Faith, Activity, and Nutrition Randomized Dissemination and Implementation Study: Countywide Adoption, Reach, and Effectiveness

Barriers and Facilitators to 24-Month Maintenance of the Faith, Activity, and Nutrition Program in the U.S

Little is known about the barriers and facilitators to organizational maintenance of faith-based health promotion programs. This study used qualitative data (collected from 2016-2019) from pastors (n = 81) and program coordinators (n = 103) to identify barriers and facilitators to 24-month maintenance of a faith-based physical activity (PA) and healthy eating (HE) intervention in South Carolina. Barriers differed for PA versus HE: resistance to change impeded HE while church characteristics tended to impede PA. Similar themes emerged for PA and HE facilitators: healthy opportunities, church communication, and consistency. Future research should build upon this study to tailor faith-based health promotion programs for long-term sustainability.

Systems approaches to scaling up: a systematic review and narrative synthesis of evidence for physical activity and other behavioural non-communicable disease risk factors

BACKGROUND

Non-communicable diseases (NCDs) are the leading causes of death worldwide. Systems approaches have potential for creating sustainable outcomes at scale but have rarely been used to support scale up in physical activity/nutrition promotion or NCD prevention more generally. This review aimed to: (i) synthesise evidence on the use of systems approaches in scaling up interventions targeting four behavioural risk factors for NCDs; and (ii) to explore how systems approaches have been conceptualised and used in intervention implementation and scale up.

METHOD

Seven electronic databases were searched for studies published 2016-2021. Eligible studies targeted at least one of four NCD behavioural risk factors (physical inactivity, tobacco use, alcohol consumption, diet), or described evaluation of an intervention planned for or scaled up. Studies were categorised as having a (i) high, (ii) moderate, or (iii) no use of a systems approach. A narrative synthesis of how systems approaches had been operationalised in scale up, following PRISMA guidelines.

RESULTS

Twenty-one intervention studies were included. Only 19% (n = 4) of interventions explicitly used systems thinking to inform intervention design, implementation and scale up (targeting all four risk factors n = 2, diet n = 1, tobacco use n = 1). Five studies ('high use') planned and implemented scale up with an explicit focus on relations between system elements and used system changes to drive impact at scale. Seven studies ('moderate use') considered systems elements impacting scale-up processes or outcomes but did not require achieving system-level changes from the outset. Nine studies ('no use') were designed to work at multiple levels among multiple agencies in an intervention setting, but the complexity of the system and relations between system elements was not articulated. We synthesised reported barriers and facilitators to scaling up, and how studies within each group conceptualised and used systems approaches, and methods, frameworks and principles for scaling up.

CONCLUSION

In physical activity research, and NCD prevention more broadly, the use of systems approaches in scale up remains in its infancy. For researchers, practitioners and policymakers wishing to adopt systems approaches to intervention implementation at scale, guidance is needed on how to communicate and operationalise systems approaches in research and in practice.

TRIAL REGISTRATION

PROSPERO (CRD42021287265).

NEW Soul in the neighborhood-reach and effectiveness of a dissemination and implementation feasibility study

Dissemination and implementation (D&I) studies of dietary interventions for African Americans are limited. Restaurants may be an innovative setting to deliver dietary interventions. Purpose: Assess weight loss, self-efficacy for healthy eating, diet quality, and quality of life in African Americans in two groups: virtual synchronous and virtual asynchronous. Guided by RE-AIM, the Nutritious Eating with Soul @ Rare Variety Café Feasibility study included nutrition education, accountability partners for support, and cooking demonstrations led by a community health worker and was delivered across two cohorts in a non-randomized design. The intervention was conducted over 12 consecutive weekly classes. Due to the COVID-19 pandemic, intervention delivery was online. African Americans between 18-65 years old with overweight/obesity, not currently following a plant-based diet or taking medications to control diabetes, and living in a southeastern city were recruited. Participants completed in-person weight assessments and online surveys at baseline and post-intervention. Linear mixed models analyzed changes in outcomes and differences in 3-month outcomes between groups. All models controlled for age and sex. Regarding Reach, 199 participants expressed interest, and 60 enrolled. Among the full sample, participants decreased body weight -2.6 ± 0.5 kg (p < .0001) and increased self-efficacy 1.6 ± 0.7 points (p = .03). No differences in 3-month outcomes between groups were observed. This D&I feasibility study successfully recruited participants during the COVID-19 pandemic and produced significant results. The successful online intervention delivery compared to in-person suggests the potential for greater D&I in vegan soul food restaurants. As restrictions are loosened, future studies will test in-person delivery.

Exploring church members' perceptions towards physical activity, fruits and vegetables consumption, and church's role in health promotion: implications for the development of church-based health interventions

Background

The study explored the perceptions of church members towards physical activity (PA), the consumption of fruits and vegetables (FV), and the church's role in health promotion prior to the development of a church-based intervention for physical activity and fruit and vegetable consumption in Lagos, Nigeria.

Method

Sixteen focus group discussions (FGD) and eleven key Informant Interviews (KII) were conducted. Eight FGDs among adults and four among the youth and the elderly church members. Key informant interviews were held among church leaders and members of the church medical advisory. Study findings were categorized under thematic headings. Based on the data analysis, several key themes were identified: the knowledge of the concept of health and common health problems, opinions of physical activity, opinions of healthy eating and fruit and vegetable consumption, types and attitudes towards existing church-based health programs and the role of the church in health promotion and church-based health programs. Within each theme, several childthemes were noted such as the challenges with fruit and vegetable consumption, biblical support for physical activity and fruit & vegetable consumption, the role of the church leaders, program sustainability and barriers to participation.

