Cultural tailoring is increasingly recognized in sexual and gender minority (SGM) focused health interventions, yet its effectiveness in anti-smoking messages for sexual minority women (SMW) remains underexplored. This formative study examined how culturally tailored messages were received among SMW populations. Using a quantitative online experiment ( N = 155), we investigated whether tailored messages are more effective than non-tailored messages in influencing SMW’s message perceptions (i.e., perceived message effectiveness and perceived targetedness) and whether message effects varied by sexual orientation. Participants were randomly assigned to view either SGM-tailored messages, which featured rainbow colors and LGBTQ+-themed slogans, or non-tailored messages that used pink colors and slogans highlighting general women’s health. Tailored and non-tailored anti-smoking messages were equally influential in shaping young adult SMW’s message perceptions. However, variations were observed within different SMW subgroups. Compared to bisexual participants, gay/lesbian participants and those with another sexual orientation (e.g., asexual, queer, and pansexual) showed a preference for tailored messages, with gay/lesbian participants rating non-tailored messages as less effective and those of another sexual orientation considering non-tailored messages as less personally relevant. In contrast, bisexual participants reported relatively high message effectiveness across both conditions but did not find either message type particularly targeted. These findings suggest that while broad tailoring efforts may enhance general appeal, their impact may vary across SMW subgroups. More nuanced and inclusive tailoring strategies may be needed to strengthen the relevance and impact of health communication among SMW populations.

BackgroundThe potential for implementation science (IS) to address health inequities is limited by insufficient attention to power. Although the field emphasizes context, it remains unclear how best to examine and intervene on power relations related to the implementation of evidence-based interventions (EBIs). This scoping review aimed to determine: 1) To what extent do research projects studying EBI implementation explicitly examine power? 2) In these studies, how is power conceptualized, defined, operationalized, and understood? 3) What opportunities exist to examine and intervene upon power through IS research?MethodsFollowing established procedures, we undertook a six-step process: 1) articulating research question and purpose; 2) identifying relevant studies; 3) selecting studies; 4) extracting data; 5) summarizing data; and 6) reporting results. We characterized studies' attention to power using Fung's power framework, which attends to everyday, policy, structural, and ethical power. Based on publications available as of February 2022, we included English-language EBI implementation studies from clinical, community, and public health settings that explicitly attended to power. Data extraction included study context, IS frameworks used, definitions and measures of power, and characterizations of how power influenced implementation processes and outcomes.ResultsOf 3,531 articles screened, 28 papers explicitly discussed power in relation to EBI implementation and 11 presented a formal definition of power. Most studies explored everyday and structural power, with far less attention to policy power and almost none to ethical power. Conceptualizations and operationalizations of power varied widely, and few studies reported grounding in IS frameworks. Explicit strategies to intervene upon power were limited. Most studies focused on short-term integration goals, with limited discussion of how power dynamics shape what counts as evidence, whose interests are served, or opportunities for systems transformation.ConclusionsResearchers have the opportunity to explicitly integrate power theories and frameworks into conceptual models for IS studies to reshape IS efforts and build this evidence base. This will allow the field to move towards critical, systems-focused perspectives that examine how power shapes and can be used to reshape the evidence base, implementation systems, implementation strategies, and implementation, health, and system outcomes.

Introduction Smoking rates among sexual and gender minority (SGM) adults are generally higher than those in the general population. Tailoring anti-smoking messages for SGM young adults is a promising strategy to reduce health inequalities, but ignoring the difference between gender groups within the SGM community is problematic.Methods We conducted two experiments to examine whether gender expression affected the perceived targetedness (PT) among SGM young adults aged 18 to 30. In the first study, participants were randomly assigned to view 8 out of 80 images using various gender expressions. In the second study, participants were randomly assigned to one of four conditions (transgender/nonbinary expressions vs. feminine expressions vs. masculine expressions vs. multiple gender expressions) and viewed six anti-smoking campaign messages in each condition.Results Both studies found that compared to messages with other gender expressions, gender-expansive individuals reported higher PT when viewing messages with transgender/nonbinary expressions. Cisgender sexual minority women reported higher PT when viewing messages with feminine expressions. Cisgender sexual minority men reported higher PT when viewing messages with masculine expressions. There was no significant difference in PT between multiple gender expressions and gender expressions matching individuals' gender identity.Conclusions Culturally tailored anti-smoking messages using gender expressions matched to gender identity or messages using multiple gender expressions were more effective in achieving PT than messages using unmatched gender expressions.Implications Gender is critical to tailoring anti-smoking campaign messages for SGM young adults. We should not view the SGM community as a monolith in smoking interventions and need to tailor messages to different gender groups within the community. Future research should investigate how sexual expressions affect PT and how gender expressions influence persuasion outcomes beyond PT. Additionally, intersectional analyses of multiple social identities may provide deeper insights into the effects of SGM-tailored anti-smoking messages.

