Table 4 Stakeholder interviews findings on the implementation of community-based SMA program
Implementation Questions | Themes |
|---|---|
What are the organizational resources to carry out the FFL Community program? | • Existing program adapted to community setting • FTE support for multidisciplinary team - dietitian, health coach, clinician, and administrative teams to deliver the program • Ability to obtain in-kind donations for meal delivery, dietary supplements, laboratory testing, and printed health education material • Existing community health activities and team that facilitated the selection of participants |
What are the staff experience and capacity to carry out FFL Community? | • Significant clinical staff experience and passion to adapt the SMA program for a group with more health and socioeconomic needs than usual patients who may not have financial or environmental barriers • Cultural competency and authenticity of providers |
What are the potential barriers to implementing FFL Community? | • Significant time preparation for those that delivered the program content to meet participants’ health literacy and morbidity level (e.g., most participants did not have computers or wifi access so all materials needed to be printed) • Large group as there was no attrition among the participants • Lack of space in community setting made one-on-one sessions challenging for physical exam or lab review • Lack of staff knowledge about local community resources - unsure if enough tools provide for participants to continue program on their own given environment and health conditions • Sustainability and scaling limited as program was resource intense and non-revenue generating; dependent on philanthropic support • Distrust between community residents and healthcare system |
What are the potential facilitators to implementing FFL Community? | • Ongoing communication and engagement between the clinical and community teams for planning, flexible execution, and evaluation • Weekly reminder calls to participants from the community team • Participants were familiar with each other, health activities, and the community site which facilitated group engagement • Meal delivery facilitated nutrition; unclear if sustainable |
What potential modification to FFL Community would need to be made to maximize implementation? | • Better understanding of community members’ needs and assets to adapt program content • More experiential learning, such as cooking demonstrations and grocery store shopping on food vouchers • Develop and incorporate activities for longer support of participants |