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Designing Implementation Strategies for Lay-Delivered Depression Care: Senior Center Organizational Perspectives From
Margaret Z Wang1, Lesley Steinman1, Jo Anne Sirey1
1Department of Psychiatry and Behavioral Sciences (MZW, BEB, AD, PJR), University of Washington, Seattle, WA; Health Promotion Research Center (LS), University of Washington School of Public Health, Seattle, WA; Department of Psychiatry (JAS, IR), Weill-Cornell Medical College, New York, NY; and the Department of Mental Health Law and Policy (NC), University of South Florida, Tampa, FL. Send correspondence and reprint requests to Margaret Z. Wang, M.D., Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
Summary
The "Do More, Feel Better" (DMFB) intervention shows promise for older adults via a train-the-trainer model. Successful implementation requires adequate training, expert support, and funding for this behavioral activation program.
Area of Science:
- Gerontology
- Mental Health Interventions
- Implementation Science
Background:
- The "Do More, Feel Better" (DMFB) is a Behavioral Activation intervention tailored for lay providers to address depression in older adults within senior centers.
- This study investigates senior center partners' perspectives on implementing DMFB outside of research settings.
Purpose of the Study:
- To explore adaptations to proposed implementation strategies for DMFB.
- To identify implementation determinants influencing DMFB adoption.
- To assess preimplementation outcomes, including feasibility, acceptability, and appropriateness of DMFB.
Main Methods:
- A convergent mixed-methods design was employed, utilizing semi-structured interviews and surveys with 12 senior center partners across three states.
- Stratified, purposive sampling targeted administrators and frontline staff.
- Implementation science frameworks (FRAME-IS, CFIR, IOF) guided the analysis of strategies, determinants, and outcomes, employing rapid qualitative analysis and descriptive statistics.
Main Results:
- Partners endorsed a train-the-trainer model and educational materials, suggesting additions for supervision, confidentiality, expert consultation, and broader client inclusion.
- Emergent strategies included interactive training, volunteer incentives, and local DMFB networks.
- Barriers comprised funding limitations, staff recruitment challenges, reliance on volunteers, and mental health stigma; facilitators included program credibility, mission alignment, and community needs.
- Quantitative data confirmed high feasibility, acceptability, and appropriateness.
Conclusions:
- The DMFB intervention is a promising behavioral activation strategy for real-world implementation in senior centers.
- A train-the-trainer model is viable but necessitates robust training, expert consultation, and adequate funding.
- Addressing implementation barriers and leveraging facilitators is crucial for successful adoption and sustainability.
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