Evidence-based approaches to dissemination and diffusion of physical activity interventions

Dissemination research in cancer control: where are we and where should we go?

Dissemination of evidence-based programs and policies is a critical final step in reducing the burden of cancer in the general public. Yet, we have not been fully successful to date in improving clinical or public health practice by disseminating programs found to be effective in research. Therefore, research is needed into the dissemination process and outcomes to enable better efforts in the future. This paper explores the definitions and models used for dissemination, the designs of dissemination studies, and possible research questions in dissemination research, all focused on cancer prevention and control. We hope that this paper will encourage dissemination research in our field.

Promoting physical activity during school break times: piloting a simple, low cost intervention

OBJECTIVE

The purpose of this pilot study was to examine the effectiveness of two interventions on children's physical activity during the 20-min school break.

METHODS

Children from three schools participated in this study. In the first intervention school (n=89) the school's courts were allocated to different children on alternate days of the week, playground markings were painted in the school's yard and jump ropes were provided. In the second intervention school (n=89) the school's courts were just allocated to different children on alternate days of the week. The third school served as the control group (n=69). Physical activity was measured with a pedometer during the 20-min break (09:05-09:25) and during the after school period (13:05 till bed time). Data were collected in Cyprus, between January/April of 2007.

RESULTS

A significant time by group interaction indicated a change in break-time activity. Four weeks after the intervention, mean steps in the first (1427+/-499) and second (1331+/-651) intervention schools were significantly higher than steps in the control school (1053+/-447). Non-significant increases were observed in the after-school activity of children in the intervention schools.

CONCLUSIONS

Implementing simple, low-cost interventions during break periods could help increase children's activity.

Dissemination of a breast and cervical cancer early detection program through a network of community-based organizations

ENCORE (plus) , a breast and cervical cancer outreach, education, and screening referral program, was implemented by the YWCA of the United States and funded by Avon's Breast Cancer Awareness Crusade. ENCORE (plus) was designed to address the educational and access needs of low socioeconomic status and minority women who experience substantial barriers to breast and cervical cancer screening. This article describes the dissemination of ENCORE (plus) to 78 YWCAs in 30 states. It illustrates the application of social cognitive theory and diffusion theory to increase program adoption, implementation, and maintenance among community organizations that have not traditionally provided public health related services. The article highlights elements of the program that enhanced its adoption and implementation and describes procedures for accelerating the diffusion of the program across the country.

Optimizing practice through research: a new perspective to solve an old problem

Policy makers, researchers, clinicians, and the public are frustrated that research in the health sciences has not resulted in a greater improvement in patient outcomes. Our experience as clinicians and researchers suggests that this frustration could be reduced if health sciences research were directed by 5 broad principles: (1) the needs of patients and populations determine the research agenda; (2) the research agenda addresses contextual and implementation issues, including the development of delivery and accountability systems; (3) the research agenda determines the research methods rather than methods determines the research agenda; (4) researchers and clinicians collaborate to define the research agenda, allocate resources, and implement findings; and (5) the level of funding for implementation research is commensurate with and proportional to the magnitude of the task. To keep the research agenda focused on the task of improving health and to acknowledge that the effort must be seen as more comprehensive than translating or transferring research into practice (TRIP), we suggest that the task be reframed, using the term optimizing practice through research.

Sustaining health promotion programs within sport and recreation organisations

The involvement of the sport and recreation sector as a setting for health promotion is a new strategy implemented by health policy makers and strategic planners. Strategies to promote and sustain health promotion activities are important considering the risk that programs may cease after initial funding ends. This study explored the factors affecting the sustainability of a sport- and recreation-based health promotion program. A stratified sampling method was used to select four of the nine Regional Sports Assemblies (RSAs) that delivered a state-wide health promotion program funded by the Victorian Health Promotion Foundation in Australia. Data were collected from in-depth interviews with four Executive Officers (EOs) and focus group discussions with their Boards of Management. A sustainability checklist with pre-specified dimensions (e.g. organisational setting, broader community environment, and program design and implementation) guided data collection and analysis. The results showed that the organisational setting and the broader community environment supported program institutionalisation; whilst the design and implementation of the program worked against institutionalisation. The capacity of the organisations to generate new funds for the program was limited; the relationship between the central funding organisation and the Boards of Management was weak; and the program did not support the retention of staff. The engagement of sport and recreation organisations has potential to facilitate health promotion and public health. To enhance organisational capacity and achieve program sustainability, it is important that organisational processes, structures, and resources that support long-term health promotion practice are effectively and efficiently planned and managed.

Telephone interventions for physical activity and dietary behavior change: a systematic review

BACKGROUND

Given the epidemic of lifestyle-related chronic diseases, building the evidence base for physical activity and dietary behavior change interventions with a wide population reach is of critical importance. For this purpose, telephone counseling interventions have considerable potential.

PURPOSE

To systematically review the literature on interventions for physical activity and dietary behavior change in which a telephone was the primary method of intervention delivery, with a focus on both internal and external validity.

METHODS

A structured search of PubMed, Medline, and PsycInfo was conducted for studies published in English from 1965 to January 2006. Studies targeted primary or secondary prevention in adults, used randomized designs, and included physical activity and/or dietary behavior outcomes.

RESULTS

Twenty-six studies were reviewed, including 16 on physical activity, six on dietary behavior, and four on physical activity plus dietary behavior. Twenty of 26 studies reported significant behavioral improvements. Positive outcomes were reported for 69% of physical activity studies, 83% of dietary behavior studies, and 75% of studies addressing both outcomes. Factors associated with positive outcomes appear to be the length of intervention and the number of calls, with interventions lasting 6 to 12 months and those including 12 or more calls producing the most favorable outcomes. Data on the representativeness of participants, implementation of calls, and costs were reported much less frequently.

CONCLUSIONS

There is now a solid evidence base supporting the efficacy of physical activity and dietary behavior change interventions in which the telephone is the primary intervention method. Thus, research studies on broader dissemination are necessary, and should address questions relevant to the translation of this body of work into population health practice.