title: Barriers and Facilitators to Health Center Implementation of Evidence-Based Clinical Practices in Adolescent Reproductive Health Services.
abstract: OBJECTIVE
  Despite the substantial evidence supporting the guidelines for the provision of reproductive health services for adolescents, research points to a persistent gap in their translation into health care practice. This study examines barriers and facilitators that health centers experience when implementing evidence-based clinical practices for adolescent reproductive health services and discusses strategies to address identified barriers.
  
  
  METHODS
  Semistructured interviews were conducted with 85 leaders and staff of 30 health centers in Alabama, Georgia, Massachusetts, North Carolina, South Carolina, Pennsylvania, and Texas. Interview data were analyzed for emergent themes following a grounded theory approach.
  
  
  RESULTS
  Data analysis revealed that certain factors at health system and community levels influenced health centers' efforts to implement evidence-based clinical practices for adolescent reproductive health care. In particular, support from health center leadership, communication between leadership and staff, and staff attitudes and beliefs were reported as factors that facilitated the implementation of new practices.
  
  
  CONCLUSIONS
  Health center efforts to implement new practice guidelines should include efforts to build the capacity of health center leadership to mobilize staff and resources to ensure that new practices are implemented consistently and with quality.
authors.affiliation: CAI, New York, New York. Electronic address: rhallum.montes@gmail.com.
authors.forename: Rachel
authors.initials: R
authors.lastname: Hallum-Montes
authors.affiliation: CAI, New York, New York.
authors.forename: Dawn
authors.initials: D
authors.lastname: Middleton
authors.affiliation: CAI, New York, New York.
authors.forename: Karen
authors.initials: K
authors.lastname: Schlanger
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Romero
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D001291:Attitude of Health Personnel; D055317:Evidence-Based Practice; D005260:Female; D066296:Grounded Theory; D006284:Health Plan Implementation / Q000379:methods*; D006801:Humans; D007857:Leadership; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control; D034121:Reproductive Health Services; D014481:United States
keywords: Contraception; Implementation science; Long-acting reversible contraception; Reproductive health; Teen pregnancy