Transcript Moving a research-based intervention into practice: Diffusion of the Mpowerment Project Greg Rebchook, Ph.D., Susan Kegeles, Ph.D., & The TRIP Research Team Center for AIDS.

Moving a research-based
intervention into practice: Diffusion
of the Mpowerment Project
Greg Rebchook, Ph.D., Susan Kegeles, Ph.D., &
The TRIP Research Team
Center for AIDS Prevention Studies
University of California, San Francisco
NIMH Center Grant No. MH42459
The Mpowerment Project is an
Evidence-based Program
• Tested through randomizedcontrolled trials (RCTs)
• Listed in CDC’s Compendium
• MP was tested and found
effective through RCTs in
several communities
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Santa Cruz, CA
Eugene, OR
Santa Barbara, CA
Albuquerque, NM
Austin, TX (analysis pending)
The Mpowerment Project
• MP is a community-level project that
is designed to be tailored to each
community
– Implemented by and for young
gay/bisexual men, ages 18-29
– Not designed for any one racial/ethnic
group
– HIV-positive and HIV-negative guys
together
• Creates healthy community
• Promotes supportive friendship
networks
• Disseminates a norm of safer sex
throughout the community
Mpowerment Project Core
Elements
Operating Structure
• Core Group
• Volunteers
• Coordinators
Program Components
• Formal Outreach
• Informal Outreach
• M-Groups
• Project Space
• Publicity Campaign
What Comes After Intervention
Research?
• Significant amount of resources spent developing
evidence-based interventions
• Little attention given to putting the research into
practice
• CAPS is helping CBOs implement MP through:
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Trainings
TA
Materials
Online resources
• We are now researching the technology exchange process
• Research findings are preliminary, about two-thirds into
the project
We are studying how CBOs
implement MP over time
• When organizations contact us • Additionally, we interview staff and
for information on MP, we
volunteers at each implementing
conduct a “staging” interview to
CBO (and a subset of nondetermine their interest in the
implementers) every 6 months for
project
18 months to assess:
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Knowledge
Evaluation
Decision
Ready to implement
Implementation
Maintenance
Discontinued
Decided not to implement
• We “restage” them on
subsequent contacts as necessary
– Barriers and facilitators to
implementation
• Organizational level
• Community level
• Intervention level
– Fidelity and adaptation
– Evaluate our technology exchange
services (e.g, trainings, TA, etc.)
Technology Exchange Services
depend on CBO stage of
implementation
• Pamphlet
• Replication Package
 Videos (Overview, M-group)
 Manuals (Program, M-group)
• Training, off-site, 3 days
• Technical Assistance
• Internet Resources
 mpowerment.org
 Online forum
 On-line chats
Implementation Stages
% of CBOs in each stage
100%
7
5
1
21
14
90%
42
80%
34
69
62
20
1
70%
60%
40%
Discontinued
54
50%
94
81
30%
Maintenance
Implementing
Ready to implem
Decision stage
Evaluation stage
20%
10%
Decided not
90
69
Knowledge stage
Initial stage
Follow-up
n=335
0%
Time
How implementers progress
through stages
Initial
implementers
8
2
From RTI
From decision
12
42
4
6
From know/eval
Thru 2 or more
stages
15
Discontinued
MP
N=79
Not in study
Location of Implementing CBOs
N in study = 69
Community Size
Geographic Region
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13% < 100k
13% 100k – 200k
35% 200k – 500k
17% 500k – 1m
7% 1m – 2m
13% >2m
30% Western
17% Northeastern
16% Southeastern
16% Midwestern
10% Southern
9% Southwestern
1% Puerto Rican
0
White
Native
American
Asian/Pacific
Islander
Men of color
Latino/Hispanic
African
American
All Ethnicities
Number of CBOs
Race/Ethnicity of MP’s target
populations
45
40
35
30
25
20
15
10
5
Age Ranges of Current MP
Target Populations
Ages
Youth oriented (12/13 to 23/24 year olds)
Teens/young men (14/16 to 21/29 year olds)
% of programs
10%
19%
Original age range (18 to 29 year olds)
Young men (18/19 to 30/35 year olds)
Includes older men (15/25 to no upper limit)
31%
17%
23%
Sources of MP Money
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CDC pass-through (n=44)
State (n=34)
Private foundations/pharm (n=25)
Private fund-raising (n=18)
Direct from CDC (n=10)
County (n=10)
City (n=1)
Other federal (n=5)
Don’t know (n=9)
Size of budgets at implementing
CBOs
N=69
DK (respondent didn't
know)
27%
29%
<$500k
$500k-$1m
12%
$1m-$2m
19%
13%
>$2m
Budget for MP
N=26*
DK (respondent
didn't know)
23%
<$25k
27%
$25k=$50k
5%
$50k-$100k
9%
9%
27%
*Did not begin asking this
question until part-way into
the project
$100k-$150k
$150k-$350k
How are CBOs adapting MP?
• We have preliminary data from CBOs about which Core
Elements they are implementing as described in our
materials, which they are modifying, and which they are
not implementing
• We are interviewing 2-5 people at each CBO
• We took a conservative approach to classifying
implementation of core elements (e.g., “Yes, we are
implementing the core element” required unanimous
agreement)
• These are baseline data—before we provided TA to the
agencies. Anecdotes from TA-providers indicate that TA
helps agencies implement the Core Elements with fidelity
Adoption of MP’s Operating
Structure (baseline)
Not implementing
element
Modified element
Vo
lu
nt
ee
rs
B
CA
Sp
ac
e
G
ro
up
Yes-implementing
element
Co
re
Co
or
di
na
to
rs
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
n=69 Implementing CBOs
Adoption of MP’s Program
Components (baseline)
100%
90%
80%
Not implementing
element
70%
60%
Modified element
50%
40%
30%
Yes-implementing
element
20%
10%
0%
Social
Events
Venue OR Informal M-groups Publicity
OR
n=69 Implementing CBOs
Prevention Research is Moving
Into Practice
• MP was originally developed in 3
communities
• We then tested the model in 2 larger, more
complex communities
• Today, it is being implemented in over 70
communities (and still counting…)
• MP is being implemented with MSM of color
• Successful diffusion of interventions is
facilitated by cooperation between
community members, CBOs, health
departments, capacity building agencies,
funders, trainers, policy-makers, and
researchers