1. Optimizing Your DEBIs: Ways
to Enhance the Success of
Evidence-Based Interventions
Marlene Glassman, Ph.D.
Prevention Research Branch
Centers for Disease Control and Prevention
National HIV Prevention Conference
August 15, 2011

2. The findings and conclusions in
this presentation are those of
the author and do not
necessarily represent the views
of the CDC

3. “If you don't know where you are going,
any road will get you there.”
Lewis Carroll
Alice's Adventures in Wonderland

4. Optimization Requires an Inquiring
Mind
• Where Do You Want To Go With Your
DEBI?
• What Do You Want To Accomplish?
• What Else Do You Want To Know?
• How Will You Know It?

5. Why All the Questions?
Accountability
• Board of Directors
• Funders (CDC, Congress)
• National HIV/AIDS Strategy
• Local elected officials
• Fiscal responsibility/taxpayers’
money/competition for scarce resources
• CLIENTS

6. Key Questions
• Resources
• Client recruitment
• Characteristics of clients (did we reach target
population?)
• Extent of client participation
• How intervention was delivered
IMPLEMENTATION
• Client outcomes

7. IMPLEMENTATION
“Over the past decade, the science related to
developing and identifying ‘evidence-based
practices and programs’ has improved –
however, the science related to implementing
these programs with fidelity and good outcomes
for consumers lags far behind.”
Dean L. Fixsen
The National Implementation Research
Network
2005

8. How Can We Assess
Implementation?
• Operational research
• Implementation research
• Process monitoring
• Process evaluation

9. Operational Research
The study of factors that affect the implementation
of HIV prevention programs and the subsequent
identification and assessment of
recommendations to strengthen programs in
order to reduce HIV/AIDS incidence, morbidity,
and mortality

10. Operational Research Questions
Overriding Questions
• What factors affect the delivery of DEBIs by
community-based organizations (CBOs)?
• What factors are associated with intervention
success?
• How can implementation be improved so that
more clients achieve the intended outcomes of
the intervention?

11. Operational Research Questions
More Specific Questions
• Do CBOs select appropriate DEBIs to meet the
needs of their target populations?
• Do CBOs adapt DEBIs in accordance with CDC
guidelines?

12. Implementation Research
Questions
• Have DEBI facilitators received required training on the
intervention?
• Do CBOs implement DEBIs in accordance with the
protocol and core elements of the intervention?
• How do CBOs assess whether DEBIs are implemented
according to the protocol and core elements of the
intervention (quality assurance)?
• Do CBOs have/implement client recruitment and
retention plans?
• Do CBOs have/implement monitoring and evaluation
plans?

13. Process Monitoring Questions
• How many clients did we recruit?
• What are their characteristics (e.g., age,
race, gender) and risk factors?
• How many clients completed all sessions?
Less than half of the sessions? Only one
session?

14. Process Evaluation Questions
• Did recruitment take place according to
client recruitment and retention
plan/SMART objectives?
• Did retention take place according to
client recruitment and retention
plan/SMART objectives?
• Are expenditures in line with projections
and budget?

15. Outcome Monitoring Questions
Outcomes depend on implementation: that’s
what all the fuss is about!*
• Did clients achieve the immediate and behavior
change outcomes identified in the DEBI’s
monitoring and evaluation plan (e.g., immediate:
increased knowledge and self-efficacy; behavior
change: increase in correct condom use)?
• Were outcomes measured with appropriate
instruments?
*assumption that efficacy = effectiveness

16. What You Need to Answer
Questions
• DEBI budget
• Behavior change logic model
• Protocol/curriculum with core elements
• Client recruitment and retention plan
• Monitoring and evaluation plan with SMART
objectives and instruments to measure change
• Quality assurance plan (fidelity checklist to
assess fidelity to core elements)

17. An Inquiring Mind
• Whether you perform operational research,
implementation research, process monitoring, or
process evaluation, maintain an inquiring mind
and carry out activities to answer key
implementation questions.
• Remember: without proper implementation you
reduce the potential for clients to achieve
optimal outcomes.

18. Summary Checklist
Trained facilitators and other staff; e.g., outreach
workers (client eligibility), supervisors (quality assurance)
Implementation according to intervention protocol and
core elements
SMART process and outcome objectives
– Recruitment of target population
– Retention of target population
– Changes in clients
Financial oversight

19. Knowing Where You’ve Been Can
Help You Change Direction
(when needed)

20. “I haven't failed. I've just found
10,000 ways that won't work.”
Thomas Edison

21. For more information
Marlene Glassman
mug7@cdc.gov
404-639-1998