Model and approach for assessing implementation context and fidelity in the HEALing Communities Study

Hannah K Knudsen; Mari-Lynn Drainoni; Louisa Gilbert; Timothy R Huerta; Carrie B Oser; Alison M Aldrich; Aimee N C Campbell; Erika L Crable; Bryan R Garner; LaShawn M Glasgow; Dawn Goddard-Eckrich; Katherine R Marks; Ann Scheck McAlearney; Emmanuel A Oga; Ariel L Scalise; Daniel M Walker

doi:10.1016/j.drugalcdep.2020.108330

Model and approach for assessing implementation context and fidelity in the HEALing Communities Study

Drug Alcohol Depend. 2020 Dec 1:217:108330. doi: 10.1016/j.drugalcdep.2020.108330. Epub 2020 Oct 2.

Authors

Hannah K Knudsen¹, Mari-Lynn Drainoni², Louisa Gilbert³, Timothy R Huerta⁴, Carrie B Oser⁵, Alison M Aldrich⁶, Aimee N C Campbell⁷, Erika L Crable⁸, Bryan R Garner⁹, LaShawn M Glasgow¹⁰, Dawn Goddard-Eckrich¹¹, Katherine R Marks¹², Ann Scheck McAlearney¹³, Emmanuel A Oga¹⁴, Ariel L Scalise¹⁵, Daniel M Walker¹⁶

Affiliations

¹ Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY, 40508, USA. Electronic address: [email protected].
² Section of Infectious Diseases and Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Department of Health Law, Policy and Management, Boston University School of Public Health, 801 Massachusetts Avenue, Room 2014, Boston, MA, 02118, USA. Electronic address: [email protected].
³ Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA. Electronic address: [email protected].
⁴ College of Medicine, The Ohio State University, 460 Medical Center Drive, Suite 530, Columbus, OH, 43210, USA. Electronic address: [email protected].
⁵ Department of Sociology and Center on Drug and Alcohol Research, University of Kentucky, 1531 Patterson Office Tower, Lexington, KY, 40506, USA. Electronic address: [email protected].
⁶ CATALYST, the Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 460 Medical Center Drive, Suite 530, Columbus, OH, 43210, USA. Electronic address: [email protected].
⁷ Columbia University Irving Medical Center, Department of Psychiatry and New York State Psychiatric Institute, 1051 Riverside Drive, Box 120, New York, NY, 10032, USA. Electronic address: [email protected].
⁸ Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Department of Health Law, Policy and Management, Boston University School of Public Health, 801 Massachusetts Avenue, Room 2030, Boston, MA, 02118, USA. Electronic address: [email protected].
⁹ RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA. Electronic address: [email protected].
¹⁰ RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA. Electronic address: [email protected].
¹¹ Social Intervention Group, Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA. Electronic address: [email protected].
¹² Department of Behavioral Science, University of Kentucky, 1100 Veterans Drive, Medical Behavioral Science Building Room 108, Lexington, KY, 40536, USA. Electronic address: [email protected].
¹³ Department of Family and Community Medicine and CATALYST, the Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, 460 Medical Center Drive, Suite 530, Columbus, OH, 43210, USA. Electronic address: [email protected].
¹⁴ RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, USA. Electronic address: [email protected].
¹⁵ Department of Infectious Disease, Boston Medical Center, 801 Massachusetts Avenue, Boston, MA, 02118, USA. Electronic address: [email protected].
¹⁶ Department of Family and Community Medicine, College of Medicine, The Ohio State University, 460 Medical Center Drive, Suite 520, Columbus, OH, 43210, USA. Electronic address: [email protected].

Abstract

Background: In response to the U.S. opioid epidemic, the HEALing (Helping to End Addiction Long-term^SM) Communities Study (HCS) is a multisite, wait-listed, community-level cluster-randomized trial that aims to test the novel Communities That HEAL (CTH) intervention, in 67 communities. CTH will expand an integrated set of evidence-based practices (EBPs) across health care, behavioral health, justice, and other community-based settings to reduce opioid overdose deaths. We present the rationale for and adaptation of the RE-AIM/PRISM framework and methodological approach used to capture the CTH implementation context and to evaluate implementation fidelity.

Methods: HCS measures key domains of the internal and external CTH implementation context with repeated annual surveys and qualitative interviews with community coalition members and key stakeholders. Core constructs of fidelity include dosage, adherence, quality, and program differentiation-the adaptation of the CTH intervention to fit each community's needs. Fidelity measures include a monthly CTH checklist, collation of artifacts produced during CTH activities, coalition and workgroup attendance, and coalition meeting minutes. Training and technical assistance delivered by the research sites to the communities are tracked monthly.

Discussion: To help attenuate the nation's opioid epidemic, the adoption of EBPs must be increased in communities. The HCS represents one of the largest and most complex implementation research experiments yet conducted. Our systematic examination of implementation context and fidelity will significantly advance understanding of how to best evaluate community-level implementation of EBPs and assess relations among implementation context, fidelity, and intervention impact.

Trial registration: ClinicalTrials.gov NCT04111939.

Keywords: Community-Level Implementation; Fidelity; HEALing Communities Study; Helping to End Addiction Long-term; Implementation Context; Implementation Strategy; Opioid Use Disorder; Overdose; PRISM Framework; RE-AIM framework.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Analgesics, Opioid
Behavior, Addictive
Checklist
Clinical Trials as Topic
Delivery of Health Care
Evidence-Based Practice
Humans
Opiate Overdose / prevention & control*

Model and approach for assessing implementation context and fidelity in the HEALing Communities Study

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