Mixed methods evaluation of implementation and outcomes in a community-based cancer prevention intervention
Abstract Background Community-based educational programs can complement clinical strategies to increase cancer screenings and encourage healthier lifestyles to reduce cancer burden. However, implementation quality can influence program outcomes and is rarely formally evaluated in community settings....
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-08-01
|
| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12889-019-7315-y |
| _version_ | 1818418601740206080 |
|---|---|
| author | Emily S. King Carla J. Moore Hannah K. Wilson Samantha M. Harden Marsha Davis Alison C. Berg |
| author_facet | Emily S. King Carla J. Moore Hannah K. Wilson Samantha M. Harden Marsha Davis Alison C. Berg |
| author_sort | Emily S. King |
| collection | DOAJ |
| description | Abstract Background Community-based educational programs can complement clinical strategies to increase cancer screenings and encourage healthier lifestyles to reduce cancer burden. However, implementation quality can influence program outcomes and is rarely formally evaluated in community settings. This mixed-methods study aimed to characterize implementation of a community-based cancer prevention program using the Consolidated Framework for Implementation Research (CFIR), determine if implementation was related to participant outcomes, and identify barriers and facilitators to implementation that could be addressed. Methods This study utilized quantitative participant evaluation data (n = 115) and quantitative and qualitative data from semi-structured interviews with program instructors (N = 13). At the participant level, demographic data (age, sex, insurance status) and behavior change intention were captured. Instructor data included implementation of program components and program attendance to create a 7-point implementation score of fidelity and reach variables. Degree of program implementation (high and low) was operationalized based on these variables (low: 0–4, high: 5–7). Relationships among degree of implementation, participant demographics, and participant outcomes (e.g., intent to be physically active or limit alcohol) were assessed using linear or ordinal logistic mixed effects models as appropriate. Interview data were transcribed and coded deductively for CFIR constructs, and constructs were then rated for magnitude and valence. Patterns between ratings of high and low implementation programs were used to determine constructs that manifested as barriers or facilitators. Results Program implementation varied with scores ranging from 4 to 7. High implementation was related to greater improvements in intention to be physically active (p < 0.05), achieve a healthy weight (p < 0.05), and limit alcohol (p < 0.01). Eight constructs distinguished between high and low implementation programs. Design quality and packaging, compatibility, external change agents, access to knowledge and information, and experience were facilitators of implementation and formally appointed internal implementation leaders was a barrier to implementation. Conclusions As higher implementation was related to improved participant outcomes, program administrators should emphasize the importance of fidelity in training for program instructors. The CFIR can be used to identify barriers and/or facilitators to implementation in community interventions, but results may be unique from clinical contexts. |
| first_indexed | 2024-12-14T12:25:16Z |
| format | Article |
| id | doaj.art-b2cfb049b70c43169ff652f4f21464ab |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-14T12:25:16Z |
| publishDate | 2019-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-b2cfb049b70c43169ff652f4f21464ab2022-12-21T23:01:21ZengBMCBMC Public Health1471-24582019-08-0119111810.1186/s12889-019-7315-yMixed methods evaluation of implementation and outcomes in a community-based cancer prevention interventionEmily S. King0Carla J. Moore1Hannah K. Wilson2Samantha M. Harden3Marsha Davis4Alison C. Berg5Department of Foods and Nutrition, University of GeorgiaDepartment of Foods and Nutrition, University of GeorgiaDepartment of Foods and Nutrition, University of GeorgiaDepartment of Human Nutrition, Foods, and Exercise, Virginia TechDean’s Office, Department of Health Promotion and Behavior, University of GeorgiaDepartment of Foods and Nutrition, University of GeorgiaAbstract Background Community-based educational programs can complement clinical strategies to increase cancer screenings and encourage healthier lifestyles to reduce cancer burden. However, implementation quality can influence program outcomes and is rarely formally evaluated in community settings. This mixed-methods study aimed to characterize implementation of a community-based cancer prevention program using the Consolidated Framework for Implementation Research (CFIR), determine if implementation was related to participant outcomes, and identify barriers and facilitators to implementation that could be addressed. Methods This study utilized quantitative participant evaluation data (n = 115) and quantitative and qualitative data from semi-structured interviews with program instructors (N = 13). At the participant level, demographic data (age, sex, insurance status) and behavior change intention were captured. Instructor data included implementation of program components and program attendance to create a 7-point implementation score of fidelity and reach variables. Degree of program implementation (high and low) was operationalized based on these variables (low: 0–4, high: 5–7). Relationships among degree of implementation, participant demographics, and participant outcomes (e.g., intent to be physically active or limit alcohol) were assessed using linear or ordinal logistic mixed effects models as appropriate. Interview data were transcribed and coded deductively for CFIR constructs, and constructs were then rated for magnitude and valence. Patterns between ratings of high and low implementation programs were used to determine constructs that manifested as barriers or facilitators. Results Program implementation varied with scores ranging from 4 to 7. High implementation was related to greater improvements in intention to be physically active (p < 0.05), achieve a healthy weight (p < 0.05), and limit alcohol (p < 0.01). Eight constructs distinguished between high and low implementation programs. Design quality and packaging, compatibility, external change agents, access to knowledge and information, and experience were facilitators of implementation and formally appointed internal implementation leaders was a barrier to implementation. Conclusions As higher implementation was related to improved participant outcomes, program administrators should emphasize the importance of fidelity in training for program instructors. The CFIR can be used to identify barriers and/or facilitators to implementation in community interventions, but results may be unique from clinical contexts.http://link.springer.com/article/10.1186/s12889-019-7315-yImplementationConsolidated Framework for Implementation ResearchCancer preventionExtensionMixed methods |
| spellingShingle | Emily S. King Carla J. Moore Hannah K. Wilson Samantha M. Harden Marsha Davis Alison C. Berg Mixed methods evaluation of implementation and outcomes in a community-based cancer prevention intervention BMC Public Health Implementation Consolidated Framework for Implementation Research Cancer prevention Extension Mixed methods |
| title | Mixed methods evaluation of implementation and outcomes in a community-based cancer prevention intervention |
| title_full | Mixed methods evaluation of implementation and outcomes in a community-based cancer prevention intervention |
| title_fullStr | Mixed methods evaluation of implementation and outcomes in a community-based cancer prevention intervention |
| title_full_unstemmed | Mixed methods evaluation of implementation and outcomes in a community-based cancer prevention intervention |
| title_short | Mixed methods evaluation of implementation and outcomes in a community-based cancer prevention intervention |
| title_sort | mixed methods evaluation of implementation and outcomes in a community based cancer prevention intervention |
| topic | Implementation Consolidated Framework for Implementation Research Cancer prevention Extension Mixed methods |
| url | http://link.springer.com/article/10.1186/s12889-019-7315-y |
| work_keys_str_mv | AT emilysking mixedmethodsevaluationofimplementationandoutcomesinacommunitybasedcancerpreventionintervention AT carlajmoore mixedmethodsevaluationofimplementationandoutcomesinacommunitybasedcancerpreventionintervention AT hannahkwilson mixedmethodsevaluationofimplementationandoutcomesinacommunitybasedcancerpreventionintervention AT samanthamharden mixedmethodsevaluationofimplementationandoutcomesinacommunitybasedcancerpreventionintervention AT marshadavis mixedmethodsevaluationofimplementationandoutcomesinacommunitybasedcancerpreventionintervention AT alisoncberg mixedmethodsevaluationofimplementationandoutcomesinacommunitybasedcancerpreventionintervention |