Michelle Kegler, DrPH, MPH
Michelle Carvalho, MPH, CHES
Emory
Prevention
Research
Center
Mini-Grants as a Strategy for
Dissemination
 Mini-grants are common in health promotion initiatives
& have potential for creating demand for evidencebased interventions
 Mini-grants can be combined with dissemination
strategies shown to work
 Training workshops

(Rohrbach 2006; Elliot 2004)
Increases adoption, capacity, fidelity, maintenance
 Technical Assistance

Ongoing support, feedback, coaching
 Incentives

(Pentz 2006; Shepherd 2008; Rohrbach 2006)
(Basen-Engquist ,1994; Glanz, 2002)
stipends, equipment, materials
NCCDPHP Knowledge To Action Framework
May 2009
RESEARCH PHASE
INSTITUTIONALIZATION
PHASE
TRANSLATION PHASE
DISCOVERY
STUDIES
EFFICACY
STUDIES
Practice-based
Discovery
EFFECTIVENESS
AND
IMPLEMENTATION
STUDIES
DECISION to
TRANSLATE
Practice-based
Evidence
KNOWLEDGE INTO
PRODUCTS
DISSEMINATION
DECISION to
ADOPT
INSTITUTIONALIZATION
PRACTICE
ENGAGEMENT
DIFFUSION
Research Supporting Structures
Translation Supporting Structures
Insitutionalization
Supporting
Structures
EVALUATION
This product is in the public domain. Please cite this work in this manner:
The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Knowledge to Action Framework, Centers for Disease Control
and Prevention, NCCDPHP Work Group on Translation, May 2009. Adapted from Wilson K & Fridinger F. Focusing on Public Health: A Different Look
at Translating Research to Practice. Journal of Women’s Health; 2008;17(2):173-179.
Interactive Systems Framework
Wandersman, A., Duffy, J., Flaspohler, P., Noonan, R., Lubell, K., Stillman, L., et al. (2008). Bridging the Gap Between Prevention Research and Practice:
The Interactive Systems Framework for Dissemination and Implementation. American Journal of Community Psychology, 41(3), 171-181.
Mini-grants Program
to Disseminate EBPs
 A “push-pull method” (i.e. funds + TA) increases
demand while building capacity*
 2 cohorts: 2007 & 2008 (12-18 month period)
 12 SW GA community organizations awarded
 Received up to $4000 &
technical assistance (TA)
 Implemented 5 RTIPs programs
(nutrition or PA)
*Orleans, C., Gruman, J., & Anderson, N. (2002). Designing for Dissemination: The Larger Challenge of Translation: An
Extraordinary Opportunity for Cancer Control. Designing for Dissemination Collaborative Meeting, Washington, D.C.
12 Awarded Sites
& 5 Programs
Funded Organizations
Evidence-Based Program
4 Churches
Body and Soul
4 Worksites
Treatwell 5-A-Day
2 Community Coalitions Parents as Teachers (PAT)
High 5 Low Fat Program
Senior Center
Little By Little Nutrition
Program
Hospital Diabetes
Management Center
Patient-Centered
Assessment & Counseling
for Exercise (PACE)
Engaging Community Expertise
Emory PRC Community Advisory Board (CAB) roles:
 Prioritized behavioral risk factors:
 nutrition, physical activity, tobacco prevention/cessation
 Helped to develop mini-grants and TA process
 Facilitated promotion of program to community
 Joint EPRC/CAB review committee
selected grantees
 Currently co-authoring presentations
and publications
Program Core Elements
Core elements for each program were
identified based on:
 underlying theory & process evaluation
findings
 published articles describing the program
 available program materials
 program description on NCI’s Research
Tested Intervention Programs (RTIPs)
website
Construct
Reach
Evaluation Question(s)
What proportion of the intended audience
participated in each activity?
Data Collection Methods
 Project Report Forms*
 Demographics form

Implementation

Fidelity: To what extent were core
elements of the program implemented as
described in program materials?



Project Report Forms*
Monthly calls
Interviews (coordinators)*

Adaptation: How and why did sites adapt
core elements of the intervention?




Project Report Forms*
Monthly calls
Interviews (coordinators)*
Committee focus group
Context

What contextual factors may have affected 
intervention adoption and implementation? 



Interviews (coordinators)*
Committee focus group
Monthly calls
Mini-grant applications*
Census data
Maintenance



Interviews (coordinators)*
Committee focus group
Resources

What plans has the site made to continue
promoting health after the end of the
project?
What resources did EPRC provide to
support this project?


