Moving a research-based intervention into practice: Diffusion of the Mpowerment Project Greg Rebchook, Ph.D., Susan Kegeles, Ph.D., & The TRIP Research Team Center for AIDS Prevention Studies University of California, San Francisco NIMH Center Grant No. MH42459

The Mpowerment Project is an Evidence-based Program Tested through randomized- controlled trials (RCTs) Listed in CDC’s Compendium MP was tested and found effective through RCTs in several communities –Santa Cruz, CA –Eugene, OR –Santa Barbara, CA –Albuquerque, NM –Austin, TX (analysis pending)

The Mpowerment Project MP is a community-level project that is designed to be tailored to each community –Implemented by and for young gay/bisexual men, ages –Not designed for any one racial/ethnic group –HIV-positive and HIV-negative guys together Creates healthy community Promotes supportive friendship networks Disseminates a norm of safer sex throughout the community

Mpowerment Project Core Elements Operating Structure Core Group Volunteers Coordinators Program Components Formal Outreach Informal Outreach M-Groups Project Space Publicity Campaign

What Comes After Intervention Research? Significant amount of resources spent developing evidence-based interventions Little attention given to putting the research into practice CAPS is helping CBOs implement MP through: –Trainings –TA –Materials –Online resources We are now researching the technology exchange process Research findings are preliminary, about two-thirds into the project

We are studying how CBOs implement MP over time When organizations contact us for information on MP, we conduct a “staging” interview to determine their interest in the project –Knowledge –Evaluation –Decision –Ready to implement –Implementation –Maintenance –Discontinued –Decided not to implement We “restage” them on subsequent contacts as necessary Additionally, we interview staff and volunteers at each implementing CBO (and a subset of non- implementers) every 6 months for 18 months to assess: –Barriers and facilitators to implementation Organizational level Community level Intervention level –Fidelity and adaptation –Evaluate our technology exchange services (e.g, trainings, TA, etc.)

Technology Exchange Services depend on CBO stage of implementation Pamphlet Replication Package  Videos (Overview, M-group)  Manuals (Program, M-group) Training, off-site, 3 days Technical Assistance Internet Resources  mpowerment.org  Online forum  On-line chats

Implementation Stages

How implementers progress through stages

Location of Implementing CBOs N in study = 69 Community Size 13% < 100k 13% 100k – 200k 35% 200k – 500k 17% 500k – 1m 7% 1m – 2m 13% >2m Geographic Region 30% Western 17% Northeastern 16% Southeastern 16% Midwestern 10% Southern 9% Southwestern 1% Puerto Rican

Race/Ethnicity of MP’s target populations

Age Ranges of Current MP Target Populations Ages% of programs Youth oriented (12/13 to 23/24 year olds)10% Teens/young men (14/16 to 21/29 year olds)19% Original age range (18 to 29 year olds)31% Young men (18/19 to 30/35 year olds)17% Includes older men (15/25 to no upper limit)23%

Sources of MP Money CDC pass-through (n=44) State (n=34) Private foundations/pharm (n=25) Private fund-raising (n=18) Direct from CDC (n=10) County (n=10) City (n=1) Other federal (n=5) Don’t know (n=9)

Size of budgets at implementing CBOs

Budget for MP * Did not begin asking this question until part-way into the project

How are CBOs adapting MP? We have preliminary data from CBOs about which Core Elements they are implementing as described in our materials, which they are modifying, and which they are not implementing We are interviewing 2-5 people at each CBO We took a conservative approach to classifying implementation of core elements (e.g., “Yes, we are implementing the core element” required unanimous agreement) These are baseline data—before we provided TA to the agencies. Anecdotes from TA-providers indicate that TA helps agencies implement the Core Elements with fidelity

Adoption of MP’s Operating Structure (baseline)

Adoption of MP’s Program Components (baseline)

Prevention Research is Moving Into Practice MP was originally developed in 3 communities We then tested the model in 2 larger, more complex communities Today, it is being implemented in over 70 communities (and still counting…) MP is being implemented with MSM of color Successful diffusion of interventions is facilitated by cooperation between community members, CBOs, health departments, capacity building agencies, funders, trainers, policy-makers, and researchers