Adimu, Tanisa Foxworth

Martinez, Amanda Phillips

Minyard, Karen

Smith, Tina Anderson

English

ScholarWorks @ Georgia State University

Georgia State University ScholarWorks @ Georgia State University GHPC Materials Georgia Health Policy Center 8-28-2018 Adapting Evidence-based Interventions in Rural Settings: An Analysis of 70 Community Examples Tanisa Foxworth Adimu Tina Anderson Smith Amanda Phillips Martinez Karen Minyard Follow this and additional works at: https://scholarworks.gsu.edu/ghpc_materials Recommended Citation Adimu, Tanisa Foxworth; Smith, Tina Anderson; Martinez, Amanda Phillips; and Minyard, Karen, "Adapting Evidence-based Interventions in Rural Settings: An Analysis of 70 Community Examples" (2018). GHPC Materials. 60. https://scholarworks.gsu.edu/ghpc_materials/60 This Article is brought to you for free and open access by the Georgia Health Policy Center at ScholarWorks @ Georgia State University. It has been accepted for inclusion in GHPC Materials by an authorized administrator of ScholarWorks @ Georgia State University. For more information, please contact scholarworks@gsu.edu. ANDREW  YOUNG SCHOOLO F  P O L I C Y  S T U D I E SAdapting Evidence-based Interventions in Rural Settings: An Analysis of 70 Community ExamplesTanisa Foxworth Adimu, M.P.H.; Tina Anderson Smith, M.P.H.; Amanda Phillips Martinez, M.P.H.; Karen Minyard, Ph.D.For more information, please contact the Georgia Health Policy Center at 404.413.0314 or visit us online at www.ghpc.gsu.eduOn the left end of the spectrum are the textbook evidence-based practices—time-tested interventions built on cumulative, credible evidence of effectiveness in multiple settings.The midsection of the spectrum consists of two distinct types of promising practices as operationalized by the grantees: widely endorsed and recognized approaches and frameworks and secondly, emerging and expanding homegrown programs.  On the far right end of the spectrum are less well-documented reference programs that grantees said “inspired” their intervention designs.A vast majority of the cohort employed strategies that fall within the “promising practice” range, versus the much smaller subset that applied strictly-defined evidence based practices (far left).  Grantees attributed this disparity to the limited selection of evidence-based models that had demonstrated effectiveness in rural settings or that seemed feasible in their rural contexts.How Rural Communities Adapted Evidence-based and Promising Practices to Rural and Frontier SettingsBecause relatively few evidence-based models have been developed or thoroughly tested in rural contexts, the grantees faced cultural and practical realities translating otherwise reputable practices into frontier and rural community settings. The rural community context, the shortage of sufficient workforce capacity, and practitioner support are some factors that can influence the translation of evidenced-based into any community setting but often play out differently in rural communities. How these factors complicated implementation across grantee sites included:• Cultural	misalignment.  A lack of alignment betweenthe programmatic content and the target population• Practical	 limitations. Practical obstacles related tothe time and financial resources required to conductand participate in staff training and patient educationclasses (e.g., time to travel long distances, expenses incurred for travel)• Lack	of	practitioner	or	partner	buy-in.	Resistance from strategic partners and providers in implementing new clinical guidelines,approaches, standards• Insufficient	capacity.	Barriers to health care workforce development, recruitment, and retention surfaced as a persistentchallenge in rural communities• Unfavorable	policy	conditions.	Significant contextual challenges that were beyond grantee control (e.g., reimbursementpolicies)CONCLUSIONLevers for building a more robust rural evidence base include investments to incentivize evidence-based programming in rural settings; rural-specific research and theory-building; translation of existing evidence using a “rural lens”; technical assistance to support rural innovation; and prioritization of evaluation at the local level. By stipulating that funded communities implement a promising or evidence-based practice, FORHP provided an opportunity to explore what is involved in the translation of recognized approaches specifically in rural and frontier settings. Funded agencies and consortia chose a broad range of evidence-based and promising practices and modified them to fit the contexts and the needs of rural and frontier communities. In combination, these federal and local investments have begun to create the conditions for cultivating a new generation of rural-specific evidence-based practices.OBJECTIVEThis poster explores the barriers and solutions to adapting evidence-based practices to rural contexts. METHODSA descriptive, qualitative analysis was conducted using data from 70 grantees funded by the Federal Office of Rural Health Policy to implement evidence-based practices in rural settings.RESULTSGrantees selecting “evidence-based” practices reported adapting these models to match their rural reality, resulting in programs tailored to meet community-specific needs and interests.Range of Models ImplementedPROMISING PRACTICESEvidence-based ModelsWidely-Endorsed, Recognized Approaches and FrameworksEmerging and Expanding “Home-Grown” ProgramsInspiring Reference Programs and Examples

Adapting Evidence-based Interventions in Rural Settings: An Analysis of 70 Community Examples

