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

A scoping review of outer context constructs in dissemination and implementation science theories, models, and frameworks

Many studies have explored organizational factors that facilitate implementation. However, there is still a limited understanding of determinants external to the implementing organization and their effects on evidence-based intervention (EBI) adoption, implementation, and outcomes. The purpose of this scoping review was to assess definitions of context and identify salient determinants of outer context found in dissemination and implementation theories, models, and frameworks. We employed a compilation of dissemination and implementation frameworks from two reviews as the data source. We abstracted the following information: type of article, outcomes of the framework, presence of a context definition, presence of any outer setting definition and the definition, number and domains of outer setting mentioned, definitions of outer context constructs, and any quantitative measures of outer setting. We identified 19 definitions of outer context. Forty-seven (49%) frameworks reported one or more specific constructs of the outer setting. While the outer context domains described in the frameworks varied, the most common domains were policy (n = 24), community (n = 20), partnerships (n = 13), and communications (n = 12). Based on our review of the frameworks, more conceptualization and measurement development for outer context domains are needed. Few measures were found and definitions of domains varied across frameworks. Expanding outer context construct definitions would advance measure development for important factors external to the organizations related to EBI implementation.

Where is "policy" in dissemination and implementation science? Recommendations to advance theories, models, and frameworks: EPIS as a case example

BACKGROUND

Implementation science aims to accelerate the public health impact of evidence-based interventions. However, implementation science has had too little focus on the role of health policy - and its inseparable politics, polity structures, and policymakers - in the implementation and sustainment of evidence-based healthcare. Policies can serve as determinants, implementation strategies, the evidence-based "thing" to be implemented, or another variable in the causal pathway to healthcare access, quality, and patient outcomes. Research describing the roles of policy in dissemination and implementation (D&I) efforts is needed to resolve persistent knowledge gaps about policymakers' evidence use, how evidence-based policies are implemented and sustained, and methods to de-implement policies that are ineffective or cause harm. Few D&I theories, models, or frameworks (TMF) explicitly guide researchers in conceptualizing where, how, and when policy should be empirically investigated. We conducted and reflected on the results of a scoping review to identify gaps of existing Exploration, Preparation, Implementation, and Sustainment (EPIS) framework-guided policy D&I studies. We argue that rather than creating new TMF, researchers should optimize existing TMF to examine policy's role in D&I. We describe six recommendations to help researchers optimize existing D&I TMF. Recommendations are applied to EPIS, as one example for advancing TMF for policy D&I.

RECOMMENDATIONS

(1) Specify dimensions of a policy's function (policy goals, type, contexts, capital exchanged). (2) Specify dimensions of a policy's form (origin, structure, dynamism, outcomes). (3) Identify and define the nonlinear phases of policy D&I across outer and inner contexts. (4) Describe the temporal roles that stakeholders play in policy D&I over time. (5) Consider policy-relevant outer and inner context adaptations. (6) Identify and describe bridging factors necessary for policy D&I success.

CONCLUSION

Researchers should use TMF to meaningfully conceptualize policy's role in D&I efforts to accelerate the public health impact of evidence-based policies or practices and de-implement ineffective and harmful policies. Applying these six recommendations to existing D&I TMF advances existing theoretical knowledge, especially EPIS application, rather than introducing new models. Using these recommendations will sensitize researchers to help them investigate the multifaceted roles policy can play within a causal pathway leading to D&I success.

Rethinking early intervention rehabilitation services for children with motor difficulties: engaging stakeholders in the conceptualization of telerehabilitation primary care

PURPOSE

Rehabilitation services for children with mild motor difficulties are limited. Telehealth could be a novel avenue through which to provide these services. With the input of various stakeholder groups, this study aimed to develop a logic model for a new primary care telerehabilitation intervention and to identify influencing implementation factors.

METHODS AND MATERIALS

A participatory research design was used. A logic model, developed in consultation with five healthcare managers, was discussed with four stakeholder groups. Focus groups were conducted with clinicians (n = 9), pediatric healthcare managers (n = 5), and technology information consultants (n = 2), while parents (n = 4) were interviewed to explore their perceptions of the proposed intervention, and factors influencing implementation. Transcribed discussions were analyzed using reflexive thematic analysis.

RESULTS

Stakeholders supported the delivery of telerehabilitation services for children with mild motor difficulties. Although agreement was generated for each logic model component, important recommendations were voiced related to service relevance and sustainability, parent and community capacity building, and platform dependability, security, and support. Identified factors influencing the implementation encompassed consumer, provider, technological, systemic and contextual barriers and facilitators. Strategies to address them were also suggested.

CONCLUSION

This study demonstrates the value of, and a process to engage stakeholders in the designing of pediatric telerehabilitation services and its implementation.IMPLICATIONS FOR PRACTICEPediatric telerehabilitation service are complex interventions which operate in complicate systems.Designing telerehabilitation services with stakeholders is recommended, yet how to do so often not clear.This study demonstrated that the development of a logic model can provide a systematic framework to helps guide the co-design process with stakeholders.Resulting recommendation underscored a broader vision for the intervention and identified crucial factors and strategies required for its successful implementation and sustainability.

A scoping review of frameworks in empirical studies and a review of dissemination frameworks

BACKGROUND

The field of dissemination and implementation (D&I) research has grown immensely in recent years. However, the field of dissemination research has not coalesced to the same degree as the field of implementation research. To advance the field of dissemination research, this review aimed to (1) identify the extent to which dissemination frameworks are used in dissemination empirical studies, (2) examine how scholars define dissemination, and (3) identify key constructs from dissemination frameworks.

METHODS

To achieve aims 1 and 2, we conducted a scoping review of dissemination studies published in D&I science journals. The search strategy included manuscripts published from 1985 to 2020. Articles were included if they were empirical quantitative or mixed methods studies about the dissemination of information to a professional audience. Studies were excluded if they were systematic reviews, commentaries or conceptual papers, scale-up or scale-out studies, qualitative or case studies, or descriptions of programs. To achieve aim 1, we compiled the frameworks identified in the empirical studies. To achieve aim 2, we compiled the definitions from dissemination from frameworks identified in aim 1 and from dissemination frameworks identified in a 2021 review (Tabak RG, Am J Prev Med 43:337-350, 2012). To achieve aim 3, we compile the constructs and their definitions from the frameworks.

FINDINGS

Out of 6017 studies, 89 studies were included for full-text extraction. Of these, 45 (51%) used a framework to guide the study. Across the 45 studies, 34 distinct frameworks were identified, out of which 13 (38%) defined dissemination. There is a lack of consensus on the definition of dissemination. Altogether, we identified 48 constructs, divided into 4 categories: process, determinants, strategies, and outcomes. Constructs in the frameworks are not well defined.

IMPLICATION FOR D&I RESEARCH

This study provides a critical step in the dissemination research literature by offering suggestions on how to define dissemination research and by cataloging and defining dissemination constructs. Strengthening these definitions and distinctions between D&I research could enhance scientific reproducibility and advance the field of dissemination research.

Overview of national health reporting in the EU and quality criteria for public health reports - results of the Joint Action InfAct

BACKGROUND

Health reporting shall provide up-to-date health-related data to inform policy-makers, researchers and the public. To this end, health reporting formats should be tailored to the needs and competencies of the target groups and provide comparable and high-quality information. Within the Joint Action on Health Information 'InfAct', we aimed at gaining an overview of health reporting practices in the EU Member States and associated countries, and developed quality criteria for the preparation of public health reports. The results are intended to facilitate making health information adequately available while reducing inequalities in health reporting across the EU.

METHODS

A web-based desk research was conducted among EU Member States and associated countries to generate an overview of different formats of national health reporting and their respective target groups. To identify possible quality criteria for public health reports, an exploratory literature review was performed and earlier projects were analysed. The final set of criteria was developed in exchange with experts from the InfAct consortium.

RESULTS

The web-based desk research showed that public health reports are the most frequently used format across countries (94%), most often addressed to scientists and researchers (51%), politicians and decision-makers (41%). However, across all reporting formats, the general public is the most frequently addressed target group. With regards to quality criteria for public health reports, the literature review has yielded few results. Therefore, two earlier projects served as main sources: the 'Evaluation of National and Regional Public Health Reports' and the guideline 'Good Practice in Health Reporting'from Germany. In collaboration with experts, quality criteria were identified and grouped into eight categories, ranging from topic selection to presentation of results, and compiled in a checklist for easy reference.

CONCLUSION

Health reporting practices in the EU are heterogeneous across Member States. The assembled quality criteria are intended to facilitate the preparation, dissemination and access to better comparable high-quality public health reports as a basis for evidence-based decision-making. A comprehensive conceptual and integrative approach that incorporates the policy perspective would be useful to investigate which dissemination strategies are the most suitable for specific requirements of the targeted groups.

