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Table 5 Delivery Agent Qualitative Assessment of Recruitment, Delivery Expectations, Implementation Strategy

From: SIPsmartER delivered through rural, local health districts: adoption and implementation outcomes

  Positive Negative Example Quotesa
Recruitment
Recruitment • Targeting intact groups instead of more broadly recruiting in the community
• Having recruitment materials and adjusting them to reflect needs of population
• Perceived lack of interest by community
• Difficult to engage other staff in recruitment
+ “I think finding those groups that are already together has been key for us. I think we would still be struggling if we were just reaching for general community members”
+“For us, the only way it started to become successful was when we had our brochure to give to people early on”
-“…we’re hitting the people we need to hit; it’s just been trying to find a way to get them interested in realizing ‘OK, yes, I’m consuming too many sugary drinks and maybe need to stop’ and then get them interested in taking this class”
- “…[what] was said that we were going to do, each employee was going to do 4 surveys. And, for I don’t know how that approach is working for other districts, but for us, it’s just not feasible to ask other employees who already have a busy schedule”
Intervention Delivery
Lesson Delivery • Program was well developed
• Aligned with professional training/experience of educators
• Able to modify lessons to meet needs of population
• Participant interactions with one another
• Seeing participants make changes
• Class attendance issues + “Well I think the classes were designed very well. You know each on kind of followed a natural, kind of logical progression and slow”
+ “I’m a health educator so this is what I do. I teach a lot and I have that ability and I know how to read my audience to get information”
+ “We just had a great group that was very supportive of each other and very interactive”
+ “We found a couple of things that ‘hey this is what people here drink so let’s get it in here too’ and then we added a couple [of images] to the celebrity [marketing slide]. We added a couple that we felt like folks would relate to me than what already existed so you know, we just tweaked it here and there, but it was very helpful that we were allowed to do that because it helped with our presenting… It gave us flexibility without losing you know the content”
+“I feel like the most positive thing was actually seeing the change because I think that the group from [location 1], it was tremendous though the outcome from where they started to the end”
+ “Well, I feel like the most positive thing was actually seeing the change because I think that the group from [location 1], it was tremendous though the outcome from where they started to the end”
- “I guess the biggest thing would be getting people to come back and keeping them interested throughout the program, and of course, you have that with any program”
- “The only thing for me is just not having enough people actually sitting in the classroom and that’s really hard when you have an audience of two to get a lot of interaction”
Teach-Back & Missed Class Calls • Calls provided a nice way to connect with participants about content, either reviewing or missed • Perceived as not feasible because of time commitment
• Scheduling can be difficult if participants need to be contacted outside of normal business hours
+ “I found it very useful for me to see what they retained and then knowledge wise and then making the connection and just saying good luck”
+ “Yeah, the missed class calls are good because that brings people up to speed and also lets them know ‘hey you missed it but you know we’re gonna bring [you] up to date’”
- “For me it is completely unfeasible. I mean with my time and what I cover on the day-to-day basis, I personally could not do it”
- “It’s just gonna be hard to get those in with you know the regular day. You never have enough time anyway”
- “You know most people want call backs at night and that doesn’t really fit with most work schedules”
Implementation Strategy
General • Research staff had content expertise
• Able to effectively communicate with research staff about needs and questions
• Support did not seem necessary as content was not new +“It was helpful to have you guys there during the class so if there was any question I could not answer or address… you were able to answer that question”
+“It allowed us to have honest and open communication and I think that was the most important thing”
−/+“I mean, initially, I was a little uncomfortable, I thought you know, this information is not anything new to me and why does somebody have to observe me doing it … but after the first lesson I didn’t feel like anybody was there to judge me but really to judge the program itself”
Training Specific • Provided a complete picture of the program
• Set expectations clear expectations for what was required
• Opportunity to develop a network with researchers and other delivery agents
  + “It was really good to see the lessons as well as the calls kind of modeled for you just to get a general idea of, you know, the flow of the class, the timing and things like that. I think that that was really the strong point”
+“So that was huge for use to actually be able to go through the mock sessions and to understand what our audience might be thinking and then be able to ask the right questions so that we all got the best answers.”
General Comments
Need • Addresses a behavioral and health needs in the community
• Extends existing programming
• Duplicates other (less intense) programming + “I think it will be really good for them, especially in our area we have a culture of Mountain Dew drinking and things like that so I think shining a light on sugar-sweetened beverages will have a really big impact”
+ “…I think it’s something that’s incredibly useful … there’s of course Rev. Your Bev and like different events or different campaigns that are out here as far as drinking more water but not like actually having participants set goals, giving them strategies and things like that”
-“We you know, already teach a similar curriculum”
Logistics   • Length of program
• Focus of staff is dictated by funds
- “Over that you know fourteen plus week timeframe, it’s a large commitment for anybody”
- “Our priorities are determined by the funds that are coming into the health department”
  1. a + = positive statement and - = negative statement