Georgia State University

Georgia State University 
ScholarWorks @ Georgia State University 
GHPC Materials Georgia Health Policy Center 
8-28-2018 
Adapting Evidence-based Interventions in Rural Settings: An 
Analysis of 70 Community Examples 
Tanisa Foxworth Adimu 
Tina Anderson Smith 
Amanda Phillips Martinez 
Karen Minyard 
Follow this and additional works at: https://scholarworks.gsu.edu/ghpc_materials 
Recommended Citation 
Adimu, Tanisa Foxworth; Smith, Tina Anderson; Martinez, Amanda Phillips; and Minyard, Karen, "Adapting 
Evidence-based Interventions in Rural Settings: An Analysis of 70 Community Examples" (2018). GHPC 
Materials. 60. 
https://scholarworks.gsu.edu/ghpc_materials/60 
This Article is brought to you for free and open access by the Georgia Health Policy Center at ScholarWorks @ 
Georgia State University. It has been accepted for inclusion in GHPC Materials by an authorized administrator of 
ScholarWorks @ Georgia State University. For more information, please contact scholarworks@gsu.edu. 
ANDREW  YOUNG SCHOOL
O F  P O L I C Y  S T U D I E S
Adapting Evidence-based Interventions in Rural Settings: 
An Analysis of 70 Community Examples
Tanisa Foxworth Adimu, M.P.H.; Tina Anderson Smith, M.P.H.; Amanda Phillips Martinez, M.P.H.; Karen Minyard, Ph.D.
For more information, please contact the Georgia Health Policy Center 
at 404.413.0314 or visit us online at www.ghpc.gsu.edu
On the left end of the spectrum are the textbook evidence-based practices—time-tested interventions built on cumulative, 
credible evidence of effectiveness in multiple settings.
The midsection of the spectrum consists of two distinct types of promising practices as operationalized by the grantees: widely 
endorsed and recognized approaches and frameworks and secondly, emerging and expanding homegrown programs.  
On the far right end of the spectrum are less well-documented reference programs that grantees said “inspired” their intervention 
designs.
A vast majority of the cohort employed strategies that fall within the “promising practice” range, versus the much smaller subset 
that applied strictly-defined evidence based practices (far left).  Grantees attributed this disparity to the limited selection of 
evidence-based models that had demonstrated effectiveness in rural settings or that seemed feasible in their rural contexts.
How Rural Communities Adapted Evidence-based and Promising Practices to Rural and Frontier Settings
Because relatively few evidence-based models have been 
developed or thoroughly tested in rural contexts, the 
grantees faced cultural and practical realities translating 
otherwise reputable practices into frontier and rural 
community settings. The rural community context, the 
shortage of sufficient workforce capacity, and practitioner 
support are some factors that can influence the translation 
of evidenced-based into any community setting but often 
play out differently in rural communities. 
How these factors complicated implementation across 
grantee sites included:
• Cultural	misalignment.  A lack of alignment between
the programmatic content and the target population
• Practical	 limitations. Practical obstacles related to
the time and financial resources required to conduct
and participate in staff training and patient education
classes (e.g., time to travel long distances, expenses incurred for travel)
• Lack	of	practitioner	or	partner	buy-in.	Resistance from strategic partners and providers in implementing new clinical guidelines,
approaches, standards
• Insufficient	capacity.	Barriers to health care workforce development, recruitment, and retention surfaced as a persistent
challenge in rural communities
• Unfavorable	policy	conditions.	Significant contextual challenges that were beyond grantee control (e.g., reimbursement
policies)
CONCLUSION
Levers for building a more robust rural evidence base include investments to incentivize evidence-based programming in rural 
settings; rural-specific research and theory-building; translation of existing evidence using a “rural lens”; technical assistance 
to support rural innovation; and prioritization of evaluation at the local level. 
By stipulating that funded communities implement a promising or evidence-based practice, FORHP provided an opportunity to 
explore what is involved in the translation of recognized approaches specifically in rural and frontier settings. Funded agencies 
and consortia chose a broad range of evidence-based and promising practices and modified them to fit the contexts and the 
needs of rural and frontier communities. In combination, these federal and local investments have begun to create the conditions 
for cultivating a new generation of rural-specific evidence-based practices.
OBJECTIVE
This poster explores the barriers and solutions to adapting evidence-based practices to rural contexts. 
METHODS
A descriptive, qualitative analysis was conducted using data from 70 grantees funded by the Federal Office of Rural Health 
Policy to implement evidence-based practices in rural settings.
RESULTS
Grantees selecting “evidence-based” practices reported adapting these models to match their rural reality, resulting in 
programs tailored to meet community-specific needs and interests.
Range of Models Implemented
PROMISING PRACTICES
Evidence-based 
Models
Widely-Endorsed, 
Recognized Approaches 
and Frameworks
Emerging and Expanding 
“Home-Grown” Programs
Inspiring Reference 
Programs and Examples


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Adapting Evidence-based Interventions in Rural Settings: An Analysis of 70 Community Examples

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