Results

The participants perceived health not only as the absence of disease but as general well-being of the body and soul. Health was also related to the ability to perform religious activities. Common health problems included a mix of communicable and non-communicable diseases. They are aware that physical activity, fruits and vegetables are essential for healthy living. The youth saw it as a means of improving their physical appearance however the elderly expressed concerns about the possibility of associated trips and falls. Overall, they viewed fruits and vegetables as healthy foods while processed western foods were perceived as unhealthy. Fruits and vegetables were seen as beneficial primarily to aid food digestion, boost immunity, improve youthfulness, aid weight control and to prevent chronic disease. The study participants agreed that the church, as an institution, has a significant role to play in promoting the health of her members. Instituted health committees embedded within existing church structures often lead church-based health-promoting activities and are imperative for sustainability. Types of health programs included health talks, screening programs for common NCDs, sport competitions, distributions of FV during church ceremonies such as harvests, Lenten seasons, Love feasts and church bazaars. Health outreaches were seen as a means of evangelism, and it was unanimously agreed that the Bible supports PA and healthy eating. Generally, the respondents had positive attitudes towards church-based health programs and they advised that future programs include the use of technology and should be integrated into existing church activities to improve participation. The participants also noted that the opinion of the church leaders influences the behaviours of church members and their support is critical in the development and implementation of church-based health programs.

Conclusion

Church members are aware that physical activity and the consumption of fruits and vegetables are important for healthy living and expressed support for church-based health programs. They believe that the Bible supports the promotion of PA and FV consumption as healthy behaviours. Program integration, the use of technology and support of church leaders and existing church medical advisory groups are imperative for developing and sustaining church-based health programs.

Implementation of an Evidence-Based, Tai Ji Quan Fall Prevention Program in Rural West Virginia Churches: A RE-AIM Evaluation

This study implemented a 16-week Tai Ji Quan: Moving for Better Balance® intervention for older adults in churches in hard-to-reach, medically underserved, rural communities, and evaluated the process using the RE-AIM Framework. Community-dwelling adults, aged 55 years, or older, were eligible. Data (N = 237) were collected at baseline, 16 weeks, and 32 weeks on falls efficacy, depression, physical/mental health-related quality of life, aerobic activity, gait speed, mobility, balance, and leg strength. Generalized/linear mixed models determined if outcomes improved. Eighteen churches sponsored 16 classes. Church adoption was 94%, instructor adoption was 86%, reach was 90%, and fidelity was good/fair. All outcomes improved except physical health-related quality of life and gait speed. Thirty-six percent of participants, 28% of churches, and 37% of instructors continued Tai Ji Quan: Moving for Better Balance at 32 weeks. Compared with two prior RE-AIM evaluations, adoption and reach rates, improvements in outcomes, and satisfaction were comparable; attendance, program completion, and continuation rates were lower.

A process for converting an in-person training to increase church capacity to implement physical activity and healthy eating practices and policies to an online format

The implementation of evidence-based public health programs into practice is critical for improving health, but trainings for organizational change agents are often not scalable. To describe the process of converting a training that targets faith-based organizational capacity development from an in-person to an online format. We engaged in an iterative process to convert the training delivery mode from in-person to online that included assessing stakeholder support, consulting the literature on best practices, seeking a design team, consolidating content, designing engaging lessons, and building an online site. Feedback from end-users and other audiences was incorporated throughout. Pilot participants with characteristics like intended training users were then recruited via community and faith-based partner networks. They rated their agreement with statements about the effectiveness as well as design and functionality of each lesson and the overall training (1 = strongly disagree, 5 = strongly agree) and participated in a structured follow-up interview. Nine pilot participants (representing 9 churches in 7 states; 6 African American, 5 with health ministries) rated the online lessons favorably (all ratings ≥ 4.5). Most (90.4%) perceived the lesson duration to be "just right" and spent 52.5 ± 9.9 minutes/lesson. Participants evaluated the overall training positively (all ratings ≥ 4.7). Lesson content, resources, multimedia, and program ideas were most-liked aspects of lessons, while content, staff responsiveness, discussion board, and pace were most-liked aspects of the overall training in open-ended and interview responses. This paper shares a replicable process for converting training modalities from in-person to online with the goal of increased scalability.

Cardiovascular health promotion: A systematic review involving effectiveness of faith-based institutions in facilitating maintenance of normal blood pressure

