Abstract
It is well-established in the field of implementation science that the context in which an intervention is delivered can play a crucial role in how well it is implemented. However, less is known about how organizational context or capacity relates to efficacy outcomes, particularly with health promotion interventions delivered outside of healthcare settings. The present study examined whether organizational capacity indicators were linked to key efficacy outcomes in an evidence-based cancer control intervention delivered in 13 African American churches in Maryland. Outcomes included increases in colorectal cancer knowledge and self-report colonoscopy screening behavior from baseline to follow-up. We used Coincidence Analysis to identify features of organizational capacity that uniquely distinguished churches with varying levels of cancer knowledge and screening. Indicators of organizational capacity (e.g., congregation size, prior health promotion experience) were from an existing measure of church organizational capacity for health promotion. A single solution pathway accounted for greater increases in colorectal cancer knowledge over 12 months, with a combination of two conditions: conducting 3 or more health promotion activities in the prior 2 years together with not receiving any technical assistance from outside partners in the prior 2 years. A single condition accounted for greater increases in colonoscopy screening over 24 months: churches that had conducted health promotion activities in 1–4 different topical areas in the prior 2 years. Findings highlight aspects of organizational capacity (e.g., prior experience in health promotion) that may facilitate intervention efficacy and can help practitioners identify organizational settings most promising for intervention impact.
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Study materials are available upon request from the corresponding author.
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15 July 2023
A Correction to this paper has been published: https://doi.org/10.1007/s43477-023-00091-6
References
Aarons, G. A., Green, A. E., Palinkas, L. A., Self-Brown, S., Whitaker, D. J., Lutzker, J. R., & Chaffin, M. J. (2012). Dynamic adaptation process to implement an evidence-based child maltreatment intervention. Implementation Science, 7, 32. https://doi.org/10.1186/1748-5908-7-32
Adams, K. K., Miech, E. J., & Sobieraj, D. M. (2022). Factors that distinguish opioid withdrawal during induction with buprenorphine microdosing: A configurational analysis. Addiction Science & Clinical Practice, 17(1), 55. https://doi.org/10.1186/s13722-022-00336-z
Allen, J. D., Torres, M. I., Tom, L. S., Leyva, B., Galeas, A. V., & Ospino, H. (2016). Dissemination of evidence-based cancer control interventions among Catholic faith-based organizations: Results from the CRUZA randomized trial. Implementation Science, 11, 74. https://doi.org/10.1186/s13012-016-0430-6
Allen, J. D., Torres, M. I., Tom, L. S., Rustan, S., Leyva, B., Negron, R., & Ospino, H. (2015). Enhancing organizational capacity to provide cancer control programs among Latino churches: Design and baseline findings of the CRUZA Study. BMC Health Services Research, 15, 147. https://doi.org/10.1186/s12913-015-0735-1
Ambühl, M., Baumgartner, M., Epple, R., Parkkinen, V.-P., & Thiem, A. (2021). Cna: causal modeling with coincidence analysis. Retrieved from https://cran.microsoft.com/snapshot/2021-10-10/web/packages/cna/cna.pdf
American Cancer Society. (2019). Cancer facts & figures for African Americans 2019–2021. Retrieved from Atlanta, GA: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-african-americans/cancer-facts-and-figures-for-african-americans-2019-2021.pdf
Centers for Disease Control and Prevention. (2003). Behavioral risk factor surveillance system: U.S. Department of Health and Human Services.
