- Translation of efficacious programs into real-world settings is an important step in ensuring improved public health outcomes. Yet, the process of translating evidence-based interventions (EBIs) according to fidelity is fraught with challenges. Organizational factors, specifically organizational communication, have been shown to influence translation processes.
To date, there is limited research on communication processes within public health organizations implementing prevention programs.
To address this gap, this study aimed to understand the association between participatory internal communication (PIC) and program fidelity. This study examined the influence of patterns of PIC within the problem-solving context on program fidelity in Departments of Public Health (DPHs) and Community-Based Organizations (CBOs) implementing an evidence-based HIV program (i.e., RESPECT). To provide insight into the relationship between the patterns of PIC and program fidelity, this study examined the influence of key psychological variables such as perceived usefulness of EBIs and employee morale. To this end, this study investigated the relationship between the patterns of PIC, employees’ perceived usefulness of RESPECT, and employee morale. Lastly, this study examined the influence of employees’ perceived usefulness of EBI and employee morale on the relationship between the patterns of PIC and program fidelity. This dissertation study was guided by a conceptual model developed based on existing literature.
Semi-structured in-person and telephone interviews were conducted with executive directors, supervisors, and program delivery staff from a national survey of CBOs and DPHs implementing RESPECT (n= 26). 114 organizational personnel were interviewed to identify the degree of PIC, employee morale, and perceived usefulness. The interview data were manually coded to categorize patterns of PIC, employee morale, and perceived usefulness. A qualitative methodological approach including descriptive, magnitude, and causation coding techniques was used to analyze the data.
Three general patterns of PIC were reported and identified across the agencies: (1) full-PIC, (2) partial-PIC, and (3) non-PIC. The findings of this study observed a consistent pattern between the various levels of PIC and program fidelity. However, some inconsistent cases (39%) and an outlier were also observed. Of note, the data on employees’ perceived usefulness and morale showed a significant number of cases (73%) that did not fit in the hypothesized model pathway.
The findings of this qualitative study show an association between the patterns of PIC and program fidelity. A critical mass effect was observed in partial-PIC agencies with high fidelity, in that fifty percent or more of the program delivery staff in these agencies were involved in problem-solving communication. This finding suggests that achieving a critical mass of program delivery staff within partial-PIC agencies may be sufficient to facilitate the delivery of EBI programs with fidelity. However, program modification may independently influence program fidelity even when full PIC exists within the organization or a critical mass effect has been attained in partial-PIC agencies.
In conclusion, public health administrators need to take into account the effect of critical mass on the patterns of PIC in order to facilitate positive program outcomes in translating EBIs into practice. To promote the delivery of EBIs with fidelity, public health practitioners could use information from this study to inform strategies and protocols for improving internal communication practices within their organizations.