Globally, faith institutions have a range of beneficial social utility, but a lack of understanding remains regarding their role in cardiovascular health promotion, particularly for hypertension. Our objective was assessment of modalities, mechanisms and effectiveness of hypertension health promotion and education delivered through faith institutions. A result-based convergent mixed methods review was conducted with 24 databases including MEDLINE, Embase and grey literature sources searched on 30 March 2021, results independently screened by three researchers, and data extracted based on behaviour change theories. Quality assessment tools were selected by study design, from Cochrane risk of bias, ROBINS I and E, and The Joanna Briggs Institute's Qualitative Assessment and Review Instrument tools. Twenty-four publications contributed data. Faith institution roles include cardiovascular health/disease teaching with direct lifestyle linking, and teaching/ encouragement of personal psychological control. Also included were facilitation of: exercise/physical activity as part of normal lifestyle, nutrition change for cardiovascular health, cardiovascular health measurements, and opportunistic blood pressure checks. These demand relationships of trust with local leadership, contextualisation to local sociocultural realities, volitional participation but prior consent by faith / community leaders. Limited evidence for effectiveness: significant mean SBP reduction of 2.98 mmHg (95%CI -4.39 to -1.57), non-significant mean DBP increase of 0.14 mmHg (95%CI -2.74 to +3.01) three months after interventions; and significant mean SBP reduction of 0.65 mmHg (95%CI -0.91 to -0.39), non-significant mean DBP reduction of 0.53 mmHg (95%CI -1.86 to 0.80) twelve months after interventions. Body weight, waist circumference and multiple outcomes beneficially reduced for cardiovascular health: significant mean weight reduction 0.83kg (95% CI -1.19 to -0.46), and non-significant mean waist circumference reduction 1.48cm (95% CI -3.96 to +1.00). In addressing the global hypertension epidemic the cardiovascular health promotion roles of faith institutions probably hold unrealised potential. Deliberate cultural awareness, intervention contextualisation, immersive involvement of faith leaders and alignment with religious practice characterise their deployment as healthcare assets.

The FAN program plan: Creating a healthy church environment for physical activity and healthy eating

Background

Faith, Activity, & Nutrition (FAN) helps churches create a healthier environment for physical activity (PA) and healthy eating (HE) through policy, systems, and environmental changes.

Objective

The purpose of this paper is to describe the implementation, evaluation, and revision of the FAN Program Plan across a two-phase study to help churches create guidelines and policies for PA and HE.

Methods

In Phase 1, church committees attended trainings led by Community Health Advisors (CHA) where they assessed current practices to PA and HE. Committees used the FAN Program Plan to outline an implementation plan to increase opportunities, programs, messages, pastor support, and guidelines/practices for PA and HE. FAN Program Plans were submitted to the research team for review. Findings from Phase 1 plans directed revisions in program materials for Phase 2, where the submission and review processes were repeated.

Results

Review of Phase 1 FAN Program Plans (53/54 churches submitted a Program Plan) revealed that church committees confused guidelines/practices with programs and had trouble differentiating programs for PA and HE from providing opportunities (i.e., building PA/HE into existing events). The CHA training, FAN church committee training, FAN Program Plan, and other documents were revised to use the term "guidelines (policies)" instead of "guidelines/practices." In addition, CHAs facilitated a training section on guidelines (policies) to committees, and a guidelines (policies) section was added in the FAN Program Plan and other program documents. These changes in Phase 2 were helpful for differentiating policies from programs and programs from opportunities in FAN Program Plans (53/115 churches submitted a Program Plan), although some confusion remained.

Conclusions

This study underscored challenges churches may have in setting policies for PA and HE and discusses strategies to address these challenges in future faith-based initiatives.

Influence of implementation strategies on implementation outcomes in a statewide dissemination of Faith, Activity, and Nutrition (FAN)

Faith-based organizations are promising settings for implementation science because they can reach populations bearing a disproportionate burden of chronic disease. This study examined how implementation strategies influenced implementation outcomes in Faith, Activity, and Nutrition (FAN) statewide dissemination. Ninety-three (9%) of 985 invited churches enrolled; 91 (98%) and 83 (89%) completed baseline and 12-month assessments. Community Health Advisors trained and provided phone technical assistance to church committees, led by a FAN coordinator. Church committees were charged with developing plans and installing healthy eating (HE) and physical activity (PA) policies, opportunities, messages and pastor support (implementation outcomes). Structural equation modeling examined how implementation strategies influenced implementation outcomes. Nearly all (99%) FAN coordinators and 60% of pastors attended training, 57% of committees submitted program plans and 51%/54% (HE/PA) of committees met 'every few months'. Statistically significant (P < 0.05) model paths showed positive influences of strategies on implementation outcomes: pastor training on HE and PA pastor support; plan completion on HE and PA messages, PA policies and opportunities as well as FAN committee meetings and committee meetings on HE pastor support, HE policies, PA opportunities and HE and PA messages. This study advances implementation science and provides a model applicable to organizations such as worksites and schools.

Using implementation strategies in community settings: an introduction to the Expert Recommendations for Implementing Change (ERIC) compilation and future directions

In this commentary, we introduce public health practitioners and researchers to implementation science through an established compilation of implementation strategies. We provide terminology and examples for community settings so public health practitioners and researchers can use implementation strategies and document efforts using standard terminology. We also discuss the need for future work to determine the extent to which these implementation strategies work and are most useful in community settings, and ultimately, how health behaviors are impacted. We intend this commentary to serve as a dissemination strategy for implementation strategies and to contribute to knowledge in the growing field of implementation science in community settings.

Dissemination trial for Health for Hearts United: Model development, preliminary outcomes and lessons learned

Background

Cardiovascular disease CVD), the leading cause of death in the U.S., is a particular problem for African Americans (AAs). Church-based health interventions are effective in reducing CVD risk, yet few have been successfully disseminated. This paper describes the model development, preliminary health outcomes, and lessons learned from the Health for Hearts United (HHU) dissemination trial which evolved from the longitudinal Reducing CVD Risk Study in a two-county area in North Florida. Community-based participatory research approaches and the socio-ecological model guided the study.

