Applying a Race(ism)-Conscious Adaptation of the CFIR Framework to Understand Implementation of a School-Based Equity-Oriented Intervention
Michele Allen, April K. Wilhelm, Luis Enrique Ortega, Shannon Pergament, Nicole Bates, Brooke A. Cunningham
Abstract
Objectives: To use the Consolidated Framework for Implementation Research (CFIR) adapted to a race-conscious frame to understand ways that structural racism interacts with intervention implementation and uptake within an equity-oriented trial designed to enhance student-school connectedness. Design: Secondary analysis of qualitative implementation data from Project TRUST (Training for Resiliency in Urban Students and Teachers), a hybrid effectiveness-implementation, community-based participatory intervention. Setting: Ten schools across one urban school district. Methods: We analyzed qualitative observational field notes, youth and parent researcher reflections, and semi-structured interviews with community-academic researchers and school-based partners within CFIR constructs based on framing questions using a Public Health Critical Race Praxis approach. Results: Within most CFIR constructs and sub-constructs, we identified barriers to implementation uptake not previously recognized using standard race-neutral definitions. Themes that crossed constructs included: 1) Leaders' willingness to examine Black, Indigenous, People of Color (BIPOC) student and parent experiences of school discrimination and marginalization had a cascading influence on multiple factors related to implementation uptake; 2) The race/ethnicity of the principals was related to intervention engagement and intervention uptake, particularly at the extremes, but the relationship was complex; 3) External change agents from BIPOC communities facilitated intervention uptake in indirect but significant ways; 4) Highly networked implementation champions had the ability to enhance commitment to intervention uptake; however, perceptions of these individuals and the degree to which they were networked was highly racialized. Conclusions: Equity-oriented interventions should consider structural racism within the CFIR model to better understand intervention uptake.