Using PRISM (the Practical Robust Implementation and Sustainability Model) as a Framework for Identifying Community and Contextual Factors that Enhance RCT Interpretation

There is often a disconnect between effectiveness-focused RCTs and implementation science, especially in health research. RCTs primarily assess intervention effectiveness but can neglect the process data crucial for understanding sustainability. The Practical Robust Implementation and Sustainability Model (PRISM), an extension of RE-AIM, addresses this by adding four contextual domains: perspectives on the intervention, characteristics of implementers, external environment, and implementation infrastructure. This model helps researchers assess sustainability and health equity during design, implementation, and evaluation. In our adolescent pregnancy prevention study, we applied PRISM to our evaluation of a teen-pregnancy prevention booster program designed to equip older adolescents with sexual health knowledge. PRISM allows us to gather data on perspectives from youth, facilitators, and school communities, addressing factors like recruitment, retention, and implementation fidelity. Incorporating implementation science into evaluations provides a deeper understanding of how programs perform in real-world settings, identifying barriers and facilitators that enhance sustainability.