Exploring the decision-making process of prevention providers in adopting or rejecting a community-level approach to substance abuse prevention.

摘要

Interventions for the prevention of alcohol, tobacco and other drug use (ATOD) have become more sophisticated (Biglan, Mrazek, Carnine, & Flay, 2003; Botvin & Griffin, 2005), partly because the demand for accountability from federal and private funding has increased (Gorman, 2002a, 2002b). Community-level interventions1,2 are multi-component interventions that combine individual and environmental change strategies across multiple settings to prevent dysfunction and promote well-being among population groups in a defined local community (Wandersman and Florin, 2003). A community-level intervention delivered by a community coalition is a model being advocated in the academic literature (Warner, 2000) and increasingly promulgated by federal funding agencies. There is, however, little or no literature on the decision-making process of the community-based organizations and coalitions who must choose whether to adopt or reject this model.;Fourteen participants from seven organizations funded through the community-level intervention funding pool and seven organizations funded through an alternative funding pool to implement evidence-based curricula completed a mixed-method, semi-structured interview. The questionnaire was designed to capture information regarding the decision-making process of the organization.;Findings from the analyses support the application of Rogers' organization innovation-decision process model in combination with specific characteristics from the individual model for understanding community-based organization and coalition funding decisions. The most relevant and influential stages and overarching characteristics from the models were the Matching stage, Characteristics of the Decision-maker, Characteristics of the Innovation, and Communication Behavior. An analysis of organizations serving culturally diverse organizations did not reveal any differences in coded themes, however, the low number of such organizations in this sample may have been a factor.;1Terms such as "community-based", "comprehensive community", "community coalition", and "collaborative partnerships" have also been used to refer to interventions with similar characteristics. 2Local community is often geographically defined (e.g., neighborhood or municipality) but may be a community of presumed common interest (e.g., the gay community). 3This is to be contrasted with an expectation that Roger's stages would be followed in sequence. Rogers himself (1995) states that stages may NOT follow the specific order outlined in his model. For example, in the individual process the stage order might be knowledge-decision-persuasion.;This study sought to answer three main questions: (1) to determine how many characteristics3 in the individual and organizational stages of Rogers' innovation-decision process (1995) were used by the community-based organizations and coalitions in their decision making process; (2) to determine which characteristics were most influential in the decision to adopt or reject the community-level intervention; and (3) to determine whether the characteristics that influence a decision to adopt differ for organizations representing culturally diverse communities.