The MEDIA model: An innovative method for digitizing and training community members to facilitate an HIV prevention intervention

The MEDIA model: An innovative method for digitizing and training community members to facilitate... Abstract As human immunodeficiency virus (HIV) continues to disproportionately affect African American women, practitioners remain committed to developing innovative strategies to reduce HIV prevalence. These strategies include training community organizations, such as churches, and utilizing digital media to make intervention dissemination more sustainable. This article describes one such effort to train lay community members within predominantly Black churches in Atlanta, GA, to implement an HIV prevention intervention. Lay educators were trained by translating a face-to-face Training of Facilitators (TOF) to a digital platform using the MEDIA (Motivate-Engage-Digitize-Implement-Assess) model. Formative evaluations, consultation with experts in the digital platform of choice, and the experience of two P4 for Women Master Trainers informed our translation. The model guided the translation process as our research team worked alongside topical experts and a production company to develop storyboards for core curriculum activities, which were later scripted and filmed with mock participants. A user guide, toolkit, and program website were also developed as supplemental materials to accompany the video training. Lessons learned from this study indicate future attempts at digitizing TOFs should keep in mind that digitization can be a time-consuming process, pilot testing in the new format is necessary even for a previously tested intervention, and the structure provided by facilitators in face-to-face training must be embedded into the format of digitized trainings. Implications Research: The use of the digital training model can assist researchers in expanding health promotion information to scale for community use. Digitized trainings can also allow for training fidelity for lay health educators and quality assurance measures when evaluating the uptake of health interventions in community settings. Practitioners: Trained health practitioners can utilize the MEDIA model to train community lay leaders on health intervention modules. Community agencies often reliant on volunteers can plan for staff transitions and conduct the digitized training when needed. Digitized trainings also allow the practitioner to review training modules as needed for refreshers. Policymakers: This digitized module can assist policy makers in researching the significance of community health programs that utilize lay health leaders to increase awareness of health promotion topics. Digitized trainings can be viewed as a sustainable and cost-effective method for health promotion messaging. INTRODUCTION Although great strides have been made in preventing and treating human immunodeficiency virus (HIV), it continues to disproportionately affect African American women. Currently one in four people living with HIV and one in five newly diagnosed individuals are women. African American women make up 62% of new infections among women, making them the fourth most at-risk group in the USA [1]. The church has a unique opportunity to impact this crisis among African Americans. Historically, black churches are among the most visible, respected, and credible institutions in the African American community and a tremendous source of social support [2, 3]. According to the Pew Research Center, 75% of African Americans consider religion very important in their lives, and over half of Black adults are affiliated with Black Protestant churches. These congregations are about 60% female and more likely to be located in the South, the epicenter of the HIV epidemic [4]. In recent years, health professionals regarded faith communities as ideal places to intervene on pressing health issues. Such communities are particularly effective venues for health promotion because they offer physical space for programming, a history of community engagement, and established relationships with individuals and organizations [5]. Black churches also reach a community plagued by substandard medical care and disingenuous research studies, causing prolonged distrust in medical systems [6–8]. Working in partnership with research organizations and institutions, black churches are well placed to bridge their congregants’ historical distrust of health care [9]. Utilizing faith leaders serving in trusted positions of influence within the community to relay health messages prioritizes the in-group viewpoint and empowers faith leaders as health advocates. Health promotion in faith-based communities has repeatedly shown to be effective for reducing health disparities within populations with the highest rates of disease [10–12]. One barrier to widespread implementation of health promotion programs in faith-based communities is a lack of trained professionals to serve as educators and community health workers. Some researchers have solved this problem by training lay people to implement interventions. In the UK, peer educators worked in minority communities to raise awareness about kidney health and support diabetes self-management [13, 14]. In the USA, researchers mobilized lay health educators from faith communities to increase awareness about common health concerns, providing leadership for programs that combat noncommunicable disease, and increase engagement in health care [8, 15, 16]. The Centers for Disease Control and Prevention (CDC) also uses this model of training lay people to serve as health educators to disseminate their Effective Behavioral Interventions (EBIs) for HIV prevention. The authors of this article, in conjunction with associated Master Trainers and research staff, previously developed and disseminated SISTA, the most widely disseminated HIV prevention intervention for women in the USA [17]. Health professionals, organizations, and lay community members have been trained to implement SISTA in over 40 states, with some states exceeding 100 trained organizations and more than 290 trained facilitators. Figure 1 shows the diffusion of SISTA to organizations and individuals across the USA. Fig 1 View largeDownload slide Organizations and individuals trained in SISTA in the USA as of 2010 Fig 1 View largeDownload slide Organizations and individuals trained in SISTA in the USA as of 2010 Although training lay educators primarily required face-to-face sessions previously, increasing access to digital media creates a new opportunity to train them in larger numbers. A review by Ballew et al. found that digital trainings are more geographically and financially accessible, provide for greater flexibility of scheduling and personal learning style, and increase the consistency of messaging across trainees [18]. Additionally, digital trainings allow for improved learning experiences through use of creative multimedia content and opportunities for active participation [19]. Digital trainings are used to address a variety of health issues including behavioral weight management, HIV-risk reduction, psychosocial support for cancer patients, and management of multiple chronic conditions [20–23]. Digital trainings and virtual communities of practice also improved the reach of continuing education and support for professionals, particularly those serving in rural areas who may be isolated from traditional forms of training [24–27]. Thus far, despite the strengths and successes of digital trainings, such trainings have not been widely used to train lay health educators. The HEAL (Health through Early Awareness and Learning) study has previously demonstrated the feasibility of using digital trainings with faith-based populations, finding that a digital training decreased the time needed for training while maintaining similar implementation outcomes when compared to a traditional, in-person training [28–30]. In this article, we describe how we sought to combine these areas of innovation by translating a face-to-face facilitator training to a digital platform to disseminate a faith-based HIV EBI, P4 for Women, in hopes of increasing program feasibility and sustainability. The P4 for Women curriculum, which is comprised of three 3-hr sessions, was previously found to be effective at reducing sexual risk and increasing religious social capital among participants from predominantly African American churches in Atlanta, GA in a randomized control trial comparing this adapted intervention to the original SISTA intervention [31, 32]. After conducting the randomized control trial to compare the effectiveness of the two interventions, our research team also piloted a P4 for Women dissemination and Training of Facilitators (TOF) with four local Atlanta churches, which internally informed this study. The lessons learned from this small P4 for Women dissemination pilot were never formally published. In adapting this face-to-face dissemination to a digital format, we developed and utilized the MEDIA (Motivate-Engage-Digitize-Implement-Assess) model. This model guided the process of developing, translating, and refining training materials, helping to maintain the core content, while repackaging it into a more appropriate format for the digital medium of choice. METHODS The P4 for Women TOF is a training module delivered to leaders in a faith-based setting who plan to implement a group-level, gender and culturally tailored HIV prevention intervention among single, African American women aged 18–34. The originally piloted 14-hr face-to-face training consisted of a programmatic overview, introduction to HIV among the target population, facilitation skills for implementing the intervention, and modeling of intervention activities by two Master Trainers. A teach-back opportunity concluded the training, which allowed trainees to model intervention activities and receive helpful critiques from their peers and the Master Trainers. To improve fidelity, reach, and sustainability of community-based training efforts, intervention developers and Master Trainers worked from May 2013 through August 2014 to develop a digitized TOF for the P4 for Women intervention to be disseminated among predominantly African American churches in Atlanta, GA. This process involved two concurrent phases. In the first phase, we followed the five-step MEDIA model to translate the core TOF content into a digitized delivery platform. The development of the MEDIA model was informed by the ADAPT-ITT model, which is a framework for systematically adapting HIV-related EBIs in sequential phases [33]. Using the principles of the ADAPT-ITT model as a foundation, we created the MEDIA model to specify sequential translational steps for digitizing traditionally face-to-face TOFs. In the second phase, we developed supplemental materials to support the digitized P4 for Women TOF intervention. The supplemental materials included a written user guide, a website, and a facilitation toolkit. Phase 1 took place from May 2013 through August 2014. Phase 2 took place from January 2014 through June 2014. The digitized P4 for Women TOF was developed for and intended to be disseminated among predominantly African American churches in Atlanta, GA. To be eligible for participation in the dissemination study, churches must (a) have a predominantly African American congregation according to current membership records; (b) be located in the five Atlanta metropolitan counties with the highest HIV prevalence rates; (c) provide pastoral consent; and (d) agree to the 1-year research participation period. Twenty churches enrolled in the dissemination study and were provided with the digitized P4 for Women training materials. A total of 130 church leaders and members from the 20 churches consented to participate in the digitized P4 for Women training and subsequent session implementation. Emory University’s Institutional Review Board approved all study procedures prior to any data collection. RESULTS Phase 1: Translation of TOF to digital platform using the MEDIA model The MEDIA model guided the digitization of the P4 for Women TOF into video-based trainings. We describe the steps and lessons learned below, as well as in Table 1. Table 1 The MEDIA model: phases and methodology applied to digitize the P4 for Women TOF Phase  Methodology  Lessons learned  1. Motivate (How would a digital training be utilized by trainees?)  Determine current use and preferred features of digital platforms. Review process and outcome evaluations from face-to-face TOFs.  Ensure a diverse population is represented in formative evaluation to gain insight into what level of digital access is typical for the community.  2. Engage (What core components from the face-to-face TOF should be integrated into the digitized version?)  Consult topical experts to review translation options and trends. Evaluate innovative technologies (such as DVD, web, and app platforms) to deliver digitized training based on intended audience. Hire a video production company knowledgeable about health promotion and topical area. Consider TOF core components for inclusion in digitized version. Outline translation plan based on core components.  Engage with experts who are knowledgeable about digital platforms and experienced communicating the subject matter of interest. Be clear about the scope of the project with stakeholders and collaborators, including limitations of timeline, budget, and other resources. Consider potential trainees’ familiarity with topical knowledge, technical language, and group facilitation when selecting core components.  3. Digitize (How do you create the digitization plan?)  