Open AccessApplying a Race(ism)-Conscious Adaptation of the CFIR Framework to Understand Implementation of a School-Based Equity-Oriented Intervention
Author(s) -
Michele Allen,
April K. Wilhelm,
Luis Ortega,
Shan Pergament,
Nicole Bates,
Brooke A. Cunningham
Publication year - 2021
Publication title -
ethnicity and disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.767
H-Index - 67
eISSN - 1945-0826
pISSN - 1049-510X
DOI - 10.18865/ed.31.s1.375
Subject(s) - implementation research , psychological intervention , qualitative research , health equity , psychology , participatory action research , ethnic group , framing (construction) , equity (law) , intervention (counseling) , medical education , applied psychology , medicine , public health , sociology , nursing , political science , social science , anthropology , law , structural engineering , engineering
Objectives: To use the Consolidated Framework for Implementation Research (CFIR) adapted to a race-conscious frame to understand ways that structural racism interacts with intervention implementation and uptake within an equity-oriented trial designed to enhance student-school connectedness.Design: Secondary analysis of qualitative implementation data from Project TRUST (Training for Resiliency in Urban Students and Teachers), a hybrid effectiveness-implementation, community-based participatory intervention.Setting: Ten schools across one urban school district.Methods: We analyzed qualitative observational field notes, youth and parent researcher reflections, and semi-structured interviews with community-academic researchers and school-based partners within CFIR constructs based on framing questions using a Public Health Critical Race Praxis approach.Results: Within most CFIR constructs and sub-constructs, we identified barriers to implementation uptake not previously recognized using standard race-neutral definitions. Themes that crossed constructs included: 1) Leaders’ willingness to examine Black, Indigenous, People of Color (BIPOC) student and parent experiences of school discrimination and marginalization had a cascading influence on multiple factors related to implementation uptake; 2) The race/ethnicity of the principals was related to intervention engagement and intervention uptake, particularly at the extremes, but the relationship was complex; 3) External change agents from BIPOC communities facilitated intervention uptake in indirect but significant ways; 4) Highly networked implementation champions had the ability to enhance commitment to intervention uptake; however, perceptions of these individuals and the degree to which they were networked was highly racialized.Conclusions: Equity-oriented interventions should consider structural racism within the CFIR model to better understand intervention uptake.Ethn Dis. 2021;31(Suppl 1):375-388; doi:10.18865/ed.31.S1.375