Evaluation of a school-based participatory intervention to improve school environments using the Consolidated Framework for Implementation Research

Abstract

Background Participatory research offers a promising approach to addressing health inequities and improving the social determinants of health for diverse populations of adolescents. However, little research has systematically explored factors influencing the implementation of participatory health interventions targeting health disparities. Objective This study examined the utility of the Consolidated Framework for Implementation Research (CFIR) in identifying and comparing barriers and facilitators influencing implementation of participatory research trials by employing an adaptation of the CFIR to assess the implementation of a multi-component, urban public school-based participatory health intervention. Methods We collected qualitative data over a one-year period through weekly team meeting observational field notes and regular semi-structured interviews with five community-based participatory researchers, one school-based partner, and four school principals involved in implementing a participatory intervention in five schools. Adapted CFIR constructs guided our largely deductive approach to thematic data analysis. We ranked each of the three intervention components as high or low implementation to create an overall implementation effectiveness score for all five schools. Cross-case comparison of constructs across high and low implementation schools identified constructs that most strongly influenced implementation. Results Ten of 30 assessed constructs consistently distinguished between high and low implementation schools in this participatory intervention, with five strongly distinguishing. Three additional constructs played influential, though non-distinguishing, roles within this participatory intervention implementation. Influential constructs spanned all five domains and fit within three broad themes: 1) leadership engagement, 2) alignment between the intervention and institutional goals, priorities, demographics, and existing systems, and 3) tensions between adaptability and complexity within participatory interventions. However, the dynamic and collaborative nature of participatory intervention implementation underscores the artificial distinction between inner and outer settings in participatory research and the individual behavior change focus does not consider how relationships between stakeholders at multiple levels of participatory interventions shape the implementation process. Conclusions The CFIR is a useful framework for the assessment of participatory research trial implementation. Our findings underscore how the framework can be readily adapted to further strengthen its fit as a tool to examine project implementation in this context.

Identifying essential implementation strategies: a mixed methods process evaluation of a multi-strategy policy implementation intervention for schools

“…As the administrative leader within schools, executives have the potential to influence implementation of health programs via endorsement, providing oversight and accountability, and/or enacting formal requirements [ 50 ]. In a 2021 evaluation of a school-based participatory health intervention, the level of leadership engagement by school administrators strongly distinguished between high and low implementation schools [ 51 ]. Similarly, an evaluation of a multi-strategy school smoking prevention program found that high- and medium- implementation schools had higher levels of administrative leadership than low implementation schools (77.3 and 83.3% vs 42.9%) [ 52 ].…”

Somali, Latino, and Hmong Youth Perceptions of School Connectedness

“…The results of this study shaped a teacher professional development curriculum to address these gaps and to strengthen student–teacher relationships and school connectedness. 55 We have since integrated this professional development curriculum as one component within a multicomponent pragmatic participatory intervention trial that aims to promote policy and programmatic changes in schools to strengthen school connectedness as a social determinant for students who identify as Black, Indigenous, and People of Color; 56 , 57 final results are forthcoming.…”

Implementing school‐wide sexual assault prevention in middle schools: A qualitative analysis of school stakeholder perspectives

“…The domains include factors relating to the intervention/innovation (i.e., intervention source, evidence strength and quality, relative advantage, adaptability, trialability, complexity, design quality/packaging, cost), outer setting characteristics (i.e., population needs/resources, cosmopolitanism, peer pressure, external policies/incentives), inner setting characteristics (i.e., structural characteristics, networks/communication, culture, implementation climate, readiness), factors relating to individuals (i.e., knowledge, self‐efficacy, individual stage of change, individual identification with the organization), and process domains (i.e., planning, engaging, executing, reflecting/evaluating). CFIR has been applied to a wide range of implementation studies and interventions within medical settings (Vranceanu et al, 2021), educational and school environments (Koester et al, 2021; Wilhelm et al, 2021), and leadership settings (Shea, 2021). Numerous international studies have also provided evidence for CFIR's use in identifying facilitators and barriers to successful intervention implementation (Busca et al, 2021; Cooper et al, 2021; Vranceanu et al, 2021), while also garnering stakeholder perspective on processes of intervention implementation (André et al, 2021).…”