Designing Implementation Strategies for Lay-Delivered Depression Care: Senior Center Organizational Perspectives From...

"Do More, Feel Better" (DMFB) is a Behavioral Activation intervention designed for lay providers to address depression in older adults attending senior centers. This study explored senior center partners' perspectives on implementing DMFB outside research settings, focusing on adaptations to proposed implementation strategies, implementation determinants, and preimplementation outcomes, including feasibility, acceptability, and appropriateness.

Using a convergent mixed-methods design, we conducted semi-structured interviews and surveyed 12 senior centers partners from Washington, Florida, and New York as part of a collaborative randomized controlled trial. Stratified, purposive sampling was used to select for administrators and frontline staff. We used the implementation science frameworks FRAME-IS, CFIR, and IOF, respectively, to identify recommended adaptations to strategies, determinants, and preimplementation outcomes. Rapid qualitative analysis, descriptive analyses, and joint display cross-comparing qualitative themes with quantitative data were used.

Partners supported train-the-trainer strategy and educational materials but recommended adding content on supervision and confidentiality; offering expert consultation and support for the lead trainer beyond technical assistance; and broadening client inclusion criteria. New strategies that emerged from the data included interactive training, volunteer incentives, and local DMFB networks. Barriers included limited funding for a lead trainer, finding the right candidate, a volunteer workforce, and mental health stigma. Facilitators included program credibility, alignment with center missions, meeting community and organizational needs, and contextual fit. Quantitative ratings confirmed high feasibility, acceptability, and appropriateness.

DMFB is promising for real-world implementation using a train-the-trainer model if supported by adequate training, access to expert consultation and support, and funding.