High smoking rates among sexual and gender minority (SGM) people call for anti-smoking campaigns for the population. Although cultural tailoring is an effective strategy, SGM-tailored health messages may lead to unintended effects such as psychological reactance. This study investigates whether different SGM gender groups experience reactance to tailored anti-smoking messages using different gender expressions. We conducted a between-subjects experiment in 1190 SGM young adults (18-30 years) with four conditions (transgender/nonbinary expression versus feminine expression versus masculine expression versus multiple gender expressions). We found that SGM-tailored messages elicited low levels of perceived threat to freedom, anger, negative thoughts, and counterarguing. In most cases, these outcomes were not different between conditions across gender groups. Our findings suggest that it is possible to design culturally tailored messages that elicit low reactance among SGM individuals regardless of gender identity. Additionally, using multiple gender expressions in cultural tailoring appears to be a promising approach to mitigating reactance.

Introduction: LGBTQ + youth of color face profound mental health inequities driven by intersecting systems of oppression, including racism, homophobia, and transphobia. Community-based organizations (CBOs) can mitigate this, but their impact is hindered by contextual constraints and a culturally unresponsive evidence base that tends to privilege individual-level interventions and restrictive definitions of effectiveness. Methods: We conducted a three-year, participatory, single-case qualitative study of Boston GLASS, a CBO serving LGBTQ + youth of color, to elucidate how high-quality mental health care is conceptualized and enacted. Co-led by community- and university-based researchers, the study gathered data via interviews, focus groups, document review, and observations between October 2022 and December 2025. Results: GLASS staff treat care not as a set of discrete clinical encounters but as a structurally and culturally responsive, relationship-centered ecosystem. Three forces animate this model: (1) connecting to broader social movements; (2) centering collective joy, community, and shared humanity; and (3) elevating lived, practicebased, and local expertise. However, the model is vulnerable to restrictive and fragmented funding and administrative burden, staff burnout, and a hostile sociopolitical environment targeting LGBTQ + people of color. Conclusion: The GLASS model problematizes dominant conceptions of the active ingredients in "effective" care by foregrounding community, infrastructure, and relational practices as central to impact. Sustaining such models will require broadening definitions of evidence to support community-led frameworks, with correspondingly broad metrics to capture diverse impacts, and political will of funders, policy-makers, and researchers to cultivate conditions in which community-led models thrive.

Professional development (PD) to help teachers learn to use curriculum materials can be effective in aiding fidelity of implementation and supporting student learning. PD may be particularly necessary for curricula focused on students' ethnic-racial identities, given educators' potential discomfort and limited formal training focused on strategies for discussing race/ethnicity in class. The Equipping Educators for Equity through Ethnic-Racial Identity (E⁴) PD prepares educators to implement an eight-lesson ethnic-racial identity curriculum with high school students. We tested whether fidelity of implementation of the ethnic-racial identity curriculum varied by two training modalities: in-person versus remote. Teachers' ( N  = 14) fidelity of implementation across 55 classrooms was assessed via 440 observations. Teachers' fidelity regarding curriculum adherence was high (76%) and did not vary significantly by training modality. Remote and in-person training resulted in similar fidelity of implementation, suggesting remote trainings may enable scaling up without sacrificing impact.

