Pilot Project 1: Planning for Sustainability of Evidence-based Interventions

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Abstract Developers of evidence-based interventions want to maintain the beneficial health outcomes of their efforts and “sustain” them over an extended period of time, even after external support from a donor agency or funder is terminated. Grounded in community-based participatory research, our interdisciplinary research team has produced a wide array of effective interventions focused on addressing cancer disparities and based on a strong, 15 year partnership with 300 beauty salons, 80 barbershops, and over than 3000 customers. Unfortunately, and despite evidence of effectiveness, when the study was completed, these programs were typically not continued. The goal of the proposed pilot outreach project is to rigorously and systematically investigate factors that influence the sustainability of FITShop, a recent barbershop-based, evidence-based intervention designed to promote physical activity among African American men. This mixed-methods, two-phase proof-of-concept study will occur over 3 years and be guided by a planning for sustainability approach we will adapt from the work of Shediac-Rizkallah & Bone (1998) and Scheirer (2013). In Phase 1, Aims 1-3, we will conduct 130 interviews and community discussion groups to explore three hypothesized set of factors that influence sustainability: 1) Broad social, political and economic factors in the larger community; 2) Organizational influences (barbershop and hair care industry); and, 3) Program design and implementation factors that relate to the FITShop intervention. Using these results, Phase 2 will implement a theory-guided approach to sustain the FITShop intervention in Durham, North Carolina – a community with disproportionately high cancer incidence and mortality rates (Aim 4). Consistent with the original FITShop study, we will measure six month physical activity outcomes (e.g. maintenance of health benefits) among 100 customers from 10 barbershops using both objective (Actigraph/FITBit) and self-report (CHART) measures. This study will yield important new knowledge about how to 1) follow a theory-informed process to plan for sustainability of evidence-based interventions; 2) identify and work to advance theory and develop new measures of sustainability outcomes (e.g. maintenance of health benefits at the individual level, organizational/community capacity building, and institutionalization of programming); and, 3) assess the extent to which FITShop can be sustained in one community. Our results have important implications by developing a new approach to plan early in the initial funding period to sustain interventions, and, will enhance the sustainability of the next generation of evidence-based interventions, to help eliminate persistent health and cancer disparities.