Optimizing Your DEBIs: Ways to Enhance the Success of Evidence-Based Interventions
Optimizing Your DEBIs: Ways to Enhance the Success ofEvidence-Based Interventions Marlene Glassman, Ph.D. Prevention Research Branch Centers for Disease Control and Prevention National HIV Prevention Conference August 15, 2011
The findings and conclusions in this presentation are those of the author and do notnecessarily represent the views of the CDC
“If you dont know where you are going, any road will get you there.” Lewis Carroll Alices Adventures in Wonderland
Optimization Requires an Inquiring Mind• Where Do You Want To Go With Your DEBI?• What Do You Want To Accomplish?• What Else Do You Want To Know?• How Will You Know It?
Why All the Questions? Accountability• Board of Directors• Funders (CDC, Congress)• National HIV/AIDS Strategy• Local elected officials• Fiscal responsibility/taxpayers’ money/competition for scarce resources• CLIENTS
Key Questions• Resources• Client recruitment• Characteristics of clients (did we reach target population?)• Extent of client participation• How intervention was delivered IMPLEMENTATION• Client outcomes
IMPLEMENTATION“Over the past decade, the science related todeveloping and identifying ‘evidence-basedpractices and programs’ has improved –however, the science related to implementingthese programs with fidelity and good outcomesfor consumers lags far behind.” Dean L. Fixsen The National Implementation Research Network 2005
How Can We Assess Implementation?• Operational research• Implementation research• Process monitoring• Process evaluation
Operational ResearchThe study of factors that affect the implementation of HIV prevention programs and the subsequent identification and assessment of recommendations to strengthen programs in order to reduce HIV/AIDS incidence, morbidity, and mortality
Operational Research Questions Overriding Questions• What factors affect the delivery of DEBIs by community-based organizations (CBOs)?• What factors are associated with intervention success?• How can implementation be improved so that more clients achieve the intended outcomes of the intervention?
Operational Research Questions More Specific Questions• Do CBOs select appropriate DEBIs to meet the needs of their target populations?• Do CBOs adapt DEBIs in accordance with CDC guidelines?
Implementation Research Questions• Have DEBI facilitators received required training on the intervention?• Do CBOs implement DEBIs in accordance with the protocol and core elements of the intervention?• How do CBOs assess whether DEBIs are implemented according to the protocol and core elements of the intervention (quality assurance)?• Do CBOs have/implement client recruitment and retention plans?• Do CBOs have/implement monitoring and evaluation plans?
Process Monitoring Questions• How many clients did we recruit?• What are their characteristics (e.g., age, race, gender) and risk factors?• How many clients completed all sessions? Less than half of the sessions? Only one session?
Process Evaluation Questions• Did recruitment take place according to client recruitment and retention plan/SMART objectives?• Did retention take place according to client recruitment and retention plan/SMART objectives?• Are expenditures in line with projections and budget?
Outcome Monitoring Questions Outcomes depend on implementation: that’s what all the fuss is about!*• Did clients achieve the immediate and behavior change outcomes identified in the DEBI’s monitoring and evaluation plan (e.g., immediate: increased knowledge and self-efficacy; behavior change: increase in correct condom use)?• Were outcomes measured with appropriate instruments? *assumption that efficacy = effectiveness
What You Need to Answer Questions• DEBI budget• Behavior change logic model• Protocol/curriculum with core elements• Client recruitment and retention plan• Monitoring and evaluation plan with SMART objectives and instruments to measure change• Quality assurance plan (fidelity checklist to assess fidelity to core elements)
An Inquiring Mind• Whether you perform operational research, implementation research, process monitoring, or process evaluation, maintain an inquiring mind and carry out activities to answer key implementation questions.• Remember: without proper implementation you reduce the potential for clients to achieve optimal outcomes.
Summary ChecklistTrained facilitators and other staff; e.g., outreachworkers (client eligibility), supervisors (quality assurance)Implementation according to intervention protocol andcore elementsSMART process and outcome objectives – Recruitment of target population – Retention of target population – Changes in clientsFinancial oversight
Knowing Where You’ve Been Can Help You Change Direction (when needed)
“I havent failed. Ive just found 10,000 ways that wont work.” Thomas Edison
For more informationMarlene Glassman email@example.com 404-639-1998