabled us to highlight challenges associated with the community implementation of health risk prevention interventions. We also demonstrate how comprehensive descriptions of interventions facilitate understanding of the requirements of program implementation and decisions about the feasibility of implementing a program in community settings. Keywords: Implementation science, Behavioral interventions, Systems engineering
Background Drug use and sexually transmitted infections remain significant public health problems in the USA. In 2011, an estimated 8.7 % of the population had used or abused an illicit drug or a psychotherapeutic medication; of these 24 % were 18–20 year olds [1]. Drug and alcohol disorders and sexually risky behaviors, which increase
* Correspondence: [email protected] 1 Department of Psychiatry and Behavioral Science, Miller School of Medicine, University of Miami, 1694 NW 9th Ave., Miami, FL 33136, USA Full list of author information is available at the end of the article
the chance of sexually transmitted infections, are closely tied especially in adolescence [1–8]. In this regard, a large number of interventions have been shown to be effective in reducing the incidence of drug and alcohol abuse [9] and engagement in risky sexual behavior among young adults (e.g., [10, 11]). But there are challenges to widely delivering these programs [12], especially to minority populations [13, 14]. Despite the r
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