title: The dynamics of de-adoption: a case study of policy change, de-adoption, and replacement of an evidence-based HIV intervention.
abstract: Evidence-based intervention (EBI) de-adoption and its influence on public health organizations are largely unexplored within public health implementation research. However, a recent shift in support for HIV prevention EBIs by the Centers for Disease Control and Prevention provides an opportunity to explore EBI de-adoption. The current mixed-method study examines EBI de-adoption and the subsequent impact on a community-based organization (CBO) dedicated to HIV prevention. We conducted a case study with a CBO implementing RESPECT, an HIV prevention EBI, over 5 years (2010-2014), but then de-adopted the intervention. We collected archival data documenting RESPECT implementation and conducted two semi-structured interviews with RESPECT staff (N = 5). Using Fixsen and colleagues' implementation framework, we developed a narrative of RESPECT implementation, delivery, and de-adoption and a thematic analysis to understand additional consequences of RESPECT de-adoption. Discontinuation of RESPECT activities unfolded in a process over time, requiring effort by RESPECT staff. RESPECT de-adoption had wide-reaching influences on individual staff, interactions between the staff and the community, the agency overall, and for implementation of future EBIs. We propose a revision of the implementation framework, incorporating EBI de-adoption as a phase of the implementation cycle. Furthermore, EBI de-adoption may have important, unintended consequences and can inform future HIV prevention strategies and guide research focusing on EBI de-adoption.
authors.affiliation: Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA. Virginia.McKay@wustl.edu.
authors.forename: Virginia R
authors.initials: VR
authors.lastname: McKay
authors.affiliation: School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA.
authors.forename: M
authors.initials: M
authors.lastname: Margaret Dolcini
authors.affiliation: Department of Anthropology, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Lee D
authors.initials: LD
authors.lastname: Hoffer
mesh_terms: D000293:Adolescent; D000328:Adult; D002487:Centers for Disease Control and Prevention, U.S.; D019317:Evidence-Based Medicine; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006284:Health Plan Implementation; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D016730:Program Development; D014481:United States; D055815:Young Adult
keywords: Complex adaptive system; De-adoption; De-implementation; Dissemination and implementation; Evidence-based intervention; HIV prevention