Symposia
Dissemination & Implementation Science
Ali Giusto, Ph.D. (she/her/hers)
New York State Psychiatric Institute/Columbia University Medical Center
Delray Beach, Florida
Florence Jaguga, MBChB, MMed Psych
Consultant Psychiatrist Department of Mental Health
Moi Teaching and Referral Hospital
Eldoret, Rift Valley, Kenya
Victor Pereira-Sanchez, MD
Clinical Assistant Professor
Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine
New York, New York
Wilter Rono, B.A.
Research Assistant
Moi Teaching and Referral Hospital
Eldoret, Rift Valley, Kenya
Noah S. Triplett, M.S. (he/him/his)
Graduate Student
University of Washington
Seattle, Washington
Hani Rukh-E-Qamar, B.Sc.
Volunteer Research Assistant
Department of Psychology, McGill University
Montreal, Quebec, Canada
Mattea Parker, B.A.
Volunteer Research Assistant
Tuskegee University
Tuskeegee, Alabama
Milton Wainberg, MD
Professor of Clinical Psychiatry
New York State Psychiatric Institute/ Columbia University Medical Center
New York, New York
Background: Understanding barriers and facilitators to sustainability implementing treatment is important for delivering care that lasts. This study explored how an intervention for father depression and alcohol use could be implemented within Eldoret, Kenya. Methods: To do this, two implementation determinant frameworks, the Integrated Sustainability Framework (ISF) and the Consolidated Framework for Implementation Research (CFIR) guided the study. Both Frameworks provide a pragmatic approach to identify barriers and facilitators to implementation across domains such as individual characteristics and sustainability. The local team conducted 18 key informant interviews and 7 focus group discussions (31 total participants) with different individuals who might be impacted by implementation. This included hospital leaders, policy makers, mental health providers, community leaders, fathers, lay providers, and patients previously engaged in treatment. Interviews were analyzed using the framework method; themes were matrixed by framework domains. Results: Participants identified several barriers and facilitators within domains of innovation, outer setting, inner setting, individual, sustainability, and system characteristics. Within these domains, the data revealed opportunities for successful implementation and engagement as well. (Opportunities typically constituted suggestions for leveraging strengths or adding elements to a domain that could enhance implementation or sustainability). Identified barriers included lack of resources, stigma, masculine norms, cost of services, and alcohol dependence. Facilitators included community buy-in, family support, providers with lived experience, government support, and relevant treatment content. Key opportunities for enhancing sustainability included incorporating policy makers early in implementation and integrating services into existing community structures (e.g., churches).
Conclusion: Findings will inform development of implementation strategies that emphasize potential sustainability -- a key element for building and maintaining community trust.
