Session: Capturing Complexity in Community-Based Prevention Efforts: Applications of Qualitative Comparative Analysis to Advance Implementation Science (Society for Prevention Research 27th Annual Meeting)

Prevention Science embraces the use of advanced parametric analyses in the investigation of implementation best practices. Though frequently appropriate, they often do not answer key implementation science questions like: 1) Which conditions are necessary or sufficient for a program to succeed? and 2) What are the multiple pathways to implementation success? In translational contexts, these questions are of primary concern. This symposium highlights the use of Qualitative Comparative Analysis (QCA), a mixed-method approach based in Boolean algebra, to answer key implementation questions in three studies of complex community prevention efforts.

First, “The application of Qualitative Comparative Analysis in implementation research: When and how to use it” provides an overview of the process by which QCA examines the configurations of conditions necessary and sufficient to produce outcomes in natural implementation settings. This review of the QCA method will be couched within two implementation studies: one identifying pathways associated with sustainment of evidence-based programs across diverse SAMHSA-funded programs and another identifying pathways to fidelity of cognitive therapies across mental health programs in an inner-city context.

Second, “Necessary and sufficient coalition functioning conditions for model fidelity across developmental stages: A qualitative comparative analysis” discusses application of QCA to examine the relationship between coalition functioning and model fidelity. Analyses will be conducted at three levels of coalition development. This degree of sub-group scrutiny will allow for more specific inferences about the technical assistance needed to ensure achievement of model fidelity, a significant predictor of positive outcomes, by coalitions at various developmental stages. Preliminary analyses demonstrate significant differences across stages in the aspects of coalition functioning that are necessary and sufficient to achieve model fidelity.

Third, “Health equity prioritization among community coalitions: A QCA analysis” reviews use of QCA in the investigation of systemic factors affecting implementation of a key component of a national health improvement campaign’s theory of change: health equity. Findings underscore the significance of macro-political context for achievements in health equity by highlighting differences between sites’ Medicaid expansion. Results suggest that community-level implementation efforts may be a lower priority in states which expanded Medicaid, as policies may already address the health of under-resourced citizens.

Finally, the discussant, a national expert in implementation science, will conclude with a summary overview and will moderate discussion between presenters and symposium attendees.