BACKGROUND:Effective cancer prevention interventions are not equitably implemented, particularly in healthcare settings serving underserved populations. Engaging a diverse range of partners, especially those involved in frontline care, is critical for advancing equity-focused implementation. Research networks that include community-based providers can help co-create knowledge, strengthen collaboration, and drive system-level change. PURPOSE:This study aims to assess the composition and structure of the Implementation Science Center for Cancer Control Equity (ISCCCE) partnership to identify opportunities for enhancing engagement, increasing diversity, and strengthening collaboration in cancer prevention research. METHODS:A descriptive social network analysis was conducted to examine the ISCCCE partnership and identify areas for enhanced engagement. Network demographics and characteristics were analyzed across collaboration-type subnetworks using the Implementation Science Centers for Cancer Control and ISCCCE network survey data. RESULTS:The baseline network consisted of 27 respondents, most in faculty roles (55%), with 15+ years of experience (48%). Most identified as non-Hispanic White (63%) and female (70%). The overall network density was 61%, with subnetwork densities ranging from 13% (scientific dissemination) to 55% (planning/conducting research). Centralization was moderate overall (0.3), with certain subnetworks more centralized. CONCLUSIONS:The network demonstrated strong connectivity in research planning but weaker ties in dissemination and capacity building. To strengthen impact, efforts should focus on engaging trainees and partners more deeply, increasing demographic diversity, and fostering inclusive collaboration. These insights inform practice (e.g. strengthening FQHC partnerships), policy (e.g. funding diverse networks), and research (e.g. leveraging social network analysis to improve equity in implementation science).

Proactive, action-oriented dissemination planning is still too rare for community-engaged research teams. To fill this gap, a national program for community-engaged research teams addressing health inequities developed a training to support dissemination planning. Our objectives in this paper are to 1) describe the curricular components that support research teams’ dissemination planning processes; 2) share a template that can be used and adapted by other community-engaged, action-oriented research teams for proactive dissemination planning; 3) describe the high-level dissemination planning themes (i.e., goals, audiences) and initial strategies of 15 research teams that went through the training and dissemination planning process. A dissemination planning curriculum was developed and implemented over the first year of the research program. The curriculum consisted of an interactive webinar, didactic self-paced video modules, and two, two-hour workshops, alongside a dissemination planning template that all research teams completed. Reflection on the curriculum evolution and a systematic analysis of a set of 15 teams’ submitted dissemination plans generated themes applicable to future community-based researchers’ dissemination processes. Advancing health equity through the generation of community-engaged research requires a systematic and proactive approach to dissemination of research results to audiences to advance action goals. Elements of this curriculum and/or the planning protocol can be used by other community-engaged research teams.

OBJECTIVE:To assess the equitable implementation of a case management program integrating medical and social services for Medicaid members. STUDY SETTING AND DESIGN:This qualitative study assessed the equitable implementation of a case management program in Contra Costa County, CA. Study participants were identified using purposive sampling. Semi-structured interviews were conducted in person or by phone. DATA SOURCES AND ANALYTIC SAMPLE:Primary data were collected between Fall 2019 and Spring 2021 and included 92 semi-structured interviews with patients (n = 31), case managers (n = 47), and county administrators (n = 14). Data were coded using an inductive-deductive framework analysis approach informed by the Health Equity Implementation Framework (HEIF). PRINCIPAL FINDINGS:Characteristics of the innovation influencing equitable implementation included experienced public health nursing leadership and inclusion of social risk factors in a predictive algorithm determining patient program eligibility. Recipient factors included inequitable emotional demands of medical and social service integration work on case management teams from diverse racial/ethnic and training backgrounds, and patient experiences of mistreatment from medical and social service institutions. Clinical encounter factors highlighted the necessity for trust building between patients and case managers and the importance of multidisciplinary expertise to address patients' interconnected medical and social needs. Contextual factors described organizational readiness in the form of multidisciplinary teams with reduced hierarchical power imbalances, system-wide investments in a universal data infrastructure and data insights team, and strong intra- and inter-organizational partnerships. Societal factors included systemic discrimination and racism, insufficient affordable housing and public transit, pervasive administrative barriers in accessing health and social services, and federal funding for holistic approaches to integrated care. CONCLUSIONS:Case management programs aiming to equitably integrate social and medical services should invest in multidisciplinary case management teams, organizational readiness for equitable implementation via committed, experienced leadership, and interventions to address systemic factors hindering the engagement of historically marginalized groups.

