Foundations for the long haul: A process to facilitate large scale implementation of a school-based healthy relationships program in the Dominican Republic

Background: Implementing evidence-based interventions (EBI) to prevent violence and strengthen socio-emotional capacities among adolescents is a priority for the future of every society, especially post-pandemic. Yet, integrating EBI in real-world settings is complex. Use of dissemination and implementation (D&I) approaches can increase efficiency/effectiveness of EBI translation in new contexts, reduce resource waste, sustainably improve health care, and enhance population health. Yet, rigorous application in low- and middle-income countries (LMICs) lags and guidance on how to do so is limited. We describe 4 main components of our process that built foundations for a research program that will evaluate large-scale implementation of a school-based EBI in the Dominican Republic (DR) aimed at promoting healthy relationships.   

Process: Early Planning: From project initiation, apply team science: (a) develop shared vision/mission and research priorities aligned with local community/government and leading international funding agencies; (b) co-create strategic research plans for successive projects to achieve vision/mission; (c) evaluate and refine vision/plan based on evolving evidence and context of health/funding. Grounding in D&I Sciences: Apply D&I frameworks and methods to evaluate: (a) sustainability/equity of effectiveness and D&I outcomes; (b) barriers/facilitators of D&I; (c) contextually appropriate D&I strategies; (e) cost of EBI D&I. Intensive Stakeholder Engagement: Reflect cultural humility and best practices in global health research through: (a) US principal investigator based in country for deep, proximate, long-term engagement with local stakeholders and research team; (b) continuous expansion of multisectoral stakeholder network: government policy/decision-makers, community leaders/influencers, service providers, affected individuals. Strategic International Partnerships: Build/sustain an international transdisciplinary team and institutional partnerships as key resources to: (a) advance strategic research: access to target population, established local research structure/resources, ethics consultation/oversight, community/multinational collaborators, internal research funds, institutional environment/resources for competitive funding applications, pre- and post-grant management, support for D&I pragmatic trials; (b) translate findings into practice/policy: knowledge of system/structures for large scale D&I of EBI, access/power to change policy, influence international/local buy-in of vision.  

Conclusions and next steps: This process provided a foundation for DR-specific implementation of a school-based EBI. It facilitated establishment of partnerships, structures, and processes needed for large-scale testing of the strategy and sustainable translation into practice/policy.