Table 3.

Scale-Up and Spread Constructs, Themes, and Illustrative Quotations.

Strong organizational leadership and commitment to innovation 1) Need for strong and attentive supervision to problem solve before challenges grow and/or discourage staff, stakeholders, and participants “We were slow; our organization was challenged early on, and it brought down the motivation of everyone involved like the coordinator and the soccer league.”*

Believability of evidence supporting the innovation 2) Intervention was viewed as strong, evidence based, and meaningful 3) History built with the WFSM partners supported confidence in the intervention “[Our site] has been working with [the WFSM team] for over a decade on different interventions. We have seen our work together be successful and grow. We have wanted to implement HoMBReS for many years so this was a special opportunity for us.”*

Existence of a champion 4) A champion existed at each organization, but the project coordinator must also be a champion “What do I think was key? My own enthusiasm [as the project coordinator]. I had to work with everyone to move this intervention forward. I had to do a lot of convincing and a lot of cheerleading.”* 5) Commitment of a soccer league champion was critical “It goes without saying that the soccer teams have to be onboard.”*

Organizational capacity 6) All organizations had limited experience and capacity working closely with heterosexual men “I really hate to say this, but this project has taught our organization that we need to increase our capacity to work with men. We work with them, but we really work with families, and that is different. We didn’t know this about ourselves when we started this work together.”* 7) Security guard and sign-in requirements at the entrances of the buildings that housed some organizations were barriers to men’s participation 8) Flexibility at organizations was important “We changed a number of policies at [our organization] to facilitate this work.”*

Well-trained workforce (e.g., project coordinators) 9) Difficult to find qualified men who can work with other men; project coordinator must have documentation that allows him to work in the US, meet education requirements, have reliable transportation/valid driver’s license, and be bilingual (in most cases) 10) Competing with higher paying jobs “There are so many challenges to finding the right coordinator to do this work. I’d say it is particularly difficult given that some ideal coordinators can’t legally work in the US. The other issue we faced is that men can find another higher paying job, and most have already.”*

Engagement and commitment of stakeholders 11) Building relationships with soccer leagues took time 12) Many Latinx men are not accustomed to participating in health-related programming “Getting men to think about their health was really a battle that our team had to overcome. They didn’t want to participate in something health related; maybe they would have if we had included their families.”* 13) Many Latinx men, particularly heterosexual men, held stigmatized attitudes about HIV and STIs “I know [the Wake Forest team] has had lots of success working with Latino men around issues of sex and HIV. But this seemed hard, in our case, in our community. HIV is still viewed as a gay disease, and that’s unfortunate, I hate to say it, but it is true.”* 14) Discussions of sexual health were seen as taboo among some Latinx men

Detailed and staged guidance 15) Timelines with short-term objectives and incremental deadlines are necessary for implementation success “I appreciated the freedom we have been given, but trust me, as an organization, we need to hear about expectations, benchmarks, deadlines, and deliverables, often.”* 16) Difficult to teach and to learn how to build trust “Sometimes we take trust for granted, but building rapport with groups, like the local soccer teams, that we haven’t previously [built rapport with], is really much harder than presumed.”*

Role modeling 17) Onsite role modeling is critical “We sometimes needed more onsite support. We needed someone from the team [at WFSM or from other sites] who knows how to do the work, like recruitment, who has done it before.”*

Thorough planning 18) Clear and useful materials including the Implementation Toolkit are critical to successful implementation “The materials for implementation were useful and comprehensive.”*

Easy and timely access to resources 19) Implementation Toolkit was identified as useful 20) Organization-specific approval processes created obstacles to beginning implementation “We have many layers for approvals to work in partnership, well, not really in partnership. Partnership is fine, but if there is any exchange of money or materials or resources, things get dicey.”*

Understanding of and planning for different contexts 21) Urgency of concrete office activities and responsibilities for project coordinator can take precedence over long-term and more abstract field work in the community “I know it was tough for the coordinator to leave the office and face the community sometimes. This is hard work. It can be easier to get involved with what is going on in the office. There’s always something to do, some type of drama here.”* 22) Anti-immigration rhetoric dramatically reduced community trust, buy-in, enrollment, participation, and retention “This country has become so anti-Latino. It makes everything we do in the community not just a little bit but a lot harder.”* 23) Latinx men have competing priorities, that include affordable housing, food security, and immigration

Ongoing evaluation and quality improvement 24) Organizations did not provide consistent guidance and supervision for project implementation locally; they assumed that the WFSM partners were providing supervision “We are all busy, but you know the saying, trust then verify. I think a bit more supervision from the Wake [Forest] team would have been useful so we didn’t fall behind.”*

Note. *Because of the sample size and to maintain participant privacy, attribution of quotations by organization or by role is not provided. WFSM = Wake Forest School of Medicine.