Methods

Data for this paper were from health leaders (n = 25) in the first six churches investigated, and the outreach participants (n = 86) they engaged. Health leaders completed survey items (daily servings of fruits/vegetables [F/V], fat consumption [FAT], and daily minutes of physical activity [PA]) and clinical measures (body mass index [BMI]; waist, hip and abdomen circumferences; and systolic and diastolic blood pressure [BP]). For outreach participants, a brief CVD Awareness Quiz was administered. Data were analyzed using description statistics, Pearson correlations, and repeated measures analysis of variance.

Results

Findings showed that the dissemination model was implemented by 100% of the churches, and resulted in health outcomes changes for health leaders (significant increases between pre- and post-test in F/V; significant decreases in FAT, BMI, abdomen circumference, with educational level and marital status as selected significant covariates) and in a significant increase in CVD awareness for outreach participants. Lessons learned are discussed. Although preliminary, the results suggest that the HHU dissemination model has promise for reducing CVD risk in AA's.

Engaging adults with obesity in organic online communities to support weight loss: a mixed methods pilot study

OBJECTIVES

Organic online communities have shown potential for aiding weight loss, but few adults use them. We sought to test strategies to encourage adults to select and engage in online communities for weight loss.

DESIGN

4-week single-arm, mixed-methods pilot.

MAIN OUTCOME MEASURES

Quantitative and qualitative data on selection of online community, engagement with community, and engagement and satisfaction with tasks.

RESULTS

On average, participants (n = 25) were female (80.0%) and white (68.0%), 45.2 ± 18.1 years old, with a BMI of 36.2 ± 6.5 kg/m2. Selection of online community varied across participants (13 MyFitnessPal, 5 Facebook, 5 Reddit). In qualitative analyses, reasons for selection included experience with community, privacy considerations, and seeking people similar to them. Most tasks were fully or partially completed by a majority of participants (>80.0%). For most tasks, ∼50% of participants felt the task helped them with weight loss support. Variability in response was observed, especially between tasks that requested reading compared to posting/commenting in the community. Frequent reading of community content throughout the study was reported by >70.0% of participants, though posting/commenting was less frequent. Barriers to further engagement included concerns about privacy, judgement, and misinformation.

CONCLUSIONS

This study provides insights about strategies for engaging individuals in online health communities.

Implementation Strategies to Support Built Environment Approaches in Community Settings

BACKGROUND

Built environment approaches are recommended to improve population physical activity levels. Implementation strategies are needed to improve uptake, but little is known about effective strategies to translate research to practice in community settings.

PURPOSE

Inform implementation strategies through understanding delivery agents' perceptions of (1) built environment approaches, (2) a toolkit developed to support implementation, and (3) other required implementation strategies.

METHOD

A toolkit was developed to detail the process of partnering to change the built environment and provide examples of built environment approaches (e.g., walking paths, traffic calming). Data were collected through focus groups (N = 3) with Extension Agents (n = 46) in 2020. The semi-structured focus group script was based on the Consolidated Framework for Implementation Research and the Technology Acceptance model. Rapid content analysis techniques and a deductive, grounded theory approach were used to interpret the data. Results. Focus groups generated meaning units coded into themes of perceptions of the intervention (subthemes: barriers, resources needed, and facilitators) and perceptions of the toolkit (subthemes: components to add, positive perceptions, and helpful components). The most common resources needed were coalition guidance and funding.

CONCLUSION

Agents experience barriers and facilitators to implementing built environment approaches and have specific needs for support. Based on the results, we created implementation strategies: (1) Places for Physical Activity toolkit, (2) Coalition Coaching, and (3) Mini-Grants. Future work is needed to investigate the effectiveness of these implementation strategies.

The Faith, Activity, and Nutrition (FAN) dissemination and implementation study: changes in and maintenance of organizational practices over 24 months in a statewide initiative

BACKGROUND

Few studies have examined the impact of ecological health promotion interventions on organizational practices over time, especially in faith-based settings. This statewide dissemination and implementation study examined change in organizational practices and their predictors across a 24-month period, as well as maintenance of change.

METHODS

Using a pre-post quasi-experimental design, church coordinators from 92 United Methodist Churches in South Carolina (42% predominantly African American congregations) completed surveys at baseline, and immediate, 12-, and 24-months post-training regarding physical activity (PA) and healthy eating (HE) organizational practices consistent with the Faith, Activity, and Nutrition (FAN) program (opportunities, policies, pastor support, messages) and possible predictors. The study was guided by the RE-AIM framework and the Consolidated Framework for Implementation Research (CFIR). Mixed model repeated measures analyses examined change in organizational practices over time. Regression models examined CFIR predictors of 24-month PA and HE organizational practices, controlling for baseline practices. Churches were also classified as maintainers (implemented at 12 and 24 months), non-sustained implementers (implemented at 12 but not 24 months), delayed implementers (implemented at 24 but not 12 months), and low implementers (implemented at neither 12 nor 24 months) for each FAN component.

RESULTS

PA and HE organizational practices increased over time (p < .0001). CFIR domains (and constructs within) of intervention characteristics (adaptability, relative advantage, cost/time), inner setting (relative priority, organizational rewards, readiness, congregant needs), characteristics of the implementer (self-efficacy, perceived benefits), and implementation process (engaging opinion leaders, engaging champions) were important predictors of 24-month PA and HE organizational practices. Over half of churches implementing PA policies, PA messages, HE policies, and HE opportunities at 12 months were maintainers at 24 months, and one-third were maintainers for PA opportunities, HE messages, and PA and HE pastor support. Furthermore, 16% of 12-month non-implementers were delayed implementers at 24 months for PA policies and 31% were delayed implementers for HE policies.

