Organizational component challenges
Even in this successful implementation structure, challenges still exist, and significant facilitative administrative support from both LPHI and PRG staff is required to make this multilevel partnership work. The work site organizations essentially act as a venue for 4Real Health programming; work sites are not responsible for 4Real Health staffing, training, or evaluation activities, but site administrators must still be willing to work with LPHI and PRG to meet 4Real Health's structural and logistical implementation requirements. This requires many meetings with work site administrators to first determine whether they are willing and logistically capable of acting as an implementation site. Achieving these partnerships takes much coordination, relationship building, and planning to ensure that the sites understand what is required of them. Conversely, LPHI and PRG also recognize that 4Real Health is just one component (2 hours 1 day a week) of these sites' varied summer program activities. Even with the best intentions, the work site administrators do not necessarily have the time to devote to ensuring they meet all requirements. 4Real Health staff must be organized, accommodating, and flexible in order to meet the needs of the sites and implement 4Real Health with fidelity.
One approach LPHI and PRG used to accomplish this was to conduct a presentation for work site staff members to provide an overview of the program, evaluation, and site-level participation requirements in an effort to encourage open communication and foster support from work site staff. Another strategy used to facilitate the implementation process at these sites was distributing a work site expectations checklist (Table 1) to site administrators. This document was developed by PRG and LPHI to clearly and succinctly outline the implementation requirements and other necessities to become a 4Real Health partner. PRG and LPHI staff also conducted several site visits to each work site prior to implementation to meet with site staff and administrators to discuss program plans, ensure that they could meet the checklist requirements, and address any potential barriers to implementation.