Evaluation of the Sharp Toolkit by Community Champions Implementing the Health Education and Counseling Program

Purpose: One of the most critical issues impeding improvement in public health is the gap between what we know can optimize health and what gets implemented. Implementation science seeks to address this gap by understanding how best to transfer effective programs into real world settings. The purpose of this presentation is to share our experience in developing an evidence-based, integrated toolkit for targeted users responsible for disseminating and implementing an innovative and effective theory-guided, evidence-based academic asthma health education and counseling self-management program for schools and community settings. The program, promoted by the National Institute of Nursing Research [1], challenges an existing paradigm that condition-specific self-management programs are inappropriate for academic settings and addresses a critical school barrier to progress in the field of asthma self-management. The novel program, Staying Healthy-Asthma Responsible & Prepared™ (SHARP) has two components: a school component for older school age students with asthma aged 9–14 years enrolled in grades 4–7 delivered by trained certified elementary school teachers in schools during instructional time and a community component for invited members of the students’ social network delivered by public health educators during scheduled evening and weekend events [2–4]. The specific aim of this project was to evaluate the acceptability, user-friendliness, cultural relevance, and readiness for implementation of the newly-developed, evidence-based, integrated SHARP toolkit by community champions seeking to disseminate and implement the program in more than a dozen school districts and communities across the U.S.

The transdisciplinary dissemination and implementation of SHARP model (TDISM) used to guide the project integrates concepts and processes of three related frameworks: (a) the consolidated framework for implementation research (CFIR) that provides structure for implementing complex, interacting, and multi-level interventions in real world settings [5], (b) the logic model of school-based asthma interventions (LM-SAI) that provides structure for implementing asthma health education and counseling programs in school settings [6], and (c) the acceptance of asthma model (AAM) that served as the basis for development and evaluation of the SHARP program [7].

Methods: We used a hybrid, blended, type III implementation design. The research question asked, what is the perception of acceptability, user-friendliness, cultural relevance, and readiness for implementation of the integrated toolkit by community champions engaged in dissemination and implementation of the program? As a quality improvement project, our activities were exempt from institutional review board approval. The participants consisted of community champions seeking to disseminate and implement the program in their community. The process involved (a) mailing of the toolkit to the participants, (b) obtaining written feedback about their perception of the toolkit’s acceptability, user-friendliness, cultural relevance, and readiness for implementation, and (c) conducting follow-up interviews to clarify specific areas of interest. Customized pragmatic open-ended and guided interview items that map to the CFIR domains and constructs were used to evaluate the content and presentation of content contained in the toolkit. Research Electronic Data Capture (REDCap), a secure web application for building and managing online surveys and databases, was used for data collection. We downloaded responses into Microsoft Excel for analysis. We extracted themes from the data to guide revision of the toolkit prior to global dissemination and implementation of the program.

Results: Participants represented over 12 communities and 20 school districts in Alabama, West Virginia, Ohio, Texas, and Wisconsin. Qualitative analysis confirmed the integrated toolkit’s acceptability, user-friendliness, cultural relevance, and readiness for implementation. Content and presentation of content related to the introduction and welcome message, purpose and objectives of the toolkit, table of contents, overview of the program, and overview of the dissemination and implementation process including flowcharts, timelines, adoption guidelines, and possible adaptation guidelines were deemed feasible, realistic, reasonable, and practical for the targeted user groups. The participants confirmed that the guidelines for targeted user groups including community champions, school liaisons, school teachers, and public health educators would facilitate performance of roles and responsibilities of each targeted user group throughout the dissemination and implementation process. Participants valued having all supportive documents and materials readily available to them in one, 3-ring binder.

Conclusion: The toolkit clearly communicates the roles and responsibilities of all targeted users, in relationship to others involved in the process, as the program is implemented in each community. In addition, the toolkit provides supportive materials needed for successful adoption and delivery of the program. Findings advance dissemination and implementation science, guide dissemination and implementation of other effective programs, uncover further direction for dissemination and implementation science, and inform health policy related to delivery of asthma self-management programs in schools and community settings.