Characterization of Strategies to Enhance the Provision of Holistic Services Across Three Community‐Based Organizations in King County, Washington, United States

Abstract

INTRODUCTION: Addressing social determinants of health within HIV services is essential to achieve HIV epidemic control in the United States. Community-based organizations (CBOs) are uniquely positioned to implement integrated services, particularly for under-resourced and marginalized communities. However, effective strategies to support integrated services are needed for these settings. In a community-academic partnership, we applied implementation science tools to identify, prioritize and characterize strategies supporting three CBOs' goals to enhance integrated services and reduce health inequities in King County, Washington, United States. METHODS: From November 2021 to June 2022, we facilitated nominal group technique methods with each CBO to generate strategies aligned with conditions CBOs deemed necessary for successful integration. Staff evaluated strategies' feasibility and effectiveness using 5-point Likert scales (Feasibility: 1 = Very hard to do with current resources to 5 = Very easy; Effectiveness: 1 = Large negative to 5 = Large positive impact). Go-Zone plots comparing strategies' feasibility and effectiveness scores were generated to inform implementation prioritization. We mapped strategies to Expert Recommendations for Implementing Change (ERIC) thematic clusters and Consolidated Framework for Implementation Research (CFIR) constructs. RESULTS: This participatory process generated 118 strategies perceived as highly impactful (mean = 4.7, range = 4.6-5.0) and with mixed feasibility (mean = 3.3, range = 3.2-4.6). Strategies most frequently aimed to improve organizational structural characteristics, staff access to knowledge/information, communications, implementer and community engagement, reflecting and evaluating, and teaming. All nine ERIC thematic clusters were represented, most commonly change infrastructure, train/educate relevant groups, develop interrelationships, use evaluative and iterative strategies, and engage consumers. Highly feasible and impactful strategies often addressed knowledge access and engagement, while fewer addressed structural characteristics and teaming. We observed patterns in barrier-strategy mapping (CFIR-ERIC) and in strategy feasibility and impact when reviewing construct combinations. CONCLUSIONS: Implementing integrated services requires systems-level approaches that strengthen organizational infrastructure and respond to community priorities. Despite diverse organizational contexts, a core set of determinants and strategy types emerged, suggesting their importance for integrated services. Implementation science frameworks were valuable for translating context-specific strategies into potentially generalizable takeaways about determinants and strategy types, though they may be unnecessary for strategy and determinant identification with CBOs. Examining the feasibility and effectiveness of strategy types addressing unique combinations of determinants may strengthen barrier-strategy mapping.

The authors' abstract, as published at the source. Journal of the International AIDS Society, 2026 · DOI ↗