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. 2024 Apr 24:5:26334895241249417.
doi: 10.1177/26334895241249417. eCollection 2024 Jan-Dec.

Outer-context determinants on the implementation of school-based interventions for LGBTQ+ adolescents

Daniel Shattuck  1 , Cathleen E Willging  1 , Jeffery Peterson  2 , Mary M Ramos  3
Affiliations

Outer-context determinants on the implementation of school-based interventions for LGBTQ+ adolescents

Daniel Shattuck et al. Implement Res Pract. .

Abstract

Background: Schools are critical venues for supporting LGBTQ+ youth well-being. Implementing LGBTQ-supportive practices can decrease experiences of stigmatization, discrimination, and victimization that lead to adverse mental health outcomes like anxiety, depression, and suicidality. However, schools are also subject to a wide range of outer-context pressures that may influence their priorities and implementation of LGBTQ-supportive practices. We assessed the role of emergent outer-context determinants in the context of a 5-year cluster randomized controlled trial to study the implementation of LGBTQ-supportive evidence-informed practices (EIPs) in New Mexico high schools.

Method: Using an iterative coding approach, we analyzed qualitative data from annual interviews with school professionals involved in EIP implementation efforts.

Results: The analysis yielded three categories of outer-context determinants that created challenges and opportunities for implementation: (a) social barriers related to heterocentrism, cisgenderism, and religious conservatism; (b) local, state, and national policy and political discourse; and (c) crisis events.

Conclusions: By exploring the implications of outer-context determinants for the uptake of LGBTQ-supportive practices, we demonstrate that these elements are dynamic-not simply reducible to barriers or facilitators-and that assessing outer-context determinants shaping implementation environments is crucial for addressing LGBTQ health equity.

Keywords: adolescent health; health equity; implementation science; school health; sexual and gender minority health.

Plain language summary

High schools are critical to supporting youth who identify as lesbian, gay, bisexual, transgender, and queer or of other diverse sexualities and gender identities (LGBTQ+). The use of supportive practices in schools can help reduce experiences of stigmatization, discrimination, and victimization that lead to negative mental health outcomes like anxiety, depression, and suicidality. However, schools’ ability to implement new practices is heavily influenced by forces stemming from their surrounding communities and broader society. These outer-context factors and their impact on implementation are generally understudied compared to factors considered to be squarely a part of schools. This article examines the role of outer-context factors, such as structurally-based social barriers, policy and political discourse, and crisis events, on the implementation of six evidence-informed practices (EIPs) intended to make schools safer and more supportive of LGBTQ+ youth. We find that while stigma, politics, and crises can undermine efforts within schools to improve their support and services, these same factors sometimes create opportunities, including renewed interest or urgency for addressing student needs. This article encourages implementation science researchers and practitioners to think through and plan for the ways that outer-context factors impact schools and other institutional settings, including using adaptable implementation frameworks and multilevel implementation strategies.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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