Dissertations and Theses (Open Access)

Date of Award

Fall 12-31-2025

Degree Name

Doctor of Public Health (DrPH)

Advisor(s)

VANESSA SCHICK, PHD

Second Advisor

PAIGE WERMUTH, PHD

Third Advisor

GRETCHEN WALTON, JD, MPH

Abstract

This study examined how community-based practitioners implement public health interventions in practice settings to identify gaps between existing implementation frameworks and real-world practice. Six farmers' markets in Southeast Texas served as cases to understand implementation decision-making by community-based practitioners addressing food access challenges. A qualitative case study approach was employed, using semi-structured interviews with program adopters and key stakeholders to examine how practitioners addressed food access problems, selected interventions, and navigated implementation decisions. This methodology captured the contextual nature of implementation decision-making in community settings. The findings revealed that program adopters recognized health problems through lived experience rather than formal surveillance, responded with contextual and experiential knowledge rather than following linear planning sequences, and relied primarily on contextual and experiential knowledge over academic knowledge. Respondents noted that while they valued flexibility in their work, this flexibility meant they operated in ways that diverged substantially from how existing frameworks depict implementation. These patterns revealed substantial gaps between how existing frameworks depict implementation and how it actually unfolds in community settings. These findings have important implications for implementation science and community health practice. They demonstrate a disconnect between theoretical implementation models and the actual processes practitioners use in community settings. The practitioners' reliance on experiential rather than formalized planning sequences suggests that current frameworks may not adequately capture or support how community-based work actually unfolds. This gap points to the need for approaches that better reflect the adaptive, context-driven nature of implementation in community settings. In response, this study introduces the Framework for Collaborative Intervention Design and Implementation in Community Health, a model that seeks to bridge the divide between implementation theory and community practice realities.

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