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LESSONS LEARNED FROM IMPLEMENTING PROVEN INTERVENTIONS INTO REAL-WORLD CONTEXTS

LAURA N. GITLIN AND BRUCE LEFF

. . . start with the end in mind.

—Covey(1989)

Many behavioral interventions are designed and evaluated in a context external to, or independent of, a health or social service system or community agency. As such, a translational phase (see Chapter 2) is often required in which adaptations to the proven intervention are needed to optimize delivery in a particular setting and to facilitate implementation, dissemination, and adoption on a broad scale.

In this chapter, we examine some of the key challenges that are encountered when moving a proven intervention from its developmental and evaluative phases to its translation and implementation in real-world settings. We draw upon three of our own interventions that vary in their purposes, delivery characteristics, and levels of evidence and contexts for delivery to illustrate key lessons learned from the implementation experience.

Building on the discussion of implementation science constructs in Chapter 19, we start with the primary lesson learned—the importance of understanding “context” for implementation of interventions. We then consider how characteristics of interventionists can impact implementation potential. Finally, we discuss the need to derive the value alignment or the “just right fit” between the benefits of an intervention and stakeholder interests. Drawing upon our case examples, we highlight the relative strengths and limitations of the delivery characteristics of these exemplar interventions as related to their implementation potential in different real-world contexts.

Reflecting upon the lessons learned from attempts to move interventions from their test phase to real-world contexts can inform the next generation of intervention development work. Specifically, our purpose is to explicitly link intervention delivery characteristics and approaches to their evaluation, to the unique challenges encountered when implementing these interventions in practice and community settings. Our goal is to shed light on the trade-offs in decision making that may need to occur early on when designing delivery characteristics of an intervention (discussed in Chapter 5) and when choosing evaluative approaches (see Part III) to prove intervention effectiveness. Familiarity with potential future implementation challenges can enable investigators/teams to proceed more knowledgeably in the construction of interventions and evaluation approaches.

 
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