A systematic review of adaptations and effectiveness of scaled-up nutrition interventions

Context

Public health nutrition interventions shown to be effective under optimal research conditions need to be scaled up and implemented in real-world settings.

Objectives

The primary aim for this review was to assess the effectiveness of scaled-up public health nutrition interventions with proven efficacy, as examined in a randomized controlled trial. Secondary objectives were to: 1) determine if the effect size of scaled-up interventions were comparable to the prescale effect, and; 2) identify any adaptations made during the scale-up process.

Data sources

Six electronic databases were searched and field experts contacted.

Study selection

An intervention was considered scaled up if it was delivered on a larger scale than a preceding randomized controlled trial (“prescale”) in which a significant intervention effect (P ≤ 0.05) was reported on a measure of nutrition.

Data extraction

Two reviewers independently performed screening and data extraction. Effect size differences between prescale and scaled-up interventions were quantified. Adaptations to scale-up studies were coded according to the Adaptome model.

Results

Ten scaled-up nutrition interventions were identified. The effect size difference between prescale trials and scaled-up studies ranged from –32.2% to 222% (median, 50%). All studies made adaptations between prescale to scaled-up interventions.

Conclusion

The effects of nutrition interventions implemented at scale typically were half that achieved in prior efficacy trials. Identifying effective scale-up strategies and methods to support retainment of the original prescale effect size is urgently needed to inform public health policy.

Systematic Review Registration

PROSPERO registration no.CRD42020149267.

Evaluating the reach, effectiveness, adoption, implementation and maintenance of the Resistance Training for Teens program

BACKGROUND

Physical activity guidelines recommend young people engage in regular muscle-strengthening activities (e.g., resistance training [RT]). However, few school-based physical activity interventions have been delivered at-scale or promoted RT. The aim of this study was to evaluate the reach, effectiveness, adoption, implementation and maintenance of the Resistance Training for Teens (RT for Teens) program.

METHODS

Data were collected between August 2015 and October 2020. RE-AIM was operationalized as: (i) Reach: number and characteristics of students estimated to be exposed to the program; (ii) Effectiveness: impact of the program on student-level outcomes measured in a subsample of 750 students from 17 schools; (iii) Adoption: number and representativeness of schools with one or more teachers trained to deliver the program; (iv) Implementation: extent to which the program was delivered as intended; and (v) Maintenance: extent to which the program was sustained in schools.

RESULTS

The estimated program reach was ~ 10,000 students, out of a total student population of ~ 200,000 (~ 5%). Students were from diverse socioeconomic and ethnic backgrounds. Improvements in muscular fitness, RT self-efficacy, perceived cardiorespiratory fitness and flexibility, and participation in muscle-strengthening physical activities were documented. A total of 30 workshops were delivered, involving 468 teachers from 249 schools from diverse geographical regions. Implementation varied considerably, with teachers adapting the program to suit the context of their school and student cohorts. However, RT skill development and the promotion of muscular fitness were the session components delivered most during sessions. Teachers' adherence to the SAAFE (Supportive, Active, Autonomous, Fair and Enjoyable) teaching principles was high. Approximately 30% of teachers (144/476) registered to use the RT for Teens app. At the school-level, 37% (93/249) of schools had at least one registered user (teacher and/or student). A total of 2,336 workouts and 3,116 fitness tests were completed by registered users. Of the 249 schools represented, 51 (20.5%) sent an additional (previously untrained) teacher to a second workshop.

CONCLUSIONS

The RT for Teens program had broad reach and adoption. However, intervention delivery varied considerably across schools and additional support strategies are required to optimize intervention implementation and maintain program delivery over time. Future studies will benefit from the utilization of accepted frameworks, recommendations and guidelines for implementation research.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12621000352808), retrospectively registered 1^st February 2021.

Cluster Randomized Trial: Sun Protection Intervention 'Clever in Sun and Shade for Preschools'-Effectiveness and Dissemination

Skin cancer is one of the most common types of cancer and UV radiation is one of the main risk factors. Therefore, sun protection, especially in childhood, is strongly recommended. We examined the effectiveness of the ‘Clever in Sun and Shade for Preschools’ program (CLEVER) in promoting sun protection behavior among preschool staff (trial registration: DRKS00023468) and describe its dissemination. Within a cluster randomized trial with 24 preschools (n = 273 staff members) stating a high need for sun protection measures, an educational workshop for preschool staff and a project kit with materials applicable in preschool groups was provided. Staff members of preschools taking part in CLEVER report significantly stronger sun protection behavior to avoid the sun (effect size [ES] 0.70, 95% confidence interval [CI] 0.04 0.71, p < 0.05) and less perceived impediments to avoid the sun (ES −0.56, CI −0.82 −0.17, p < 0.01) after 12 months as well as higher self-efficacy to avoid the sun (ES 1.09, CI 0.39 1.07, p < 0.001) and to use sunscreen (ES 0.71, CI 0.03 0.88, p < 0.05) after 1 month. Compared to the control group, there was no significant effect on sunscreen use and further psychosocial outcomes. The effectiveness of CLEVER may be underrated due to a high drop-out rate. Within three years, an enhanced free-of-charge program kit, including a media-based workshop and materials, had reached over 4000 preschools, i.e., 7.1% of all daycare centers in Germany. The results show that CLEVER can strengthen sun protection, offer high-quality information at low cost, and is easily disseminable.

A cluster-randomised controlled trial of the LifeLab education intervention to improve health literacy in adolescents

Adolescence offers a window of opportunity during which improvements in health behaviours could benefit long-term health, and enable preparation for parenthood-albeit a long way off, passing on good health prospects to future children. This study was carried out to evaluate whether an educational intervention, which engages adolescents in science, can improve their health literacy and behaviours. A cluster-randomised controlled trial of 38 secondary schools in England, UK was conducted. The intervention (LifeLab) drew on principles of education, psychology and public health to engage students with science for health literacy, focused on the message "Me, my health and my children's health". The programme comprised: • Professional development for teachers. • A 2-3 week module of work for 13-14-year-olds. • A "hands-on" practical health science day visit to a dedicated facility in a university teaching hospital. Data were collected from 2929 adolescents (aged 13-14 years) at baseline and 2487 (84.9%) at 12-month follow-up. The primary outcome was change in theoretical health literacy from pre- to 12 months post- intervention. This study is registered (ISRCTN71951436) and the trial status is complete. Participation in the LifeLab educational intervention was associated with an increase in the students' standardised total theoretical health literacy score (adjusted difference between groups = 0.27 SDs (95%CI = 0.12, 0.42)) at 12-month follow-up. There was an indication that intervention participants subsequently judged their own lifestyles more critically than controls, with fewer reporting their behaviours as healthy (53.4% vs. 59.5%; adjusted PRR = 0.94 [0.87, 1.01]). We conclude that experiencing LifeLab led to improved health literacy in adolescents and that they demonstrated a move towards a more critical judgement of health behaviour 12 months after the intervention. Further work is needed to examine whether this leads to sustained behaviour change, and whether other activities are needed to support this change.

Sports Injury Prevention is Complex: We Need to Invest in Better Processes, Not Singular Solutions

In recent years, an understanding has developed that sports injuries are the emergent outcomes of complex, dynamic systems. Thus, the influence of local contextual factors on injury outcomes is increasingly being acknowledged. These realisations place injury prevention research at a crossroads. Currently, injury prevention researchers develop universally applicable injury prevention solutions, but the adoption of these solutions in practice is low. This occurs because implementation contexts are both unique and dynamic in nature, and as a result singular, static solutions are often incompatible. In contrast, practitioners address injury prevention through iterative cycles of trial and error, aiming to optimise the injury prevention process within their own unique contexts. The purpose of this critical review is to draw attention to the misalignment between research and practice-based approaches to injury prevention. In light of this, we propose alternative research approaches that acknowledge the process-driven nature of injury prevention in practice. We propose that a core focus of sport injury prevention research should be to provide practitioners with useful and relevant information to support their decision making around their localised injury prevention practice. Through this approach, injury prevention research ceases to be about what works, and begins to engage with understanding what works in what contexts and why?