CONCLUSIONS

This study makes important contributions to the faith-based health promotion literature by including a large sample of churches, testing an ecological intervention approach, and assessing organizational practices over a 24-month period. Study findings can guide technical assistance and program adaptations over time.

TRIAL REGISTRATION

This study was registered in clinicaltrials.gov NCT02868866 on August 16, 2016.

Engaging primary care patients with existing online tools for weight loss: A pilot trial

Objective

Free online tools show potential for promoting weight loss at a low cost, but there is limited evidence about how to effectively engage patients with them. To address this, a low‐dose, flexible intervention was developed that aims to enhance weight‐related discussions with primary care providers (PCPs) and engage patients with an organic (i.e., not researcher‐created) weight loss‐focused social media community and online self‐monitoring tool. Feasibility and acceptability of the intervention was evaluated in a single‐arm, 12‐week pilot.

Methods

PCPs were recruited at two clinics, then PCP's patients with upcoming appointments were identified and recruited. Patients received an interactive online kickoff before their scheduled primary care appointment, then 8 follow‐up messages over 12 weeks via email or their electronic health record patient portal. Patients completed assessments at baseline, post‐appointment, and week 12. Primary care providers and patients completed semi‐structured interviews.

Results

All PCPs approached enrolled (n = 6); patient recruitment was on track to meet the study goal prior to COVID‐19 restrictions, and n = 27 patients enrolled. Patient satisfaction with the pre‐appointment kickoff was high. Twenty‐four patients reported discussing weight‐related topics at their primary care appointment and all were satisfied with the discussion. Twenty‐two patients completed 12‐week assessments. Of these, 15 reported engaging with the self‐monitoring tool and 9 with the social media community. Patient interviews revealed reasons for low social media community engagement, including perceived lack of fit. On average, patients with available data (n = 21) lost 2.4 ± 4.1% of baseline weight, and 28.6% of these patients lost ≥3% of baseline weight. Primary care providers reported high intervention satisfaction.

Conclusions

The intervention and trial design show potential, although additional strategies are needed to promote tool engagement.

Assessing the Walkability Environments of Churches in a Rural Southeastern County of the United States

CONTEXT

Churches can serve as important health promotion partners, especially in rural areas. However, little is known about the built environment surrounding churches in rural areas, including how these environments may impact opportunities for physical activity (PA) and may differ by neighborhood income levels.

OBJECTIVE

This study described walkability around churches in a rural county and examined differences in church walkability between high-, medium-, and low-income neighborhoods.

DESIGN

As part of the Faith, Activity, and Nutrition study, trained data collectors conducted a windshield survey of adjacent street segments within a half-mile of churches.

SETTING

Churches (N = 54) in a rural southeastern county in the United States.

MAIN OUTCOME MEASURE

A summary walkability score (eg, presence of sidewalks, safety features, low traffic volume) was created with a possible range from 0 to 7. Analysis of variance was used to assess differences in walkability of churches by neighborhood income levels.

RESULTS

Walkability scores ranged from 0 to 6 (M = 2.31, SD = 1.23). Few churches had sidewalks, shoulders or buffers, or amenities nearby. In contrast, most churches had low traffic volume and no environmental incivilities. While not statistically significant, churches in low-income neighborhoods scored higher for walkability than churches in medium- and high-income neighborhoods.

CONCLUSIONS

This study used low-cost environmental audits to analyze walkability in a sample of churches in a rural area and examined differences by neighborhood income. While churches may improve reach of people living in underserved and rural communities, a lack of environmental supports may limit effective PA promotion activities. Partnerships focused on improving existing areas or providing alternative PA opportunities for church and community members may be needed, especially in African American communities.

Predictors of implementation in the Faith, Activity, and Nutrition dissemination and implementation study: application of the Consolidated Framework for Implementation Research (CFIR) in a statewide initiative

Faith-based organizations, with broad reach and trust, are well-positioned to promote health. The purpose of the study was to examine 12-month implementation and its predictors in the statewide Faith, Activity, and Nutrition (FAN) dissemination and implementation (D&I) study. Churches (n = 93; 42% predominantly African American) in the [South Carolina] Conference of the United Methodist Church trained by Community Health Advisors participated in the study. Church FAN coordinators (n = 92) completed implementation surveys regarding opportunities, policies, messages, and pastor support for physical activity (PA) and healthy eating (HE) at baseline and 12 months. FAN coordinators and pastors (n = 93) completed CFIR-based measures at baseline, immediate post-training, and 12 months. Repeated measures ANOVAs tested change in PA and HE implementation composite scores; Cohen's d indicated magnitude of change. Mixed model linear regression tested whether CFIR items predicted 12-month implementation, controlling for baseline implementation. PA (d = 1.42) and HE (d = 2.05) implementation increased significantly over time. PA and HE implementation were significantly greater in predominantly African American (versus White) congregations, and HE implementation was greater in churches with <500 members. FAN coordinators' ratings of the inner setting (networks/communication, culture, tension for change, organizational rewards, readiness, and congregant needs) and implementation process (engaging opinion leaders and champions) domains were most predictive of implementation outcomes. Few pastor ratings related to implementation outcomes. This study identified constructs, guided by CFIR, that may be important for understanding PA and HE implementation in churches. Future studies will need to test them for replication. Greater changes in implementation outcomes among African American churches underscores the potential of promoting health equity through this setting.