Work with production staff to determine best practices for digitization process. Create storyboards and scripts of all training modules based on original face- to-face training manual.  Write in plain language for easy user readability. Utilize shorter modules, as trainees are willing to invest less time per sitting in reviewing training materials.  4. Implement (How will the TOF training be filmed and packaged?)  Determine filming set and locations(s). Schedule filming dates and times. Cast actors or extras to model core intervention activities. Collect props or materials needed. Reserve any technical or A/V equipment needed for filming. Film all training modules and record voice-overs. Collaborate with video production company to edit and compile digitized training. Package training for dissemination.  Obtain media and photo releases for copyrighted material in advance of filming. Ensure all modules are fully scripted and blocked before arriving on set for filming. Develop a comprehensive list of any props, equipment, and backdrops needed. Consider how wardrobe choices such as colors, fabrics, and patterns may appear on screen, as they may distract from the activities being modeled.  5. Assess (How will we determine the impact and effectiveness of the TOF training?)  Determine best evaluation strategies to assess uptake and effectiveness. Develop and integrate assessment and quality assurance measures into process evaluation. Analyze results of the evaluation to determine efficacy.  Anticipate the need to track uptake and utilization beyond self-report measures. Recognize limitations of data collection methods when participants may have little to no contact with project staff.  Phase  Methodology  Lessons learned  1. Motivate (How would a digital training be utilized by trainees?)  Determine current use and preferred features of digital platforms. Review process and outcome evaluations from face-to-face TOFs.  Ensure a diverse population is represented in formative evaluation to gain insight into what level of digital access is typical for the community.  2. Engage (What core components from the face-to-face TOF should be integrated into the digitized version?)  Consult topical experts to review translation options and trends. Evaluate innovative technologies (such as DVD, web, and app platforms) to deliver digitized training based on intended audience. Hire a video production company knowledgeable about health promotion and topical area. Consider TOF core components for inclusion in digitized version. Outline translation plan based on core components.  Engage with experts who are knowledgeable about digital platforms and experienced communicating the subject matter of interest. Be clear about the scope of the project with stakeholders and collaborators, including limitations of timeline, budget, and other resources. Consider potential trainees’ familiarity with topical knowledge, technical language, and group facilitation when selecting core components.  3. Digitize (How do you create the digitization plan?)  Work with production staff to determine best practices for digitization process. Create storyboards and scripts of all training modules based on original face- to-face training manual.  Write in plain language for easy user readability. Utilize shorter modules, as trainees are willing to invest less time per sitting in reviewing training materials.  4. Implement (How will the TOF training be filmed and packaged?)  Determine filming set and locations(s). Schedule filming dates and times. Cast actors or extras to model core intervention activities. Collect props or materials needed. Reserve any technical or A/V equipment needed for filming. Film all training modules and record voice-overs. Collaborate with video production company to edit and compile digitized training. Package training for dissemination.  Obtain media and photo releases for copyrighted material in advance of filming. Ensure all modules are fully scripted and blocked before arriving on set for filming. Develop a comprehensive list of any props, equipment, and backdrops needed. Consider how wardrobe choices such as colors, fabrics, and patterns may appear on screen, as they may distract from the activities being modeled.  5. Assess (How will we determine the impact and effectiveness of the TOF training?)  Determine best evaluation strategies to assess uptake and effectiveness. Develop and integrate assessment and quality assurance measures into process evaluation. Analyze results of the evaluation to determine efficacy.  Anticipate the need to track uptake and utilization beyond self-report measures. Recognize limitations of data collection methods when participants may have little to no contact with project staff.  TOF Training of Facilitators. View Large Table 1 The MEDIA model: phases and methodology applied to digitize the P4 for Women TOF Phase  Methodology  Lessons learned  1. Motivate (How would a digital training be utilized by trainees?)  Determine current use and preferred features of digital platforms. Review process and outcome evaluations from face-to-face TOFs.  Ensure a diverse population is represented in formative evaluation to gain insight into what level of digital access is typical for the community.  2. Engage (What core components from the face-to-face TOF should be integrated into the digitized version?)  Consult topical experts to review translation options and trends. Evaluate innovative technologies (such as DVD, web, and app platforms) to deliver digitized training based on intended audience. Hire a video production company knowledgeable about health promotion and topical area. Consider TOF core components for inclusion in digitized version. Outline translation plan based on core components.  Engage with experts who are knowledgeable about digital platforms and experienced communicating the subject matter of interest. Be clear about the scope of the project with stakeholders and collaborators, including limitations of timeline, budget, and other resources. Consider potential trainees’ familiarity with topical knowledge, technical language, and group facilitation when selecting core components.  3. Digitize (How do you create the digitization plan?)  Work with production staff to determine best practices for digitization process. Create storyboards and scripts of all training modules based on original face- to-face training manual.  Write in plain language for easy user readability. Utilize shorter modules, as trainees are willing to invest less time per sitting in reviewing training materials.  4. Implement (How will the TOF training be filmed and packaged?)  Determine filming set and locations(s). Schedule filming dates and times. Cast actors or extras to model core intervention activities. Collect props or materials needed. Reserve any technical or A/V equipment needed for filming. Film all training modules and record voice-overs. Collaborate with video production company to edit and compile digitized training. Package training for dissemination.  Obtain media and photo releases for copyrighted material in advance of filming. Ensure all modules are fully scripted and blocked before arriving on set for filming. Develop a comprehensive list of any props, equipment, and backdrops needed. Consider how wardrobe choices such as colors, fabrics, and patterns may appear on screen, as they may distract from the activities being modeled.  5. Assess (How will we determine the impact and effectiveness of the TOF training?)  Determine best evaluation strategies to assess uptake and effectiveness. Develop and integrate assessment and quality assurance measures into process evaluation. Analyze results of the evaluation to determine efficacy.  Anticipate the need to track uptake and utilization beyond self-report measures. Recognize limitations of data collection methods when participants may have little to no contact with project staff.  Phase  Methodology  Lessons learned  1. Motivate (How would a digital training be utilized by trainees?)  Determine current use and preferred features of digital platforms. Review process and outcome evaluations from face-to-face TOFs.  Ensure a diverse population is represented in formative evaluation to gain insight into what level of digital access is typical for the community.  2. Engage (What core components from the face-to-face TOF should be integrated into the digitized version?)  Consult topical experts to review translation options and trends. Evaluate innovative technologies (such as DVD, web, and app platforms) to deliver digitized training based on intended audience. Hire a video production company knowledgeable about health promotion and topical area. Consider TOF core components for inclusion in digitized version. Outline translation plan based on core components.  Engage with experts who are knowledgeable about digital platforms and experienced communicating the subject matter of interest. Be clear about the scope of the project with stakeholders and collaborators, including limitations of timeline, budget, and other resources. Consider potential trainees’ familiarity with topical knowledge, technical language, and group facilitation when selecting core components.  3. Digitize (How do you create the digitization plan?)  Work with production staff to determine best practices for digitization process. Create storyboards and scripts of all training modules based on original face- to-face training manual.  Write in plain language for easy user readability. Utilize shorter modules, as trainees are willing to invest less time per sitting in reviewing training materials.  4. Implement (How will the TOF training be filmed and packaged?)  Determine filming set and locations(s). Schedule filming dates and times. Cast actors or extras to model core intervention activities. Collect props or materials needed. Reserve any technical or A/V equipment needed for filming. Film all training modules and record voice-overs. Collaborate with video production company to edit and compile digitized training. Package training for dissemination.  Obtain media and photo releases for copyrighted material in advance of filming. Ensure all modules are fully scripted and blocked before arriving on set for filming. Develop a comprehensive list of any props, equipment, and backdrops needed. Consider how wardrobe choices such as colors, fabrics, and patterns may appear on screen, as they may distract from the activities being modeled.  5. Assess (How will we determine the impact and effectiveness of the TOF training?)  Determine best evaluation strategies to assess uptake and effectiveness. Develop and integrate assessment and quality assurance measures into process evaluation. Analyze results of the evaluation to determine efficacy.  Anticipate the need to track uptake and utilization beyond self-report measures. Recognize limitations of data collection methods when participants may have little to no contact with project staff.  TOF Training of Facilitators. View Large Step 1: Motivate This step aims to determine the usefulness of digitized trainings for intended end users by assessing their current use of and familiarity with technology. Review feedback from previous projects that directly involved the community in question, or use qualitative methods to gather new data. These formative efforts should assess the feasibility, accessibility, and desirability of proposed digital platforms. Be sure to include a diverse sample of respondents in formative work to accurately represent the attitudes of the user base. During the first 3 months of development, our team analyzed process and outcome evaluations from the previously piloted P4 for Women face-to-face TOFs to assess the potential acceptability of DVD-based trainings. Our analysis suggested that transitioning from face-to-face instruction to a digital platform would be well received, as a digital TOF would (a) reduce participant burden; (b) improve sustainability of community trainings; (c) eliminate travel costs; (d) increase delivery fidelity; and (e) provide opportunity for repeated viewings. Step 2: Engage This step includes consulting with topical experts to determine the best digital platform and format for translation efforts. Possible platforms might include live or recorded webinars, interactive web applications, smartphone apps, and training videos. In making this decision, consider the costs required to develop, film, and disseminate a digitized training, as well as the accessibility of the platform for the intended audience. Also consider what components should be translated into the chosen format and what components might be best conveyed using supplemental materials. After reviewing the formative evaluations described in Step 1, we determined that a video training would be the most appropriate, accessible, and flexible platform for dissemination, as it could be distributed as both a DVD and online through a website or video hosting service. The research team selected a local production company with prior experience developing a variety of health promotion videos including public service announcement campaigns, trainings, and digital interventions. The production company also had experience working with our target population. After meeting with our study team to brainstorm the anticipated product, the video production experts aided the team in determining which pieces of the TOF should be filmed, appropriate length of video segments, and considerations for developing materials to support the self-administered video training. Based on this advice and the formative findings from Step 1, the Master Trainers developed an outline for the