Examining Complex Program Adoption Decision-Making in a Health Pilot for U.S. Women Military Veterans: A Single Revelatory Case Study

A single retrospective, qualitative case study was conducted to examine the decision-making factors that impacted the adoption of a women-specific health transition pilot as a permanent program. The pilot was adopted as a permanent program prior to completing all expected pilot sessions and before the final pilot evaluation report was produced. This study examined factors affecting the program adoption decision at the societal, organizational, interpersonal, and individual levels. To examine this research question, the socioecological model was used as a theoretical framework to identify and understand the decision-making factors and their interactions at the various socio-ecological levels. Semi-structured interviews were conducted with 15 Veterans Health Administration (VHA) Transition Training pilot stakeholders. The study identified 12 predominant factors that facilitated the pilot’s adoption as a permanent program. The paper discusses implications and considerations for practitioners for making evidence-based decisions in highly complex contexts. Plain language summary A case study was conducted to examine the decision-making factors that impacted the adoption of a women’s-specific health program for transitioning service members as a permanent program. The pilot was adopted as a permanent program prior to completion of all expected pilot sessions and before the final pilot evaluation report was produced. This study examined the decision-making factors that affected the program adoption decision at levels of the socioecological model, including societal, organizational, interpersonal, and individual levels. Interviews were conducted with pilot stakeholders to understand the decision-making factors. The study identified 12 predominant factors (and 24 overall factors) that facilitated the pilot being adopted as a permanent program. The paper discusses implications and considerations for practitioners for making evidence-based decisions in highly complex contexts.