Dissemination and uptake of HIV/STD preventive interventions in American Indian and Alaska Native communities: a case study

Objectives: HIV and sexually transmitted diseases (STDs) are serious health conditions among American Indian and Alaska Native (AIAN) populations, especially youth. However, few sexual risk reduction evidence-based interventions (EBIs) have been implemented by AIAN-serving organizations. This project sought to identify and assess the parameters facilitating the uptake and use of EBIs in order to strengthen opportunities for sustainability and improved sexual health among AIANs.Design: Guided by Rogers' theory of diffusion of innovation, we conducted a survey with a national sample of stakeholders involved with sexual health and well-being of AIAN youth (N = 142). We collected surveys for nine months beginning September 2010 and analyzed data in 2014 and 2015. We assessed respondents' perceptions of factors that might facilitate or hinder the use of a sexual risk reduction EBI, called RESPECT, in their communities. We regressed the scale of likely program uptake (alpha = 0.88) on each of five measures of perception of diffusion and uptake: trialability (extent new program can be altered), relative advantage (more advantageous than current program), observability (impact of program), complexity (difficulty of implementation), and compatibility (consistent with community values and practices).Results: Trialability (p = .009), observability (p = .003), and compatibility (p = .005) were found to be significantly related to program uptake in the adjusted model. Standardized betas showed that compatibility ranked highest of the three, followed by trialability and observability.Conclusions: For AIAN-serving organizations and AIAN communities, demonstrating trialability, compatibility, and observability of a sexual risk reduction EBI in specific cultural settings may increase likelihood of implementation and sustainability.

Rapid Realist Review of School-Based Physical Activity Interventions in 7- to 11-Year-Old Children

Meta-analysis of physical activity interventions in school settings have revealed low efficacy and that there is a need to explore implementation fidelity. The aim of this rapid realist review was to determine, what physical activity interventions in school settings for children aged 7- to 11-years-old works, for whom, and in what circumstances. The realist synthesis was conducted following RAMESES guidelines. Relevant studies were identified following a systematic search process and data from 28 studies was extracted for evidence to form context-mechanism-outcome configurations that were clustered and refined. Using the five-level socioecological model, the program theories were classified into the levels of intrapersonal (child), interpersonal (teachers), institutional (program content, school administration, and school environment), community (home and neighborhood), and policy. The school level led to most context-mechanism-outcome configurations related to school leadership and policy, workforce structure, program characteristics, and school environment. At each level, we identified features of interventions, alongside implementation considerations that might work to promote efficacy and sustainability. The need to recognize the school environment as part of a complex system with multi-level interaction and influences was a key finding. In line with realist philosophy, the researchers encouraged primary research to confirm, refute, and refine the program theories presented.

Evaluating the Implementation of a Before-School Physical Activity Program: A Mixed-Methods Approach in Massachusetts, 2018

Purpose and Objectives

Our aim was to evaluate the implementation of a widely available, before-school, physical activity program in a low-resource, racially/ethnically and socioeconomically diverse, urban school setting to identify adaptations needed for successful implementation.

Intervention Approach

We used a collaborative effort with stakeholders to implement the Build Our Kids’ Success (BOKS) program in 3 schools in Revere, Massachusetts. Program structure followed a preexisting curriculum, including 60-minute sessions, 3 mornings per week, over 2 sessions (spring and fall 2018). Programs had a capacity of 40 students per school per session and the ability to adapt as needed.

Evaluation Methods

We used a mixed-methods approach, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. RE-AIM domains were assessed by use of baseline and follow-up student measures, parent interviews, and program administrative records.

Results

From a district of 11 schools, 3 schools (2 elementary, 1 middle) implemented the BOKS program. Program enrollment reached 82% capacity (188 of 230 potential participants). Of the 188 enrolled students, 128 (68%) had parental consent for study participation. Among the 128 study participants, 61 (48%) were male, 52 (41%) identified as Hispanic/Latino, and mean age was 9.3 years (SD, 2.2). Program duration varied by school (25–60 minutes), with a mean of 33% (SD, 16%) of the session spent in actigraphy-measured moderate-to-vigorous physical activity (MVPA), or mean 16.3 (SD, 9.3) minutes of MVPA. Participants attended a median 90% (interquartile range [IQR], 56%–97%) of sessions. We observed no change in body mass index (BMI) z score or self-reported quality of life from baseline to follow-up assessment. Parents reported positive program effects. Enrollment was sustained in elementary schools and decreased in the middle school during the study period, expanding to 3 additional schools for spring 2019.

Implications for Public Health

Implementation and evaluation of an evidence-based physical activity program, in a low-resource setting, are feasible and yield relevant information about program adaptations and future dissemination of similar programs.

The translation of an evidence-based preschool physical activity intervention from in-person to online delivery of professional development to preschool teachers

Study of Health and Activity in Preschool Environments (SHAPES) aimed to increase preschoolers' physical activity by engaging preschool teachers in professional development designed to modify instructional practices. SHAPES originated as a randomized controlled trial, tested in 16 preschools and disseminated to 4 control schools, and was shown to be effective in increasing preschool children's physical activity (Phase I, 2008-2012). This article describes the steps taken to translate an evidence-based physical activity intervention, SHAPES, from in-person delivery to online delivery of professional development to preschool teachers. In Phase II (2013-2016), professional development delivery was modified from an in-person to an online program for preschool teachers. Teacher implementation completeness and fidelity were examined in 10 pilot preschools and then replicated in 30 preschools. Large-scale dissemination of SHAPES began in Phase III (2017-2019), reaching 818 teachers from 228 unique centers after 2 years. The final SHAPES program consisted of six online modules, an accompanying guidebook, over 90 activities, self-assessment techniques, a video library, and an electronic community forum. The SHAPES core elements, defined in Phase I, were retained throughout all three phases. The Phase II change to online delivery was characterized by high levels of implementation completeness and fidelity. Results of Phase III statewide dissemination revealed comparable implementation completeness and fidelity. An intervention shown to be effective in a randomized controlled trial can be translated into an online professional development program and disseminated on a large scale in a timely manner.

Factors associated with state legislators' support for opioid use disorder parity laws

BACKGROUND

In the United States, state behavioral health parity laws play a crucial role in ensuring equitable insurance coverage and access to substance use disorder treatment and services for people that need them. State legislators have the exclusive authority to adopt these laws. The purpose of this study was to identify legislator beliefs independently associated with "strong support" for opioid use disorder (OUD) parity.

METHODS

Data were from a 2017 cross-sectional, state-stratified, multi-modal survey of state legislators (N = 475). The dependent variable was "strong support" for OUD parity. Primary independent variables were beliefs about state parity laws. Bivariate analyses and mixed effects logistic regression were conducted.

RESULTS

Legislators who "strongly supported" OUD parity were significantly more likely than legislators who did not "strongly support" OUD parity to be female (64.1% vs. 46.5%, p<.001) , Democrat (76.2% vs. 29.3%, p<.001), and have liberal, compared to conservative, ideology (85.6% vs. 27.1%, p<.001). After adjusting for legislator demographics and state-level covariates, beliefs such as agreeing that state parity laws do not increase health insurance premium costs (aOR=6.77, p<.01) and that substance use disorder treatments can be effective (aOR=5.00, p<.001) remained associated with "strong support" for OUD parity. These state legislators' beliefs were more strongly associated with "strong support" for OUD parity than political party, ideology, and other demographic and state-level characteristics.

CONCLUSIONS

Dissemination materials and communication strategies to cultivate support for OUD parity laws among state legislators should focus on the fiscal impacts of parity laws and the effectiveness of substance use disorder treatments.

Older adults' experiences of using a wearable activity tracker with health professional feedback over a 12-month randomised controlled trial

Objective

Wearable activity trackers can help older adults remain physically active. However, knowledge of the user experience during long-term use is scarce. Therefore, this study examined older adults' experiences with, and perceptions of, wearable activity trackers combined with health professional feedback after a year's use as part of a randomised controlled trial.

Methods

Twenty older adults (73.6 ± 5.5 years) who had used a Jawbone UP24 activity tracker for 12 months during a randomised controlled trial were recruited for this study. All participants had at least one chronic condition. Acceptability data relating to activity tracker wear time was combined with focus group data to explore participants experiences of long-term activity tracker use. Data was analysed using thematic analysis.

Results

The activity tracker was well-accepted with the device worn on an average of 86% of possible days and participants reported an overall positive experience. Four themes were identified: (a) increased sense of awareness of activity levels is related to motivation; (b) the level of engagement with the activity tracker influences the user experience; (c) the role of feedback from a health professional in providing ongoing support; d) the role of habits in supporting long-term behaviour change.

Conclusions

The use of an activity tracker combined with health professional support can assist older adults to maintain their activity levels over 12 months. Consideration should be given to the previous technology experience of users and the design and accuracy of an activity tracker when recommending their use in a research or clinical setting.

What are effective policies for promoting physical activity? A systematic review of reviews

•

There is a growing need for evidence on the effectiveness of different policies to promote physical activity.

•

We conducted a systematic literature review to collate the available evidence.

•

We identified 57 reviews with evidence on 53 types of physical activity policies from 7 areas.

•

There is a solid evidence base for the effectiveness of school-based and some infrastructural policies.

•

The evidence for other (e.g. economic) policies remains insufficient.

