Document Type


Publication Date


Publication Title

Implementation Research and Practice






BACKGROUND: Understanding the barriers and facilitators of implementation completion is critical to determining why some implementation efforts fail and some succeed. Such studies provide the foundation for developing further strategies to support implementation completion when scaling up evidence-based practices (EBPs) such as Motivational Interviewing.

METHOD: This mixed-methods study utilized the Exploration, Preparation, Implementation, and Sustainment framework in an iterative analytic design to compare adolescent HIV clinics that demonstrated either high or low implementation completion in the context of a hybrid Type III trial of tailored motivational interviewing. Ten clinics were assigned to one of three completion categories (high, medium, and low) based on percentage of staff who adhered to three components of implementation strategies. Comparative analysis of staff qualitative interviews compared and contrasted the three high-completion clinics with the three low-completion clinics.

RESULTS: Results suggested several factors that distinguished high-completion clinics compared to low-completion clinics including optimism, problem-solving barriers, leadership, and staff stress and turnover.

CONCLUSIONS: Implementation strategies targeting these factors can be added to EBP implementation packages to improve implementation success.

PLAIN LANGUAGE SUMMARY: While studies have begun to address adherence to intervention techniques, this is one of the first studies to address organizational adherence to implementation strategies. Youth HIV providers from different disciplines completed interviews about critical factors in both the inner and outer context that can support or hinder an organization's adherence to implementation strategies. Compared to less adherent clinics, more adherent clinics reported more optimism, problem-solving, and leadership strengths and less staff stress and turnover. Implementation strategies addressing these factors could be added to implementation packages to improve implementation success.


The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN 146, 153) as part of the Scale It Up Program (U19HD089875; PI: Naar). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Henna Budhwani was supported by the National Institute of Mental Health (NIMH) on award K01MH116737. Gregory A. Aarons was supported by the US National Institute on Drug Abuse on grant R01DA049891. Additionally, Dr. Aarons serves on the editorial board for Implementation Research and Practice (all decisions on this paper are to be made by another editor).

Creative Commons License

Creative Commons Attribution-NonCommercial 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License



Peer Reviewed