Applying an Equity Lens in a Randomized Control Trial to Assess the Effects of an Intervention to Enhance Culturally Diverse, Low-Income Couples’ Partner Relationships and Economic Stability: The Together Project

Reports of 20+-year lags for translating research into practice have stimulated interest in accelerating effective implementation of research-based interventions into practice settings. Research has often not included sufficient sub-samples of diverse cultural, racial/ethnic or economic backgrounds to understand the challenges in implementing and scaling prevention programs. Monitoring data collection and assessing implementation fidelity for continuous quality improvement (CQI) are strategies to move evidence-based findings more quickly into real-world settings. Our local evaluation team utilizes traditional CQI approaches with contemporary frameworks in prevention science to address data collection challenges in tracking 720 low-income couples of diverse racial/ethnic backgrounds over eight months each in the randomized control trial (RCT) for the TOGETHER Project (a couples’ relationship and financial education intervention with supportive services). Couples’ demographics posed challenges for recruitment, participation and retention that were addressed through strategies related to social determinants of participation (e.g., transportation and child care; recruiting staff and community partners experienced with the participant populations; and infusing trainings with cultural competency best practices). CQI strategies to which we applied an equity lens to monitor fidelity implementation and data collection included: asking community partners to anticipate adverse consequences of supposed “best practices” based on race/ethnicity or social economic status of participants; conducting sample equivalency analyses for selected equity demographics; and monitoring implementation fidelity for cultural adaptations made to the intervention workshop. Findings are from July 1, 2016 (start of recruitment) through September 29, 2017 (end of year 2 implementation). Data collection included: automated randomization, electronic participant tracking systems, automated electronic implementation fidelity system for the intervention workshop, evidence-based practices to develop the case management fidelity system, automated electronic Survey Completion Monitoring Reports, and automated electronic Response Rate Reports. We captured data from 278 individuals/139 couples: 140 CG/70 couples (50.4%); 138 IG/69 couples (49%). Use of tools such as the Completion Monitoring Reports allowed staff to check in with facilitators real-time as to whether there were inequities in implementation and make needed adjustments. Recommendations are made regarding CQI strategies to work with the project’s leadership team, project frontline staff, and community partners to identify ways to improve enrollment, participation, and response rates across diverse populations.