Skip to main content
SpringerLink
Log in

“During early implementation you just muddle through”: factors that impacted a statewide arthritis program’s implementation

  • Original Research
  • Published:
Translational Behavioral Medicine

Abstract

The need to scale-up effective arthritis self-management programs is pressing as the prevalence of arthritis increases. The CDC Arthritis Program funds state health departments to work with local delivery systems to embed arthritis programs into their day-to-day work. To encourage organizational ownership and sustainability of programs, funding is restricted to offset program start-up costs. The purpose of this study was to identify factors that impacted the success of implementing an evidence-based arthritis self-management program, funded by the CDC Arthritis Program, into the Oregon Extension Service. We interviewed staff and partners involved in implementation who had and had not successfully delivered Walk With Ease (N = 12) to identify barriers and facilitators to scaling-up. Document analysis of administrative records was used to triangulate and expand on findings. Delivery goals defined by the funder were not met in Year 1: only 3 of the expected 28 programs were delivered. Barriers to implementation included insufficient planning for implementation driven by pressure to deliver programs and insufficient resources to support staff time. Facilitators included centralized administration of key implementation activities and staffs’ previous experience implementing new programs. The importance of planning and preparing for implementation cannot be overlooked. Funders, however, eager to see deliverables, continue to define implementation goals in terms of program reach, exclusive of capacity-building. Lack of capacity-building can jeopardize staff buy-in, implementation quality, and sustainability. Based on our findings coupled with support from implementation literature, we offer recommendations for future large-scale implementation efforts operating under such funding restrictions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hootman, J. M., Brault, M. W., Helmick, C. G., Theis, K. A., & Armour, B. S. (2009). Prevalence and most common causes of disability among adults—United States, 2005. Morb Mortal Weekly Rep., 58(16), 421–426.

    Google Scholar 

  2. Barbour, K. E., Helmick, C. G., Theis, K. A., et al. (2013). Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation—United States, 2010-2012. Morb Mortal Weekly Rep, 62(44), 869–873.

    Google Scholar 

  3. Brady, T. J., Jernick, S. L., Hootman, J. M., & Sniezek, J. E. (2009). Public health interventions for arthritis: expanding the toolbox of evidence-based interventions. J Women's Health, 18(12), 1905–1917. doi:10.1089/jwh.2009.1571.

    Article  Google Scholar 

  4. Hootman, J. M., Helmick, C. G., & Brady, T. J. (2012). A public health approach to addressing arthritis in older adults: the most common cause of disability. Am J Public Health, 102(3), 426–433. doi:10.2105/AJPH.2011.300423.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Brady, T. J., Sniezek, J., & Ramsey, L. (2012). News from the CDC: scaling up sustainable intervention delivery–lessons learned from the CDC arthritis program. Transl Behav Med., 2(1), 3–5. doi:10.1007/s13142-011-0105-4.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Fishbein, D. H., Ridenour, T. A., Stahl, M., & Sussman, S. (2016). The full translational spectrum of prevention science: facilitating the transfer of knowledge to practices and policies that prevent behavioral health problems. Transl Behav Med, 6(1), 5–16. doi:10.1007/s13142-015-0376-2.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Centers for Disease Control. A national public health agenda for osteoarthritis. 2010; 1–62. Available at: http://www.cdc.gov/arthritis/docs/oaagenda.pdf. Accessed 22 Oct 2015.

  8. Centers for Disease Control. Funded state arthritis programs. 2015; http://www.cdc.gov/arthritis/partners/funded-states.htm. Accessed 1 Mar 2016.

  9. Burnes, B. (2004). Emergent change and planned change—competitors or allies?: the case of XYZ construction. Int J Oper Prod Manag, 24(9), 886–902. doi:10.1108/01443570410552108.

    Article  Google Scholar 

  10. Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: a synthesis of the literature. Tampa, FL: University of South Florida.

    Google Scholar 

  11. Glasgow, R. E., & Emmons, K. M. (2007). How can we increase translation of research into practice? Types of evidence needed. Annu Rev Public Health, 28(1), 413–433. doi:10.1146/annurev.publhealth.28.021406.144145.

    Article  PubMed  Google Scholar 

  12. Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol, 41(3–4), 327–350. doi:10.1007/s10464-008-9165-0.

    Article  PubMed  Google Scholar 

  13. Bruno, M., Cummins, S., Guadiano, L., Stoos, J., & Blanpied, P. (2006). Effectiveness of two Arthritis Foundation programs: Walk With Ease, and You Can Break the Pain Cycle. Clin Interv Aging, 1(3), 295–306. doi:10.2147/ciia.2006.1.3.295.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Callahan, L. F., Shreffler, J. H., Altpeter, M., et al. (2011). Evaluation of group and self-directed formats of the Arthritis Foundation’s Walk With Ease program. Arthritis Care Res, 63(8), 1098–1107. doi:10.1002/acr.20490.

    Article  Google Scholar 

  15. Meyers, D. C., Durlak, J. A., & Wandersman, A. (2012). The quality implementation framework: a synthesis of critical steps in the implementation process. Am J Community Psychol, 50(3–4), 462–480. doi:10.1007/s10464-012-9522-x.

    Article  PubMed  Google Scholar 

  16. QSR International Pty Ltd. (2012). Nvivo qualitative data analysis software [Version 10].

  17. Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qual Health Res, 15(9), 1277–1288. doi:10.1177/1049732305276687.

    Article  PubMed  Google Scholar 

  18. StataCorp. (2011). Stata Statistical Software: Release 12. College Station, TX: StataCorp LP.

  19. Office of Management and Budget. (2013). Revised delineations of metropolitan statistical areas, micropolitan statistical areas, and combined statistical areas, and guidance on uses of the delineations of these areas. Washington, D.C: United States Census Bureau.