digital translation process, noting core components to be included. Step 3: Digitize The digitization step includes translating and scripting face-to-face TOF components for a digital platform using storyboards or other platform-specific tools as a plan for your digitization process. Throughout the process, work closely with production staff to corroborate that these plans are compatible with the digital platform of choice. Bear the end user in mind at all times, scripting the training for ease of understanding and utilizing shorter modules for reduced participant burden. The research team worked in collaboration with the video production company to translate the face-to-face training into a series of storyboards. Utilizing this as a translation plan, the master trainers developed scripts for each module of the training, including brief introductions to segments intended to guide viewers through the training process. Throughout the development of the script, the master trainers kept in mind the theoretical underpinnings of the original intervention and TOF including Social Cognitive Theory (SCT), Theory of Gender and Power (TGP), and the ADAPT-ITT model [33–35]. Trainers applied SCT and TGP by casting appropriately aged African American women as health educators and participants in mock sessions throughout the training videos. The scripted digitized training commenced with the history and aims of the P4 for Women intervention, the goals for the training, an overview of the HIV epidemic in the South, and the role of the Black church in combatting the epidemic. To emulate facilitation of a live training, Master Trainers introduced each new segment and modeled core activities with mock participants. The script included instructions for setting up the room and a detailed presentation of the toolkit and session materials. The training also included a condom demonstration appropriate for both training facilitators and use as a video clip during a session activity. Step 4: Implement Utilize the developed translation plan and storyboards to guide implementation. This includes determining and scheduling filming location, casting extras, collecting props, renting A/V equipment, and securing media releases for copyrighted material. For efficiency during filming, ensure all modules are fully scripted and blocked in advance, develop a comprehensive list of props and equipment, and consider how wardrobe choices or backdrop patterns may appear on screen. The originally piloted 14-hr face-to-face TOF was translated into a 4-hr video training, divided into shorter segments, or video chapters. Four days (36 hr of effort) were required to stage and film the 4-hr training, including the introductory remarks, one 50-min segment for each of the three P4 for Women Intervention sessions, and the condom demonstration. For each P4 for Women session, the Master Trainers explained the session’s goals, detailed an ideal facilitation, and demonstrated selected intervention activities. After filming was completed and an initial draft of the training video was created, the Master Trainers met with the production company to select camera shots, edit the sequences, incorporate voice-overs relaying key training concepts, and add in unique features such as on-screen pop-ups to highlight training tips and name facilitation skills being demonstrated. Finally, the TOF DVD was reviewed for quality assurance, reproduced, and packaged for distribution. Step 5: Assess Evaluate the feasibility and effectiveness of the digitized TOF by assessing the fidelity with which newly trained facilitators implement the program and evaluating how trainees used the training materials. In developing the assessment, anticipate the need to track uptake beyond self-report measures and recognize potential limitations of data collection when trained facilitators have little to no contact with research staff. A variety of methods were used to assess implementation fidelity, measure uptake of training materials, and evaluate acceptability of the digitized TOF. Two quality assurance raters attended sessions implemented by trained P4 for Women facilitators to measure implementation fidelity according to the provided scripted curriculum, as well as the ability of lay health educators to incorporate key facilitation skills into the sessions. Quality assurance raters used standardized forms to score facilitators, which facilitators received as part of their toolkit. Quality assurance raters also administered self-evaluation forms to trained facilitators immediately after P4 for Women sessions, which evaluated facilitators’ perceptions of the session and asked about training materials reviewed to date. In addition, facilitators received quantitative electronic surveys, distributed via email at the close of the implementation period, which collected detailed information about the number of times trainees watched each video module and reviewed supplemental materials. To supplement self-reported uptake of training materials, web analytics were used to monitor the number of times each video module was viewed on the program’s website, the average amount of time spent viewing the online training videos, and the number of repeat versus unique visitors. From launching the P4 for Women training website in February 2015, which contained the digitized training videos, to the final church implementation of the P4 for Women sessions in July 2016, web analytics captured the uptake of the training videos. The link to the website, and therefore training videos, was private and would not appear in any search engines. Study participants drove traffic to the website through either their direct use or through dissemination of the website link to their social network. Over the course of 17 months, 715 unique users visited the website 1,432 times. A total of 49.79% of the website visits were from new users. The P4 for Women introduction video and three session training videos were watched for a combined 3,645 min (60.75 hr) over the 17 months. Data demonstrate that the three core intervention training videos (sessions 1, 2, and 3) were, on average, not viewed in their entirety and the first and second session videos were viewed more frequently than the third session video. More detailed web analytics for each training video are described in Table 2. Table 2 Web analytics describing P4 for Women digitized training video uptake Video title  Number of views  Total watch time (min)  Full video run time (hh:mm:ss)  Average view duration (mm:ss)  P4 for Women Training Introduction  70  317  00:08:18  04:31  Session 1 Training  62  1,202  00:58:03  19:22  Session 2 Training  68  2,403  01:27:10  35:20  Session 3 Training  38  777  00:58:06  20:26  Condom Demonstration  19  26  00:01:32  01:23  Video title  Number of views  Total watch time (min)  Full video run time (hh:mm:ss)  Average view duration (mm:ss)  P4 for Women Training Introduction  70  317  00:08:18  04:31  Session 1 Training  62  1,202  00:58:03  19:22  Session 2 Training  68  2,403  01:27:10  35:20  Session 3 Training  38  777  00:58:06  20:26  Condom Demonstration  19  26  00:01:32  01:23  View Large Table 2 Web analytics describing P4 for Women digitized training video uptake Video title  Number of views  Total watch time (min)  Full video run time (hh:mm:ss)  Average view duration (mm:ss)  P4 for Women Training Introduction  70  317  00:08:18  04:31  Session 1 Training  62  1,202  00:58:03  19:22  Session 2 Training  68  2,403  01:27:10  35:20  Session 3 Training  38  777  00:58:06  20:26  Condom Demonstration  19  26  00:01:32  01:23  Video title  Number of views  Total watch time (min)  Full video run time (hh:mm:ss)  Average view duration (mm:ss)  P4 for Women Training Introduction  70  317  00:08:18  04:31  Session 1 Training  62  1,202  00:58:03  19:22  Session 2 Training  68  2,403  01:27:10  35:20  Session 3 Training  38  777  00:58:06  20:26  Condom Demonstration  19  26  00:01:32  01:23  View Large Phase 2: Development of supplemental materials Three major components supplemented the video trainings to aid in ease of training, uptake, and session implementation: a user guide, a toolkit, and a program website. Differences between the components included in the face-to-face TOF and the digitized TOF are detailed in Table 3. Table 3 Comparison of components included in face-to-face TOF versus digitized TOF for the P4 for Women faith-based HIV prevention intervention Training component  Prior face-to-face TOF  Digitized TOF components  Training video  User guide  Website  Toolkit  Training and Intervention Introduction  X  X    X    P4 for Women Session 1 Training  X  X    X    P4 for Women Session 2 Training  X  X    X    P4 for Women Session 3 Training  X  X    X    Preparing for Sessions and Room Setup  X  X    X    Past Participant Testimonials    X    X    Supplemental Informational Videos from Collaborators    X    X    Facilitation Skills  X  X  X  X    Local Referrals and Resources to Community Partners      X  X    Reflective and Debriefing Materials      X  X  X  Instructions for Using the Training Materials      X      HIV 101 Video          X  Scripted Intervention Manuals  X        X  Example Participant Manuals          X  Intervention Activities Props          X  Training component  Prior face-to-face TOF  Digitized TOF components  Training video  User guide  Website  Toolkit  Training and Intervention Introduction  X  X    X    P4 for Women Session 1 Training  X  X    X    P4 for Women Session 2 Training  X  X    X    P4 for Women Session 3 Training  X  X    X    Preparing for Sessions and Room Setup  X  X    X    Past Participant Testimonials    X    X    Supplemental Informational Videos from Collaborators    X    X    Facilitation Skills  X  X  X  X    Local Referrals and Resources to Community Partners      X  X    Reflective and Debriefing Materials      X  X  X  Instructions for Using the Training Materials      X      HIV 101 Video          X  Scripted Intervention Manuals  X        X  Example Participant Manuals          X  Intervention Activities Props          X  TOF Training of Facilitators. View Large Table 3 Comparison of components included in face-to-face TOF versus digitized TOF for the P4 for Women faith-based HIV prevention intervention Training component  Prior face-to-face TOF  Digitized TOF components  Training video  User guide  Website  Toolkit  Training and Intervention Introduction  X  X    X    P4 for Women Session 1 Training  X  X    X    P4 for Women Session 2 Training  X  X    X    P4 for Women Session 3 Training  X  X    X    Preparing for Sessions and Room Setup  X  X    X    Past Participant Testimonials    X    X    Supplemental Informational Videos from Collaborators    X    X    Facilitation Skills  X  X  X  X    Local Referrals and Resources to Community Partners      X  X    Reflective and Debriefing Materials      X  X  X  Instructions for Using the Training Materials      X      HIV 101 Video          X  Scripted Intervention Manuals  X        X  Example Participant Manuals          X  Intervention Activities Props          X  Training component  Prior face-to-face TOF  Digitized TOF components  Training video  User guide  Website  Toolkit  Training and Intervention Introduction  X  X    X    P4 for Women Session 1 Training  X  X    X    P4 for Women Session 2 Training  X  X    X    P4 for Women Session 3 Training  X  X    X    Preparing for Sessions and Room Setup  X  X    X    Past Participant Testimonials    X    X    Supplemental Informational Videos from Collaborators    X    X    Facilitation Skills  X  X  X  X    Local Referrals and Resources to Community Partners      X  X    Reflective and Debriefing Materials      X  X  X  Instructions for Using the Training Materials      X      HIV 101 Video          X  Scripted Intervention Manuals  X        X  Example Participant Manuals          X  Intervention Activities Props          X  TOF Training of Facilitators. View Large User guide. One of the Master Trainers collaborated with a health educator from the research team who had not previously worked with the P4 for Women curriculum to create the TOF user guide. This collaboration specifically intended to combine the knowledgeable perspective of a Master Trainer with the viewpoint of a health educator learning the intervention materials for the first time, an experience that would closely mirror that of the facilitators who would be relying on the user guide to provide further clarification. Throughout the development process, the two authors worked to ensure that the guide was visually appealing and interactive, that critical information was centralized and highlighted, and that materials were appropriate for an audience without health education experience. First, the authors met to review the P4 for Women curriculum and compile a list of modules excluded from the video training in Step 2. These modules focused primarily on developing and applying facilitation skills such as active listening, being nonjudgmental, and roleplaying. The authors developed and iteratively edited these modules over the course of 3 months, before submitting a final set of translated modules to the research team for review. Next, the two authors met to discuss additional topics that needed to be covered in the user guide. To tailor the guide to a completely naive audience, they generated a list of possible questions and concerns facilitators with no prior knowledge or information about the P4 for Women program might have. This list was informed by common questions asked during previous HIV prevention trainings conducted by the research team. In answering questions about implementing specific lessons, the authors tried to include high, medium, and low resource options for each activity to increase the sustainability of the program in the event supplies were depleted or misplaced over time. After finalizing the content, the authors met again to discuss how to organize the user guide. Again, the authors attempted to take the perspective of someone unfamiliar with the P4 for Women curriculum and inexperienced as a health educator in order to make the materials easy to navigate and ensure that successive sections would build on each other in a logical way. In the end, the user guide was split into five sections, which are described in detail in Table 4. Table 4 Description of P4 for Women supplemental user guide components User guide chapter  Description of content  Chapter 1: Welcome and Course Introduction  A brief explanation of the P4 for Women program, a literature review, a summary of the facilitator training course, and brief bios of the main actors in the training video.  