The importance of policy for promoting physical activity (PA) is increasingly recognized by academics, and there is a push by national governments and international institutions for PA policy development and monitoring. However, our knowledge about which policies are actually effective to promote PA remains limited. This article summarizes the currently available evidence by reviewing existing reviews on the subject.

Building on results from a previous scoping review on different types of PA-related evidence, we ran searches for combinations of the terms “physical activity”, “evidence”, “effect”, “review”, and “policy” in six different databases (PubMed, Scopus, SportDiscus, PsycInfo, ERIC, and IBSS). We used EPPI Reviewer 4 to further process the results and conduct an in-depth analysis.

We identified 57 reviews providing evidence on 53 types of policies and seven broader groups of policies. Reviews fell into four main categories: 1) setting- and target group-specific; 2) urban design, environment and transport; 3) economic instruments; and 4) broad-range perspective. Results indicate that there is solid evidence for policy effectiveness in some areas (esp. school-based and infrastructural policies) but that the evidence in other areas is insufficient (esp. for economic policies).

The available evidence provides some guidance for policy-makers regarding which policies can currently be recommended as effective. However, results also highlight some broader epistemological issues deriving from the current research. This includes the conflation of PA policies and PA interventions, the lack of appropriate tools for benchmarking individual policies, and the need to critically revisit research methodologies for collating evidence on policies.

A cluster randomised trial of an intervention to increase the implementation of physical activity practices in secondary schools: study protocol for scaling up the Physical Activity 4 Everyone (PA4E1) program

Background

The implementation of interventions at-scale is required to maximise population health benefits. ‘Physical Activity 4 Everyone (PA4E1)’ was a multi-component school-based program targeting adolescents attending secondary schools in low socio-economic areas. An efficacy trial of the intervention demonstrated an increase in students’ mean minutes of moderate-to-vigorous physical activity (MVPA) per day and lower weight gain at low incremental cost. This study aims to assess the effectiveness and cost effectiveness of a multi-component implementation support intervention to improve implementation, at-scale, of the evidence based school physical activity (PA) practices of the PA4E1 program. Impact on student PA levels and adiposity will also be assessed, in addition to the cost of implementation.

Methods

A cluster randomised controlled trial, utilising an effectiveness-implementation hybrid design, will be conducted in up to 76 secondary schools located in lower socio-economic areas across four health districts in New South Wales (NSW), Australia. Schools will be randomly allocated to a usual practice control arm or a multi-component implementation support intervention to embed the seven school PA practices of the PA4E1 program. The implementation support intervention incorporates seven strategies including executive support, in-School Champion, teacher training, resources, prompts, audit and feedback and access to an external Support Officer. The primary trial outcome will be the proportion of schools meeting at least four of the seven physical activity practices of the program, assessed via surveys with Head Physical Education teachers at 12 and 24-months. Secondary outcomes will be assessed via a nested evaluation of student PA and adiposity at 12-months (Grade 8 students) and 24 months (Grade 9 students) undertaken in 30 schools (15 per group). Resource use associated with the implementation intervention will be measured prospectively. Linear mixed effects regression models will assess program effects on the primary outcome at each follow-up period.

Discussion

This study is one of few evidence-based multi-component PA programs scaled-up to a large number of secondary schools and evaluated via randomised controlled trial. The use of implementation science theoretical frameworks to implement the evidence-based program and the rigorous evaluation design are strengths of the study.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12617000681358 registered 12th May 2017. Protocol Version 1.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6965-0) contains supplementary material, which is available to authorized users.

The Need for Local, Multidisciplinary Collaborations to Promote Advances in Physical Activity Research and Policy Change: The Creation of the Boston Physical Activity Resource Collaborative (BPARC)

This commentary describes the development, vision, and initial progress of the newly-founded Boston Physical Activity Resource Collaborative (BPARC). Our aims are to move the field of physical activity forward, with broader dissemination and translation, by creating a local Boston and Massachusetts hub for researchers, practitioners, advocates, and policymakers. Participants come from multiple academic and medical centers, local advocacy groups, and government agencies, all of whom are working on components of physical activity promotion. We have had initial success in collaborating on study design, methodology, and grant applications. Future endeavors aim to produce streamlined methods and products with maximal impact for the field of physical activity research, policy, and practice.

Understanding the Spontaneous Spreading of Stone Bunds in Ethiopia: Implications for Sustainable Land Management

This study deals with the spontaneous spreading of stone bunds in the central Ethiopian highlands, i.e., the adoption and implementation of stone bunds by farmers on their own initiative. The study tests the hypothesis that spontaneously implemented stone bunds, as compared to stone bunds implemented by mass mobilization campaigns, are more integrated with other land management practices and lead to higher yields. Data are collected in the Girar Jarso woreda through field observations and household surveys. Descriptive statistics are used to analyze and test the data at 1% and 5% probability levels. Results show that stone bunds are spontaneously implemented mainly on farmlands located nearby the homesteads where farmers perceive severe erosion, poor soil fertility and steep slope gradients. Compared to stone bunds implemented by mass mobilization, spontaneously implemented stone bunds are perceived as better maintained, more frequently modified to fit the farming system and better integrated with soil fertility management practices, such as applying fertilizer, compost and manure. Particularly, this better integration with other practices is very important, because it makes stone bunds more effective in reducing erosion, leading to beneficial effects on soil moisture and soil productivity, as perceived by farmers. The study, therefore, suggests that the mass mobilization campaign should use a more participatory and integrated approach, in which there is ample space for awareness raising and learning concerning the benefits of integrated farm management, and in which farmers themselves have a leading role in the decision on where to construct stone bunds. Such a strategy will lead to more sustainable impact on soil fertility and food security than the current top-down intervention approach.

Scale up of a multi-strategic intervention to increase implementation of a school healthy canteen policy: findings of an intervention trial

Background

Implementation interventions delivered in schools to improve food provision have been found to improve student diet and reduce child obesity risk. If the health benefits of food availability policies are to be realised, interventions that are effective need to be implemented at scale, across an entire population of schools. This study aims to assess the potential effectiveness of an intervention in increasing the implementation, at scale, of a healthy canteen policy by Australian primary schools.

Methods

A non-controlled before and after study was conducted in primary schools located in the Hunter New England region of New South Wales, Australia. Schools received a multi-component intervention adapted from a previous efficacious and cost-effective randomised control trial. The primary trial outcome was the proportion of canteen menus compliant with the state healthy canteen policy, assessed via menu audit at baseline and follow-up by dietitians. Secondary outcomes included policy reach and adoption and maintenance policy implementation.

Results

Of the 173 schools eligible for inclusion in the trial, 168 provided menus at baseline and 157 menus were collected at follow-up. At follow-up, multiple imputation analysis found 35% (55/157) of schools compared to 17% (29/168) at baseline (OR = 2.8 (1.6–4.7), p = < 0.001) had menus compliant with the state healthy canteen policy. As an assessment of the impact of the intervention on policy reach, canteen manager and principal knowledge of the policy increased from 64% (n = 76) and 38% (n = 44) respectively at baseline to 69% (n = 89) and 60% (n = 70) at follow-up (p = 0.393, p = 0.026). Adoption of the policy increased from 80% (n = 93) at baseline to 90% (n = 104) at follow-up (p = 0.005) for principals, and from 86% (n = 105) to 96% (n = 124) (p = 0.0001) for canteen managers. Multiple imputation analysis showed intervention effects were maintained six-months post intervention (33% of menus compliant OR = 2.6 (1.5–4.5), p = < 0.001 compared to baseline).

Conclusions

This study found school canteen compliance with a healthy food policy increased in association with a multi-strategy intervention delivered at scale. The study provides evidence for public health policy makers and practitioners regarding strategies and modes of support required to support improvement in nutrition policy implementation across entire populations of schools.

From Evidence-Based Research to Practice-Based Evidence: Disseminating a Web-Based Computer-Tailored Workplace Sitting Intervention through a Health Promotion Organisation

Prolonged sitting has been linked to adverse health outcomes; therefore, we developed and examined a web-based, computer-tailored workplace sitting intervention. As we had previously shown good effectiveness, the next stage was to conduct a dissemination study. This study reports on the dissemination efforts of a health promotion organisation, associated costs, reach achieved, and attributes of the website users. The organisation systematically registered all the time and resources invested to promote the intervention. Website usage statistics (reach) and descriptive statistics (website users’ attributes) were also assessed. Online strategies (promotion on their homepage; sending e-mails, newsletters, Twitter, Facebook and LinkedIn posts to professional partners) were the main dissemination methods. The total time investment was 25.6 h, which cost approximately 845 EUR in salaries. After sixteen months, 1599 adults had visited the website and 1500 (93.8%) completed the survey to receive personalized sitting advice. This sample was 38.3 ± 11.0 years, mainly female (76.9%), college/university educated (89.0%), highly sedentary (88.5% sat >8 h/day) and intending to change (93.0%) their sitting. Given the small time and money investment, these outcomes are positive and indicate the potential for wide-scale dissemination. However, more efforts are needed to reach men, non-college/university educated employees, and those not intending behavioural change.