    Google Scholar 

  20. Budget Control Act of 2011, Public Law 112–25, 112th Cong (2011). https://www.gpo.gov/fdsys/pkg/PLAW-112publ25/html/PLAW-112publ25.htm. Accessed 25 Feb 2017.

  21. Centers for Disease Control. Arthritis appropriate physical activity and self-management education interventions: a compendium of implementation information. 2012; http://www.cdc.gov/arthritis/interventions/marketing-support/compendium/docs/pdf/compendium-2012.pdf. Accessed 12 Dec 2015.

  22. Brownson, R. C., Ballew, P., Dieffenderfer, B., et al. (2007). Evidence-based interventions to promote physical activity: what contributes to dissemination by state health departments. Am J Prev Med, 33(1), S66–S78. doi:10.1016/j.amepre.2007.03.011.

    Article  PubMed  Google Scholar 

  23. Dariotis, J. K., Bumbarger, B. K., Duncan, L. G., & Greenberg, M. T. (2008). How do implementation efforts relate to program adherence? Examining the role of organizational, implementer, and program factors. J Community Psychol, 36(6), 744–760. doi:10.1002/jcop.20255.

    Article  Google Scholar 

  24. Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci, 4, 50. doi:10.1186/1748-5908-4-50.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ahmed, K., & Ahmed, H. (2013). The mediating effect of organizational commitment on the relationship between perceived organizational support and turnover intention. Journal of Research in Social Sciences, 1(2), 33.

    Google Scholar 

  26. Park, T., & Shaw, J. D. (2013). Turnover rates and organizational performance: a meta-analysis. J Appl Psychol, 98(2), 268–309. doi:10.1037/a0030723.

    Article  PubMed  Google Scholar 

  27. Bartholomew, L. K., Parcel, G. S., & Kok, G. (1998). Intervention mapping: a process for developing theory- and evidence-based health education programs. Health Educ Behav, 25(5), 545–563.

    Article  CAS  PubMed  Google Scholar 

  28. Flaspohler, P., Duffy, J., Wandersman, A., Stillman, L., & Maras, M. A. (2008). Unpacking prevention capacity: an intersection of research-to-practice models and community-centered models. Am J Community Psychol, 41(3–4), 182–196. doi:10.1007/s10464-008-9162-3.

    Article  PubMed  Google Scholar 

  29. Lorig, K. R., Hurwicz, M.-L., Sobel, D., Hobbs, M., & Ritter, P. L. (2005). A national dissemination of an evidence-based self-management program: a process evaluation study. Patient Educ Couns, 59(1), 69–79. doi:10.1016/j.pec.2004.10.002.

    Article  PubMed  Google Scholar 

  30. Wandersman, A., Duffy, J., Flaspohler, P., et al. (2008). Bridging the gap between prevention research and practice: the interactive systems framework for dissemination and implementation. Am J Community Psychol, 41(3–4), 171–181.

  31. Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. Implement Sci, 10(1), 1–13.

  32. Milat, A. J., Newson, R., King, L., et al. (2016). A guide to scaling up population health interventions. Public Health Res Pract, 26(1), e2611604.

  33. Conte, K. P., Odden, M. C., Linton, N. M., Harvey, S. M. (2016). Effectiveness of a scaled-up arthritis self-management program in Oregon: walk with ease. Am J Public Health, 106(12):2227–2230. doi: 10.2105/AJPH.2016.303478.

Download references

Acknowledgements

We would like to thank our partners at the Oregon Health Authority and the Arthritis Foundation for their contributions to this effort. In addition, we thank Olivia Pipitone for her assistance in coding material, and Drs. Robert Topp, Penny Hawe, and Luca Conte for their comments on earlier drafts.

Author information

Authors and Affiliations

  1. The Australian Prevention Partnership Centre, Sydney, Australia

    Kathleen P. Conte Ph.D.

  2. Menzies Centre for Health Policy, University of Sydney, Sydney, Australia

    Kathleen P. Conte Ph.D.

  3. School of Social and Behavioral Health Sciences, Oregon State University, Corvallis, OR, USA

    S. Marie Harvey Dr.P.H.

  4. Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, NC, USA

    R. Turner Goins Ph.D.

Authors
  1. Kathleen P. Conte Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Marie Harvey Dr.P.H.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Turner Goins Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathleen P. Conte Ph.D..

Ethics declarations

The findings reported in this study have not been previously published and the manuscript is not being simultaneously submitted elsewhere. The authors have full control of all primary data and agree to allow the journal to review their data if requested.

Funding

This study was funded by a grant from the John C Erkkila Endowment for Health and Human Performance, administered by the Good Samaritan Foundation.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were reviewed and approved by the Oregon State University Institutional Research Ethics Committee: Protocol no. 5593. Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

Additional information

Implications

Practice: Thorough planning prior to implementation of programs is essential and cannot be overlooked or rushed; centralized administration of key implementation activities can reduce pressure on staff time and help guide implementation

Policy: Defining implementation goals in terms of capacity-building for program delivery can legitimize the importance of capacity-building and better facilitate organizational ownership and program sustainability.

Research: Further research is needed to establish whether the CDC Arthritis Program funding model is effective at promoting organizational buy-in and sustained implementation; the 5-year CDC funding cycle ends in 2017 and represents a prime opportunity to compare experiences and outcomes across all 12 state recipients of the CDC Arthritis Program grants.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Conte, K.P., Marie Harvey, S. & Turner Goins, R. “During early implementation you just muddle through”: factors that impacted a statewide arthritis program’s implementation. Behav. Med. Pract. Policy Res. 7, 804–815 (2017). https://doi.org/10.1007/s13142-017-0478-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13142-017-0478-0

Keywords

Search

Navigation