Chapter 2: Preparing to Implement  A systematic guide on how to plan and implement sessions, develop connections with community resources for referrals, communicate with participants, and reflect on the successes and challenges of each session.  Chapter 3: Facilitation Skills  An overview of facilitation skills and opportunities for reflection and discussion regarding facilitation challenges.  Chapter 4: Using the Training Materials  An explanation of each of the training materials and how they can be best used as well as summaries and tips for each P4 for Women session.  Appendices  The appendices were used to house forms that were too long to place in the main body of the user guide including an example community resource sheet, a list of needed supplies and where churches could obtain replacements, and materials to help facilitators debrief after sessions.  User guide chapter  Description of content  Chapter 1: Welcome and Course Introduction  A brief explanation of the P4 for Women program, a literature review, a summary of the facilitator training course, and brief bios of the main actors in the training video.  Chapter 2: Preparing to Implement  A systematic guide on how to plan and implement sessions, develop connections with community resources for referrals, communicate with participants, and reflect on the successes and challenges of each session.  Chapter 3: Facilitation Skills  An overview of facilitation skills and opportunities for reflection and discussion regarding facilitation challenges.  Chapter 4: Using the Training Materials  An explanation of each of the training materials and how they can be best used as well as summaries and tips for each P4 for Women session.  Appendices  The appendices were used to house forms that were too long to place in the main body of the user guide including an example community resource sheet, a list of needed supplies and where churches could obtain replacements, and materials to help facilitators debrief after sessions.  View Large Table 4 Description of P4 for Women supplemental user guide components User guide chapter  Description of content  Chapter 1: Welcome and Course Introduction  A brief explanation of the P4 for Women program, a literature review, a summary of the facilitator training course, and brief bios of the main actors in the training video.  Chapter 2: Preparing to Implement  A systematic guide on how to plan and implement sessions, develop connections with community resources for referrals, communicate with participants, and reflect on the successes and challenges of each session.  Chapter 3: Facilitation Skills  An overview of facilitation skills and opportunities for reflection and discussion regarding facilitation challenges.  Chapter 4: Using the Training Materials  An explanation of each of the training materials and how they can be best used as well as summaries and tips for each P4 for Women session.  Appendices  The appendices were used to house forms that were too long to place in the main body of the user guide including an example community resource sheet, a list of needed supplies and where churches could obtain replacements, and materials to help facilitators debrief after sessions.  User guide chapter  Description of content  Chapter 1: Welcome and Course Introduction  A brief explanation of the P4 for Women program, a literature review, a summary of the facilitator training course, and brief bios of the main actors in the training video.  Chapter 2: Preparing to Implement  A systematic guide on how to plan and implement sessions, develop connections with community resources for referrals, communicate with participants, and reflect on the successes and challenges of each session.  Chapter 3: Facilitation Skills  An overview of facilitation skills and opportunities for reflection and discussion regarding facilitation challenges.  Chapter 4: Using the Training Materials  An explanation of each of the training materials and how they can be best used as well as summaries and tips for each P4 for Women session.  Appendices  The appendices were used to house forms that were too long to place in the main body of the user guide including an example community resource sheet, a list of needed supplies and where churches could obtain replacements, and materials to help facilitators debrief after sessions.  View Large Facilitation toolkit It was our goal to have no costs associated with implementation to limit finances being a barrier to study participation. The research team used supply lists from the P4 for Women pilot study to create an initial list of materials to include in the toolkit. Experienced P4 for Women facilitators reviewed this list for completeness. Other members of the research team unfamiliar with the intricacies of program implementation also reviewed the list to determine whether additional explanatory materials were necessary. Website In an effort to increase access to the training videos, as only one DVD copy was provided per toolkit, a program website was designed to house the training videos, provide highlights of the user guide, and connect participating churches to resources within their community. The website was only accessible via a private URL, which research staff shared with churches. Users could post questions and comments anonymously or with a username on each page of the website. Utilization of the website was monitored using Google Analytics. The website was the last supplemental resource developed and finalized, as it mirrored the final versions of the training videos, user guide, and other resources within the toolkit. The website ultimately included information about the P4 for Women program, frequently asked questions, all training video chapters, an overview of successful facilitation skills, the handouts and materials needed to implement each session, and links to community organizations that provided HIV-related testing and services. DISCUSSION The purpose of this study was to digitize a traditional face-to-face TOF of a faith-based HIV prevention program for young African American women to a digital platform and to describe the MEDIA model, which guided the digitization process. The digital TOF and accompanying materials were then disseminated to predominantly Black churches in the Atlanta Metro Area and utilized to train church leadership and facilitators to implement the P4 for Women intervention among their congregants. Based on the digitization and implementation process from this study, we derived three key lessons learned. Allow ample time for digitization Based on the steps outlined in the MEDIA model, anticipate that the digitization process will require more time than expected. The entire process for this study took 15 months, double the originally allotted time for development and digitization. Due to the collaborative nature of this process, delays will occur. Be sure to discuss clear timelines with partners or collaborators in advance and build in extra time for additional edits or rewrites. Additionally, consider that utilizing a local production company can decrease the time needed, as it may allow for more flexible scheduling and faster turn-around times. Pilot with appropriate and diverse audiences prior to filming Piloting in advance is just as key to the adaptation process as it is to the initial intervention design [30, 33, 36]. Once filming occurs it is expensive, time consuming, and often not feasible to make changes to the digitized training. Therefore, obtain feedback from anticipated end users throughout the process. Keep in mind that aspects of traditional face-to-face trainings will not translate identically to digitized versions, and it is important to ensure usability among audiences who have not yet been exposed to the curriculum. Assessing preferred video length and total run time in advance is particularly important. In this study, although the digitized videos were significantly shorter than the modules taught during a face-to-face training, facilitators ultimately preferred chapters to be even shorter than anticipated and divided into small sections that could be viewed over time. Incorporate structure and a clear progression within the training modules Lastly, it is important to incorporate structure into the training, especially within the digitized content itself. In previous face-to-face trainings, the Master Trainers were physically present to guide the training and provide oversight. With the digitized version, this oversight and instruction needed to be built in. For example, although the video chapters were numbered and the user guide extensively described best practices for reviewing all materials, facilitators in this study often did not consult these materials first and would therefore move through the video chapters out of order. In this training, successive modules built on knowledge and skills from previous sections of the training, so initially viewing the modules out of order may have resulted in confusion and poorer training outcomes. Incorporating a required linear progression for facilitators to follow the first time they view the materials may be beneficial [30]. PUBLIC HEALTH IMPLICATIONS Digital trainings for lay health educators have the potential to increase capacity in vulnerable communities to address significant public health problems without creating undue burdens on scarce resources. However, creating such trainings requires collaborative efforts between health educators, digital media experts, and community stakeholders, as well as careful thought to translation and repackaging of key training messages. The MEDIA model and the lessons learned presented here can help guide the creation of future digitized trainings for lay health educators. Future publications from this dissemination study will explore findings more thoroughly from Step 5 (Assessment), including the analysis of the research team’s quality assurance ratings, the lay health educator’s self-evaluations, P4 for Women participant evaluations from the enrolled churches, and pre- and post-intervention qualitative interviews. Acknowledgments We are excited to report that findings from this article were presented at the 144th American Public Health Association’s Annual Meeting in 2016. We confirm that this manuscript has not been published elsewhere and is not under consideration by any other journal. Funding: Funding from the Agency for Healthcare Research and Quality supported this study (grant number 1R24HS022059). The authors would like to recognize and thank the hard work and dedication of all the staff, consultants, and collaborators who made this study possible. Special thanks to the project director, LaShun Robinson, and two P4 for Women Master Trainers, Tiffaney Renfro and Nikia Braxton. Thank you to MEE Productions for spearheading filming and video production. Thank you to key community collaborators and contributors such as the National Black Leadership Commission on AIDS (NBLCA), Gilead Sciences, Inc., NAACP, and AID Atlanta. The authors would also like to thank the churches that were involved in the initial pilot and served on the Community Advisory Board for this study, providing essential feedback and support. Human Rights Statement and IRB Approval: The Emory University institutional review board (IRB: 00064678) approved the study protocol. The informed consent explicitly stated that research participant’s involvement in or data from any aspect of the study would remain confidential. This study embodies the Helsinki Statement on ensuring research methods that promote health equity and health promotion for all populations. Compliance with Ethical Standards Author’s Contributions: T.R. was the master trainer for the digitized training, conceptualized the process for the training model, assisted with training implementation, and assisted with writing the article. E.J. conceptualized and developed the supplemental training components and toolkit materials for the study and assisted with writing the article. D.L. supervised the data team and conducted data analysis, assisted with study implementation, and assisted with writing the article. G.W. received the funding, conceptualized and supervised the study, and revised and provided feedback for the article. R.D. conceptualized and supervised the study and revised and provided feedback for the article. These authors have full control of all primary data from the main trial and if needed will allow the journal to review if requested. Conflict of Interest: These authors pose no conflicts of interest related to this study. References 1. 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The MEDIA model: An innovative method for digitizing and training community members to facilitate an HIV prevention intervention

