Organizational change in the aging network to promote evidence-based programs

Abstract

Demand for preventing, delaying the onset of, and managing chronic diseases has escalated. Attention is being given to expanding replication of evidence-based programs, those proven to work, to address chronic disease. Although federal agencies encourage communities to adapt evidence-based programs, studies on how organizations learn about and adapt such programs are limited. The purpose of this research was to develop a roadmap for adapting the Chronic Disease Self-Management Program (CDSMP). Findings are based on five years of experience of the Hawaiʻi Healthy Aging Partnership (HHAP), a statewide coalition devoted to replicating evidence-based health promotion programs for older adults. Planned adaptation theory and life cycle theory guided the exploration of processes in adapting, replicating, and sustaining CDSMP in eldercare providers in Honolulu, Hawaiʻi. Using an embedded case study design, this dissertation study collected data from multiple sources (including documents, interviews, and questionnaires) from three levels of participants (state/county offices, service providers, and program participants) at three phases of program adoption (initiation, delivery, and sustainment). Findings describe conditions that contribute to or hinder organizational functioning in adapting, delivering, and sustaining evidence-based programs. Necessary ingredients are continuous support from government and strong coalition infrastructure. Successful adapters also had: 1) on-the-ground champions who examined program content, identified and applied modifications, had on-going commitment, adapted evaluation strategies, perceived benefits of the program, and worked well with other organizations; 2) organizational champions, including supervisors, who bought-in to the program and perceived its fit with the organization; 3) sufficient organization capacity, including willingness to contribute or seek funding, develop internal champions, and market the program; and 4) good interactions with external organizations that could provide technical assistance or attain potential participants. The theory-based framework developed to guide this dissertation study was supported by the data, but findings suggest ways to strengthen the framework. An 11-step guide for the initiation, delivery, and sustainment of CDSMP adoption by government officials and service providers emerged. These proposed guide should be helpful to other communities that want to adapt CDSMP, however it should be further tested to validate its usefulness in non-Aging Network coalitions and for other evidence-based programs.