EPRC financial records*
TA log

To what extent did grantees perceive that 
EPRC technical assistance helped them to
implement the programs with fidelity?
* Collected in both cohorts (Other tools in 1st cohort only)
Interviews (coordinators)*
Project Report Form
Documented progress on core elements
Treatwell - Core Element
Documentation Examples
Employee Advisory Board
Meeting topic, date, # participants
EatWell Discussion Series
Session topic, date, # participants
Exposure to “5-A-Day”
campaign
Promotion of national
hotlines
Activity, date, # participants
Environmental Change
Please describe environmental and/or policy
changes made at your site
Family/home component
Newsletter topic, Date mailed, # mailed
Annual family event
Description, Date, # participants
Please describe how you have promoted the
national hotlines (or More Matters website)
Interview/Focus Group Guides
Section Topic
Example Questions
Staff/Volunteers
•What motivated you personally to be involved in this program?
•How would you describe the level of support of your site’s
leadership ?
Implementation
•What factors within your organization helped to implement the
program?
•What barriers did you face in implementing the program?
Participants
•In general, how did people respond to the program?
Adaptation
•Did you change anything in the original program or its
program materials to better reach participants?
Technical
Assistance
Maintenance
• If you feel you needed technical assistance, what kind of help
was needed?
• Do you think your organization will continue similar program
activities after the program is over?
Fidelity Findings
 95% of core elements conducted across all sites
 9 of 12 (75%) sites conducted all core elements
 3 (of 7) sites in 1st cohort did not conduct all
core elements
 All 5 sites in 2nd cohort conducted all core
elements
Participation and Reach of Core Elements
Implemented by 2007 Mini-Grant Recipients
Core Element of Body & Soul
Project Committee
Kick-off event
Church-wide nutrition event with Pastor
Other church-wide event #1
Other church-wide event #2
Other church-wide event #3
At least one motivational interviewing call
Core Elements of Treatwell
Employee Advisory Board
EatWell Discussion Series
At least one other activity to change individual
behavior
Family/home component of learning
Annual family/holiday event
Reach within Churches
A
B
C
Low
Low
Low
High
High
High
High
Med
High
Low
Low
Low
Med
Low
Low
Low
Med
N/A
Low
Low
Low
Reach within Worksites
E
F
G
Low
Low
Low
Low
High
Low
Low
Low
--
Low
Low
Reach = proportion of the site population that participated in a given event:
Categories: Low (<1/3), Medium (1/3 to 2/3), High (>2/3).
N/A
N/A
Low
High
D
Low
High
Med
Med
Med
N/A
Low
Contextual Factors
(related to implementation)
BARRIERS
 Schedule/time conflicts*
 Difficulty with recruitment or
retention*
 Lack of resources/funds*
 Difficulty with changing
behavior
 Staff/leadership transitions
 Slow economy/worksite
financial difficulties
FACILITATORS








Leadership support*
Staff/volunteers*
Print materials/resources*
In-kind resources/facilities*
Partnerships*
Donated Resources*
Fit with mission
Fit with
Infrastructure/Activities
* Mentioned in both cohorts
Blue text = barrier that prevented completion of core element(s) - 1st cohort
Fidelity-Adaptation Continuum
 Shifted primary audience
 Held concurrent physical activity
& weight loss events
 Changed delivery format/process
steps
 Expanded audience (to community)
MINOR
ADAPTATION
NEEDS EVALUATION
HIGH
ADAPTATION EXAMPLES
FIDELITY  Added/customized materials
 Added activities
 Shifted focus to other behaviors
LOW
 Did not complete all core elements
FIDELITY
MAJOR
ADAPTATION
Reasons for Adaptations
 Expand program reach (broader community)
 Generate/maintain engagement
 Strengthen/reinforce program message
 Fit program to organization’s infrastructure/activities
 Reach specific audiences (esp. underserved)
Added content to reach specific audiences (teen parents)
“You got to think about being also sensitive to the age
of the parent. If you have [a parent] that’s maybe
14…give them something that can be kinda fun…”
- Site coordinator
Limitations
 Small number of sites (n=12) in rural SW GA
 Limited measurement of fidelity & implementation quality
 Time span 12-18 months – more time needed to learn
about maintenance
 Self report/social desirability
 Data reflects information from only 5 intervention
programs
 Data may not be generalizable to other settings,
populations, regions and programs
2010-12 Mini-grants Cohort
 Mini-grants period will span 2 years
 4 sites funded at $8000 each
 Structured and proactive TA and training
 RTIPs programs:
 CATCH: Coordinated Approach to Child Health
 Family Matters
 Body & Soul
 Process evaluation focused on TA and training
Map of the Adaptation Process
Developed a structured TA model derived from the
Map of the Adaptation Process (Mckleroy et al., 2006)
Focus on objectives of each key step:
Feedback Loops, Checkpoints
Prepare

