Dissemination of Motivational Interviewing-Based Brief Intervention for Substance Use Disorders to HIV Service Organizations: A Cluster-Randomized Adaptive Dissemination Experiment Testing Facilitation as a Dissemination Strategy
Bryan R. Garner, Heather J. Gotham, Elizabeth Solinger, Jen Brinker, Stephen J. Tueller, Sheila V. Patel, Michael Bradshaw, Sarah Philbrick, Jackie Mungo, Tom Donohoe, Thomas E. Freese, Beth A. Rutkowski, Mathew R. Roosa, Kathryn J. Speck, Hannah K. KnudsenBackground
Strategies that improve integration of evidence-based substance use disorder (SUD) innovations within HIV service organizations (HSOs) are needed. Building on research supporting the effectiveness of facilitation to improve HSOs’ implementation of a motivational interviewing-based brief intervention (MIBI) for SUDs, this dissemination research sought to test the effectiveness of brief exploration facilitation to improve organization-level MIBI adoption/preparation (primary outcome) and exploration (secondary outcome) after an initial distributing educational materials strategy.
Methods
HSOs that did not transition to adoption/preparation within one week of the initial distributing educational materials strategy were randomized to either (a) continue in the distributing educational materials condition or (b) receive exploration facilitation. Outcomes were assessed four months post-dissemination. The primary dissemination outcome was organizational-level adoption/preparation, defined as 1+ HSO staff downloading the manual and/or enrolling in online asynchronous training. The secondary dissemination outcome was organization-level exploration of the intervention (i.e., 1+ HSO staff opened the dissemination email).
Results
At the end of week 1 after the initial distributing educational materials strategy, 327 (46.7%) of 700 HSOs had transitioned to exploration and an additional 15 HSOs (2.1%) had transitioned to adoption/preparation. After randomization, no additional HSOs achieved adoption as a function of being in either study condition. Of 341 HSOs randomized to exploration facilitation, only 11 HSOs (3.2%) received the single facilitation session delivered by our team of facilitators.
Conclusion
The project’s initial distributing educational materials dissemination strategy led to minimal MIBI adoption by HSOs. Despite several phone attempts per HSO, the project’s facilitators were generally unsuccessful in engaging HSOs and unable to deliver the exploration facilitation strategy; thus, the exploration facilitation strategy was not effective. Future research should consider testing alternative dissemination strategies, such as incentivization, which has demonstrated effectiveness as an implementation strategy.