A theory of planned behaviour perspective on practitioners' beliefs toward the integration of the WIXX communication campaign messages and activities into daily practice

OBJECTIVES

To favour the dissemination and the implementation of the WIXX multimedia communication campaign, the aim of this study was to examine practitioners' beliefs towards the integration of the WIXX campaign activities into daily practice.

STUDY DESIGN

An exploratory qualitative study.

METHODS

Overall, 58 community-based practitioners completed an online questionnaire based on the theory of planned behaviour guidelines pertaining to perceived advantages/disadvantages and perceived barriers/facilitators toward the campaign. A content analysis was performed by two independent coders to extract modal beliefs. Results were validated by a third coder.

RESULTS

Local partners had a positive attitude toward the WIXX campaign, but significant barriers remained and needed to be addressed to ensure full implementation of this campaign (e.g. lack of time or resources, additional workload, complexity of the registration process and so forth). Beliefs were fragmented and diversified, indicating that they were highly context dependent.

CONCLUSIONS

To conclude, some remaining challenges regarding the full implementation of the WIXX communication campaign were identified, suggesting that additional efforts might be needed to ensure the full adoption of the campaign by local practitioners.

Meaningful components of a community-based exercise program for individuals with disabilities: A qualitative study

BACKGROUND

Enhanced methods of evaluation are necessary to identify community-based exercise interventions that promote physical activity and improve health and participation for individuals with disabilities. The heterogeneity of the populations served, interventions implemented, and outcome measures used remains a barrier to effectively evaluate programs and generate evidence to inform best practice.

OBJECTIVE

To explore goals and benefits of community-based exercise for individuals with disabilities and determine barriers and facilitators to evaluation in a community setting.

METHODS

We conducted semi-structured interviews with exercise participants and staff of a community-based exercise program for individuals with disabilities. We then coded responses to interview questions for themes using thematic analysis or deductive content analysis, with codes linked to categories within the International Classification of Functioning, Disability and Health (ICF).

RESULTS

Identified goals and benefits spanned the ICF domains of Body Functions and Activities and Participation. Commonly cited goals and benefits included improving strength and endurance, general health, self-efficacy, community participation, and the importance of returning to exercise. Barriers and facilitators to evaluation identified by staff included maintaining a balance between evaluation and services, negative attitudes toward evaluation, access to data, and consistency with scheduling.

CONCLUSIONS

These results can be used to enhance evaluation within community-based exercise programs for individuals with disabilities, which may improve both the quality and impact of these programs.

A Community-Based Participatory Research Guided Model for the Dissemination of Evidence-Based Interventions

BACKGROUND

Dissemination is a principle within community-based participatory research (CBPR); however, published research focuses on the dissemination of findings from CBPR projects but less on dissemination of interventions developed through CBPR approaches. To disseminate an evidence-based lifestyle intervention tailored for Native Hawaiians and other Pacific Islanders, the PILI 'Ohana Project (POP), an 11-year CBPR initiative, developed an innovative dissemination model.

OBJECTIVES

The community-to-community mentoring (CCM) model described in this paper extends the application of CBPR values and principles used in intervention development to intervention dissemination.

METHODS

The CCM model combines a CBPR orientation with the diffusion of innovation theory, the social cognitive theory, and key concepts from community organizing and community building to address the multilevel factors that influence uptake of an evidence-based intervention (EBI). Grounding the model in CBPR principles provides benefits for intervention dissemination and integrates a focus on community benefits and capacity building.

CONCLUSIONS

By establishing co-equal, mutually beneficial relationships at the core of the CCM model, opportunities are created for building critical consciousness, community capacity, and social capital. More research is needed to determine the effectiveness of this model of intervention dissemination which may enhance diffusion of CBPR interventions and empower communities in the process.

Assessing citation networks for dissemination and implementation research frameworks

BACKGROUND

A recent review of frameworks used in dissemination and implementation (D&I) science described 61 judged to be related either to dissemination, implementation, or both. The current use of these frameworks and their contributions to D&I science more broadly has yet to be reviewed. For these reasons, our objective was to determine the role of these frameworks in the development of D&I science.

METHODS

We used the Web of Science™ Core Collection and Google Scholar™ to conduct a citation network analysis for the key frameworks described in a recent systematic review of D&I frameworks (Am J Prev Med 43(3):337-350, 2012). From January to August 2016, we collected framework data including title, reference, publication year, and citations per year and conducted descriptive and main path network analyses to identify those most important in holding the current citation network for D&I frameworks together.

RESULTS

The source article contained 119 cited references, with 50 published articles and 11 documents identified as a primary framework reference. The average citations per year for the 61 frameworks reviewed ranged from 0.7 to 103.3 among articles published from 1985 to 2012. Citation rates from all frameworks are reported with citation network analyses for the framework review article and ten highly cited framework seed articles. The main path for the D&I framework citation network is presented.

CONCLUSIONS

We examined citation rates and the main paths through the citation network to delineate the current landscape of D&I framework research, and opportunities for advancing framework development and use. Dissemination and implementation researchers and practitioners may consider frequency of framework citation and our network findings when planning implementation efforts to build upon this foundation and promote systematic advances in D&I science.

Implementing and Evaluating Environmental and Policy Interventions for Promoting Physical Activity in Rural Schools

BACKGROUND

Schools are an important setting for improving behaviors associated with obesity, including physical activity. However, within schools there is often a tension between spending time on activities promoting academic achievement and those promoting physical activity.

METHODS

A community-based intervention provided administrators and teachers with a training on evidence-based public health and then collaborated with them to identify and implement environmental (walking track) and local school policy interventions (brain breaks). The evaluation included conducting in-depth interviews and SOPLAY observations to assess the facilitators and barriers and impact of the dissemination of environmental and policy changes.

RESULTS

Individual, organizational, intervention, and contextual factors influenced dissemination. Teachers reported that brain breaks increased student focus and engagement with classroom material and decreased student behavioral problems. Students decreased sedentary behavior and increased vigorous behavior. Of the 4 schools, 2 increased walking.

CONCLUSIONS

Active dissemination of environmental and policy interventions by engaging school administrators and teachers in planning and implementation shows potential for increasing physical activity in rural school settings.

An audience research study to disseminate evidence about comprehensive state mental health parity legislation to US State policymakers: protocol

BACKGROUND

A large proportion of the US population has limited access to mental health treatments because insurance providers limit the utilization of mental health services in ways that are more restrictive than for physical health services. Comprehensive state mental health parity legislation (C-SMHPL) is an evidence-based policy intervention that enhances mental health insurance coverage and improves access to care. Implementation of C-SMHPL, however, is limited. State policymakers have the exclusive authority to implement C-SMHPL, but sparse guidance exists to inform the design of strategies to disseminate evidence about C-SMHPL, and more broadly, evidence-based treatments and mental illness, to this audience. The aims of this exploratory audience research study are to (1) characterize US State policymakers' knowledge and attitudes about C-SMHPL and identify individual- and state-level attributes associated with support for C-SMHPL; and (2) integrate quantitative and qualitative data to develop a conceptual framework to disseminate evidence about C-SMHPL, evidence-based treatments, and mental illness to US State policymakers.

METHODS

The study uses a multi-level (policymaker, state), mixed method (QUAN→qual) approach and is guided by Kingdon's Multiple Streams Framework, adapted to incorporate constructs from Aarons' Model of Evidence-Based Implementation in Public Sectors. A multi-modal survey (telephone, post-mail, e-mail) of 600 US State policymakers (500 legislative, 100 administrative) will be conducted and responses will be linked to state-level variables. The survey will span domains such as support for C-SMHPL, knowledge and attitudes about C-SMHPL and evidence-based treatments, mental illness stigma, and research dissemination preferences. State-level variables will measure factors associated with C-SMHPL implementation, such as economic climate and political environment. Multi-level regression will determine the relative strength of individual- and state-level variables on policymaker support for C-SMHPL. Informed by survey results, semi-structured interviews will be conducted with approximately 50 US State policymakers to elaborate upon quantitative findings. Then, using a systematic process, quantitative and qualitative data will be integrated and a US State policymaker-focused C-SMHPL dissemination framework will be developed.

DISCUSSION

Study results will provide the foundation for hypothesis-driven, experimental studies testing the effects of different dissemination strategies on state policymakers' support for, and implementation of, evidence-based mental health policy interventions.

