Abstract: Identifying Elements Important for Sustainment of Evidence-Based Programs Using Qualitative Comparative Analysis: A New Look at the Consolidated Framework for Implementation Research (Society for Social Work and Research 22nd Annual Conference - Achieving Equal Opportunity, Equity, and Justice)

Schedule:

Sunday, January 14, 2018: 8:00 AM

Independence BR B (ML 4) (Marriott Marquis Washington DC)

* noted as presenting author

Sapna Mendon, MSW, Doctoral Fellow, University of Southern California, Los, CA

Lawrence Palinkas, PhD, Professor and Chair, University of Southern California, Los Angeles, CA

Suzanne Spear, Assistant Professor, California State University, Northridge, Northridge, CA

Juan Villamar, MSEd, Executive Director, Northwestern University, Chicago, IL

Hendricks Brown, PhD, Professor of Psychiatry, Northwestern University, Chicago, IL

Background: Major advances in prevention research have led to the development of numerous community-based programs that target substance abuse, mental health problems, and suicide. While previous studies have established facilitators and barriers of implementation, most have focused on adoption, and have neglected to consider factors and processes associated with sustainment. The current study aimed to identify what factors are important to sustainment based on ratings of characteristics from the Consolidated Framework for Implementation Research (CFIR) and supplemental qualitative data. Specifically, we identified which conditions are necessary (conditions that must almost always be present for an outcome to occur) and which conditions are sufficient (outcome will almost always occur when these conditions are present) to sustainment.

Materials and Methods: Representatives from 10 grantees within 4 SAMHSA programs were interviewed to understand factors and processes of sustainment. Data collection consisted of three parts: a semi-structured interview to capture experiences with implementation and sustainment, a free list exercise, and a checklist of elements from CFIR. We used Qualitative Comparative Analysis (QCA), a set theory approach, to identify necessary and sufficient conditions across the 10 grantees. Using Boolean algebra, QCA allows us to describe causal conditions and outcomes in the context of relationships within given sets of conditions².

Findings: All but 2 characteristics were rated as being important to program sustainment by more than 50% of participants. Notably, the highest rated CFIR elements were: needs and resources of the communities being served (97.4%); program champions (94.9%); assessment of progress made towards sustainment (94.7%); access to knowledge and information about the program (92.3%) and knowledge and beliefs about the program (91.4%). Least important elements were pressures to implement from other states, tribes and communities (21.1%) and organizational incentives and rewards for implementing program (45.9%). Correlational and multivariate regression analyses identified which of the 18 characteristics rated as important to sustainment by 76-100% were associated with program elements grantees sought to have sustained. These findings then informed which characteristics should be included in a QCA to determine which sets of these conditions are necessary and sufficient for sustainment.

Conclusion: Unique approaches to analyzing a hybrid of qualitative-quantitative data allow researchers to further expands our knowledge about implementation outcomes. In particular, QCA advances our application of a widely used framework, and enables us to understand the relationships of CFIR domains and characteristics in the context of sustainment.