Implementation, interrupted: Identifying and leveraging factors that sustain after a programme interruption

Hennein, Rachel; Ggita, Joseph; Ssuna, Bashir; Shelley, Donna; Akiteng, Ann R.; Davis, J. Lucian; Katamba, Achilles; Armstrong-Hough, Mari

doi:10.1080/17441692.2021.2003838

Cited by 7 publications

(11 citation statements)

References 35 publications

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“…Given the lack of consideration for sustainment, especially early in the implementation process, researchers and practitioners are consistently faced with the problem of re-implementation-that is, implementing the same prevention or intervention program again in the same context. 33 However, it is important to acknowledge that it can be particularly difficult to plan for sustainability in schools given its inherent challenges, such as high staff turnover, students advancing grades, incoming students midyear, and families leaving the district. 34 Some of these challenges have been addressed in other fields by focusing on organizational implementation.…”

Section: Recommendation 3: Employ and Report Implementation Strategie...mentioning

confidence: 99%

School‐Based Mental Health Interventions: Recommendations for Selecting and Reporting Implementation Strategies*

Lawson,

Azad

2024

Journal of School Health

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A key component of student health and wellbeing is mental health. The rates of diagnosable mental health concerns among students are high-the lifetime prevalence for at least 1 mental health disorder was nearly 50% in a large, nationally representative sample of adolescents from 2010, 1 and prevalence has increased among school-age children and adolescents in recent years. 2 Notably, only about half of youth with mental health concerns receive treatment, 3,4 and rates of treatment receipt are lower among marginalized or low-income youth. 3,5 When children and adolescents do receive mental health treatment, they frequently access these services through their preK-12 schools. [6][7][8] Compared to clinic-based settings, schools offer many advantages for mental health service provision, including promoting access to care and reducing stigma 9 particularly within underresourced settings. 10 Unfortunately, there are significant implementation challenges to the uptake and delivery, as well as the study, of mental health services within schools. The primary mission of schools is academic education, and many schools, particularly those serving marginalized or low-income students, frequently lack the resources to achieve their academic mission. As a result, there are often limited resources left to deliver mental health services, especially if they are not directly aligned with the schools' academic mission. 9 Furthermore, schoolbased mental health practitioners face multilevel

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Section: Recommendation 3: Employ and Report Implementation Strategie...mentioning

confidence: 99%

School‐Based Mental Health Interventions: Recommendations for Selecting and Reporting Implementation Strategies*

Lawson,

Azad

2024

Journal of School Health

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“…We found evidence of construct validity of the adapted General Self-Efficacy Scale. We selected five validation constructs based on previous validation studies of the General Self-Efficacy Scale (Luszczynska et al, 2005) and qualitative studies on community health worker self-efficacy in Uganda (Hennein et al, 2021(Hennein et al, , 2022Ochom et al, 2018). We collected concurrent measures of years of experience, social support, educational attainment, and depressive symptoms to assess convergent validity, and age to assess discriminant validity.…”

Section: Response Optionsmentioning

confidence: 99%

“…Bandura identified four information sources that influence an individual's self-efficacy: performance accomplishments (i.e., previous success performing behaviors), vicarious experiences (i.e., observation of the success of peers in performing behaviors), verbal persuasion (i.e., receiving instructions, advice, and encouragement about performing behaviors), and physiological arousal (i.e., emotional state when performing behaviors) (Bandura, 1977;Bandura & Walters, 1977;Shortridge-Baggett, 2000). Researchers have also evaluated the role of selfefficacy as a determinant of successful implementation of community health worker-focused interventions (Hennein et al, 2021;Ndejjo et al, 2020;Vareilles et al, 2017). For example, in a qualitative study evaluating the implementation of a cardiovascular disease prevention program in Uganda, community health workers reported that their self-efficacy facilitated their work (Ndejjo et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

“…Self-efficacy can be measured with respect to specific tasks (e.g., self-efficacy to test patients for HIV), or more generally to assess one's overall level of confidence in accomplishing various tasks. General self-efficacy, rather than task-specific self-efficacy, is most relevant to community health workers given the breadth of services they provide, which include visiting patient's homes, collecting specimens for diagnostic testing, counseling patients, administering treatments, and integrating care for various diseases (e.g., tuberculosis, HIV, and diabetes) (Hennein et al, 2021;Kok et al, 2015;Singh & Sachs, 2013;World Health Organization, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…Other studies of community health workers in East Africa have found that higher educational attainment, although not a prerequisite for becoming a community health worker, may enhance their skills and confidence in delivering health services (Crispin et al, 2012;Kok et al, 2015). Furthermore, perceived social support can be used to assess convergent validity of the General Self-Efficacy Scale in this population, as Ugandan community health workers have previously reported that seeking support from their colleagues is important to their confidence in carrying out their daily work tasks (Hennein et al, 2021(Hennein et al, , 2022.…”