Movement integration in elementary classrooms: Teacher perceptions and implications for program planning

Movement integration (MI), which involves infusing physical activity (PA) into regular classroom time in schools, is widely recommended to help children meet the national guideline of 60min of PA each day. Understanding the perspective of elementary classroom teachers (ECTs) toward MI is critical to program planning for interventions/professional development. This study examined the MI perceptions of ECTs in order to inform the design and implementation of a school-based pilot program that focused in part on increasing children's PA through MI. Twelve ECTs (Grades 1-3) from four schools were selected to participate based on their responses to a survey about their use of MI. Based on the idea that MI programming should be designed with particular attention to teachers who integrate relatively few movement opportunities in their classrooms, the intent was to select the teacher who reported integrating movement the least at her/his respective grade level at each school. However, not all of these teachers agreed to participate in the study. The final sample included two groups of ECTs, including eight lowest integrating teachers and four additional teachers. Each ECT participated in an interview during the semester before the pilot program was implemented. Through qualitative analysis of the interview transcripts, four themes emerged: (a) challenges and barriers (e.g., lack of time), (b) current and ideal resources (e.g., school support), (c) current implementation processes (e.g., scheduling MI into daily routines), and (e) teachers' ideas and tips for MI (e.g., stick with it and learn as you go). The themes were supported by data from both groups of teachers. This study's findings can inform future efforts to increase movement opportunities for children during regular classroom time.

Does public health advocacy seek to redress health inequities? A scoping review

The public health (PH) sector is ideally situated to take a lead advocacy role in catalysing and guiding multi-sectoral action to address social determinants of health inequities, but evidence suggests that PH's advocacy role has not been fully realised. The purpose of this review was to determine the extent to which the PH advocacy literature addresses the goal of reducing health and social inequities, and to increase understanding of contextual factors shaping the discourse and practice of PH advocacy. We employed scoping review methods to systematically examine and chart peer-reviewed and grey literature on PH advocacy published from January 1, 2000 to June 30, 2015. Databases and search engines used included: PubMed, CINAHL, PsycINFO, Social Sciences Citation Index, Google Scholar, Google, Google Books, ProQuest Dissertations and Theses, Grey Literature Report. A total of 183 documents were charted, and included in the final analysis. Thematic analysis was both inductive and deductive according to the objectives. Although PH advocacy to address root causes of health inequities is supported theoretically and through professional practice standards, the empirical literature does not reflect that this is occurring widely in PH practice. Tensions within the discourse were noted and multiple barriers to engaging in PH advocacy for health equity were identified, including a preoccupation with individual responsibilities for healthy lifestyles and behaviours, consistent with the emergence of neoliberal governance. If the PH sector is to fulfil its advocacy role in catalysing action to reduce health inequities, it will be necessary to address advocacy barriers at multiple levels, promote multi-sectoral efforts that implicate the state and corporations in the production of health inequities, and rally state involvement to redress these injustices.

Factors influencing implementation of a preschool-based physical activity intervention

Examining factors that influence implementation of key program components that underlie an intervention’s success provides important information to inform the development of effective dissemination strategies. We examined direct and indirect effects of preschool capacity, quality of prevention support system and teacher characteristics on implementation levels of a component, called Move Outside (i.e., preschool classroom teachers to provide at least 40 min of outdoor recess per day), that was fundamental to the success of a preschool-based physical activity intervention. Level of implementation, defined as the percent of daily goal met for the Move Outside component, was assessed via direct observation. Items assessing preschool capacity, quality of prevention support system and teacher characteristics were selected from surveys and an environmental checklist completed by preschool directors and teachers. Preschool classroom was used as the unit of analysis (Year 1: n = 19; Year 2: n = 17). Results from Bayesian path analyses showed that the three factors were not significantly associated with level of implementation in Year 1, but preschool capacity was directly associated with level of implementation in Year 2 (β= 0.528, 95% CI: 0.134, 0.827). The current findings suggest that factors that influence level of implementation appear to differ as an intervention evolved over time.

The relationship between the implementation and effectiveness of a nationwide physical activity telephone counseling service for adults with spinal cord injury

PURPOSE

Get in Motion (GIM) is an evidence-based telephone counseling service that promotes leisure-time physical activity (LTPA) among Canadian adults with spinal cord injury (SCI). The first phase of GIM sustained intentions for, and increased participation in, LTPA; however, it is unclear how GIM led to these outcomes. The purpose of this study was to explore the implementation correlates of change in LTPA intentions and behavior in the second phase of GIM.

METHODS

The frequency, duration, and content of counseling sessions were tailored to meet clients' (N = 46; 50.0% male; 50.0% paraplegia; 51.46 (SD 12.36) years old) needs and preferences. Intervention dose and content were monitored using Counseling Session Checklists. Clients self-reported their intentions for and actual aerobic and strength-training LTPA participation at baseline, 2-, 4-, and 6-months, and their perceptions of service quality at 6-months.

RESULTS

The second phase of GIM effectively sustained LTPA intentions and increased time spent on moderate-to-vigorous strength-training and total LTPA. Increases in clients' moderate-to-vigorous aerobic LTPA were significantly positively related to intervention dose, intervention content (both informational and behavioral strategies), and clients' perceptions of service credibility.

CONCLUSIONS

This study identified intervention dose and content as key implementation variables for an LTPA telephone counseling service for adults with SCI. Implications for Rehabilitation An evidence- and theory-based telephone counseling service can effectively sustain LTPA intentions and increase LTPA behavior among adults with SCI. The first two months of the service are a critical period for enhancing LTPA participation and for minimizing dropouts. The provision of both informational and behavioral strategies is important for increasing aerobic LTPA levels among adults with SCI.

Physical activity maintenance among Spanish-speaking Latinas in a randomized controlled trial of an Internet-based intervention

Spanish-speaking Latinas have some of the lowest rates of meeting physical activity guidelines in the U.S. and are at high risk for many related chronic diseases. The purpose of the current study was to examine the maintenance of a culturally and individually-tailored Internet-based physical activity intervention for Spanish-speaking Latinas. Inactive Latinas (N  =  205) were randomly assigned to a 6-month Tailored Physical Activity Internet Intervention or a Wellness Contact Control Internet Group, with a 6-month follow-up. Maintenance was measured by assessing group differences in minutes per week of self-reported and accelerometer measured moderate to vigorous physical activity (MVPA) at 12 months after baseline and changes in MVPA between the end of the active intervention (month 6) and the end of the study (month 12). Potential moderators of the intervention were also examined. Data were collected between 2011 and 2014, and were analyzed in 2015 at the University of California, San Diego. The Intervention Group engaged in significantly more minutes of MVPA per week than the Control Group at the end of the maintenance period for both self-reported (mean diff. = 30.68, SE = 11.27, p = .007) and accelerometer measured (mean diff. = 11.47, SE = 3.19, p = .01) MVPA. There were no significant between- or within-group changes in MVPA from month 6 to 12. Greater intervention effects were seen for those with lower BMI (BMI × intervention = -6.67, SE = 2.88, p = .02) and lower perceived places to walk to in their neighborhood (access × intervention = -43.25, SE = 19.07, p = .02), with a trend for less family support (social support × intervention = -3.49, SE = 2.05, p = .08). Acculturation, health literacy, and physical activity related psychosocial variables were not significant moderators of the intervention effect during the maintenance period. Findings from the current study support the efficacy of an Internet-delivered individually tailored intervention for maintenance of MVPA gains over time.

A non-equivalent group pilot trial of a school-based physical activity and fitness intervention for 10-11 year old english children: born to move

Background

PE lessons are the formal opportunity in schools for promotion of physical activity and fitness. This study aimed to evaluate the effectiveness of a pilot PE intervention on physical activity, fitness, and psychosocial outcomes.

Methods

Participants were 139 children aged 10–11 years from four schools. For six weeks children in two schools received a twice-weekly pilot ‘Born to Move’ (BTM) physical activity (PA) and fitness intervention alongside one regular PE lesson. Children in the two comparison (COM) schools received their regular twice weekly PE lessons. Outcomes were lesson time and whole-day light (LPA), moderate (MPA), vigorous (VPA), and MVPA, and sedentary time, muscular fitness, cardiorespiratory fitness (CRF), and lesson-specific perceived exertion, enjoyment, and perceived competence. Outcomes were assessed at baseline (T0), midway through the intervention (T1), and at the end (T2) using ANOVAs and ANCOVAs. Intervention fidelity was measured using child and teacher surveys at T2 and analysed using Chi-square tests.