Purpose:Rural women in the U.S. experience persistent inequities in breast cancer (BrCa) screening access, yet rural populations are often treated as a monolith in research and practice. This study serves as a proof of concept by examining how contextual heterogeneity across rural settings in South-Central Washington shapes screening behaviors and access, emphasizing the intersection of structural, cultural, and environmental factors through a community-informed lens. Methods:Guided by the Community Capitals Framework, we conducted focus groups with women in two demographically and economically distinct rural communities in South-Central Washington. Participants discussed how barriers to BrCa screening manifest across seven domains of community capital-natural, cultural, human, social, political, financial, and built-offering a multidimensional understanding of health access in context. Findings:Participants across both rural settings identified overlapping community barriers, but also revealed unique, context-specific barriers. Four emergent themes captured these dynamics: (1) seasonality and competing resource demands; (2) distance as a resource-dependent constraint; (3) gendered expectations shaping care access; and (4) race and place influencing resource distribution. These findings illustrate how overlapping systems of power and community assets interact to shape health behavior and access. Conclusions:Addressing rural BrCa screening inequities requires more than generic rural interventions; this study demonstrates that inequities may manifest differently across rural types, with distinct underlying dynamics shaping barriers. By showing how contextual variation influences health behaviors, this proof-of-concept study underscores the importance of disaggregating rural populations in health research and tailoring interventions to the specific mechanisms and resources operating within each context.

STUDY OBJECTIVES:The transition from Standard Time (ST) to Daylight Saving Time (DST) is associated with health, safety, economic, and other risks, and there is broad public support to "do away" with the change. However, most legislators have proposed permanent DST (pDST), contrary to medical and scientific recommendations. There is an urgent need to garner public support for legislation that would enact permanent Standard Time (pST), not pDST. METHODS:We employed a method called Design Thinking to uncover opportunities to design public communication strategies that garner public opinion supporting pST. As a first step, we recruited a multidisciplinary group (n = 19) of individuals with diverse expertise (e.g., sleep/circadian rhythms, design, policy/legislation). Attendees gave talks on their area of expertise then broke into groups to discuss why pDST is viewed positively by the public and data informing the medical and scientific endorsement for pST over pDST. During each activity, participant wrote down their reactions on sticky notes. Sticky notes were analyzed qualitatively to identify the primary themes. Finally, participants were instructed to create news headlines declaring a hypothetical future event in which pST was enacted. RESULTS:The reaction exercise generated 72 sticky notes. Themes regarding why pDST is viewed favorably included perception of longer days, social connections, freedom, and summer. Themes relating to the reasons pST should be preferred included better health and sleep, improved alertness, and learning/productivity. Participants identified potential 11 headlines, many of which emphasized health or cost savings associated with pST. CONCLUSIONS:Design Thinking is an under-explored but effective tool for uncovering potential barriers and brainstorming approaches for engendering support of evidence-based pST legislation. Statement of Significance The transition from Standard Time to Daylight Saving Time is associated with health, safety, economic, and other concerns. There is broad public support to "do away" with the clock change, but legislative efforts have proposed permanent Daylight Savings Time, which is contrary to medical and scientific society recommendations. There is an urgent need to garner public support for evidence-based clock time legislation, which would be for permanent Standard Time. We employed Design Thinking methodology with a multidisciplinary group of stakeholders, including sleep/circadian rhythms researchers, design experts, and policymakers. The results of the Design Thinking activities illuminated themes relating to the barriers to evidence-based clock time legislation, and opportunities for designing evidence-based slogans and messages.

Community-based organizations (CBOs) are well-positioned to deliver evidence-based interventions (EBIs) to communities facing health inequities. However, CBO practitioners do not typically have the opportunity to build the necessary skills for EBI delivery. Few validated measures assess EBI skill levels among CBO practitioners, limiting the development and evaluation of capacity-building interventions. Additionally, capacity-building models typically represent academics’ views of the subject, with little incorporation of practitioner voices. Thus, we sought to develop a new measure of EBI skills among CBO practitioners. Drawing on existing measures, qualitative research, and group concept mapping processes that privileged practitioner and academic expertise, we developed a 54-item instrument covering 10 core EBI skill domains (assessing needs, collaborating with partners, identifying evidence-based programs, adapting for context, implementing; evaluating and iterating; community engagement; planning for sustainability; managing; and funding). After conducting cognitive testing (n = 12), the instrument was administered online to CBO practitioners with at least 3 years of practice experience who served populations experiencing health inequities. Complete case factor analysis and reliability testing were conducted using R. Participants included 314 respondents, 96

