Assessing organizational readiness for the Clean Cuts and Sharp Minds Collective: a barbershop health promotion network.

BACKGROUND: Black men have among the lowest life expectancy in the United States. Alarmingly, these men are underrepresented in health promotion efforts. There are well-documented barriers to recruiting and retaining Black men in health promotion efforts, such as exclusionary research practices - many researchers may be hesitant to reach Black men in culturally unique spaces, such as barbershops. Despite these practices, qualitative research among Black men unanimously find that Black men are interested in health promotion efforts. The Clean Cuts and Sharp Minds Collective (CCSMC) was designed to bridge this gap. The objectives of the CCSMC are to train barbers to be lay advocates for their clients, train barbers to be research partners, and serve as a nexus between barbers interested in health promotion at their shops and researchers interested in implementing such efforts. The present study sought to assess the organizational readiness of barbershops in South Carolina (SC) to participate in the CCSMC. METHODS: Barbers in SC were invited to complete a modified version of the Readiness Thinking Tool to assess organizational readiness to participate in the CCSMC. RESULTS: Thirty-six (36; mean age = 41.12; 94.4% identified as Black; 91.7% identified as male) barbers completed the organizational readiness assessment. Results indicated that there was a high level of motivation, innovation-specific capacity, and general capacity within barbershops to participate in the CCSMC. Additionally, many barbers indicated that there would be widespread support to join the CCSMC. CONCLUSIONS: The results from the present study highlight exciting opportunities and future directions for barbershop-academic partnerships. Such partnerships have the potential to promote health equity among, and in partnership with, Black men.

A Proactive, Systematic Approach to Building the Capacity of Technical Assistance Providers.

Technical assistance (TA) is a major capacity building strategy used by the government sector to promote health outcomes in the United States. However, there is minimal literature about how to develop TA provider capacities. This article describes a systematic and proactive approach for developing TA provider capacity, referred to as Technical Assistance for Technical Assistance Providers (TAFTAP), which draws on three implementation science frameworks (Interactive Systems Framework for Dissemination and Implementation, Getting To Outcomes, and R = MC2). We present an application of TAFTAP within a federal agency providing a readiness-informed TA approach to health departments of states, territories, and tribal areas implementing comprehensive tobacco prevention control programs. Pilot data suggest that TAFTAP is a promising approach for improving the quality of TA delivery. At the end of the 2-year project period, TAFTAP recipients provided generally positive qualitative feedback about the support they received. They chose to sustain the readiness-informed TA by incorporating it into a future funding announcement. Downstream state-level TA grantee recipients reported positive outcomes (e.g., accelerated progress, enjoying more one-on-one time with TA providers) from receiving the TA innovation from TAFTAP recipients. We suggest that funding agencies and training and TA centers consider this approach to bolster the capacity and motivation of TA providers for downstream benefit to health and human services staff and their clients. Practical steps for employing TAFTAP to advance health outcomes are included in this article.

Implementation mapping for tobacco cessation in a federally qualified health center.

Background: Implementation mapping (IM) is a promising five-step method for guiding planning, execution, and maintenance of an innovation. Case examples are valuable for implementation practitioners to understand considerations for applying IM. This pilot study aimed to determine the feasibility of using IM within a federally qualified health center (FQHC) with limited funds and a 1-year timeline. Methods: An urban FQHC partnered with an academic team to employ IM for implementing a computerized strategy of tobacco cessation: the 5A's (Ask, Advise, Assess, Assist, Arrange). Each step of IM was supplemented with theory-driven methods and frameworks. Data collection included surveys and interviews with clinic staff, analyzed via rapid data analysis. Results: Medical assistants and clinicians were identified as primary implementers of the 5A's intervention. Salient determinants of change included the perceived compatibility and relative priority of 5A's. Performance objectives and change objectives were derived to address these determinants, along with a suite of implementation strategies. Despite indicators of adoptability and acceptability of the 5A's, reductions in willingness to adopt the implementation package occurred over time and the intervention was not adopted by the FQHC within the study timeframe. This is likely due to the strain of the COVID-19 pandemic altering health clinic priorities. Conclusions: Administratively, the five IM steps are feasible to conduct with FQHC staff within 1 year. However, this study did not obtain its intended outcomes. Lessons learned include the importance of re-assessing barriers over time and ensuring a longer timeframe to observe implementation outcomes.