Results

The BTM group engaged in moderate PA for significantly more lesson time (29.4 %) than the COM group (25.8 %; p = .009, d = .53). The amount of moderate-to-vigorous PA (MVPA) during the T1 BTM lesson contributed 14.0 % to total MVPA, which was significantly more than the COM group’s T1 PE lesson (11.4 %; p < .001, d = .47). The BTM group were significantly more active during the whole-day (p < .05) and the school-day (p < .01). In both groups push-up test performance increased (p < .001) and CRF test performance decreased (p < .01). Perceived exertion, enjoyment, and perceived competence increased in both groups (p < .05), but the BTM group rated their enjoyment of the T1 BTM lesson higher than the COM group rated their PE lesson (p = .02, d = .56). The children’s and teachers’ responses to the intervention indicated that the delivery aims of enjoyment, engagement, inclusivity, and challenge were satisfied.

Conclusions

The BTM pilot programme has potential to positively impact on physical activity, fitness, and psychosocial outcomes. Further, BTM was enjoyed by the children, and valued by the teachers. This study can inform the design of a modified larger-scale cluster RCT evaluation.

Systematic dissemination of a preschool physical activity intervention to the control preschools

For public health interventions to have a meaningful impact on public health, they must be disseminated to the wider population. Systematic planning and evaluation of dissemination efforts can aid translation from experimental trials to larger dissemination programs. The Study of Health and Activity in Preschool Environments (SHAPES) was a group-randomized intervention trial conducted in 16 preschools that successfully increased the physical activity of preschool age children. Following the completion of the research study protocol, the intervention was abbreviated, modified and implemented in four preschools that participated as control preschools in the original research study. The purposes of the current study were to describe the process of refining the intervention for dissemination to the control preschools, and to assess the acceptability of the resulting abbreviated intervention delivery. Five overarching behavioral objectives, informed by process evaluation, data from the original trial and collaboration with intervention teachers, were used to guide the implementation. Teachers in the dissemination classrooms reported high levels of acceptability, potential for sustainability of the program, and positive results in knowledge, skills, and child outcomes. Researchers can include a systematic approach to dissemination of effective intervention elements to the control participants in experimental studies to inform future dissemination efforts and begin to bridge the dissemination gap.

Expanding the Reach of Evidence-Based Self-Management Education and Physical Activity Interventions: Results of a Cross-Site Evaluation of State Health Departments

Participation in community-based self-management education and physical activity interventions has been demonstrated to improve quality of life for those who have arthritis and other chronic diseases. The Centers for Disease Control and Prevention Arthritis Program funded 21 state health departments to expand the reach (defined as the number of people who participate in interventions) of 10 evidence-based interventions in community settings. The Arthritis Centralized Evaluation assessed the strategies and tactics used by state health departments to expand the reach of these evidence-based interventions. The evaluation compared and contrasted processes used by the states to expand reach. Engaging multisite delivery system partners, prioritizing reach, embedding interventions within partners' routine operations, and collaborating across chronic disease program areas were all dissemination strategies that were correlated with expanded intervention reach. However, states also encountered challenges that limited their ability to successfully engage delivery systems as partners. These barriers included difficulty identifying delivery system partners and the lengthy time periods partners needed to adopt and embed the interventions.

Effectiveness of centre-based childcare interventions in increasing child physical activity: a systematic review and meta-analysis for policymakers and practitioners

CONTEXT

The review describes the effectiveness of physical activity interventions implemented in centre-based childcare services and (i) examines characteristics of interventions that may influence intervention effects; (ii) describes the effects of pragmatic interventions and non-pragmatic interventions; (iii) assesses adverse effects; and (iv) describes cost-effectiveness of interventions

METHODS

Data sources were Cochrane Central Register of Controlled trials, MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, SCOPUS and SPORTDISCUS. Studies selected included randomized controlled trials conducted in centre-based childcare including an intervention to increase objectively measured physical activity in children aged less than 6 years. Data were converted into standardized mean difference (SMD) and analysed using a random effects model.

RESULTS

Overall interventions significantly improved child physical activity (SMD 0.44; 95% confidence interval [CI]: 0.12-0.76). Significant effects were found for interventions that included structured activity (SMD 0.53; 95% CI: 0.12-0.94), delivery by experts (SMD 1.26; 95% CI: 0.20-2.32) and used theory (SMD 0.76; 95% CI: 0.08-1.44). Non-pragmatic (SMD 0.80; 95% CI: 0.12-1.48) but not pragmatic interventions (SMD 0.10; 95% CI:-0.13-0.33) improved child physical activity. One trial reported adverse events, and no trials reported cost data.

CONCLUSIONS

Intervention effectiveness varied according to intervention and trial design characteristics. Pragmatic trials were not effective, and information on cost and adverse effects was lacking. Evidence gaps remain for policymakers and practitioners regarding the effectiveness and feasibility of childcare-based physical activity interventions.

Exploring the Range of Lifestyle Interventions Used in Dutch Health Care Practice

Background. The application of evidence-based lifestyle interventions is suboptimal, but little is known what interventions are actually used. This study aimed to explore the range of lifestyle interventions used in Dutch ambulatory health care settings. Method. We conducted interviews (n = 67) in purposefully selected hospitals, general practices, and community care organizations. Interviews focused on identifying activities to help patients stop smoking, reduce alcohol consumption, increase physical activity, eat a healthy diet, and lose weight. We also asked who developed the interventions. All reported activities were registered and analyzed. Results. Four categories of health promotion activities emerged: giving advice, making referrals, offering counseling, and providing lifestyle interventions organized separately from the care process. In total, 102 lifestyle interventions were reported. Forty-five interventions were developed by researchers, of which 30 were developed by the Dutch Expert Center on Tobacco Control. Providers did not know the source of 31 interventions. Eighteen interventions were developed by the providers themselves, and eight were based on evidence-based guidelines. Conclusions. Health promotion activities seemed to be widely present in Dutch health care, in particular smoking cessation interventions. Although health care providers use many different interventions, replacing nontested for evidence-based interventions is required.

Mixed method evaluation of a community-based physical activity program using the RE-AIM framework: practical application in a real-world setting

BACKGROUND

Communities are a pivotal setting in which to promote increases in child and adolescent physical activity behaviours. Interventions implemented in these settings require effective evaluation to facilitate translation of findings to wider settings. The aims of this paper are to i) present findings from a RE-AIM evaluation of a community-based physical activity program, and ii) review the methodological challenges faced when applying RE-AIM in practice.

METHODS

A single mixed-methods case study was conducted based on a concurrent triangulation design. Five sources of data were collected via interviews, questionnaires, archival records, documentation and field notes. Evidence was triangulated within RE-AIM to assess individual and organisational-level program outcomes.

RESULTS

Inconsistent availability of data and a lack of robust reporting challenged assessment of all five dimensions. Reach, Implementation and setting-level Adoption were less successful, Effectiveness and Maintenance at an individual and organisational level were moderately successful. Only community-level Adoption was highly successful, reflecting the key program goal to provide community-wide participation in sport and physical activity.

CONCLUSIONS

This research highlighted important methodological constraints associated with the use of RE-AIM in practice settings. Future evaluators wishing to use RE-AIM may benefit from a mixed-method triangulation approach to offset challenges with data availability and reliability.

Evaluation of a randomized intervention to increase adoption of comparative effectiveness research by community health organizations

This randomized controlled trial examined the influence of two strategies (informational packets alone and in conjunction with Webinars) aimed at increasing the adoption of motivational interviewing (MI), a patient-centered behavioral health practice supported by evidence from comparative effectiveness studies, among community health organizations responsible for delivering mental and behavioral health services. Data were obtained from 311 directors and staff across 92 community organizations. Hierarchical linear modeling was used to examine changes in decision to adopt MI. The mediating effects of multiple contextual variables were also examined. Results showed that both strategies positively influenced the decision to adopt. The positive impact on decision to adopt was significantly greater among individuals that received informational packets in conjunction with Webinars. Baseline attitudes toward evidence-based practices and pressures for change appeared to mediate this effect.

Predictors of the decision to adopt motivational interviewing in community health settings

The purpose of this study is to concurrently examine the impact of individual and organizational characteristics on the decision to adopt the evidence-based practice (EBP) motivational interviewing (MI) among directors and staff (n = 311) in community health organizations (n = 92). Results from hierarchical linear modeling indicated that, at the individual level, attitudes toward EBPs and race each predicted directors' decisions to adopt, while gender predicted staff's decisionmaking. At the organizational level, organizational climate was inversely associated with both staff's and directors' decisions to adopt MI. Organizational barriers to implementing EBPs and use of reading materials and treatment manuals were related to directors' decision to adopt. Type of organization and staff attributes were associated with staff's decision to adopt. These findings underscore the need to tailor dissemination and implementation strategies to address differences between directors and staff in the adoption of EBPs.