Asian Indians are a diverse and growing immigrant population in the United States facing a disproportionate burden of chronic diseases, low cancer screening rates, and remain underrepresented in research. This study engages a newly developed cultural advisory board (CuAB) to guide inclusive and community-driven health research among Asian Indians. Informed by community-engaged research principles, the CuAB was composed of Asian Indian healthcare professionals from Washington State representing diverse linguistic, regional, and religious backgrounds that reflect the heterogeneity within the Asian Indian community. The CuAB guided a subsequent study that would explore the barriers and facilitators to telehealth use among Asian Indians - a key method for delivering preventive and cancer-related care. The CuAB members advised on the study design, consent process, recruitment materials and strategies, semi-structured interview guide, and next steps. Exit interviews were conducted with CuAB board members to understand their experience and to contribute to the limited literature on the formation, structure, and impact of CuABs in health research. Five individuals participated in the year-long CuAB, and four completed exit interviews. Their guidance informed the development of recruitment materials and the interview guide, highlighting opportunities to incorporate culturally relevant language, symbols, and colors. They also identified effective community-based recruitment and dissemination strategies, such as facilitating entry to local organizations for recruitment and regional groups for dissemination. The exit interviews revealed strong support for the board’s structure and size, meeting format, and its diverse composition. Suggestions for future CuABs included: dedicating the initial meeting to in-depth introductions so members can share their work and community networks; employing innovative tools to encourage participation from all members as cultural nuances may influence participation - for example, offering virtual or anonymized options for written input to support those less comfortable speaking up in group settings; and dividing the CuAB into two subgroups based on member interest and availability where one group is focused on setting meeting agendas and drafting study materials (like interview guides and recruitment tools), and the other provides feedback. This approach demonstrates how culturally nuanced community engagement models that center intracommunity diversity, like a CuAB, can shape more representative, relevant, and community-centered research. Such models offer a promising approach for cancer prevention research, where culturally tailored strategies and genuine, meaningful community involvement are critical to advancing health equity. Priyanka Gautom, Cirila Estela Vasquez Guzman, Lisa K. Marriott, Cara L. Eckhardt, Angad Singh, Stuti Nagpal, Anjulie Ganti, Shoba Ramanadhan, Gloria D. Coronado. Increasing rigor of inclusive health research with Cultural Advisory Boards (CuAB): Asian Indian recommendations for research practice [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B042.

Introduction Tobacco use accounts for approximately 1.35 million deaths annually in India, disproportionately affecting low-income individuals, men, rural residents, those without formal education and groups of low socioeconomic status (SES). Despite progress in tobacco control, scalable, low-cost solutions, such as brief advice interventions, are needed. This study explored priority implementation determinants for adapting an evidence-based brief advice/counselling intervention for high-reach, low-resource settings in Mumbai, India. The focal settings (health-focused and tuberculosis-focused non-governmental organisations (Health NGOs and TB NGOs) and dental clinics) served low-SES populations.Methods Mumbai-based and US-based team members conducted a qualitative study employing semistructured interviews to gather data from four groups connected to Health and TB NGOs and dental clinics: (1) 15 patients, (2) 33 practitioners, (3) nine practice leaders and (4) three policymakers. We used a team-based, critical, reflexive thematic analysis approach to analysis, grounded in the Exploration, Preparation, Implementation and Sustainment framework. We managed data with Nvivo software.Results Participants were supportive but highlighted diverse challenges and supports required for implementing the intervention in these diverse settings. First, many noted that societal constraints such as economic insecurity and cultural factors were expected to limit tobacco control efforts for low-SES populations. Second, setting-specific intervention adaptations were identified as necessary to support integration and ensure access to support for all patients. Various participant groups highlighted different adaptation areas. For example, patients noted that tobacco was part of their routines and social lives, practitioners emphasised the need to design implementation plans that support integration alongside existing needs, and policymakers highlighted the need for uniform implementation strategies.Conclusion Adapting brief advice/counselling interventions for Health NGOs, TB NGOs and dental clinics in Mumbai will require strategic communication to support buy-in, thoughtful workflow integration and changes to funding and support mechanisms for organisations so meaningful reductions in tobacco use can be achieved among low-SES groups. In other words, there is a need to adapt both the intervention and the implementing system to allow for brief advice/counselling to contribute to broader tobacco control efforts.Trial registration R01 CA230355.