Coates, K. E. (2021). Affecting absenteeism through school-based health services delivery: A configurational comparative methods study of Oregon’s public secondary schools. (Ph.D.). Portland State University, Oregon. Retrieved from https://www.proquest.com/docview/2572591242 ProQuest Dissertations & Theses Global database. (28546306)
Cohen, D. J., Sweeney, S. M., Miller, W. L., Hall, J. D., Miech, E. J., Springer, R. J., & Marino, M. (2021). Improving smoking and blood pressure outcomes: The interplay between operational changes and local context. Annals of Family Medicine, 19(3), 240–248. https://doi.org/10.1370/afm.2668
Coury, J., Miech, E. J., Styer, P., Petrik, A. F., Coates, K. E., Green, B. B., & Coronado, G. D. (2021). What’s the “secret sauce”? How implementation variation affects the success of colorectal cancer screening outreach. Implementation Science Communications, 2, 5. https://doi.org/10.1186/s43058-020-00104-7
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. Implementation Science, 4, 50. https://doi.org/10.1186/1748-5908-4-50
Davis, M. M., Schneider, J. L., Petrik, A. F., Miech, E. J., Younger, B., Escaron, A. L., & Coronado, G. D. (2022). Clinic factors associated with mailed fecal immunochemical test (FIT) completion: The difference-making role of support staff. The Annals of Family Medicine, 20(2), 123–129. https://doi.org/10.1370/afm.2772
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. American Journal of Community Psychology, 41(3–4), 327–350. https://doi.org/10.1007/s10464-008-9165-0
Feldstein, A. C., & Glasgow, R. E. (2008). A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. The Joint Commission Journal on Quality and Patient Safety, 34(4), 228–243. https://doi.org/10.1016/s1553-7250(08)34030-6
Furnari, S., Crilly, D., Misangyi, V. F., Greckhamer, T., Fiss, P. C., & Aguilera, R. (2020). Capturing causal complexity: Heuristics for configurational theorizing. Academy of Management Review, 46(4), 778–799. https://doi.org/10.5465/amr.2019.0298
Gingiss, P. M., Roberts-Gray, C., & Boerm, M. (2006). Bridge-It: A system for predicting implementation fidelity for school-based tobacco prevention programs. Prevention Science, 7(2), 197–207. https://doi.org/10.1007/s11121-006-0038-1
Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322–1327. https://doi.org/10.2105/ajph.89.9.1322
Green, P. M., & Kelly, B. A. (2004). Colorectal cancer knowledge, perceptions, and behaviors in African Americans. Cancer Nursing, 27(3), 206–215. https://doi.org/10.1097/00002820-200405000-00004
Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82(4), 581–629. https://doi.org/10.1111/j.0887-378X.2004.00325.x
Hickman, S. E., Miech, E. J., Stump, T. E., Fowler, N. R., & Unroe, K. T. (2020). Identifying the implementation conditions associated with positive outcomes in a successful nursing facility demonstration project. The Gerontologist, 60(8), 1566–1574. https://doi.org/10.1093/geront/gnaa041
Holt, C. L., Tagai, E. K., Santos, S. L. Z., Scheirer, M. A., Bowie, J., Haider, M., & Slade, J. L. (2018). Web-based versus in-person methods for training lay community health advisors to implement health promotion workshops: Participant outcomes from a cluster-randomized trial. Translational Behavioral Medicine, 9(4), 573–582. https://doi.org/10.1093/tbm/iby065
Holt, C. L., Tagai, E. K., Scheirer, M. A., Santos, S. L., Bowie, J., Haider, M., & Whitehead, T. (2014). Translating evidence-based interventions for implementation: Experiences from Project HEAL in African American churches. Implementation Science, 9, 66. https://doi.org/10.1186/1748-5908-9-66
Kelly, C. M., Baker, E. A., Williams, D., Nanney, M. S., & Haire-Joshu, D. (2004). Organizational capacity’s effects on the delivery and outcomes of health education programs. Journal of Public Health Management and Practice, 10(2), 164–170. https://doi.org/10.1097/00124784-200403000-00011
Knott, C. L., Chen, C., Bowie, J., Mullins, C. D., Slade, J., Woodard, N., & He, X. (2022a). Cluster randomized trial comparing organizationally-tailored vs. standard approach for integrating an evidence-based cancer control intervention into African American churches. Translational Behavioral Medicine, 12(5), 673–682. https://doi.org/10.1093/tbm/ibab088
Knott, C. L., Miech, E. J., Slade, J., Woodard, N., Robinson-Shaneman, B.-J., & Huq, M. (2022b). Evaluation of organizational capacity in the implementation of a church-based cancer education program. Global Implementation Research and Applications, 2(105), 1–11. https://doi.org/10.1007/s43477-021-00033-0