Section: Introductionmentioning

confidence: 99%

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Cultural Adaptation and Validation of the General Self-Efficacy Scale in Ugandan Community Health Workers

Hennein

Nanziri²,

Musinguzi³

et al. 2022

Glob Implement Res Appl

Self Cite

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Self-efficacy is central to community health workers' capacity and motivation to deliver evidence-based care; thus, validated measures of self-efficacy are needed to assess the effectiveness of community health worker programs. In this study, we culturally adapted and evaluated the General Self-Efficacy Scale among community health workers in Uganda using multiple methods. We adapted the ten-item General Self-Efficacy Scale through cross-cultural discussions within our multidisciplinary research team, translation from English into Luganda and back-translation into English, and six cognitive interviews with community health workers. We administered the adapted scale in a staged, two-part cross-sectional study, including a total of 147 community health workers. Exploratory factor analysis yielded three factors, which we labeled problem-solving, persistence, and resourcefulness. This three-factor solution had good model fit (standardized root mean square residual = 0.07) and explained 53.4% of the variance. We found evidence of convergent validity, as scores for the total scale were positively correlated with years of experience (r = 0.48; p < .001) and perceived social support (r = 0.39, p < .001). Scores were also higher among those with higher educational attainment in one-way analysis of variance and Bonferroni-corrected post hoc tests [F (2,72) = 9.16, p < .001]. We also found evidence of discriminant validity, as scores for the total scale were not correlated with age (r = − 0.07, p = .55), in agreement with literature showing that general self-efficacy is an age-independent construct. The internal consistency of the adapted scale was within the acceptable range for a pilot study (Cronbach's α = 0.61). This evaluation of a Uganda-adapted General Self-Efficacy Scale demonstrated promising psychometric properties; however, larger studies with repeated measures are warranted to further assess the adapted scale's factor structure, validity, reliability, and stability over time.

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Connecting unstably housed veterans living in rural areas to health care: Perspectives from Health Care Navigators

Jones,

Cusack,

True

et al. 2024

Health Services Research

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ObjectiveTo understand existing care practices and policies, and potential enhancements, to improve the effectiveness of the US Department of Veterans Affairs (VA) Supportive Services for Veteran Families (SSVF) Health Care Navigators (HCN) in linking Veterans experiencing housing instability in rural areas with health care services.Data Sources and Study SettingWe used primary data collected during semistructured interviews with HCNs (n = 21) serving rural areas across the United States during Spring 2022.Study DesignWe applied the Consolidated Framework for Implementation Research (CFIR) 2009 and the Social Ecological Model (SEM) to the collection and analysis of qualitative data to understand how HCNs administer services within SSVF and the larger community.Data Collection/Extraction MethodsWe used rapid qualitative methods to summarize and analyze data. Templated matrix summaries identified facilitators and barriers to linking Veterans with health care services and policy and practice implications.Principal FindingsUsing CFIR 2009, we identified contextual factors affecting successful implementation of HCN services within SSVF; we offer a crosswalk between CFIR 2009 and the version updated in 2022. Framing facilitators and barriers within the SEM provided insight into whether implementation strategies should be addressed at a community, interpersonal, or intrapersonal level within the SEM. Facilitators included sufficient knowledge, training, and mentorship opportunities for HCNs and their capacity to collaborate within their organization and with other community‐based organizations. Barriers included lack of local technology and housing resources, inadequate understanding of Veterans' service eligibilities and pathways to access those services, and deficient collaboration with the VA.ConclusionsUnderstanding facilitators and barriers experienced by HCN when linking unstably housed Veterans in rural areas with health care services can inform future strategies, including policy changes such as increased training to support HCNs' understanding of eligibility, benefits, and entitlements as well as improving communication and collaboration between VA and community partners.

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Implementation, interrupted: Identifying and leveraging factors that sustain after a programme interruption

Cited by 7 publications

References 35 publications

School‐Based Mental Health Interventions: Recommendations for Selecting and Reporting Implementation Strategies*

School‐Based Mental Health Interventions: Recommendations for Selecting and Reporting Implementation Strategies*

Cultural Adaptation and Validation of the General Self-Efficacy Scale in Ugandan Community Health Workers

Connecting unstably housed veterans living in rural areas to health care: Perspectives from Health Care Navigators

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