A mixed-methods approach to assessing implementers’ readiness to adopt digital health interventions (RADHI)

Dennis Henyee Li*, Alithia Zamantakis, Juan Pablo Zapata, Elizabeth Caitlin Anne Danielson, Rana Saber, Nanette Benbow, Justin Dean Smith, Gregory Swann, Kathryn Macapagal, Brian Stanley Mustanski

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Despite being the primary setting for HIV prevention among men who have sex with men (MSM) since the start of the epidemic, community-based organizations (CBOs) struggle to reach this historically stigmatized and largely hidden population with face-to-face interventions. HIV researchers have readily turned to the internet to deliver critical HIV education to this group, with evidence of high effectiveness and acceptability across studies. However, implementation outside of research contexts has been limited and not well studied. We aimed to assess HIV CBOs’ readiness to adopt digital health interventions and identify contextual factors that may contribute to differing levels of readiness. Methods: We recruited 22 CBOs across the US through a pragmatic request-for-proposals process to deliver Keep It Up! (KIU!), an evidence-based eHealth HIV prevention program. We used mixed methods to examine CBO readiness to adopt digital health interventions (RADHI). Before implementation, CBO staff completed a 5-item RADHI scale (scored 0–4) that demonstrated concurrent and predictive validity. We interviewed CBO staff using semi-structured questions guided by the Consolidated Framework for Implementation Research and compared RADHI score groups on determinants identified from the interviews. Results: Eighty-five staff (range = 1–10 per CBO) completed the RADHI. On average, CBOs reported moderate-to-great readiness (2.74) to adopt KIU!. High RADHI CBOs thought KIU! was a top priority and an innovative program complementary to their existing approaches for their clients. Low RADHI CBOs expressed concerns that KIU! could be a cultural mismatch for their clients, was lower priority than existing programs and services, relied on clients’ own motivation, and might not be suitable for clients with disabilities. Value, appeal, and limitations did not differ by RADHI group. Conclusions: While HIV CBOs are excited for the opportunities and advantages of digital interventions, additional pre-implementation and implementation support may be needed to increase perceived value and usability for different client populations. Addressing these limitations is critical to effective digital prevention interventions for HIV and other domains such as mental health, chronic disease management, and transitions in care. Future research can utilize our novel, validated measure of CBOs’ readiness to adopt digital health interventions. Trial registration: NCT03896776, clinicaltrials.gov, 1 April 2019.

Original languageEnglish (US)
Article number91
JournalImplementation Science Communications
Volume5
Issue number1
DOIs
StatePublished - Dec 2024

Funding

This work was supported by a grant from the National Institute of Mental Health, National Institute on Drug Abuse, and NIH Office of the Director (R01MH118213, PI: Mustanski). Additionally, authors az and JPZ\u2019s time was supported by a training grant from the National Institute of Mental Health (T32MH130325). Despite their critical function in brokering and providing a broad range of services, CBOs encounter various implementation challenges, such as scheduling and transportation barriers, limited resources, and staff constraints that hinder their ability to reach individuals at scale through face-to-face interventions [, ]. In response to these challenges, HIV researchers have increasingly turned to internet-based and digital approaches to provide necessary HIV education to this population. Significant funding from the National Institutes of Health and other organizations has enabled the development and evaluation of many digital tools to support HIV prevention and treatment []. These studies consistently demonstrate the effectiveness and positive reception of these interventions [], expanding the range of programs available for CBOs to choose from and implement, regardless of their specific context. However, there remains a substantial gap between the number of digital HIV interventions created and those widely adopted in public health practice.

Keywords

  • Adoption
  • Community-based organizations
  • Digital health intervention
  • HIV prevention
  • Implementation readiness
  • Measure validation

ASJC Scopus subject areas

  • Health Policy
  • Health Informatics
  • Public Health, Environmental and Occupational Health

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