Moving a research-based intervention into practice: Diffusion

of the Mpowerment Project

Greg Rebchook, Ph.D., Susan Kegeles, Ph.D., &

The TRIP Research Team

Center for AIDS Prevention Studies

University of California, San FranciscoNIMH Center Grant No. MH42459

The Mpowerment Project is an Evidence-based Program

• Tested through randomized-controlled trials (RCTs)

• Listed in CDC’s Compendium• MP was tested and found

effective through RCTs in several communities– Santa Cruz, CA

– Eugene, OR

– Santa Barbara, CA

– Albuquerque, NM

– Austin, TX (analysis pending)

The Mpowerment Project• MP is a community-level project that

is designed to be tailored to each community– Implemented by and for young

gay/bisexual men, ages 18-29

– Not designed for any one racial/ethnic group

– HIV-positive and HIV-negative guys together

• Creates healthy community

• Promotes supportive friendship networks

• Disseminates a norm of safer sex throughout the community

Mpowerment Project Core Elements

Operating Structure• Core Group• Volunteers• CoordinatorsProgram Components• Formal Outreach• Informal Outreach• M-Groups• Project Space• Publicity Campaign

What Comes After Intervention Research?

• Significant amount of resources spent developing evidence-based interventions

• Little attention given to putting the research into practice

• CAPS is helping CBOs implement MP through:– Trainings– TA– Materials– Online resources

• We are now researching the technology exchange process• Research findings are preliminary, about two-thirds into

the project

We are studying how CBOs implement MP over time

• When organizations contact us for information on MP, we conduct a “staging” interview to determine their interest in the project– Knowledge– Evaluation– Decision– Ready to implement– Implementation– Maintenance– Discontinued– Decided not to implement

• We “restage” them on subsequent contacts as necessary

• Additionally, we interview staff and volunteers at each implementing CBO (and a subset of non-implementers) every 6 months for 18 months to assess:– Barriers and facilitators to

implementation• Organizational level

• Community level

• Intervention level

– Fidelity and adaptation

– Evaluate our technology exchange services (e.g, trainings, TA, etc.)

Technology Exchange Services depend on CBO stage of

implementation• Pamphlet• Replication Package

Videos (Overview, M-group)Manuals (Program, M-group)

• Training, off-site, 3 days• Technical Assistance• Internet Resources

mpowerment.orgOnline forumOn-line chats

Implementation Stages

n=335

90 69

9481

62

54

34

20

42

69

2111

514

7

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Initial stage Follow-up

Time

% o

f C

BO

s in

eac

h s

tag

e

Decided not

Discontinued

Maintenance

Implementing

Ready to implem

Decision stage

Evaluation stage

Knowledge stage

How implementers progress through stages

N=79

42

15

6

4

12

8 2

Initialimplementers

From RTI

From decision

From know/eval

Thru 2 or morestages

DiscontinuedMP

Not in study

Location of Implementing CBOsN in study = 69

Community Size• 13% < 100k• 13% 100k – 200k• 35% 200k – 500k• 17% 500k – 1m • 7% 1m – 2m• 13% >2m

Geographic Region• 30% Western• 17% Northeastern• 16% Southeastern • 16% Midwestern• 10% Southern• 9% Southwestern• 1% Puerto Rican

Race/Ethnicity of MP’s target populations

0

5

10

15

20

25

30

35

40

45

Nu

mb

er

of

CB

Os

All

Eth

nic

itie

s

Afr

ica

nA

me

ric

an

La

tin

o/H

isp

an

ic

Me

n o

f c

olo

r

As

ian

/Pa

cif

icIs

lan

de

r

Na

tiv

eA

me

ric

an

Wh

ite

Age Ranges of Current MP Target Populations

Ages % of programs

Youth oriented (12/13 to 23/24 year olds) 10%

Teens/young men (14/16 to 21/29 year olds) 19%

Original age range (18 to 29 year olds) 31%

Young men (18/19 to 30/35 year olds) 17%

Includes older men (15/25 to no upper limit) 23%

Sources of MP Money• CDC pass-through (n=44)

• State (n=34)

• Private foundations/pharm (n=25)

• Private fund-raising (n=18)

• Direct from CDC (n=10)

• County (n=10)

• City (n=1)

• Other federal (n=5)

• Don’t know (n=9)

Size of budgets at implementing CBOs

N=69

27%

12%

13%19%

29%

DK (respondent didn'tknow)

<$500k

$500k-$1m

$1m-$2m

>$2m

Budget for MPN=26*

27%

27%9%

9%

5%

23%

DK (respondentdidn't know)

<$25k

$25k=$50k

$50k-$100k

$100k-$150k

$150k-$350k*Did not begin asking this question until part-way into the project

How are CBOs adapting MP?• We have preliminary data from CBOs about which Core

Elements they are implementing as described in our materials, which they are modifying, and which they are not implementing

• We are interviewing 2-5 people at each CBO• We took a conservative approach to classifying

implementation of core elements (e.g., “Yes, we are implementing the core element” required unanimous agreement)

• These are baseline data—before we provided TA to the agencies. Anecdotes from TA-providers indicate that TA helps agencies implement the Core Elements with fidelity

Adoption of MP’s Operating Structure (baseline)

0%10%20%30%40%50%60%70%80%90%

100%

Coordin

ators

Core G

roup

Space

CAB

Volunte

ers

n=69 Implementing CBOs

Not implementingelement

Modified element

Yes-implementingelement

Adoption of MP’s Program Components (baseline)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

SocialEvents

Venue OR InformalOR

M-groups Publicity

n=69 Implementing CBOs

Not implementingelement

Modified element

Yes-implementingelement

Prevention Research is Moving Into Practice

• MP was originally developed in 3 communities

• We then tested the model in 2 larger, more complex communities

• Today, it is being implemented in over 70 communities (and still counting…)

• MP is being implemented with MSM of color• Successful diffusion of interventions is

facilitated by cooperation between community members, CBOs, health departments, capacity building agencies, funders, trainers, policy-makers, and researchers