Understanding implementation completion of tailored motivational interviewing in multidisciplinary adolescent HIV clinics

Sylvie Naar; M Isabel Fernandez; Lisa Todd; Sara K Shaw Green; Henna Budhwani; April Carcone; Karin Coyle; Gregory A Aarons; Karen MacDonell; Gary W Harper

doi:10.1177/26334895231164585

Understanding implementation completion of tailored motivational interviewing in multidisciplinary adolescent HIV clinics

Implement Res Pract. 2023 Mar 30:4:26334895231164585. doi: 10.1177/26334895231164585. eCollection 2023 Jan-Dec.

Authors

Affiliations

¹ Center for Translational Behavioral Science, Florida State University, Tallahassee, FL, USA.
² Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA.
³ Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA.
⁴ Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
⁵ ETR, Scotts Valley, CA, USA.
⁶ Department of Psychiatry, UC San Diego, La Jolla, CA, USA.
⁷ ACTRI Dissemination and Implementation Science Center, UC San Diego, La Jolla, CA, USA.
⁸ Child and Adolescent Services Research Center, San Diego, CA, USA.
⁹ Department of Health Behavior and Health Education, School of Public Health, University of Michigan School of Public Health, Ann Arbor, MI, USA.

Abstract

Background: Understanding the barriers and facilitators of implementation completion is critical to determining why some implementation efforts fail and some succeed. Such studies provide the foundation for developing further strategies to support implementation completion when scaling up evidence-based practices (EBPs) such as Motivational Interviewing.

Method: This mixed-methods study utilized the Exploration, Preparation, Implementation, and Sustainment framework in an iterative analytic design to compare adolescent HIV clinics that demonstrated either high or low implementation completion in the context of a hybrid Type III trial of tailored motivational interviewing. Ten clinics were assigned to one of three completion categories (high, medium, and low) based on percentage of staff who adhered to three components of implementation strategies. Comparative analysis of staff qualitative interviews compared and contrasted the three high-completion clinics with the three low-completion clinics.

Results: Results suggested several factors that distinguished high-completion clinics compared to low-completion clinics including optimism, problem-solving barriers, leadership, and staff stress and turnover.

Conclusions: Implementation strategies targeting these factors can be added to EBP implementation packages to improve implementation success.

Plain language summary: While studies have begun to address adherence to intervention techniques, this is one of the first studies to address organizational adherence to implementation strategies. Youth HIV providers from different disciplines completed interviews about critical factors in both the inner and outer context that can support or hinder an organization's adherence to implementation strategies. Compared to less adherent clinics, more adherent clinics reported more optimism, problem-solving, and leadership strengths and less staff stress and turnover. Implementation strategies addressing these factors could be added to implementation packages to improve implementation success.

Keywords: HIV-AIDS; behavioral health treatment; children/child and adolescent/youth/family; implementation; inner context; motivational interviewing; organization; outer context.

Grants and funding

U19 HD089875/HD/NICHD NIH HHS/United States