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Abstract

Abstract As human immunodeficiency virus (HIV) continues to disproportionately affect African American women, practitioners remain committed to developing innovative strategies to reduce HIV prevalence. These strategies include training community organizations, such as churches, and utilizing digital media to make intervention dissemination more sustainable. This article describes one such effort to train lay community members within predominantly Black churches in Atlanta, GA, to implement an HIV prevention intervention. Lay educators were trained by translating a face-to-face Training of Facilitators (TOF) to a digital platform using the MEDIA (Motivate-Engage-Digitize-Implement-Assess) model. Formative evaluations, consultation with experts in the digital platform of choice, and the experience of two P4 for Women Master Trainers informed our translation. The model guided the translation process as our research team worked alongside topical experts and a production company to develop storyboards for core curriculum activities, which were later scripted and filmed with mock participants. A user guide, toolkit, and program website were also developed as supplemental materials to accompany the video training. Lessons learned from this study indicate future attempts at digitizing TOFs should keep in mind that digitization can be a time-consuming process, pilot testing in the new format is necessary even for a previously tested intervention, and the structure provided by facilitators in face-to-face training must be embedded into the format of digitized trainings. Implications Research: The use of the digital training model can assist researchers in expanding health promotion information to scale for community use. Digitized trainings can also allow for training fidelity for lay health educators and quality assurance measures when evaluating the uptake of health interventions in community settings. Practitioners: Trained health practitioners can utilize the MEDIA model to train community lay leaders on health intervention modules. Community agencies often reliant on volunteers can plan for staff transitions and conduct the digitized training when needed. Digitized trainings also allow the practitioner to review training modules as needed for refreshers. Policymakers: This digitized module can assist policy makers in researching the significance of community health programs that utilize lay health leaders to increase awareness of health promotion topics. Digitized trainings can be viewed as a sustainable and cost-effective method for health promotion messaging. INTRODUCTION Although great strides have been made in preventing and treating human immunodeficiency virus (HIV), it continues to disproportionately affect African American women. Currently one in four people living with HIV and one in five newly diagnosed individuals are women. African American women make up 62% of new infections among women, making them the fourth most at-risk group in the USA [1]. The church has a unique opportunity to impact this crisis among African Americans. Historically, black churches are among the most visible, respected, and credible institutions in the African American community and a tremendous source of social support [2, 3]. According to the Pew Research Center, 75% of African Americans consider religion very important in their lives, and over half of Black adults are affiliated with Black Protestant churches. These congregations are about 60% female and more likely to be located in the South, the epicenter of the HIV epidemic [4]. In recent years, health professionals regarded faith communities as ideal places to intervene on pressing health issues. Such communities are particularly effective venues for health promotion because they offer physical space for programming, a history of community engagement, and established relationships with individuals and organizations [5]. Black churches also reach a community plagued by substandard medical care and disingenuous research studies, causing prolonged distrust in medical systems [6–8]. Working in partnership with research organizations and institutions, black churches are well placed to bridge their congregants’ historical distrust of health care [9]. Utilizing faith leaders serving in trusted positions of influence within the community to relay health messages prioritizes the in-group viewpoint and empowers faith leaders as health advocates. Health promotion in faith-based communities has repeatedly shown to be effective for reducing health disparities within populations with the highest rates of disease [10–12]. One barrier to widespread implementation of health promotion programs in faith-based communities is a lack of trained professionals to serve as educators and community health workers. Some researchers have solved this problem by training lay people to implement interventions. In the UK, peer educators worked in minority communities to raise awareness about kidney health and support diabetes self-management [13, 14]. In the USA, researchers mobilized lay health educators from faith communities to increase awareness about common health concerns, providing leadership for programs that combat noncommunicable disease, and increase engagement in health care [8, 15, 16]. The Centers for Disease Control and Prevention (CDC) also uses this model of training lay people to serve as health educators to disseminate their Effective Behavioral Interventions (EBIs) for HIV prevention. The authors of this article, in conjunction with associated Master Trainers and research staff, previously developed and disseminated SISTA, the most widely disseminated HIV prevention intervention for women in the USA [17]. Health professionals, organizations, and lay community members have been trained to implement SISTA in over 40 states, with some states exceeding 100 trained organizations and more than 290 trained facilitators. Figure 1 shows the diffusion of SISTA to organizations and individuals across the USA. Fig 1 View largeDownload slide Organizations and individuals trained in SISTA in the USA as of 2010 Fig 1 View largeDownload slide Organizations and individuals trained in SISTA in the USA as of 2010 Although training lay educators primarily required face-to-face sessions previously, increasing access to digital media creates a new opportunity to train them in larger numbers. A review by Ballew et al. found that digital trainings are more geographically and financially accessible, provide for greater flexibility of scheduling and personal learning style, and increase the consistency of messaging across trainees [18]. Additionally, digital trainings allow for improved learning experiences through use of creative multimedia content and opportunities for active participation [19]. Digital trainings are used to address a variety of health issues including behavioral weight management, HIV-risk reduction, psychosocial support for cancer patients, and management of multiple chronic conditions [20–23]. Digital trainings and virtual communities of practice also improved the reach of continuing education and support for professionals, particularly those serving in rural areas who may be isolated from traditional forms of training [24–27]. Thus far, despite the strengths and successes of digital trainings, such trainings have not been widely used to train lay health educators. The HEAL (Health through Early Awareness and Learning) study has previously demonstrated the feasibility of using digital trainings with faith-based populations, finding that a digital training decreased the time needed for training while maintaining similar implementation outcomes when compared to a traditional, in-person training [28–30]. In this article, we describe how we sought to combine these areas of innovation by translating a face-to-face facilitator training to a digital platform to disseminate a faith-based HIV EBI, P4 for Women, in hopes of increasing program feasibility and sustainability. The P4 for Women curriculum, which is comprised of three 3-hr sessions, was previously found to be effective at reducing sexual risk and increasing religious social capital among participants from predominantly African American churches in Atlanta, GA in a randomized control trial comparing this adapted intervention to the original SISTA intervention [31, 32]. After conducting the randomized control trial to compare the effectiveness of the two interventions, our research team also piloted a P4 for Women dissemination and Training of Facilitators (TOF) with four local Atlanta churches, which internally informed this study. The lessons learned from this small P4 for Women dissemination pilot were never formally published. In adapting this face-to-face dissemination to a digital format, we developed and utilized the MEDIA (Motivate-Engage-Digitize-Implement-Assess) model. This model guided the process of developing, translating, and refining training materials, helping to maintain the core content, while repackaging it into a more appropriate format for the digital medium of choice. METHODS The P4 for Women TOF is a training module delivered to leaders in a faith-based setting who plan to implement a group-level, gender and culturally tailored HIV prevention intervention among single, African American women aged 18–34. The originally piloted 14-hr face-to-face training consisted of a programmatic overview, introduction to HIV among the target population, facilitation skills for implementing the intervention, and modeling of intervention activities by two Master Trainers. A teach-back opportunity concluded the training, which allowed trainees to model intervention activities and receive helpful critiques from their peers and the Master Trainers. To improve fidelity, reach, and sustainability of community-based training efforts, intervention developers and Master Trainers worked from May 2013 through August 2014 to develop a digitized TOF for the P4 for Women intervention to be disseminated among predominantly African American churches in Atlanta, GA. This process involved two concurrent phases. In the first phase, we followed the five-step MEDIA model to translate the core TOF content into a digitized delivery platform. The development of the MEDIA model was informed by the ADAPT-ITT model, which is a framework for systematically adapting HIV-related EBIs in sequential phases [33]. Using the principles of the ADAPT-ITT model as a foundation, we created the MEDIA model to specify sequential translational steps for digitizing traditionally face-to-face TOFs. In the second phase, we developed supplemental materials to support the digitized P4 for Women TOF intervention. The supplemental materials included a written user guide, a website, and a facilitation toolkit. Phase 1 took place from May 2013 through August 2014. Phase 2 took place from January 2014 through June 2014. The digitized P4 for Women TOF was developed for and intended to be disseminated among predominantly African American churches in Atlanta, GA. To be eligible for participation in the dissemination study, churches must (a) have a predominantly African American congregation according to current membership records; (b) be located in the five Atlanta metropolitan counties with the highest HIV prevalence rates; (c) provide pastoral consent; and (d) agree to the 1-year research participation period. Twenty churches enrolled in the dissemination study and were provided with the digitized P4 for Women training materials. A total of 130 church leaders and members from the 20 churches consented to participate in the digitized P4 for Women training and subsequent session implementation. Emory University’s Institutional Review Board approved all study procedures prior to any data collection. RESULTS Phase 1: Translation of TOF to digital platform using the MEDIA model The MEDIA model guided the digitization of the P4 for Women TOF into video-based trainings. We describe the steps and lessons learned below, as well as in Table 1. Table 1 The MEDIA model: phases and methodology applied to digitize the P4 for Women TOF Phase  Methodology  Lessons learned  1. Motivate (How would a digital training be utilized by trainees?)  Determine current use and preferred features of digital platforms. Review process and outcome evaluations from face-to-face TOFs.  Ensure a diverse population is represented in formative evaluation to gain insight into what level of digital access is typical for the community.  2. Engage (What core components from the face-to-face TOF should be integrated into the digitized version?)  Consult topical experts to review translation options and trends. Evaluate innovative technologies (such as DVD, web, and app platforms) to deliver digitized training based on intended audience. Hire a video production company knowledgeable about health promotion and topical area. Consider TOF core components for inclusion in digitized version. Outline translation plan based on core components.  Engage with experts who are knowledgeable about digital platforms and experienced communicating the subject matter of interest. Be clear about the scope of the project with stakeholders and collaborators, including limitations of timeline, budget, and other resources. Consider potential trainees’ familiarity with topical knowledge, technical language, and group facilitation when selecting core components.  3. Digitize (How do you create the digitization plan?)  