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The dynamics of de-adoption: a case study of policy change, de-adoption, and replacement of an evidence-based HIV intervention

  • Original Research
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Translational Behavioral Medicine

Abstract

Evidence-based intervention (EBI) de–adoption and its influence on public health organizations are largely unexplored within public health implementation research. However, a recent shift in support for HIV prevention EBIs by the Centers for Disease Control and Prevention provides an opportunity to explore EBI de–adoption. The current mixed-method study examines EBI de-adoption and the subsequent impact on a community-based organization (CBO) dedicated to HIV prevention. We conducted a case study with a CBO implementing RESPECT, an HIV prevention EBI, over 5 years (2010–2014), but then de­adopted the intervention. We collected archival data documenting RESPECT implementation and conducted two semi­structured interviews with RESPECT staff (N = 5). Using Fixsen and colleagues’ implementation framework, we developed a narrative of RESPECT implementation, delivery, and de­adoption and a thematic analysis to understand additional consequences of RESPECT de-adoption. Discontinuation of RESPECT activities unfolded in a process over time, requiring effort by RESPECT staff. RESPECT de­adoption had wide­reaching influences on individual staff, interactions between the staff and the community, the agency overall, and for implementation of future EBIs. We propose a revision of the implementation framework, incorporating EBI de­adoption as a phase of the implementation cycle. Furthermore, EBI de­adoption may have important, unintended consequences and can inform future HIV prevention strategies and guide research focusing on EBI de-adoption.

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References

  1. Ogden, T., & Fixsen, D. L. (2014). Implementation science: a brief overview and a look ahead. Zeitschrift für Psychologie., 222(1), 4–11.

    Article  Google Scholar 

  2. Fixsen DL, Naoom SF, Blase KA, Friedman RM, Wallace F. Implementation research: a synthesis of the literature. Tampa, FL: of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network, 2005; Contract No.: FMHI Publication #231.

  3. Niven, D. J., Mrklas, K. J., Holodinsky, J. K., et al. (2015). Towards understanding the de-adoption of low-value clinical practices: a scoping review. BMC medicine., 13(1), 255.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Brownson, R. C., Allen, P., Jacob, R. R., et al. (2015). Understanding mis-implementation in public health practice. American Journal of Preventive Medicine., 48(5), 543–551.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bertram, R. M., Blase, K. A., & Fixsen, D. L. (2015). Improving programs and outcomes implementation frameworks and organization change. Research on Social Work Practice., 25(4), 477–487.

    Article  Google Scholar 

  6. Shediac-Rizkallah, M. C., & Bone, L. R. (1998). Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy. Health Education Research., 13(1), 87–108.

    Article  CAS  PubMed  Google Scholar 

  7. Hawe, P., Shiell, A., & Riley, T. (2009). Theorising interventions as events in systems. American Journal of Community Psychology, 43, 267–276.

    Article  PubMed  Google Scholar 

  8. Greenhalgh, T., Macfarlane, F., Barton-Sweeney, C., & Woodard, F. (2012). “If We Build It, Will It Stay?” A case study of the sustainability of whole-system change in London. The Milbank Quarterly., 90(3), 516–547.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Aral, S. O., & Blanchard, J. F. (2012). The program science initiative: Improving the planning, implementation and evaluation of HIV/STI prevention programs. Sexually Transmitted Infections., 88(3), 157–159.

    Article  PubMed  Google Scholar 

  10. Freedman, A. M., Kuester, S. A., & Jernigan, J. (2013). Evaluating public health resources: what happens when funding disappears? Preventing Chronic Disease., 10, E190–E196.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Prasad, V., & Ioannidis, J. P. (2014). Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices. Implementation Science., 9(1), 1.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Aron, D. C., Lowery, J., Tseng, C. L., Conlin, P., & Kahwati, L. (2014). De-implementation of inappropriately tight control (of hypoglycemia) for health: protocol with an example of a research grant application. Implementation Science., 9(1), 58.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Collins, C. B., & Sapiano, T. N. (2016). Lessons learned from dissemination of evidence-based interventions for HIV prevention. American Journal of Preventive Medicine., 51, S140–S147.