Pathways of influences leading to adoption of the Faith, Activity and Nutrition (FAN) program in a statewide initiative

RE-AIM (Reach, effectiveness, Adoption, Implementation, Maintenance) and CFIR (Consolidated Framework for Implementation Research) are complementary frameworks guiding research on dissemination and implementation of evidence-based interventions and factors influencing this process. Faith, Activity, and Nutrition (FAN) is an evidence-based program that increased physical activity and fruit and vegetable intake in faith-based settings. The aims of this adoption study were to quantify state-wide church level adoption rates and congregant reach of FAN in accordance with RE-AIM guidelines, and to explore the association of CFIR-derived constructs of the church inner setting and pastor characteristics with FAN adoption. Church recruitment was documented, and data were collected via telephone-administered surveys from 93 pastors in adopting churches and 60 pastors in non-adopting churches. Qualitative Comparative Analysis (QCA) identified combinations of CFIR-derived church and pastor characteristics sufficient for FAN adoption. As defined by RE-AIM, church-level FAN adoption was 11.7 % and congregant-level reach was 20.0 %. Fourteen pathways to adoption were identified; seven of these featured the presence of a culture of concern for congregant health along with openness to new ideas. Results suggest early assessment of these two CFIR-derived inner setting constructs may help identify faith-based organizations predisposed to undertake a comprehensive, environmental intervention to promote congregant health.

Dissemination Science in School Mental Health: A Framework for Future Research

There has been an increase in school mental health research aimed at producing generalizable knowledge to address longstanding science-to-practice gaps to increase children's access to evidence-based mental health services. Successful dissemination and implementation are both important pieces to address science-to-practice gaps, but there is conceptual and semantic imprecision that creates confusion regarding where dissemination ends and implementation begins, as well as an imbalanced focus in research on implementation relative to dissemination. In this paper, we provide an enhanced operational definition of dissemination; offer a conceptual model that outlines elements of effective dissemination that can produce changes in awareness, knowledge, perceptions, and motivation across different stakeholder groups; and delineate guiding principles that can inform dissemination science and practice. The overarching goal of this paper is to stimulate future research that aims to advance dissemination science and practice in school mental health.

A Narrative Review of Ethnic Minority Studies for Faith-Based Health Promotion Interventions with Special Reference to the Contemporary Christian Nurse

Heart disease, diabetes mellitus (DM) type 2, and obesity are three of the most prevalent diseases in the USA. Some obesity-related comorbidities are disproportionately higher within African-American and Hispanic communities. While governmental and local health programs offer educational opportunities encouraging long-term health behavior changes, the most accessible programs have been through faith-based communities. This narrative review investigates the outcomes of faith-based wellness programs on Latino and African-American populations with respect to general health and wellness, obesity management, DM type 2, and hypertension. Perceived authority of faith community nurses, faith leaders, and accountability and encouragement provided by faith communities are critical. Long-term behavior change is positively affected by elements faith-based organizations can provide: cultural appropriateness, community support, and self-efficacy.

Program Implementation and Church Members' Health Behaviors in a Countywide Study of the Faith, Activity, and Nutrition Program

Implementation research of health programs in faith-based organizations is lacking. The Faith, Activity, and Nutrition (FAN) program helps churches improve physical activity and fruit and vegetable behaviors of members. This study examined associations between implementation of FAN intervention components and church members' physical activity, fruit and vegetable behaviors, and self-efficacy for improving these behaviors. FAN was implemented in 35 churches in a southeastern US county. After attending in-person training, led by community health advisors, church committees received 12 months of telephone-delivered technical assistance to implement FAN according to 4 components: increasing opportunities, increasing guidelines and policies, increasing pastor support, and increasing messages for physical activity and healthy eating in their church. In this correlational study, FAN coordinators (n = 35) for each church reported baseline practices in 2015 and 12-month follow-up implementation of the 4 components for physical activity and healthy eating in 2016. Church members (n = 893) reported perceived implementation, physical activity and fruit and vegetable behaviors, and self-efficacy at 12-month follow-up in 2016. Independent variables were coordinator-reported baseline practices, baseline-adjusted 12-month implementation, and member-perceived 12-month implementation. Multilevel modeling examined associations between independent variables and member-reported 12-month physical activity and fruit and vegetable behaviors and self-efficacy. Coordinator-reported 12-month implementation of fruit and vegetable opportunities was associated with member fruit and vegetable consumption. Member perceptions at 12 months of church physical activity opportunities, pastor support, and messages were associated with higher self-efficacy for physical activity; pastor support and messages were positively associated with physical activity. Member perceptions at 12 months of fruit and vegetable opportunities, pastor support, and messages were associated with higher fruit and vegetable consumption and self-efficacy. Member-perceived implementation was more strongly associated with member behaviors than coordinator-reported implementation. Providing opportunities for healthy eating during already scheduled events may be an effective strategy for improving fruit and vegetable behavior.

Identifying barriers, facilitators, and implementation strategies for a faith-based physical activity program

Background

Community engagement is critical to the acceleration of evidence-based interventions into community settings. Harnessing the knowledge and opinions of community leaders increases the likelihood of successful implementation, scale-up, and sustainment of evidence-based interventions. Faith in Action (Fe en Acción) is an evidence-based promotora-led physical activity program designed to increase moderate-to-vigorous physical activity among churchgoing Latina women.

