An Approach to Adapting a Community-Based Cancer Control Intervention to Organizational Context.

There has been increasing attention in implementation science to optimizing the fit of evidence-based interventions to the organizational settings where they are delivered. However, less is known about how to maximize intervention-context fit, particularly in community-based settings. We describe a new strategy to customize evidence-based health promotion interventions to community sites. Specifically, leaders in African American churches completed a memorandum of understanding where they were asked to identify two or more health promotion implementation strategies from a menu of 20 and select a planned implementation time frame for each. In a pilot phase with three churches, the menu-based strategy and protocols were successfully implemented and finalized in preparation for a subsequent randomized trial. The three pilot churches identified between two and nine strategies (e.g., form a health ministry, allocate space or budget for health activities, include health in church communications/sermons). The selected strategies varied widely, reinforcing the need for interventions that can be customized to fit the organizational context. Despite the challenges of integrating health promotion activities into non-health focused organizations, this approach has promise for fostering sustainable health activities in community settings.

Development and validation of an instrument to assess institutionalization of health promotion in faith-based organizations.

Institutionalization of health promotion interventions occurs when the organization makes changes to support the program as a component of its routine operations. To date there has not been a way to systematically measure institutionalization of health promotion interventions outside of healthcare settings. The purpose of the present study was to develop and evaluate the initial psychometric properties of an instrument to assess institutionalization (i.e., integration) of health activities into faith-based organizations (i.e., churches). This process was informed by previous institutionalization models led by a team of experts and a community-based advisory panel. We recruited African American church leaders (N = 91) to complete a 22-item instrument. An exploratory factor analysis revealed four factors: 1) Organizational Structures (e.g., existing health ministry, health team), 2) Organizational Processes (e.g., records on health activities; instituted health policy), 3) Organizational Resources (e.g., health promotion budget; space for health activities), and 4) Organizational Communication (e.g., health content in church bulletins, discussion of health within sermons) that explained 62.3 % of the variance. The measure, the Faith-Based Organization Health Integration Inventory (FBO-HII), had excellent internal consistency reliability (α = .89) including the subscales (α = .90, .82, .81, and .87). This measure has promising initial psychometric properties for assessing institutionalization of health promotion interventions in faith-based settings.

Web-based versus in-person methods for training lay community health advisors to implement health promotion workshops: participant outcomes from a cluster-randomized trial.

Project HEAL (Health through Early Awareness and Learning) is an implementation trial that compared two methods of training lay peer community health advisors (CHAs)-in-person ("Traditional") versus web-based ("Technology")-to conduct a series of three evidence-based cancer educational workshops in African American churches. This analysis reports on participant outcomes from Project HEAL. Fifteen churches were randomized to the two CHA training methods and the intervention impact was examined over 24 months. This study was conducted in Prince George's County, MD, and enrolled 375 church members age 40-75. Participants reported on knowledge and screening behaviors for breast, prostate, and colorectal cancer. Overall, cancer knowledge in all areas increased during the study period (p < .001). There were significant increases in digital rectal exam (p < .05), fecal occult blood test (p < .001), and colonoscopy (p < .01) at 24 months; however, this did not differ by study group. Mammography maintenance (56% overall) was evidenced by women reporting multiple mammograms within the study period. Participants attending all three workshops were more likely to report a fecal occult blood test or colonoscopy at 24 months (p < .05) than those who attended only one. These findings suggest that lay individuals can receive web-based training to successfully implement an evidence-based health promotion intervention that results in participant-level outcomes comparable with (a) people trained using the traditional classroom method and (b) previous efficacy trials. Findings have implications for resources and use of technology to increase widespread dissemination of evidence-based health promotion interventions through training lay persons in community settings.

The Role of Leadership Support in a Church-Based Cancer Education Implementation Study.

Leadership plays a role in the success of an organization's initiatives. We examined church leaders' support-as perceived by lay community health advisor (CHA) interventionists-and implementation outcomes in a cancer early detection trial. CHAs perceived that their pastors: helped promote the intervention (M = 3.1/4, SD 1.2) and attended about half (M = 1.6/3, SD 1.3) the workshops. CHAs used marginally more techniques to recruit members when they perceived pastors were engaged in promoting the program (r s = .44, p = .08). Pastor attendance was positively associated with member enrollment (r s = .50, p < .05). Pastor support may be related to receptivity of both CHAs and congregants to engage in church health promotion.

Adoption, reach, and implementation of a cancer education intervention in African American churches.

BACKGROUND: Use of technology is increasing in health promotion and has continued growth potential in intervention research. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this paper reports on the adoption, reach, and implementation of Project HEAL (Health through Early Awareness and Learning)-a community-based implementation trial of a cancer educational intervention in 14 African American churches. We compare adoption, reach, and implementation at the organizational and participant level for churches in which lay peer community health advisors (CHAs) were trained using traditional classroom didactic methods compared with a new online system. METHODS: Fifteen churches were randomized to one of two study groups in which two CHAs per church were trained through either classroom ("Traditional"; n = 16 CHAs in 8 churches) or web-based ("Technology"; n = 14 CHAs in 7 churches) training methods. Once trained and certified, all CHAs conducted a series of three group educational workshops in their churches on cancer early detection (breast, prostate, and colorectal). Adoption, reach, and implementation were assessed using multiple data sources including church-level data, participant engagement in the workshops, and study staff observations of CHA performance. RESULTS: The project had a 41% overall adoption rate at the church level. In terms of reach, a total of 375 participants enrolled in Project HEAL-226 participants in the Traditional group (43% reach) and 149 in the Technology group (21% reach; p < .10). Implementation was evaluated in terms of adherence, dosage, and quality. All churches fully completed the three workshops; however, the Traditional churches took somewhat longer (M = 84 days) to complete the workshop series than churches in the Technology group (M = 64 days). Other implementation outcomes were comparable between both the Traditional and Technology groups (p > .05). CONCLUSIONS: Overall, the Project HEAL intervention had reasonable adoption, though reach could have been better. Implementation was strong across both study groups, suggesting the promise of using web-based methods to disseminate and implement evidence-based interventions in faith-based settings and other areas where community health educators work to eliminate health disparities.