Work with production staff to determine best practices for digitization process. Create storyboards and scripts of all training modules based on original face- to-face training manual.  Write in plain language for easy user readability. Utilize shorter modules, as trainees are willing to invest less time per sitting in reviewing training materials.  4. Implement (How will the TOF training be filmed and packaged?)  Determine filming set and locations(s). Schedule filming dates and times. Cast actors or extras to model core intervention activities. Collect props or materials needed. Reserve any technical or A/V equipment needed for filming. Film all training modules and record voice-overs. Collaborate with video production company to edit and compile digitized training. Package training for dissemination.  Obtain media and photo releases for copyrighted material in advance of filming. Ensure all modules are fully scripted and blocked before arriving on set for filming. Develop a comprehensive list of any props, equipment, and backdrops needed. Consider how wardrobe choices such as colors, fabrics, and patterns may appear on screen, as they may distract from the activities being modeled.  5. Assess (How will we determine the impact and effectiveness of the TOF training?)  Determine best evaluation strategies to assess uptake and effectiveness. Develop and integrate assessment and quality assurance measures into process evaluation. Analyze results of the evaluation to determine efficacy.  Anticipate the need to track uptake and utilization beyond self-report measures. Recognize limitations of data collection methods when participants may have little to no contact with project staff.  Phase  Methodology  Lessons learned  1. Motivate (How would a digital training be utilized by trainees?)  Determine current use and preferred features of digital platforms. Review process and outcome evaluations from face-to-face TOFs.  Ensure a diverse population is represented in formative evaluation to gain insight into what level of digital access is typical for the community.  2. Engage (What core components from the face-to-face TOF should be integrated into the digitized version?)  Consult topical experts to review translation options and trends. Evaluate innovative technologies (such as DVD, web, and app platforms) to deliver digitized training based on intended audience. Hire a video production company knowledgeable about health promotion and topical area. Consider TOF core components for inclusion in digitized version. Outline translation plan based on core components.  Engage with experts who are knowledgeable about digital platforms and experienced communicating the subject matter of interest. Be clear about the scope of the project with stakeholders and collaborators, including limitations of timeline, budget, and other resources. Consider potential trainees’ familiarity with topical knowledge, technical language, and group facilitation when selecting core components.  3. Digitize (How do you create the digitization plan?)  Work with production staff to determine best practices for digitization process. Create storyboards and scripts of all training modules based on original face- to-face training manual.  Write in plain language for easy user readability. Utilize shorter modules, as trainees are willing to invest less time per sitting in reviewing training materials.  4. Implement (How will the TOF training be filmed and packaged?)  Determine filming set and locations(s). Schedule filming dates and times. Cast actors or extras to model core intervention activities. Collect props or materials needed. Reserve any technical or A/V equipment needed for filming. Film all training modules and record voice-overs. Collaborate with video production company to edit and compile digitized training. Package training for dissemination.  Obtain media and photo releases for copyrighted material in advance of filming. Ensure all modules are fully scripted and blocked before arriving on set for filming. Develop a comprehensive list of any props, equipment, and backdrops needed. Consider how wardrobe choices such as colors, fabrics, and patterns may appear on screen, as they may distract from the activities being modeled.  5. Assess (How will we determine the impact and effectiveness of the TOF training?)  Determine best evaluation strategies to assess uptake and effectiveness. Develop and integrate assessment and quality assurance measures into process evaluation. Analyze results of the evaluation to determine efficacy.  Anticipate the need to track uptake and utilization beyond self-report measures. Recognize limitations of data collection methods when participants may have little to no contact with project staff.  TOF Training of Facilitators. View Large Table 1 The MEDIA model: phases and methodology applied to digitize the P4 for Women TOF Phase  Methodology  Lessons learned  1. Motivate (How would a digital training be utilized by trainees?)  Determine current use and preferred features of digital platforms. Review process and outcome evaluations from face-to-face TOFs.  Ensure a diverse population is represented in formative evaluation to gain insight into what level of digital access is typical for the community.  2. Engage (What core components from the face-to-face TOF should be integrated into the digitized version?)  Consult topical experts to review translation options and trends. Evaluate innovative technologies (such as DVD, web, and app platforms) to deliver digitized training based on intended audience. Hire a video production company knowledgeable about health promotion and topical area. Consider TOF core components for inclusion in digitized version. Outline translation plan based on core components.  Engage with experts who are knowledgeable about digital platforms and experienced communicating the subject matter of interest. Be clear about the scope of the project with stakeholders and collaborators, including limitations of timeline, budget, and other resources. Consider potential trainees’ familiarity with topical knowledge, technical language, and group facilitation when selecting core components.  3. Digitize (How do you create the digitization plan?)  Work with production staff to determine best practices for digitization process. Create storyboards and scripts of all training modules based on original face- to-face training manual.  Write in plain language for easy user readability. Utilize shorter modules, as trainees are willing to invest less time per sitting in reviewing training materials.  4. Implement (How will the TOF training be filmed and packaged?)  Determine filming set and locations(s). Schedule filming dates and times. Cast actors or extras to model core intervention activities. Collect props or materials needed. Reserve any technical or A/V equipment needed for filming. Film all training modules and record voice-overs. Collaborate with video production company to edit and compile digitized training. Package training for dissemination.  Obtain media and photo releases for copyrighted material in advance of filming. Ensure all modules are fully scripted and blocked before arriving on set for filming. Develop a comprehensive list of any props, equipment, and backdrops needed. Consider how wardrobe choices such as colors, fabrics, and patterns may appear on screen, as they may distract from the activities being modeled.  5. Assess (How will we determine the impact and effectiveness of the TOF training?)  Determine best evaluation strategies to assess uptake and effectiveness. Develop and integrate assessment and quality assurance measures into process evaluation. Analyze results of the evaluation to determine efficacy.  Anticipate the need to track uptake and utilization beyond self-report measures. Recognize limitations of data collection methods when participants may have little to no contact with project staff.  Phase  Methodology  Lessons learned  1. Motivate (How would a digital training be utilized by trainees?)  Determine current use and preferred features of digital platforms. Review process and outcome evaluations from face-to-face TOFs.  Ensure a diverse population is represented in formative evaluation to gain insight into what level of digital access is typical for the community.  2. Engage (What core components from the face-to-face TOF should be integrated into the digitized version?)  Consult topical experts to review translation options and trends. Evaluate innovative technologies (such as DVD, web, and app platforms) to deliver digitized training based on intended audience. Hire a video production company knowledgeable about health promotion and topical area. Consider TOF core components for inclusion in digitized version. Outline translation plan based on core components.  Engage with experts who are knowledgeable about digital platforms and experienced communicating the subject matter of interest. Be clear about the scope of the project with stakeholders and collaborators, including limitations of timeline, budget, and other resources. Consider potential trainees’ familiarity with topical knowledge, technical language, and group facilitation when selecting core components.  3. Digitize (How do you create the digitization plan?)  Work with production staff to determine best practices for digitization process. Create storyboards and scripts of all training modules based on original face- to-face training manual.  Write in plain language for easy user readability. Utilize shorter modules, as trainees are willing to invest less time per sitting in reviewing training materials.  4. Implement (How will the TOF training be filmed and packaged?)  Determine filming set and locations(s). Schedule filming dates and times. Cast actors or extras to model core intervention activities. Collect props or materials needed. Reserve any technical or A/V equipment needed for filming. Film all training modules and record voice-overs. Collaborate with video production company to edit and compile digitized training. Package training for dissemination.  Obtain media and photo releases for copyrighted material in advance of filming. Ensure all modules are fully scripted and blocked before arriving on set for filming. Develop a comprehensive list of any props, equipment, and backdrops needed. Consider how wardrobe choices such as colors, fabrics, and patterns may appear on screen, as they may distract from the activities being modeled.  5. Assess (How will we determine the impact and effectiveness of the TOF training?)  Determine best evaluation strategies to assess uptake and effectiveness. Develop and integrate assessment and quality assurance measures into process evaluation. Analyze results of the evaluation to determine efficacy.  Anticipate the need to track uptake and utilization beyond self-report measures. Recognize limitations of data collection methods when participants may have little to no contact with project staff.  TOF Training of Facilitators. View Large Step 1: Motivate This step aims to determine the usefulness of digitized trainings for intended end users by assessing their current use of and familiarity with technology. Review feedback from previous projects that directly involved the community in question, or use qualitative methods to gather new data. These formative efforts should assess the feasibility, accessibility, and desirability of proposed digital platforms. Be sure to include a diverse sample of respondents in formative work to accurately represent the attitudes of the user base. During the first 3 months of development, our team analyzed process and outcome evaluations from the previously piloted P4 for Women face-to-face TOFs to assess the potential acceptability of DVD-based trainings. Our analysis suggested that transitioning from face-to-face instruction to a digital platform would be well received, as a digital TOF would (a) reduce participant burden; (b) improve sustainability of community trainings; (c) eliminate travel costs; (d) increase delivery fidelity; and (e) provide opportunity for repeated viewings. Step 2: Engage This step includes consulting with topical experts to determine the best digital platform and format for translation efforts. Possible platforms might include live or recorded webinars, interactive web applications, smartphone apps, and training videos. In making this decision, consider the costs required to develop, film, and disseminate a digitized training, as well as the accessibility of the platform for the intended audience. Also consider what components should be translated into the chosen format and what components might be best conveyed using supplemental materials. After reviewing the formative evaluations described in Step 1, we determined that a video training would be the most appropriate, accessible, and flexible platform for dissemination, as it could be distributed as both a DVD and online through a website or video hosting service. The research team selected a local production company with prior experience developing a variety of health promotion videos including public service announcement campaigns, trainings, and digital interventions. The production company also had experience working with our target population. After meeting with our study team to brainstorm the anticipated product, the video production experts aided the team in determining which pieces of the TOF should be filmed, appropriate length of video segments, and considerations for developing materials to support the self-administered video training. Based on this advice and the formative findings from Step 1, the Master Trainers developed an outline for the digital translation process, noting core components to be included. Step 3: Digitize The