Implementation stages in practice: A review of behavioral health innovation within hospitals.

Behavioral health influences patient health outcomes and healthcare utilization rates. Hospitals are promising settings for appropriate identification, treatment, and referral of behavioral health issues and may affect hospital admission rates and healthcare costs. Implementation frameworks are designed to aid successful adoption and scaling of health innovations. One type - process models - present staged frameworks for rolling out an innovation into routine practice. Process models are appealing for their pragmatism but are criticized for oversimplifying the complexity of implementation. This review investigates the empirical evidence for process models' utility in hospitals, chosen for their uniquely complex structures, by determining whether their use impacts implementation outcomes. Using systematic search and selection criteria across six databases, ten peer-reviewed studies were identified. Each applied a process model for implementing behavioral health innovations within hospital systems. Studies were coded by type of stage framework and reported implementation outcomes. Studies reported mostly favorable or mixed outcomes. No one framework prevailed in use nor evidence. Due to the paucity of published literature and reported data, there is limited evidence that process model application propels implementation outcomes in hospital settings. Furthering the science requires creating and utilizing systematic guidelines to employ process models, measure and report implementation stage transition, and measure and report implementation outcomes. Management and practitioners can include such data collection in standard process evaluations of hospital implementation and scale-up activities, or adopt complexity-informed approaches that lack the simplicity of process models but may be more realistic for complex settings.

Implementation Science in Thailand: Design and Methods of a Geriatric Mental Health Cluster-Randomized Trial.

BACKGROUND: Thailand has a rapidly aging population yet lacks evidence for effective and scalable evidence-based psychosocial interventions to support persons living with dementia and their family caregivers. In this study of a culturally adapted and evidence-based clinical program (Reducing Disabilities in Alzheimer's Disease [RDAD]), designed to reduce behavioral and psychological symptoms of dementia in older adults, the authors test the hypothesis that an implementation support strategy, Getting To Outcomes (GTO), would produce better implementation and clinical outcomes compared with usual implementation of RDAD in Thailand. METHODS: The study uses a hybrid type III cluster-randomized design to compare eight geographical districts that receive training on both implementing the RDAD clinical intervention and on GTO implementation support strategies (intervention arm) with eight other districts that receive the same RDAD training but without training in GTO implementation support strategies (control arm). GTO is an evidence-based intervention designed to support implementers to better plan, implement, and evaluate innovative intervention programs in a novel setting. Primary outcomes, including implementation and clinical outcomes, will be assessed at baseline, month 3 (posttreatment), and month 6 (3-month follow-up). RESULTS: The research team anticipates that there will be significantly more improvements in the delivery of the RDAD intervention program in the experimental group than in the control group. NEXT STEPS: If clinical trial findings are positive, the authors plan to replicate and scale up the proposed implementation science approach across Thailand to enhance and expand mental health services for older adults with dementia.

The community transformation map: A maturity tool for planning change in community health improvement for equity and well-being.

Transforming communities to be healthier and more equitable prosents a systemic challenge best addressed by those with native knowledge of the system. Community coalitions are a promising structure for tackling local health inequities, if they approach the change process with multiple local stakeholders and with systemic change in mind. Maturity models offer a framework for system assessment by defining sequential stages toward ideal development. Providing coalitions with a structure for self-assessing community change, the Community Transformation Map (CTM) is a maturity model that operationalizes concepts hypothesized to foster systemic change. This 40-item tool encourages self-assessment, dialogue, and reconciliation of community transformation priorities via an appreciative inquiry process. The CTM was created and applied with 18 community coalitions participating in the 100 Million Healthier Lives initiative. It was iteratively drafted with representatives from across the initiative. These coalitions self-administered the CTM four times over 24 months. Coalitions used the CTM to reconcile perspectives, identify priorities, and create transformation action plans. After the fourth administration, ten semistructured interviews were conducted with coalition members. Thematic analysis revealed good contextual validity. Coalitions saw value in the CTM's productive dialogue and the shared understanding it created, but reported perceived burden in conducting repeated administration. The CTM's value is in structuring community members' reflection on complex, systemic problems. The CTM is rooted in international improvement and change principles and continues to be adapted for other change initiatives. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

R = MC2 readiness building process: A practical approach to support implementation in local, state, and national settings.

