Does Organizational Readiness Predict Implementation of a Couple-Based HIV Prevention Intervention?

Background

Couple-based interventions are more effective at promoting HIV protective behaviors than individual or group-based interventions, yet little is known about how best to disseminate and implement couple-based programs in agency settings.  Organizational readiness is a critical component for intervention implementation and a current focus of attention in implementation science.  The field needs clearer operationalization of organizational readiness elements as well as empirical tests of existing measures. Recent literature suggests that general capacities alone might fall short in support of program implementation, and that program-specific capacities, as well as program-specific staff motivation, may also play critical roles in defining readiness. Using facilitator-level data, this study examined organizational readiness of 80 HIV services agencies in New York State to identify which elements, if any, might predict the implementation of Connect, a 6-session couple-based intervention following staff training.

Methods

Organizational readiness was assessed at baseline from 253 facilitators enrolled (2007-2009) in an NIMH-funded randomized trial (R01MH080659), testing implementation of Connect. The domain of ‘Capacities’ was measured generally – for the organization – and specifically, for the Connect program.  Measures included 1) resources, 2) staff attributes, and 3) climate.  Additionally, staff motivation to implement Connect was measured at baseline. Outcome measures: actual implementation and intention to implement - were measured at 6, 12, and 18 month follow-up. Multilevel regression models of providers within service agencies were used to examine relationships between baseline capacities and outcomes across time adjusting for staff age, education, role, years of service, and randomized program.

Results

The most parsimonious models predicted facilitators’ intention to implement Connect. Higher organizational resources (F(1,358)=4.84, p=.028) and program-specific resources (F(1,358)=3.85, p=.05), and better program-specific staff motivation (F(1,358)=6.87, p=.009) were significant predictors of increased intention to implement the program over time, whereas other general and program-specific capacities did not have significant independent effects on implementation. 

Conclusions

A persistent finding of intention to implement across time, but no findings related to actual implementation, suggests a lack of other key capacities (e.g. staff attributes and organizational climate) whose presence may otherwise bolster readiness to implement Connect and other similar interventions.  To further strengthen the likelihood of couple-based program implementation, we recommend training and technical assistance to enhance these additional general and program-specific staff attributes and organizational climate.