**4. Discussion**

The current project represents a rare, and thus far successful, effort to translate an evidence-based intervention into practice for HCWs. A pilot test of the adapted program confirmed that adjusted intervention processes were functional, and that outcomes were changing with effect sizes resembling those from the prior randomized controlled trial. Preliminary evaluation data suggest the program is well liked, rated as useful, and that workers report intentions to make safety and health changes as a result of participating. An additional strength of the dissemination effort includes an inter-agency research agreement that will generate long-term evaluation data for COMPASS participants (attendance, course evaluations, workers' compensation injury claims) with potential for some cross-sectional analyses of HCWs within the state. Several factors facilitated this successful dissemination effort and its probable long-term sustainability, but key factors included engagement and collaboration with the adopting partner (the OHCC) in initial intervention development, continued dialogue and discussion during research phases, flexibility from both investigators and the OHCC while adjusting the program to meet training system needs, and sustained top level commitment at the OHCC. Other researchers may consider following a similar model of sustained partnership across research phases in order to enhance a sense of ownership from the adopting partner and promote dissemination sustainability. Considering the factors Rogers [18] pointed out as being important for successful dissemination, we believe the OHCC perceived COMPASS as compatible with their current needs and values, feasible to deliver and implement, able to be tested for potential adoption (e.g., our adaptation pilot), and to have demonstrated effectiveness among stakeholders (this included early and consistent collaboration with and commitment from the union). Consistent with dissemination research findings of Kuehl et al. [20], leadership support included both committed chiefs (the Executive Director of the OHCC, Senior Director of Technology Transfer at OHSU) and champions (OHCC Training Directors and key members of the OHCC Training Committee).

While many facilitating factors were present, the dissemination effort faced some barriers to success. Some of these barriers included turnover of key staff at various time points, gaps in funding, and complexities in navigating government and university processes. Into the future, the long-term success of the adoption of COMPASS in the OHCC will depend on some level of continued support from OHSU, the Oregon Institute of Occupational Health Sciences, and the Oregon Healthy Workforce Center (e.g., to update and adapt the curriculum) as well as continued financial commitment from the

OHCC/state of Oregon to fund guidebook printing and wages for facilitators and workers. Stable state funding for both the OHCC and the Oregon Institute of Occupational Health Sciences will be key, as well as continued NIOSH funding for the Oregon Healthy Workforce Center. Thus, investigators and partners at the OHCC will need to plan ahead, anticipating courses of action if any one of these sources of support is disrupted. This includes evolving structures at the Oregon Institute of Occupational Health Sciences to support translation and dissemination of evidence-based programs created by its investigators and their collaborators.

Looking outside of the state of Oregon in the US, we recommend that researchers who aim to develop, evaluate, and disseminate interventions for similar populations investigate institutional structures and potential partners within their target region. For publicly funded HCWs in Oregon, both union and governmental partners were equally engaged through intervention development and evaluation phases, but governmental partners played the most central role in the dissemination phase because of their ownership of the training system for publicly funded HCWs. In contrast, in our neighboring state of Washington, an SEIU 775 Benefits Group "owns" and operates training programs for publicly funded HCWs. Therefore, development and evaluation phases of an intervention for HCWs in Washington would similarly need to involve both government and labor partners, but during a dissemination phase, the union benefits group would play the most central collaborative role.

Given that the literature on translation of *Total Worker Health*® interventions into practice is in its infancy, future dissemination and implementation science with effective programs is strongly encouraged. For example, if interest in COMPASS expanded and resources are available to study a new dissemination effort, research could systematically evaluate organizational readiness factors and measure adoption and implementation of the program across multiple new organizations. Such future dissemination science with any particular *Total Worker Health*®-informed intervention may be fruitfully guided by recommendations and tools from Dugan and Punnett [32]. Based on their experience developing the Healthy Workplace Participatory Program, the authors provide examples of potential dissemination and implementation studies and tools, such as the Five and Ten D&I Evaluation Tool to assess specific implementation outcomes.