Effective implementation of evidence-based interventions is a persistent challenge across community settings. Organizational readiness - or, the motivation and collective capacity of an entity to adopt and sustain an innovation - is important to facilitate implementation. Drawing on the R = MC2 readiness framework, we developed a readiness building process to tailor support for implementation. The process is composed of the following stages: assessment, feedback and prioritization, and strategize. In this article, we describe the application of the readiness building process through three case examples representing interventions at different ecological levels: local, state, and national. The case examples illuminate challenges and practical considerations for using the readiness building process, including the significance of on-going leadership engagement and collaboration between support system and delivery system staff. To further the research and practice of implementation readiness, we suggest examining the impact of readiness building on implementation outcomes and developing an empirically-informed repository of change management strategies matched to readiness constructs.

Stigma and psychosocial wellbeing among children affected by parental HIV in China.

OBJECTIVES: Parental HIV infection presents unique psychosocial challenges for families. Affected children are vulnerable to stigma-related distress from a parent's HIV status and are more likely to experience symptoms of depression and low self-esteem than unaffected peers. This study examined whether HIV-related stigma predicted poorer mental health among children affected by parental HIV and whether psychosocial assets mediated this relationship. METHODS: A sample of 790 children (ages 6-17) affected by parental HIV in Henan, China reported on HIV-related stigma, social support, emotional regulation, future outlook, and mental health symptoms. Structural equation modeling was used to examine the direct and indirect effects of stigma on mental health. RESULTS: Results indicated that stigma was associated with psychosocial resources, which in turn were associated with mental health symptoms. The indirect pathways from stigma to mental health symptoms through psychosocial resources were consistent across age and gender. CONCLUSION: The experience of HIV-related stigma was associated with poorer overall mental health among children affected by parental HIV in China. Children's psychosocial resources, including social support, emotional regulation, and future outlook, mediated the relationship between HIV-related stigma and mental health symptoms. Future interventions may wish to target these modifiable aspects of wellbeing to improve social and behavioral outcomes in this vulnerable population.

Prioritizing Equity: Exploring Conditions Impacting Community Coalition Efforts.

Purpose: There is a critical push toward addressing equity in health care. Community coalitions are uniquely situated to heed this call by tackling issues of equity and well-being that are the most relevant for their local context. This article analyzes internal and external contextual factors that may affect coalitions' prioritization of equity. Methods: Data were collected from 18 coalitions participating in a national, U.S.-based initiative aimed at strengthening community coalition work through the principles of equity and inclusion. A hybrid qualitative-quantitative method (qualitative comparative analysis [QCA]) was conducted using the direct method of calibration and fuzzy set QCA and to obtain casual sufficiency results. Results: Coalitions located in states that did not expand Medicaid after the Affordable Care Act were most likely to prioritize equity, as were coalitions who were both working with marginalized populations and had low organizational readiness for the initiative. However, only one case demonstrated the latter causal solution; the former accounts for greater coverage of the outcome. Conclusion: This study illustrates the use of QCA for evaluation and underscores the critical role of contextual factors for affecting meaningful community-level change. Coalitions are willing and able to prioritize tackling health inequities across settings, but those in settings with low state-level support may be more likely to emphasize inequities in their work.

Community coalition readiness for implementing something new: Using a Delphi methodology.

Organizational readiness for an innovation (a program, policy, or practice new to a setting) is important for successful implementation. The R = MC2 heuristic focuses on capacity and motivation as a framework for readiness; it comprises 3 components and 18 subcomponents. A Delphi study with community coalition leaders was undertaken to assess when each subcomponent is most significant in the life cycle of implementing an innovation in a coalition. Results include that motivation is viewed as most important in the early stages of implementation and leadership, climate, program champions, and interorganizational relationships are relevant throughout the lifespan of implementation. Results have implications for the future of assessing and building coalition readiness.