Methods

We conducted in-depth interviews using a semi-structured interview guide based on the Consolidated Framework for Implementation Research (CFIR) at various Catholic and Protestant churches with large Latino membership in San Diego County, California to explore barriers and facilitators to implementation of Faith in Action and identify promising implementation strategies for program scale-up and dissemination. We interviewed 22 pastors and church staff and analyzed transcripts using an iterative-deductive team approach.

Results

Pastors and church staff described barriers and facilitators to implementation within three domains of CFIR: characteristics of individuals (lack of self-efficacy for and knowledge of physical activity; influence on churchgoers' behaviors), inner setting (church culture and norms, alignment with mission and values, competing priorities, lack of resources), and outer setting (need for buy-in from senior leadership). From the interviews, we identified four promising implementation strategies for the scale-up of faith-based health promotion programs: (1) health behavior change training for pastors and staff, (2) tailored messaging, (3) developing community collaborations, and (4) gaining denominational support.

Conclusions

While churches can serve as valuable partners in health promotion, specific barriers and facilitators to implementation must be recognized and understood. Addressing these barriers through targeted implementation strategies at the adopter and organizational level can facilitate improved program implementation and lead the way for scale-up and dissemination.

A systematic review of the use and reporting of evaluation frameworks within evaluations of physical activity interventions

BACKGROUND

Evaluation of physical activity interventions is vital to inform, and justify, evidence-based policy and practice to support population-wide changes in physical activity. Several evaluation frameworks and guidance documents have been developed to facilitate the evaluation and reporting of evaluation studies in public health. However, there is a lack of evidence about whether frameworks are being used to guide evaluation. There continues to be claims of poor and inconsistent reporting in evaluation studies. The aim of this review was to assess the use of evaluation frameworks and the quality of reporting of how they were applied within evaluation studies of physical activity interventions.

OBJECTIVES

1. To identify whether evaluation frameworks are reported to have been used within evaluation studies of physical activity interventions, and which frameworks have been used. 2. To appraise the quality of reporting with regards to how evaluation frameworks have been used.

METHOD

We developed a checklist of indicators to enable a critical appraisal of the use and reporting of different evaluation frameworks in evaluation studies. We conducted a systematic search and review of evaluation studies published between 2015 and the date of the search to appraise the use and reporting of evaluation frameworks. A narrative synthesis is provided.

RESULTS

The review identified 292 evaluation studies of physical activity interventions, only 69 (23%) of these mentioned using an evaluation framework, and only 16 different frameworks were referred to. There was variation in the quality of reporting of framework use. 51 (74%) studies were identified as being explicitly based on the stated framework, however only 26 (38%) provided detailed descriptions consistently across all the checklist indicators. Details of adaptations and limitations in how frameworks were applied were less frequently reported. The review also highlighted variability in the reporting of intervention components. More consistent and precise reporting of framework and intervention components is needed.

CONCLUSION

Evaluation frameworks can facilitate a more systematic evaluation report and we argue their limited use suggests missed opportunities to apply frameworks to guide evaluation and reporting in evaluation studies. Variability in the quality of reporting of framework use limits the comparability and transferability of evidence. Where a framework has been used, the checklist of indicators can be employed to facilitate the reporting of an evaluation study and to review the quality of an evaluation report.

Wellness project implementation within Houston's Faith and Diabetes initiative: a mixed methods study

Background

Faith-based health promotion has shown promise for supporting healthy lifestyles, but has limited evidence of reaching scale or sustainability. In one recent such effort, volunteers from a diverse range of faith organizations were trained as peer educators to implement diabetes self-management education (DSME) classes within their communities. The purpose of this study was to identify factors associated with provision of these classes within six months of peer-educator training.

Methods

This study used the Consolidated Framework for Implementation Research (CFIR) to identify patterns from interviews, observations, attendance records, and organizational background information. Two research team members thematically coded interview transcripts and observation memos to identify patterns distinguishing faith organizations that did, versus did not, conduct DSME classes within six months of peer-educator training. Bivariate statistics were also used to identify faith organizational characteristics associated with DSME class completion within this time frame.

Results

Volunteers from 24 faith organizations received peer-educator training. Of these, 15 led a DSME class within six months, graduating a total of 132 participants. Thematic analyses yielded two challenges experienced disproportionately by organizations unable to complete DSME within six months: [1] Their peer educators experienced DSME as complex, despite substantial planning efforts at simplification, and [2] the process of engaging peer educators and leadership within their organizations was often more difficult than anticipated, despite initial communication by Faith and Diabetes organizers intended to secure informed commitments by both groups. Many peer educators were overwhelmed by training content, the responsibility required to start and sustain DSME classes, and other time commitments. Other priorities competed for time in participants’ lives and on organizational calendars, and scheduling processes could be slow. In an apparent dynamic of “crowding out,” coordination was particularly difficult in larger organizations, which were less likely than smaller organizations to complete DSME classes despite their more substantial resources.

Conclusions

Initial commitment from faith organizations’ leadership and volunteers may not suffice to implement even relatively short and low cost health promotion programs. Faith organizations might benefit from realistic previews about just how challenging it is to make these programs a sufficiently high organizational and individual priority.

Dietary policies and programs in the United States: A narrative review

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School-based and youth targeted programs and policies were most frequently studied.

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Research has rather neglected older adult, Asian, Native Hawaiian and American Indian populations.

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Despite existing research indicating effectiveness, faith-based were understudied.