KIDS OUT! Protocol of a brief school-based intervention to promote physical activity and to reduce screen time in a sub-cohort of Finnish eighth graders

Background

Adolescents’ physical activity (PA) is decreasing and sedentary behavior (SB) increasing alarmingly. Insufficient PA and excessive SB are both related to various health risks indicating that interventions to promote adolescents’ PA and to reduce their SB are needed. Schools have a great potential to reach most adolescents, and in Finland health education (HE) as stand-alone subject provides an excellent platform for health promotion. This paper describes the protocol and evaluation (RE-AIM) of an intervention developed for three HE lessons to increase PA and reduce SB during leisure among 8^th graders.

Methods/Design

All city-owned secondary schools in Tampere (n = 14) were invited to the study and were randomized in pairs to intervention (n = 7) and comparison group (n = 7). A specific content on PA and SB based on Health Action Process Approach model was integrated into routinely scheduled three HE lessons with the help of educational material: SoftGIS-questionnaire followed by feedback views on adolescents’ current PA and SB, FeetEnergy-homework leaflet for adolescents, FeetEnergy-video in YouTube, FeetEnergy-poster for classroom and FeetEnergy-leaflet for parents. In the comparison group standard HE lessons were held. The primary indicators of Effectiveness are changes in PA and SB and in their psychosocial factors as well as in parental interference with PA and SB. The measurement points are baseline, 4 weeks after the intervention and 7 months from baseline, the last indicating also the measurement point for individual level Maintenance. The measures are accelerometers, 7-day activity diaries and questionnaires. The evaluation of Reach, Adoption and Implementation is based on the data collected during the intervention. Maintenance at organizational level is assessed two years after the intervention with a questionnaire to the HE teachers. The intervention was implemented in 2012 and the last measurements to assess organizational Maintenance were conducted in the end of 2014. A detailed description of the protocol and evaluation is provided to enable replication and better understanding of the findings, which will be reported in 2015.

Discussion

The findings will add our current knowledge about the feasibility and effectiveness of integrating simple structured elements into the HE lessons to increase PA and reduce SB in adolescents.

Trial registration

NCT01633918 (June 27^th, 2012)

A mixed-methods exploration of implementation of a comprehensive school healthy eating model one year after scale-up

OBJECTIVE

To study the implementation of a school-based healthy eating (HE) model one year after scale-up in British Columbia (BC). Specifically, to examine implementation of Action Schools! BC (AS! BC) and its influence on implementation of classroom HE activities, and to explore factors associated with implementation.

DESIGN

Diffusion of Innovations, Social Cognitive and Organizational Change theories guided our approach. We used a mixed-methods research design including focus group interviews (seven schools, sixty-two implementers) and a cross-sectional multistage survey to principals (n 36, 92 % response rate) and teachers of grades 4 to 7 (n 168, 70 % response rate). Self-reported implementation of classroom HE activities and reported use of specific AS! BC HE activities were primary implementation measures. Thematic analysis of focus group data and multilevel mixed-effect logistic regression analyses of survey data were conducted.

SETTING

Elementary schools across BC, Canada.

SUBJECTS

Thirty-nine school districts, thirty-six principals, 168 grade 4 to 7 teachers.

RESULTS

Forty-two per cent of teachers in registered schools were implementing AS! BC HE in their classrooms. Users were 6·25 times more likely to have delivered a HE lesson in the past week. Implementation facilitators were school champions, technical support and access to resources; barriers were lack of time, loss of leadership or momentum. Implementation predictors were teacher training, self-efficacy, experience with the physical activity component of AS! BC, supportive school climate and parental post-secondary education.

CONCLUSIONS

Our findings reinforce that continued teacher training and support are important public health investments that contribute to successful implementation of school-based HE models after scale-up.

Evaluation of Intervention Reach on a Citywide Health Behavior Change Campaign

Little is known about dissemination strategies that contribute to health information recognition. This study examined (a) health campaign exposure and awareness (slogan and logo recognition); (b) perceived communication channels; (c) differences between perceptions of researcher-developed and enhancement community health information materials; and (d) differences in campaign awareness and communication channels, according to Japanese community demographic characteristics. A cross-sectional survey ( N = 508) was conducted in Tokigawa, Japan, in 2013. The Small Change Campaign focused on increasing physical activity and improving dietary habits. Information dissemination was carried out using leaflets, newsletters, posters, website, local public relations magazines, health classes, events, and online newsletters. The participants completed a survey assessing their campaign awareness (i.e., slogan and logo) and exposure to the informational materials presented during the campaign. Fewer than half (45.4%) knew the slogan, and only 24.4% were aware of the logo. Public relations magazines, leaflets, and newsletters were significantly better-perceived health communication channels. Researcher-developed and enhancement community health information materials were equally recognized ( p = .34, w = .08). Furthermore, women and those who were employed were significantly more aware of the slogan, logo, and communication materials. Further research should explore effective communication strategies for community-based health promotion intervention via randomized control trials.

A systematic review of public health-aligned recommendations for preparing physical education teacher candidates

PURPOSE

Since Sallis and McKenzie's seminal article in 1991 outlining physical education's role in public health, increased attention has been given to promoting youth physical activity in schools. The present study systematically reviewed the literature from 1991 to 2013 to identify recommendations for the preparation of physical education teacher candidates (PETCs) from a public health perspective.

METHOD

Eight online databases (e.g., Educational Resources Information Center, Google Scholar) served as data sources for the study. Multiple combinations of key terms (e.g., physical education teacher education [PETE], public health, health-oriented) were used to identify relevant literature meeting search criteria. A content analysis was used to identify 47 distinct recommendations from 25 included articles and to synthesize these recommendations into major areas of focus.

RESULTS

Three major areas of focus were identified: (a) candidate profile (e.g., PETCs should be physically active and fit role models), (b) candidate knowledge (e.g., PETCs should know about behavior change theories), and (c) candidate skills (e.g., PETCs should be able to advocate for school-based physical activity).

CONCLUSION

This review can serve as a blueprint for PETE programs seeking to align professional preparation with public health goals.

Evaluation of the Coaches Educators training implementation of the PAPA project: A comparison between Norway and France

This study cross-culturally compares the implementation process of the Empowering Coaching™ training program to grassroots coaches (GCs) by trained Coach Educators (CEs) from the Promoting Adolescent Physical Activity project in Norway and France. This program targets children's health through coach training to create a more positive environment. Using the RE-AIM framework, indicators of implementation processes at staff level were defined for adoption, implementation, and maintenance. CEs (n = 18) were interviewed about their professional use of the training, and video-filmed delivering the intervention trial workshops. GCs (n = 185) responded to a questionnaire after the workshops. Results showed that CEs were keen to participate in this project (16/18; 89%), to stay involved (12/16; 75%), and to diffuse the principles after the research project (12/12; 100%). CE training seemed effective as results indicated that CEs applied the principles of the program during the workshops and covered a high degree of the content (78%). Cross-cultural differences were found as the French Football Federation CE dropped out of the program, as Norwegian CEs delivered the content with higher fidelity and had higher enjoyment and pace scores than French CEs. More indicators are needed to use the RE-AIM framework for cross-cultural comparison.

Developing a Dissemination Model to Improve Intervention Reach among West Virginia Youth Smokers

The not-on-tobacco program is an evidence-based teen smoking cessation program adopted by the American Lung Association (ALA). Although widely disseminated nationally via ALA Master Trainers, in recent years, adoption and implementation of the N-O-T program in West Virginia (WV) has slowed. WV, unfortunately, has one of the highest smoking rates in the US. Although it is a goal of public health science, dissemination of evidence-based interventions is woefully understudied. The present manuscript reviews a theoretical model of dissemination of the not-on-tobacco program in WV. Based on social marketing, diffusion of innovations, and social cognitive theories, the nine-phase model incorporates elements of infrastructure development, accountability, training, delivery, incentives, and communication. The model components as well as preliminary lessons learned from initial implementation are discussed.

Translating Guidelines for the Diagnosis and Management of Sports-Related Concussion Into Practice

Sports injuries are a significant clinical and public health concern. There is a growing call to improve the translation of available evidence-based and expert-informed sports injury prevention interventions into sustained use in practice by physicians and others (eg, athletic trainers, coaches, and parents) who care for injured athletes. This article provides a brief overview of the current sport injury prevention implementation literature before focusing specifically on the translation of guidelines (including consensus and position statements) developed to assist physicians and others diagnose and manage athletes with sport-related concussion and the associated return-to-play decisions. The outcomes of more than 20 published studies indicate that physician, athletic trainer, coach, parent, and athlete knowledge, use of, and compliance with sport-related concussion guidelines are limited. More concerted, coordinated, and theory-informed efforts are required to facilitate the widespread dissemination, translation, and implementation of such guidelines. An example is provided of how implementation drivers could be used to inform the development of a comprehensive, multilevel implementation strategy targeting the individual, organizational, and system-level changes necessary to support the translation of available sport-related concussion guidelines in both the clinical and sports settings.