Tapping into Community Resiliency in Rural Adolescent Pregnancy Prevention: An Implementation Sciences Approach

Abstract

Although rural youth experience marked inequities in adolescent pregnancy, there is little guidance for implementing evidence-based programs (EBPs) in rural settings. When implementation occurs in rural communities, it frequently focuses on deficits, rather than strengths or capacity for growth. Using the consolidated framework for implementation research (CFIR), we describe a resiliency-focused implementation of two middle school EBPs in rural Midwestern communities, including the intervention, outer and inner settings, individuals, implementation processes and preliminary outcomes. Data included program staff interviews, feedback from local partners, community meetings notes, and participant surveys. Using the CFIR, we describe the engagement of rural communities themselves in a resilience-based implementation of adolescent pregnancy prevention EPBs. Communities self-described as rural, traditional and religious. They identified adolescent pregnancy, substance use, and academic success as priorities. To address infrastructure needs and build on local strengths, funds were used to hire local partners to implement the program. As small communities, stakeholders were closely networked and wanted to address local needs. Local partners selected the EBP based upon community values and priorities. Champions, including local partner organizations and schools were locally based and were well connected. Intensive training of local staff and piloting with adaptation assured fidelity and sustainability, while increasing community implementation skills and comfort. In Clinton County, enrollment was 1946 with students receiving the program in 6th, 7th, and/or 8th grades. In Southern Indiana, 7275 students received the program once in either 6th, 7th, or 8th. We conclude that the CFIR can facilitate the implementation of a community resiliencefocused adolescent pregnancy prevention intervention in rural communities.

The Use of the Consolidated Framework for Implementation Research to Understand Facilitators and Barriers to Sexually Transmitted Infection Screening in Primary Care

“…In leveraging the CFIR, we also demonstrate and discuss how other clinician researchers might apply this framework in promoting uptake and implementation their own evidence-based sexual health interventions in practice. [20][21][22]…”

“…The goal of our study was to understand their roles and perspectives on STI testing and identify local barriers and facilitators to provision of this care, to inform their implementation of the STI screening program. In leveraging the CFIR, we also demonstrate and discuss how other clinician researchers might apply this framework in promoting uptake and implementation their own evidence-based sexual health interventions in practice 20–22 …”