How Are the Implementation and Adaptation of Evidence-Based Interventions Applied in Community Practice Settings? Lessons from the Modelo de Intervencin Psicomdica

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  • March 22, 2019
Creator
  • Pemberton, Gisele Charmion
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Abstract
  • The use of evidence-based behavioral interventions to address the prevention and treatment needs of populations and communities is standard practice across the health professions. In the HIV prevention literature there is consensus that evidence-based interventions (EBIs), that have demonstrated efficacy in research trials, are likely to achieve similar positive outcomes when implemented with high levels of fidelity, consistency, and with similar clients and in cultural settings representative of those in controlled settings. Yet, best practice recommendations of EBIs are disconnected from the realities of community-based practice. This research study describes the selection, implementation and adaptation experiences of three community-based organizations (CBOs) and nine community health practitioners with a specific HIV prevention EBI-The Modelo de Intervencin Psicomdica (MIP). MIP is one of the 29 EBIs designated and endorsed by the Centers for Disease Control and Prevention (CDC) as suitable for community use through their Diffusion of Effective Behavioral Interventions project. The goals of the study were to describe how CBOs approached the selection of MIP to meet local needs; identify the practices and strategies used to facilitate the implementation and adaptation of MIP; inform the development of user-friendly adaptation guidelines specifically for community practice settings; and provide health care leaders with a blueprint for adaptation. A nonexperimental, descriptive design was used, characterized by triangulated research methods - purposeful sampling, semi-structured interviews and document review - to ensure validity. An iterative multi-step analysis of data consisted of data reduction and display, and conclusion drawing and verification. The study revealed 16 key findings with significant implications for community based practitioners, funders and government partners. Recommendations and the Plan for Change address the leadership, resource, training and capacity building needs of funders and CBOs in the process of EBI implementation and adaptation. This plan outlines key steps necessary for health leaders and other stakeholders to invest in, adapt, and maximize existing evidence-based HIV behavioral interventions that can be "made to fit" targeted communities in a manner that maintains the integrity of EBIs; yet responds to the need for culturally competent and relevant HIV prevention interventions in community practice settings.
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  • In Copyright
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  • ... in partial fulfillment of the requirements for the degree of Doctor of Public Health (DrPH) in the Department of Health Policy and Management within the Gillings School of Global Public Health.
Advisor
  • Hobbs, Suzanne Havala
Degree granting institution
  • University of North Carolina at Chapel Hill
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