digitization step includes translating and scripting face-to-face TOF components for a digital platform using storyboards or other platform-specific tools as a plan for your digitization process. Throughout the process, work closely with production staff to corroborate that these plans are compatible with the digital platform of choice. Bear the end user in mind at all times, scripting the training for ease of understanding and utilizing shorter modules for reduced participant burden. The research team worked in collaboration with the video production company to translate the face-to-face training into a series of storyboards. Utilizing this as a translation plan, the master trainers developed scripts for each module of the training, including brief introductions to segments intended to guide viewers through the training process. Throughout the development of the script, the master trainers kept in mind the theoretical underpinnings of the original intervention and TOF including Social Cognitive Theory (SCT), Theory of Gender and Power (TGP), and the ADAPT-ITT model [33–35]. Trainers applied SCT and TGP by casting appropriately aged African American women as health educators and participants in mock sessions throughout the training videos. The scripted digitized training commenced with the history and aims of the P4 for Women intervention, the goals for the training, an overview of the HIV epidemic in the South, and the role of the Black church in combatting the epidemic. To emulate facilitation of a live training, Master Trainers introduced each new segment and modeled core activities with mock participants. The script included instructions for setting up the room and a detailed presentation of the toolkit and session materials. The training also included a condom demonstration appropriate for both training facilitators and use as a video clip during a session activity. Step 4: Implement Utilize the developed translation plan and storyboards to guide implementation. This includes determining and scheduling filming location, casting extras, collecting props, renting A/V equipment, and securing media releases for copyrighted material. For efficiency during filming, ensure all modules are fully scripted and blocked in advance, develop a comprehensive list of props and equipment, and consider how wardrobe choices or backdrop patterns may appear on screen. The originally piloted 14-hr face-to-face TOF was translated into a 4-hr video training, divided into shorter segments, or video chapters. Four days (36 hr of effort) were required to stage and film the 4-hr training, including the introductory remarks, one 50-min segment for each of the three P4 for Women Intervention sessions, and the condom demonstration. For each P4 for Women session, the Master Trainers explained the session’s goals, detailed an ideal facilitation, and demonstrated selected intervention activities. After filming was completed and an initial draft of the training video was created, the Master Trainers met with the production company to select camera shots, edit the sequences, incorporate voice-overs relaying key training concepts, and add in unique features such as on-screen pop-ups to highlight training tips and name facilitation skills being demonstrated. Finally, the TOF DVD was reviewed for quality assurance, reproduced, and packaged for distribution. Step 5: Assess Evaluate the feasibility and effectiveness of the digitized TOF by assessing the fidelity with which newly trained facilitators implement the program and evaluating how trainees used the training materials. In developing the assessment, anticipate the need to track uptake beyond self-report measures and recognize potential limitations of data collection when trained facilitators have little to no contact with research staff. A variety of methods were used to assess implementation fidelity, measure uptake of training materials, and evaluate acceptability of the digitized TOF. Two quality assurance raters attended sessions implemented by trained P4 for Women facilitators to measure implementation fidelity according to the provided scripted curriculum, as well as the ability of lay health educators to incorporate key facilitation skills into the sessions. Quality assurance raters used standardized forms to score facilitators, which facilitators received as part of their toolkit. Quality assurance raters also administered self-evaluation forms to trained facilitators immediately after P4 for Women sessions, which evaluated facilitators’ perceptions of the session and asked about training materials reviewed to date. In addition, facilitators received quantitative electronic surveys, distributed via email at the close of the implementation period, which collected detailed information about the number of times trainees watched each video module and reviewed supplemental materials. To supplement self-reported uptake of training materials, web analytics were used to monitor the number of times each video module was viewed on the program’s website, the average amount of time spent viewing the online training videos, and the number of repeat versus unique visitors. From launching the P4 for Women training website in February 2015, which contained the digitized training videos, to the final church implementation of the P4 for Women sessions in July 2016, web analytics captured the uptake of the training videos. The link to the website, and therefore training videos, was private and would not appear in any search engines. Study participants drove traffic to the website through either their direct use or through dissemination of the website link to their social network. Over the course of 17 months, 715 unique users visited the website 1,432 times. A total of 49.79% of the website visits were from new users. The P4 for Women introduction video and three session training videos were watched for a combined 3,645 min (60.75 hr) over the 17 months. Data demonstrate that the three core intervention training videos (sessions 1, 2, and 3) were, on average, not viewed in their entirety and the first and second session videos were viewed more frequently than the third session video. More detailed web analytics for each training video are described in Table 2. Table 2 Web analytics describing P4 for Women digitized training video uptake Video title  Number of views  Total watch time (min)  Full video run time (hh:mm:ss)  Average view duration (mm:ss)  P4 for Women Training Introduction  70  317  00:08:18  04:31  Session 1 Training  62  1,202  00:58:03  19:22  Session 2 Training  68  2,403  01:27:10  35:20  Session 3 Training  38  777  00:58:06  20:26  Condom Demonstration  19  26  00:01:32  01:23  Video title  Number of views  Total watch time (min)  Full video run time (hh:mm:ss)  Average view duration (mm:ss)  P4 for Women Training Introduction  70  317  00:08:18  04:31  Session 1 Training  62  1,202  00:58:03  19:22  Session 2 Training  68  2,403  01:27:10  35:20  Session 3 Training  38  777  00:58:06  20:26  Condom Demonstration  19  26  00:01:32  01:23  View Large Table 2 Web analytics describing P4 for Women digitized training video uptake Video title  Number of views  Total watch time (min)  Full video run time (hh:mm:ss)  Average view duration (mm:ss)  P4 for Women Training Introduction  70  317  00:08:18  04:31  Session 1 Training  62  1,202  00:58:03  19:22  Session 2 Training  68  2,403  01:27:10  35:20  Session 3 Training  38  777  00:58:06  20:26  Condom Demonstration  19  26  00:01:32  01:23  Video title  Number of views  Total watch time (min)  Full video run time (hh:mm:ss)  Average view duration (mm:ss)  P4 for Women Training Introduction  70  317  00:08:18  04:31  Session 1 Training  62  1,202  00:58:03  19:22  Session 2 Training  68  2,403  01:27:10  35:20  Session 3 Training  38  777  00:58:06  20:26  Condom Demonstration  19  26  00:01:32  01:23  View Large Phase 2: Development of supplemental materials Three major components supplemented the video trainings to aid in ease of training, uptake, and session implementation: a user guide, a toolkit, and a program website. Differences between the components included in the face-to-face TOF and the digitized TOF are detailed in Table 3. Table 3 Comparison of components included in face-to-face TOF versus digitized TOF for the P4 for Women faith-based HIV prevention intervention Training component  Prior face-to-face TOF  Digitized TOF components  Training video  User guide  Website  Toolkit  Training and Intervention Introduction  X  X    X    P4 for Women Session 1 Training  X  X    X    P4 for Women Session 2 Training  X  X    X    P4 for Women Session 3 Training  X  X    X    Preparing for Sessions and Room Setup  X  X    X    Past Participant Testimonials    X    X    Supplemental Informational Videos from Collaborators    X    X    Facilitation Skills  X  X  X  X    Local Referrals and Resources to Community Partners      X  X    Reflective and Debriefing Materials      X  X  X  Instructions for Using the Training Materials      X      HIV 101 Video          X  Scripted Intervention Manuals  X        X  Example Participant Manuals          X  Intervention Activities Props          X  Training component  Prior face-to-face TOF  Digitized TOF components  Training video  User guide  Website  Toolkit  Training and Intervention Introduction  X  X    X    P4 for Women Session 1 Training  X  X    X    P4 for Women Session 2 Training  X  X    X    P4 for Women Session 3 Training  X  X    X    Preparing for Sessions and Room Setup  X  X    X    Past Participant Testimonials    X    X    Supplemental Informational Videos from Collaborators    X    X    Facilitation Skills  X  X  X  X    Local Referrals and Resources to Community Partners      X  X    Reflective and Debriefing Materials      X  X  X  Instructions for Using the Training Materials      X      HIV 101 Video          X  Scripted Intervention Manuals  X        X  Example Participant Manuals          X  Intervention Activities Props          X  TOF Training of Facilitators. View Large Table 3 Comparison of components included in face-to-face TOF versus digitized TOF for the P4 for Women faith-based HIV prevention intervention Training component  Prior face-to-face TOF  Digitized TOF components  Training video  User guide  Website  Toolkit  Training and Intervention Introduction  X  X    X    P4 for Women Session 1 Training  X  X    X    P4 for Women Session 2 Training  X  X    X    P4 for Women Session 3 Training  X  X    X    Preparing for Sessions and Room Setup  X  X    X    Past Participant Testimonials    X    X    Supplemental Informational Videos from Collaborators    X    X    Facilitation Skills  X  X  X  X    Local Referrals and Resources to Community Partners      X  X    Reflective and Debriefing Materials      X  X  X  Instructions for Using the Training Materials      X      HIV 101 Video          X  Scripted Intervention Manuals  X        X  Example Participant Manuals          X  Intervention Activities Props          X  Training component  Prior face-to-face TOF  Digitized TOF components  Training video  User guide  Website  Toolkit  Training and Intervention Introduction  X  X    X    P4 for Women Session 1 Training  X  X    X    P4 for Women Session 2 Training  X  X    X    P4 for Women Session 3 Training  X  X    X    Preparing for Sessions and Room Setup  X  X    X    Past Participant Testimonials    X    X    Supplemental Informational Videos from Collaborators    X    X    Facilitation Skills  X  X  X  X    Local Referrals and Resources to Community Partners      X  X    Reflective and Debriefing Materials      X  X  X  Instructions for Using the Training Materials      X      HIV 101 Video          X  Scripted Intervention Manuals  X        X  Example Participant Manuals          X  Intervention Activities Props          X  TOF Training of Facilitators. View Large User guide. One of the Master Trainers collaborated with a health educator from the research team who had not previously worked with the P4 for Women curriculum to create the TOF user guide. This collaboration specifically intended to combine the knowledgeable perspective of a Master Trainer with the viewpoint of a health educator learning the intervention materials for the first time, an experience that would closely mirror that of the facilitators who would be relying on the user guide to provide further clarification. Throughout the development process, the two authors worked to ensure that the guide was visually appealing and interactive, that critical information was centralized and highlighted, and that materials were appropriate for an audience without health education experience. First, the authors met to review the P4 for Women curriculum and compile a list of modules excluded from the video training in Step 2. These modules focused primarily on developing and applying facilitation skills such as active listening, being nonjudgmental, and roleplaying. The authors developed and iteratively edited these modules over the course of 3 months, before submitting a final set of translated modules to the research team for review. Next, the two authors met to discuss additional topics that needed to be covered in the user guide. To tailor the guide to a completely naive audience, they generated a list of possible questions and concerns facilitators with no prior knowledge or information about the P4 for Women program might have. This list was informed by common questions asked during previous HIV prevention trainings conducted by the research team. In answering questions about implementing specific lessons, the authors tried to include high, medium, and low resource options for each activity to increase the sustainability of the program in the event supplies were depleted or misplaced over time. After finalizing the content, the authors met again to discuss how to organize the user guide. Again, the authors attempted to take the perspective of someone unfamiliar with the P4 for Women curriculum and inexperienced as a health educator in order to make the materials easy to navigate and ensure that successive sections would build on each other in a logical way. In the end, the user guide was split into five sections, which are described in detail in Table 4. Table 4 Description of P4 for Women supplemental user guide components User guide chapter  Description of content  Chapter 1: Welcome and Course Introduction  A brief explanation of the P4 for Women program, a literature review, a summary of the facilitator training course, and brief bios of the main actors in the training video.  