Meyers, D. C., Durlak, J. A., & Wandersman, A. (2012). The quality implementation framework: A synthesis of critical steps in the implementation process. American Journal of Community Psychology, 50(3–4), 462–480. https://doi.org/10.1007/s10464-012-9522-x
Miech, E. J., Freitag, M. B., Evans, R. R., Burns, J. A., Wiitala, W. L., Annis, A., & Damschroder, L. J. (2021). Facility-level conditions leading to higher reach: A configurational analysis of national VA weight management programming. BMC Health Services Research, 21, 797. https://doi.org/10.1186/s12913-021-06774-w
Norton, W. E. (2012). An exploratory study to examine intentions to adopt an evidence-based HIV linkage-to-care intervention among state health department AIDS directors in the United States. Implementation Science, 7, 27. https://doi.org/10.1186/1748-5908-7-27
Palinkas, L. A., Mendon, S. J., & Hamilton, A. B. (2019). Innovations in mixed methods evaluations. Annual Review of Public Health, 40, 423–442. https://doi.org/10.1146/annurev-publhealth-040218-044215
Pas, E. T., & Bradshaw, C. P. (2012). Examining the association between implementation and outcomes: State-wide scale-up of school-wide positive behavior intervention and supports. The Journal of Behavioral Health Services and Research, 39(4), 417–433. https://doi.org/10.1007/s11414-012-9290-2
Petrik, A. F., Green, B., Schneider, J., Miech, E. J., Coury, J., Retecki, S., & Coronado, G. D. (2020). Factors influencing implementation of a colorectal cancer screening improvement program in community health centers: An applied use of configurational comparative methods. Journal of General Internal Medicine, 35(Suppl 2), 815–822. https://doi.org/10.1007/s11606-020-06186-2
Pfadenhauer, L. M., Gerhardus, A., Mozygemba, K., Lysdahl, K. B., Booth, A., Hofmann, B., & Brereton, L. (2017). Making sense of complexity in context and implementation: The Context and Implementation of Complex Interventions (CICI) framework. Implementation Science, 12(1), 1–17.
Piat, M., Wainwright, M., Cherkas, D., Leblanc, S., Sofouli, E., Rivest, M.-P., & Labonté, L. (2021). Identifying and understanding the contextual factors that shaped mid-implementation outcomes during the COVID-19 pandemic in organizations implementing mental health recovery innovations into services. Implementation Science Communications, 2, 1–16.
Powell, W., Richmond, J., Mohottige, D., Yen, I., Joslyn, A., & Corbie-Smith, G. (2019). Medical mistrust, racism, and delays in preventive health screening among African-American men. Behavioral Medicine, 45(2), 102–117.
Rabin, B. A., & Brownson, R. C. (2012). Developing the terminology for dissemination and implementation research. In R. C. Brownson, G. A. Colditz, & E. K. Proctor (Eds.), Dissemination and implementation research in health: Translating science to practice (pp. 23–54). Oxford University Press.
Ragin, C. C. (2014). The comparative method: Moving beyond qualitative and quantitative strategies. University of California Press.
Randolph, S. D., Golin, C., Welgus, H., Lightfoot, A. F., Harding, C. J., & Riggins, L. F. (2020). How perceived structural racism and discrimination and medical mistrust in the health system influences participation in HIV health services for Black women living in the United States South: A qualitative, descriptive study. The Journal of the Association of Nurses in AIDS Care: JANAC, 31(5), 598–605. https://doi.org/10.1097/JNC.0000000000000189
Rich, J. A., Miech, E. J., Semenza, D. C., & Corbin, T. J. (2022). How combinations of state firearm laws link to low firearm suicide and homicide rates: A configurational analysis. Preventive Medicine, 165, 107262. https://doi.org/10.1016/j.ypmed.2022.107262
Riley, B. L., Taylor, S. M., & Elliott, S. J. (2003). Organizational capacity and implementation change: A comparative case study of heart health promotion in Ontario public health agencies. Health Education Research, 18(6), 754–769. https://doi.org/10.1093/her/cyf051
Rogers, G., & Bryant-Davis, T. (2020). Historical and contemporary racial trauma among Black Americans: Black wellness matters. In R. Geffner, J. W. White, L. K. Hamberger, A. Rosenbaum, V. Vaughan-Eden, & V. I. Vieth (Eds.), Handbook of interpersonal violence and abuse across the lifespan: A project of the National Partnership to End Interpersonal Violence Across the Lifespan (NPEIV) (pp. 1–35). Springer International Publishing.
