Developing Theory to Guide Building Practitioners’ Capacity to Implement Evidence-Based Interventions

Abstract

Public health and other community-based practitioners have access to a growing number of evidence-based interventions (EBIs), and yet EBIs continue to be underused. One reason for this underuse is that practitioners often lack the capacity (knowledge, skills, and motivation) to select, adapt, and implement EBIs. Training, technical assistance, and other capacity-building strategies can be effective at increasing EBI adoption and implementation. However, little is known about how to design capacity-building strategies or tailor them to differences in capacity required across varying EBIs and practice contexts. To address this need, we conducted a scoping study of frameworks and theories detailing variations in EBIs or practice contexts and how to tailor capacity-building to address those variations. Using an iterative process, we consolidated constructs and propositions across 24 frameworks and developed a beginning theory to describe salient variations in EBIs (complexity and uncertainty) and practice contexts (decision-making structure, general capacity to innovate, resource and values fit with EBI, and unity vs. polarization of stakeholder support). The theory also includes propositions for tailoring capacity-building strategies to address salient variations. To have wide-reaching and lasting impact, the dissemination of EBIs needs to be coupled with strategies that build practitioners’ capacity to adopt and implement a variety of EBIs across diverse practice contexts.

Building Capacity for Evidence-Based Public Health: Reconciling the Pulls of Practice and the Push of Research

“…In perhaps the most exhaustive summary, Leeman and colleagues used an iterative process to review 24 capacity-building theories for their salient variations (i.e., how complexity and uncertainty influence the uptake of EBIs) (120). Several practice contexts are particularly important across the theories for capacity building.…”

“…The gap between research and practice underscores the need to understand the barriers to uptake of EBIs (120). Several studies have reported practitioners’ personal and institutional barriers to utilizing EBIs.…”

“…At an individual level, US practitioners who lacked skills to develop EBIs were likely to have had a lower level of education, suggesting that some personal barriers are modifiable through training (104). To overcome barriers, capacity-building approaches need to involve the target population (practitioners) in development of training and evidence-based approaches and take into account numerous contextual variables (e.g., resources, incentives, values) (71, 120). …”

“…Capacity building for EBPH is essential at all levels of public health, from national or international standards to agency-level practices. Yet how capacity is operationalized, built, and maintained is less straightforward, and relatively little is known about how to tailor capacity-building approaches to practitioners’ needs (120). …”

Impact of the Cancer Prevention and Control Research Network: Accelerating the Translation of Research Into Practice

“…Multiple centers have built on the workgroup’s curriculum to deliver and test local capacity-building interventions. 12–14 Workgroup members collaborated a literature review to guide the design of capacity-building interventions 15,16 and collaborated on an NCI grant (4R01CA163526-05) to develop and test an online tool (IM Adapt) based on Intervention Mapping framework 17 that guides practitioners through a systematic process of selecting and adapting evidence-based interventions (EBIs) to fit their local community and context. 18 This project formed an advisory group with representatives from multiple CPCRN sites and is being beta tested.…”