AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #96 - The influence of social determinants on evidence-based behavioral interventions– considerations for implementation in community settings
Authors: Presenting Author: Ms. Alice Gandelman - California STD/HIV Prevention Training Center
Additional Authors: Dr. Margaret Dolcini,
Aim: A qualitative study was conducted with six community-based organizations implementing evidence-based interventions from the CDC-funded Diffusion of Effective Behavioral Interventon (DEBI)program. Primary aims of the study were to: 1) identify factors that facilitated or impeded implementation 2) determine how in the context of DEBI implementation, CBOs address the social determinants affecting their clients 3) understand the barriers to addressing social determinants and how they impact DEBI implementation 4) provide recommendations to a) improve implementation fidelity b) adapt DEBIS to successfully address social detrminants that impede DEBI participation and service delivery to clients
Method / Issue: During the last decade, the emergence of CDC’s Diffusion of Effective Behavioral Interventions (DEBI) program resulted in one of the largest national diffusion efforts to date. Several hundred CBOs and state and local health departments throughout the United States have participated in this initiative. The effort to increase adoption and implementation of DEBIs in community and public health practice represented a paradigmatic shift in HIV prevention. This process has resulted in questions concerning whether DEBIs are responsive to community needs and the social and environmental contexts in which they have been diffused. Agencies are often conflicted because DEBI requirements do not always match the needs prioritized by their clients. We interviewed staff at six California agencies implementing one of the 3 group-level DEBIs to identify facilitators and/or challenges to effective implementation. Separate in-depth semi-structured interviews were conducted with Executive or Program Directors, and implementers. Interviews covered a wide range of issues related to selection, adoption, adaptation, and implementation of DEBIs. Data on social determinants were extracted from all sections of the interview. Participants’ discussions of the factors that facilitated or impeded implementation provided especially rich data on this topic.
Results / Comments: A total of 14 qualitative interviews were completed, each averaging between 60 and 90 minutes in length. Agency staff viewed social and structural determinants as challenges in the implementation of group level DEBIS. Several factors affected community members’ participation in the DEBI, including language and literacy issues, eligibility requirements for the intervention, legal status, and incarceration. Client socioeconomic status and stigma associated with HIV and sexual orientation considerably influenced participation and CBO implementation success. Group affiliation and group dynamics of intervention members were also important; challenges were observed when significant differences existed among group members, such as age and class differences or gay-identified and non-gay-identified MSM.
Discussion: Although changing individual behaviors is the ultimate measure of behavioral intervention/DEBI success, this approach overlooks the larger social and structural factors that significantly affect risk for HIV. In light of the need to address these issues, we present short-term, intermediate, and long-term strategies to help address social determinants of health, and offer suggestions for adapting DEBIs to meet the broader needs of persons prioritized for DEBIs.
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