Santos, S. L. Z., Tagai, E. K., Scheirer, M. A., Bowie, J., Haider, M., Slade, J., & Holt, C. L. (2017). Adoption, reach, and implementation of a cancer education intervention in African American churches. Implementation Science, 12, 36. https://doi.org/10.1186/s13012-017-0566-z
Santos, S. L. Z., Tagai, E. K., Wang, M. Q., Scheirer, M. A., Slade, J. L., & Holt, C. L. (2014). Feasibility of a web-based training system for peer community health advisors in cancer early detection among African Americans. American Journal of Public Health, 104(12), 2282–2289. https://doi.org/10.2105/ajph.2014.302237
Scheirer, M. A., Santos, S. L., Tagai, E. K., Bowie, J., Slade, J., Carter, R., & Holt, C. L. (2017). Dimensions of sustainability for a health communication intervention in African American churches: A multi-methods study. Implementation Science, 12, 43. https://doi.org/10.1186/s13012-017-0576-x
Tagai, E. K., Holt, C. L., Scheirer, M. A., Santos, S. L. Z., Haider, M., Bowie, J., & Wang, M. Q. (2018). Assessing capacity of faith-based organizations for health promotion activities. Health Promotion Practice, 19(5), 414–723. https://doi.org/10.1177/1524839917737510
Velloza, J., Roche, S., Concepcion, T., & Ortblad, K. F. (2023). Advancing considerations of context in the evaluation and implementation of evidence-based biomedical HIV prevention interventions: A review of recent research. Current Opinion in HIV and AIDS, 18(1), 1–11.
Weiner, B. J., Amick, J., & Shoou-Yih, D. L. (2008). Review: Conceptualization and measurement of organizational readiness for change. Medical Care Research and Review, 65(4), 379–436. https://doi.org/10.1177/1077558708317802
Wells, L., & Gowda, A. (2020). A legacy of mistrust: African Americans and the US healthcare system. Proceedings of UCLA Health, 24, 1–3.
Whitaker, R. G., Sperber, N., Baumgartner, M., Thiem, A., Cragun, D., Damschroder, L., & Birken, S. (2020). Coincidence analysis: A new method for causal inference in implementation science. Implementation Science, 15, 108. https://doi.org/10.1186/s13012-020-01070-3
Wilcox, S., Jake-Schoffman, D. E., Saunders, R. P., Kinnard, D., Kaczynski, A. T., Hutto, B., & James, K. L. (2021). Predictors of implementation in the Faith, Activity, and Nutrition dissemination and implementation study: Application of the Consolidated Framework for Implementation Research (CFIR) in a statewide initiative. Translational Behavioral Medicine, 11(2), 419–429. https://doi.org/10.1093/tbm/ibaa025
Woltmann, E. M., Whitley, R., McHugo, G. J., Brunette, M., Torrey, W. C., Coots, L., & Drake, R. E. (2008). The role of staff turnover in the implementation of evidence-based practices in mental health care. Psychiatric Services, 59(7), 732–737. https://doi.org/10.1176/ps.2008.59.7.732
Yakovchenko, V., Miech, E. J., Chinman, M. J., Chartier, M., Gonzalez, R., Kirchner, J. E., & Rogal, S. S. (2020). Strategy configurations directly linked to higher hepatitis c virus treatment starts: An applied use of configurational comparative methods. Medical Care, 58(5), e31–e38. https://doi.org/10.1097/mlr.0000000000001319
Acknowledgements
The team would like to thank Col. Jimmie Slade and Ms. Barbara Jean Shaneman-Robinson, who conducted the community engagement activities for the present study. Clinical trial registration: The study was pre-registered at clinicaltrials.gov. Identifier: NCT02076958. Registered 3/4/2014. https://clinicaltrials.gov/ct2/show/NCT02076958
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This work was supported by the National Cancer Institute under Grant R01CA147313 and by funds through the Maryland Department of Health’s Cigarette Restitution Fund Program.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All study methods were approved by the University of Maryland Institutional Review Board (#10-0691), and all participants provided written informed consent to participate.
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Knott, C.L., Miech, E.J., Woodard, N. et al. The Role of Organizational Capacity in Intervention Efficacy in a Church-Based Cancer Education Program: A Configurational Analysis. Glob Implement Res Appl 3, 284–294 (2023). https://doi.org/10.1007/s43477-023-00089-0
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DOI: https://doi.org/10.1007/s43477-023-00089-0