10.04.2017 | Original Research
The dynamics of de-adoption: a case study of policy change, de-adoption, and replacement of an evidence-based HIV intervention
Erschienen in: Translational Behavioral Medicine | Ausgabe 4/2017
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Evidence-based intervention (EBI) de–adoption and its influence on public health organizations are largely unexplored within public health implementation research. However, a recent shift in support for HIV prevention EBIs by the Centers for Disease Control and Prevention provides an opportunity to explore EBI de–adoption. The current mixed-method study examines EBI de-adoption and the subsequent impact on a community-based organization (CBO) dedicated to HIV prevention. We conducted a case study with a CBO implementing RESPECT, an HIV prevention EBI, over 5 years (2010–2014), but then deadopted the intervention. We collected archival data documenting RESPECT implementation and conducted two semistructured interviews with RESPECT staff (N = 5). Using Fixsen and colleagues’ implementation framework, we developed a narrative of RESPECT implementation, delivery, and deadoption and a thematic analysis to understand additional consequences of RESPECT de-adoption. Discontinuation of RESPECT activities unfolded in a process over time, requiring effort by RESPECT staff. RESPECT deadoption had widereaching influences on individual staff, interactions between the staff and the community, the agency overall, and for implementation of future EBIs. We propose a revision of the implementation framework, incorporating EBI deadoption as a phase of the implementation cycle. Furthermore, EBI deadoption may have important, unintended consequences and can inform future HIV prevention strategies and guide research focusing on EBI de-adoption.
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