    Article  PubMed  Google Scholar 

  14. Centers for Disease Control and Prevention. High impact HIV prevention. 2015 [cited 4/11/2016]; Available from: https://effectiveinterventions.cdc.gov/docs/default-source/general-docs/15-1106-hip-overview-factsheet.pdf?sfvrsn=2.

  15. Yin RK. Case study research: Design and methods. SAGE Publishing; 2009.

  16. Kamb, M. L., Fishbein, M., Douglas, J. M., et al. (1998). Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial. Project RESPECT Study Group. Journal of the American Medical Association, 280(13), 1161–1167.

  17. Metsch, L. R., Feaster, D. J., Gooden, L., et al. (2013). Effect of risk-reduction counseling with rapid HIV testing on risk of acquiring sexually transmitted infections: the AWARE randomized clinical trial. Journal of the American Medical Association, 310(16), 1701–1710.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Craw, J. A., Gardner, L. I., Marks, G., et al. (2008). Brief strengths-based case management promotes entry into HIV medical care: results of the antiretroviral treatment access study-II. Journal of Aquired Immune Deficiency Syndromes, 47(5), 597–606.

  19. Centers for Disease Prevention and Control. Frequently asked questions: CTR and RESPECT. [cited 02/01/17]; Available from: https://effectiveinterventions.cdc.gov/Files/RESPECT_FAQ.pdf

  20. Dolcini, M. M., Catania, J. A., Gandelman, A., & Ozer, E. M. (2014). Implementing a brief evidence-based HIV intervention: a mixed methods examination of compliance fidelity. Translational Behavioral Medicine., 4(4), 424–433.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This research was supported in part by the Ruth E. Warnke Graduate Fellowship and the Provost’s Distinguished Fellowship awarded to Virginia McKay by the College of Public Health and Human Sciences at the Oregon State University. This research was also supported in part by the National Institute of Mental Health grant number T32 MH019960, awarded to Enola Proctor and the National Institute of Mental Health grant number R01 MH085502-01, awarded to M. Margaret Dolcini.

We would like to thank Chenoa Allen for reviewing qualitative codes and acting as a second coder. We would also like to thank Brian R. Flay and Joseph A. Catania for their feedback throughout the drafting of this manuscript.

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Authors and Affiliations

  1. Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA

    Virginia R. McKay PhD, MA

  2. School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA

    M. Margaret Dolcini PhD

  3. Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA

    Lee D. Hoffer PhD, MPH

Authors
  1. Virginia R. McKay PhD, MA
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  2. M. Margaret Dolcini PhD
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  3. Lee D. Hoffer PhD, MPH
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Corresponding author

Correspondence to Virginia R. McKay PhD, MA.

Ethics declarations

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 1975 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Implications

Practice: Public health organizations that are de-adopting evidence-based interventions should plan carefully for this final stage of implementation, paying close attention to the impact of changes in staff and communities.

Policy: Policies designed to disseminate evidence-based interventions would benefit from allowing time and providing guidelines on how to successfully discontinue and replace interventions.

Research: Further exploration of intervention de-adoption is needed to understand the process and impact of de-adoption. Dissemination and implementation frameworks in public health would benefit from incorporating de-adoption as a distinct phase of the implementation process.

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McKay, V.R., Margaret Dolcini, M. & Hoffer, L.D. The dynamics of de-adoption: a case study of policy change, de-adoption, and replacement of an evidence-based HIV intervention. Behav. Med. Pract. Policy Res. 7, 821–831 (2017). https://doi.org/10.1007/s13142-017-0493-1

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  • DOI: https://doi.org/10.1007/s13142-017-0493-1

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