Chapter 2: Preparing to Implement  A systematic guide on how to plan and implement sessions, develop connections with community resources for referrals, communicate with participants, and reflect on the successes and challenges of each session.  Chapter 3: Facilitation Skills  An overview of facilitation skills and opportunities for reflection and discussion regarding facilitation challenges.  Chapter 4: Using the Training Materials  An explanation of each of the training materials and how they can be best used as well as summaries and tips for each P4 for Women session.  Appendices  The appendices were used to house forms that were too long to place in the main body of the user guide including an example community resource sheet, a list of needed supplies and where churches could obtain replacements, and materials to help facilitators debrief after sessions.  User guide chapter  Description of content  Chapter 1: Welcome and Course Introduction  A brief explanation of the P4 for Women program, a literature review, a summary of the facilitator training course, and brief bios of the main actors in the training video.  Chapter 2: Preparing to Implement  A systematic guide on how to plan and implement sessions, develop connections with community resources for referrals, communicate with participants, and reflect on the successes and challenges of each session.  Chapter 3: Facilitation Skills  An overview of facilitation skills and opportunities for reflection and discussion regarding facilitation challenges.  Chapter 4: Using the Training Materials  An explanation of each of the training materials and how they can be best used as well as summaries and tips for each P4 for Women session.  Appendices  The appendices were used to house forms that were too long to place in the main body of the user guide including an example community resource sheet, a list of needed supplies and where churches could obtain replacements, and materials to help facilitators debrief after sessions.  View Large Table 4 Description of P4 for Women supplemental user guide components User guide chapter  Description of content  Chapter 1: Welcome and Course Introduction  A brief explanation of the P4 for Women program, a literature review, a summary of the facilitator training course, and brief bios of the main actors in the training video.  Chapter 2: Preparing to Implement  A systematic guide on how to plan and implement sessions, develop connections with community resources for referrals, communicate with participants, and reflect on the successes and challenges of each session.  Chapter 3: Facilitation Skills  An overview of facilitation skills and opportunities for reflection and discussion regarding facilitation challenges.  Chapter 4: Using the Training Materials  An explanation of each of the training materials and how they can be best used as well as summaries and tips for each P4 for Women session.  Appendices  The appendices were used to house forms that were too long to place in the main body of the user guide including an example community resource sheet, a list of needed supplies and where churches could obtain replacements, and materials to help facilitators debrief after sessions.  User guide chapter  Description of content  Chapter 1: Welcome and Course Introduction  A brief explanation of the P4 for Women program, a literature review, a summary of the facilitator training course, and brief bios of the main actors in the training video.  Chapter 2: Preparing to Implement  A systematic guide on how to plan and implement sessions, develop connections with community resources for referrals, communicate with participants, and reflect on the successes and challenges of each session.  Chapter 3: Facilitation Skills  An overview of facilitation skills and opportunities for reflection and discussion regarding facilitation challenges.  Chapter 4: Using the Training Materials  An explanation of each of the training materials and how they can be best used as well as summaries and tips for each P4 for Women session.  Appendices  The appendices were used to house forms that were too long to place in the main body of the user guide including an example community resource sheet, a list of needed supplies and where churches could obtain replacements, and materials to help facilitators debrief after sessions.  View Large Facilitation toolkit It was our goal to have no costs associated with implementation to limit finances being a barrier to study participation. The research team used supply lists from the P4 for Women pilot study to create an initial list of materials to include in the toolkit. Experienced P4 for Women facilitators reviewed this list for completeness. Other members of the research team unfamiliar with the intricacies of program implementation also reviewed the list to determine whether additional explanatory materials were necessary. Website In an effort to increase access to the training videos, as only one DVD copy was provided per toolkit, a program website was designed to house the training videos, provide highlights of the user guide, and connect participating churches to resources within their community. The website was only accessible via a private URL, which research staff shared with churches. Users could post questions and comments anonymously or with a username on each page of the website. Utilization of the website was monitored using Google Analytics. The website was the last supplemental resource developed and finalized, as it mirrored the final versions of the training videos, user guide, and other resources within the toolkit. The website ultimately included information about the P4 for Women program, frequently asked questions, all training video chapters, an overview of successful facilitation skills, the handouts and materials needed to implement each session, and links to community organizations that provided HIV-related testing and services. DISCUSSION The purpose of this study was to digitize a traditional face-to-face TOF of a faith-based HIV prevention program for young African American women to a digital platform and to describe the MEDIA model, which guided the digitization process. The digital TOF and accompanying materials were then disseminated to predominantly Black churches in the Atlanta Metro Area and utilized to train church leadership and facilitators to implement the P4 for Women intervention among their congregants. Based on the digitization and implementation process from this study, we derived three key lessons learned. Allow ample time for digitization Based on the steps outlined in the MEDIA model, anticipate that the digitization process will require more time than expected. The entire process for this study took 15 months, double the originally allotted time for development and digitization. Due to the collaborative nature of this process, delays will occur. Be sure to discuss clear timelines with partners or collaborators in advance and build in extra time for additional edits or rewrites. Additionally, consider that utilizing a local production company can decrease the time needed, as it may allow for more flexible scheduling and faster turn-around times. Pilot with appropriate and diverse audiences prior to filming Piloting in advance is just as key to the adaptation process as it is to the initial intervention design [30, 33, 36]. Once filming occurs it is expensive, time consuming, and often not feasible to make changes to the digitized training. Therefore, obtain feedback from anticipated end users throughout the process. Keep in mind that aspects of traditional face-to-face trainings will not translate identically to digitized versions, and it is important to ensure usability among audiences who have not yet been exposed to the curriculum. Assessing preferred video length and total run time in advance is particularly important. In this study, although the digitized videos were significantly shorter than the modules taught during a face-to-face training, facilitators ultimately preferred chapters to be even shorter than anticipated and divided into small sections that could be viewed over time. Incorporate structure and a clear progression within the training modules Lastly, it is important to incorporate structure into the training, especially within the digitized content itself. In previous face-to-face trainings, the Master Trainers were physically present to guide the training and provide oversight. With the digitized version, this oversight and instruction needed to be built in. For example, although the video chapters were numbered and the user guide extensively described best practices for reviewing all materials, facilitators in this study often did not consult these materials first and would therefore move through the video chapters out of order. In this training, successive modules built on knowledge and skills from previous sections of the training, so initially viewing the modules out of order may have resulted in confusion and poorer training outcomes. Incorporating a required linear progression for facilitators to follow the first time they view the materials may be beneficial [30]. PUBLIC HEALTH IMPLICATIONS Digital trainings for lay health educators have the potential to increase capacity in vulnerable communities to address significant public health problems without creating undue burdens on scarce resources. However, creating such trainings requires collaborative efforts between health educators, digital media experts, and community stakeholders, as well as careful thought to translation and repackaging of key training messages. The MEDIA model and the lessons learned presented here can help guide the creation of future digitized trainings for lay health educators. Future publications from this dissemination study will explore findings more thoroughly from Step 5 (Assessment), including the analysis of the research team’s quality assurance ratings, the lay health educator’s self-evaluations, P4 for Women participant evaluations from the enrolled churches, and pre- and post-intervention qualitative interviews. Acknowledgments We are excited to report that findings from this article were presented at the 144th American Public Health Association’s Annual Meeting in 2016. We confirm that this manuscript has not been published elsewhere and is not under consideration by any other journal. Funding: Funding from the Agency for Healthcare Research and Quality supported this study (grant number 1R24HS022059). The authors would like to recognize and thank the hard work and dedication of all the staff, consultants, and collaborators who made this study possible. Special thanks to the project director, LaShun Robinson, and two P4 for Women Master Trainers, Tiffaney Renfro and Nikia Braxton. Thank you to MEE Productions for spearheading filming and video production. Thank you to key community collaborators and contributors such as the National Black Leadership Commission on AIDS (NBLCA), Gilead Sciences, Inc., NAACP, and AID Atlanta. The authors would also like to thank the churches that were involved in the initial pilot and served on the Community Advisory Board for this study, providing essential feedback and support. Human Rights Statement and IRB Approval: The Emory University institutional review board (IRB: 00064678) approved the study protocol. The informed consent explicitly stated that research participant’s involvement in or data from any aspect of the study would remain confidential. This study embodies the Helsinki Statement on ensuring research methods that promote health equity and health promotion for all populations. Compliance with Ethical Standards Author’s Contributions: T.R. was the master trainer for the digitized training, conceptualized the process for the training model, assisted with training implementation, and assisted with writing the article. E.J. conceptualized and developed the supplemental training components and toolkit materials for the study and assisted with writing the article. D.L. supervised the data team and conducted data analysis, assisted with study implementation, and assisted with writing the article. G.W. received the funding, conceptualized and supervised the study, and revised and provided feedback for the article. R.D. conceptualized and supervised the study and revised and provided feedback for the article. These authors have full control of all primary data from the main trial and if needed will allow the journal to review if requested. Conflict of Interest: These authors pose no conflicts of interest related to this study. References 1. 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Translational Behavioral MedicineOxford University Press

Published: Feb 17, 2018

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