Decide to adopt, adapt, or
select another intervention
Make necessary changes to
EBI



Prepare agency
Pre-test materials


Implementation plan
Successful pilot of adapted
intervention
Pilot
Implement 
Implement adapted EBI
Formative, Process, and Outcome Evaluation
Process Monitoring and Outcome Monitoring
Select
Target population
Interventions
Goodness of fit
Stakeholders
Organizational capacity
Supervision and Quality Assuraance
Assess





(Adapted from McKleroy et al., 2006)
EBI Training Topics (pre-award)
Session Title
What Do We Mean By Evidence-Based?
Needs Assessment and Program Planning
Finding an Evidence-Based Program
Selecting a Program That Fits Your Community
Adapting the Evidence-Based Program with Fidelity
Implementing an Evidence-Based Program
Evaluating Your Program
TEACH model: Translating Evidence into
Action through Collaboratives for Health
TA Contact
Structured TA Topics
(examples)
Stage in Map of
Adaptation Process
Pre-award Training
See training slide
Assess, Select,
Prepare
Kick-Off Training for
awarded sites
EBIs, Needs assessment,
Organizational readiness,
Core elements
Assess, Select,
Prepare
Site Visit
Fit, Adaptation, Evaluation
planning
Assess, Select,
Prepare, Pilot
Conference Call
Implementation Work Plan,
Partnerships
Assess, Select,
Prepare, Pilot
Ongoing Contact
Overcoming barriers,
implementation fidelity,
maintenance
Assess, Pilot,
Implement,
Maintenance
TEACH Evaluation Questions
Kept the original evaluation questions and added
capacity questions related to the impact of TEACH:
 Do attitudes toward EBAs become more positive
as a result of the TEACH process?
 Does self-efficacy for EBA behaviors increase as
a result of the TEACH process?
 Does organizational capacity for EBAs increase
as a result of the TEACH process?
Process Evaluation Plan
 Baseline survey (n=17) – 80 items
 Follow-up at 3, 6, and 24 months
 TA tracking Access database
 Project Report Forms
 Qualitative interviews w/ coordinators at
24 months
Survey topic areas
Example Measures – Survey Questions
Attitudes about EBPs Likert Scale: Strongly Disagree  Strongly Agree
(Hannon et al, 2009)
• EBPs lack real world experience.
• EBPs are easy to understand.
• EBPs are easy for us to adapt for use in our community.
Skills related to
Likert Scale: Very hard  Very Easy
EBPs
• Discuss the benefits of using evidence-based programs.
(Chinman et al., 2008) • Assess the fit of a potential program or strategy to your
organization or community.
• Determine what needs to be changed in an EBP to
increase fit to your community.
Organizational
functioning*
Likert Scale: Strongly Disagree  Strongly Agree
• We have appropriate staff skills to achieve our mission.
• The leadership of the organization fosters respect, trust,
inclusiveness, and openness in the organization.
• Staff are encouraged to take the lead in initiating change
or in trying to do something different.
*Levinger and Bloom, 2000; Weiss et al., 2002; Preskill and Tores, 1998; Caplan, 1971;
Kenny and Sofaer, 2000; Schminke et al, 2002)
Next Steps
 2 manuscripts in progress:
 Process evaluation of a mini-grants program to
disseminate evidence-based nutrition programs to
rural churches and work sites
 Balancing fidelity and adaptation: Case Studies in
implementing evidence-based chronic disease
prevention programs
 Conduct process evaluation of current mini-grants
program (TA, training, fidelity, adaptations)
 Dissemination research grant proposals
Acknowledgements
 Sally Honeycutt
 Cam Escoffery
 Kirsten Rodgers
 Karen Glanz
 Johanna Hinman
 Jenifer Brents







JK Veluswamy
Margaret Clawson
Megan Brock
Nidia Banuelos
Alma Nakasone
Amanda Wyatt
Ana Iturbides
Emory
Prevention
Research
Center
The CPCRN is part of the Prevention Research Centers Program. It is supported by the Centers for Disease
Control and Prevention and the National Cancer Institute (Cooperative agreement # 1U48DP0010909-01-1)
QUESTIONS?