Table 2.
Strategies to address social determinants of health in DEBI implementation
| Short-term strategies (requiring less than 2 years to implement) | |
| Strategy | Activities or methods |
| Language revisions | |
| Translationa | •Translate intervention into preferred language for intervention participants |
| Lay terminology | •Communicate intervention components in lay or street-friendly terms |
| Recruitment adjustments | |
| Modifications to eligibility and enrollment criteria to increase recruitment | •Modify protocols to collect risk-related information during later phases of implementation after confidentiality has been established |
| Formal or informal collaboration with other agencies working with similar communities | •Reduce amount of information required for recruitment or utilizing phased-in enrollment to minimize degree of personal information (e.g., legal status, drug use, etc.) collected prior to participation |
| •Increase networking opportunities among agencies delivering same DEBIs or working with similar communities to identify successful strategies | |
| Retention approaches | |
| Incentives for continued participation | •Offer allowable incentives (may vary by funder) based on participation in each session; delivered at each session or cumulative distribution at DEBI completion |
| Food | •Provide food or meals at intervention sessions |
| Transportation to and from session | •Provide transportation to and from session (e.g., bus or other transportation voucher) |
| Group composition characteristics | •Construct group sessions to include participants of similar backgrounds |
| EBI modifications or adaptations | |
| Addition of intervention session of interest to, or requested by, participants | •Add sessions based on special interests or needs of group members (e.g., pre-release issues for incarcerated, referrals for drug treatment or housing services) |
| Modification of group composition | •Decrease the number of sessions to facilitate group participation |
| •Make other modifications in structure (e.g., reconfigure group sessions to retreat) | |
| Intermediate-term strategies (requiring 2–3 years to fully implement)b | |
| Targeted social marketing campaigns | |
| To address cultural, societal, or religious attitudes | •Assess and pilot targeted campaigns to address homophobia, racism, or stigma for men who have sex with men and/or persons living with HIV |
| Piloting of new programs or services | •Implement demonstration programs to assess feasibility of new services (e.g., condom distribution in school-based clinics or correctional facilities, HIV/STD testing, syringe exchange programs, job skill workshops to provide alternative income options for sex workers, etc.) |
| Formalized faith-based strategies | |
| Educational in-services for congregation | •Conduct HIV in-services by congregation members who are knowledgeable medical providers or educators |
| Volunteer service initiatives | •Deliver prevention updates for specified members, such as adolescents and young adults |
| •Initiate activities to support local HIV organizations (e.g., food bank, clothing, funds) | |
| •Coordinate volunteer services for HIV-affected congregation members (e.g., assist with driving patients to medical appointments, delivering meals) | |
| Long-term strategies (requiring more than 5 years to implement)b | |
| Increased educational opportunities (e.g., GED programs) | •Formalize referral mechanisms to link out-of-school youth to educational tutoring, GED programs |
| •Offer client educational programs, such as reading, writing, ESL, resume writing, and/or other job development skills | |
| Poverty reduction via micro loan or similar programs | •Provide job development workshops to increase skills for future employment |
| •Provide stipends or loans to clients completing above programs to prepare for job market (e.g., purchase work clothing, loan for self-employment, etc.) | |
| •Help clients locate reputable programs for repairing credit and building assets | |
| Community-building strategies | •Combine biomedical, behavioral, social and structural strategies to address multiple ongoing issues in specific, affected communities |
| •Create formal collaborations between implementing programs, local, and/or state funding entities | |
| •Develop formal collaborations between federal funding entities | |
| Health care access and utilization | •Formalize referral mechanisms to increase health coverage for uninsured patients |
| •Link out-of-care HIV-infected patients to health services as health care reform is enacted | |
| Policies and laws | •Implement effective evidence-based strategies (i.e., syringe exchange programs) |
| •Enforce anti-discrimination laws | |
| •Increase housing assistance for persons living with HIV to maintain treatment adherence and reduce transmission to others | |
aMany CBOs are already implementing these strategies
bMay require approval from funders or other funding sources