Title: Mediation Analysis of the Efficacy of a Training and Technical Assistance Implementation Strategy on Intention to Implement a Couple-based HIV/STI Prevention Intervention
Description: The purpose of this study was to examine the effectiveness and exposure of an implementation strategy, which included a 4-day in-class training with two follow-up technical assistance calls, on mediating factors hypothesized to be positively associated with staff’s intention to use a five-session, couples-based HIV and other sexually transmitted prevention intervention. The Consolidated Framework for Implementation Research (CFIR) guided the study aims and analysis of the direct effect of exposure to the implementation strategy and 3 factors hypothesized to mediate the implementation strategies’ effect on intention to implement a couples-based intervention. Individual staff characteristics and an organizational process variable informed by Social Cognitive Theory (SCT), the Diffusion of Innovation Theory and Theory of Planned Action were examined. Two hundred and fifty-three staff, predominantly African American and Latina, from 80 organizations, were recruited from HIV service agencies, clinics and community-based organization from New York City and other regions of New York State.

They were randomized by agency to either a multimedia condition or a traditional paper-based version of the couples-based intervention and received the implementation strategy 4-day, in-class intervention training followed by a technical assistance phone call at 3 and 6-months post training. Findings suggest that greater exposure to the implementation strategy in days and contacts was significantly associated with an increase in staff’s intention to implement the intervention at six months. Further, while a statistically significant effect of the implementation strategy dose on the mediators examined was not detected, the implementer’s experience of these mediators defined as self-efficacy for couples-based implementation, positive perception of the intervention’s characteristics and the perceived availability of an organizational intervention Champion was found to be significantly associated with the outcome variable intention to implement, and also was found to reduce the dosage effect of the implementation strategy on intention.

Further examination of the implementation strategy’s content and dosage is needed to identify how increased intention to utilize an intervention at 6 months and 12 months following training and technical assistance may be enhanced through greater attention to and measurement of these mediators in addition to the implementation strategy dosage effect. Of note, the dosage effect on intention was found to diminish at the 12 month follow-up period suggesting the importance of timely support and planning prior to and post implementation strategies to increase utilization of an innovation. Implications for HIV prevention theory, and social work research, practice and policy are discussed.