Purpose Using evidence-based health communication campaigns (EBHCC) is critical for addressing disparities in tobacco-related health outcomes among LGBTQ+ populations; therefore, this study aimed to examine processes and supports for community-based organizations (CBOs) to integrate evidence-based solutions into practice using a design-for-dissemination framework. Approach Qualitative interviews were conducted. Setting CBOs serving LGBTQ+ populations. Participants 22 staff from U.S.-based CBOs participated in video interviews. Method We used reflexive thematic analysis to generate themes. Results 3 key themes included: (1) leaders perceived storytelling as a desirable and effective way to operationalize hyperlocal adaptation of content, particularly when in-group stories came from the community and included video content (which was perceived to maximize reach); (2) researcher participation in content production/delivery was seen as a compelling implementation strategy; and (3) these requested components were seen as adding value rather than as substitutions for text- and image-based EBHCC content. Adaptations envisioned by participants are associated with increased demand for limited resources (ie, requiring more time or financial resources), on the part of CBOs, the research team, or both. Researcher strategies were identified to support meeting CBOs’ needs given these contextual constraints. Conclusion This research explores supports and processes requested by CBOs serving LGBTQ+ populations as part of the adaptations envisioned in implementing EBHCCs and highlights possible avenues to better meet CBOs’ needs in effectively utilizing interventions.

Background In the USA, lesbian, gay, bisexual, transgender and queer (LGBTQ+) people report higher rates of tobacco use than non-LGBTQ+ people due to diverse factors, from anti-LGBTQ stigma to targeted marketing by the tobacco industry. There is an opportunity to support behavioural changes by delivering evidence-based health communication campaigns through community-based organisations (CBOs), but an insufficient evidence base and organisational resource restrictions limit this potential. Our previous research with CBO staff and leaders serving LGBTQ+ communities identified gaps in evidence-based campaigns, such as insufficient centering of LGBTQ+ communities in campaign development and execution. This qualitative study explores opportunities to improve the products and services supporting the dissemination of evidence-based health communication campaigns for LGBTQ+ audiences.Methods We conducted key informant interviews between January and June 2021 with individuals who direct or run health promotion programmes in CBOs serving LGBTQ+ populations in the USA (n=26 individuals from 22 organisations). Using critical and constructivist perspectives, we leveraged the analysis team and advisory committee’s diverse research, lived and practice expertise related to LGBTQ+ health. We employed a team-based, reflexive thematic analysis approach.Results We identified two key opportunities. Theme 1—show us your work: participants requested (a) details about the evidence-based campaigns, including underlying values and extent of community engagement, and (b) information about campaign mechanisms and impact. Theme 2—support us in our work: participants suggested that evidence-based campaigns should (a) be designed for flexibility and adaptation, (b) offer tools and guidance for adaptation and (c) share granular data and relevant resources. Participants nominated dissemination products and processes to address gaps, including supports to integrate campaigns into multi-level action, data collection tools for adaptation and engagement with campaign developers.Conclusions The findings highlight the potential for CBOs to be integral partners in the development and dissemination of evidence-based health communication campaigns that address tobacco-related inequities among LGBTQ+ communities.

ObjectiveTo assess multi-level factors influencing the sustainability of 26 social care pilots integrating medical and social services for Medicaid enrollees across California in newly developed Medicaid benefits.Study Setting and DesignThis qualitative study assessed the sustainability of Whole Person Care (WPC) pilots implemented between 2016 and 2021. Pilots (n = 26) represented a majority of counties in California.Data Sources and Analytic SamplePrimary qualitative data were collected between June and August 2021 and included 58 hour-long, semi-structured individual and group interviews with administrators, middle managers, and frontline case management staff representing all WPC pilots. We used hybrid inductive-deductive thematic analysis to identify and analyze patterns, and outliers, in factors influencing sustainment. Deductive codes included established implementation science factors influencing the sustainability of new programs (e.g., innovation characteristics, capacity, processes and interactions, and context).Principal FindingsOf 26 WPC pilots, 22 pilots sustained WPC by contracting with Medicaid managed care plans to provide services as part of newly developed Medicaid benefits. Three pilots chose not to sustain before the pilot period ended and one pilot decided not to sustain following completion of the full pilot. Factors influencing sustainability included: (1) program adaptability and flexibility; (2) funding structure and reimbursement requirements; (3) shared leadership with managed care plans; and (4) whether pilots chose to build out program infrastructure internally or contracted out core components to partner organizations. Many pilots, particularly those in rural areas, indicated that system and policy changes introduced as part of transitioning pilot services into Medicaid benefits reduced the sustainability of WPC for participating providers.ConclusionsMulti-level factors including program adaptability, funding, leadership, and capacity to build out infrastructure influenced the sustainability of WPC pilots. These findings have significant implications for health equity as equitable distribution of services, resources, and benefits from these programs can be supported through sustained implementation over time.