Prior reviews describing approach, methodological quality and effectiveness of dietary policies and programs may be limited in use for practitioners seeking to introduce innovative programming, or academic researchers hoping to understand and address gaps in the current literature. This review is novel, assessing the “where, who, and in whom” of dietary policies and programs research in the United States over the past decade – with results intended to serve as a practical guide and foundation for innovation. This study was conducted from October 2018 to March 2019. Papers were selected through a tailored search strategy on PubMed as well as citation searches, to identify grey literature. A total of 489 papers were relevant to our research objective. The largest proportion of papers described school-based strategies (31%) or included economic incentives (19%). In papers that specified demographics, the study populations most often included children, adults and adolescents (54%, 46%, and 42% respectively); and White, Black and Hispanic populations (77%, 76% and 70%, respectively). Results highlight opportunities for future research within workplace and faith-based settings, among racial/ethnic minorities, and older adults.

Objective Church Environment Audits and Attendee Perceptions of Healthy Eating and Physical Activity Supports within the Church Setting

Interventions in faith-based settings are increasingly popular, due to their effectiveness for improving attendee health outcomes and behaviors. Little past research has examined the important role of the church environment in individual-level outcomes using objective environmental audits. This study examined associations between the objectively measured physical church environment and attendees' perceptions of physical activity (PA) and healthy eating (HE) supports within the church environment, self-efficacy for PA and HE, and self-reported PA and HE behaviors. Data were collected via church audits and church attendee surveys in 54 churches in a rural, medically underserved county in South Carolina. Multi-level regression was used to analyze associations between the church environment and outcomes. Physical elements of churches were positively related to attendees' perceptions of church environment supports for PA (B = 0.03, 95% CI = 0.01, 0.05) and HE (B = 0.05, 95% CI = 0.01, 0.09) and there was a significant interaction between perceptions of HE supports and HE church environment. Self-efficacy and behaviors for PA and HE did not show an association with the church environment. Future research should establish a temporal relationship between the church environment and these important constructs for improving health. Future faith-based interventions should apply infrastructure changes to the church environment to influence important mediating constructs to health behavior.

The Faith, Activity, and Nutrition (FAN) Dissemination and Implementation Study: 24-Month Organizational Maintenance in a Countywide Initiative

Introduction: Despite the important role that faith-based organizations can play in eliminating health disparities, few studies have focused on organizational change and maintenance of interventions in this setting, making their long-term impact unknown. This study reports 24-month maintenance of the Faith, Activity, and Nutrition (FAN) program in a southeastern county. Previously reported findings of reach, adoption, implementation, and effectiveness are also summarized.

Methods: Church coordinators from 35 intervention churches (97% predominantly African American) located in a rural, medically underserved county in South Carolina were interviewed at baseline (2015), and 12- and 24-months post-training regarding implementation of physical activity (PA) and healthy eating (HE) components of the FAN program. Guided by the RE-AIM framework, organizational maintenance was defined as church coordinator-reported 24-month implementation of the four FAN components (providing opportunities, setting guidelines/policies, sharing messages, engaging pastor). Repeated measures analyses (mixed models) examined change in implementation over time. Churches were also classified as maintainers, non-sustained implementers, and low implementers for each FAN component. Statistical analyses were conducted in 2019.

Results: Church coordinators reported significantly greater implementation of both PA and HE FAN components at 12 and 24 months compared to baseline (medium to large effects). The percentage of churches classified as maintainers ranged from 21 to 42 and 27 to 94% across PA and HE components, respectively. Most churches (58% for PA, 97% for HE) were maintaining at least one FAN component at 24 months.

Conclusions: These promising findings position FAN well for the national implementation study now underway.

Trial Registration: This study is registered at www.clinicaltrials.gov NCT02868866.

Investigating Socioeconomic Disparities in the Potential Healthy Eating and Physical Activity Environments of Churches

Faith-based settings have the potential to improve health in underresourced communities, but little research has quantified and compared health-promoting elements in church environments. This study examines the number of potential indoor and outdoor physical activity opportunities, healthy eating opportunities, healthy living media, and total environmental resources present in churches (n = 54) in a rural, southeastern US county and the relationship between these resources and neighborhood income. In our sample, most churches offered potential indoor and outdoor opportunities for physical activity and healthy eating opportunities, with more variability in the number of healthy living media items on display compared to other environmental components. Common potential opportunities present in churches for physical activity included a fellowship hall and green/open space, while potential opportunities for healthy eating frequently included a refrigerator and sink. Compared to those in medium- and high-income neighborhoods, churches in low-income neighborhoods scored higher on measures of potential outdoor physical activity opportunities and lower on measures of total potential environment resources, healthy eating opportunities, healthy living media, and indoor physical activity opportunities, though only indoor physical activity opportunities reached statistical significance. Potential opportunities for using existing resources in and around churches for health promotion should be investigated further, particularly in rural areas.

Health for Hearts United Longitudinal Trial: Improving Dietary Behaviors in Older African Americans

INTRODUCTION

Church-based interventions have been shown to improve the dietary health of underserved populations, yet few studies have examined sustainability of health behavior change over time. This paper examines dietary outcomes over a 24-month period (baseline and 6, 18, and 24 months) for fruit and vegetable and fat consumption behaviors of African-American participants in the Health for Hearts United church-based intervention in North Florida.

STUDY DESIGN

This quasi-experimental, longitudinal trial was conducted from 2009 to 2012. Data were analyzed in 2018.

SETTING/PARTICIPANTS

Six churches in a 2-county area (3 treatment, 3 comparison) were selected for the study using community-based participatory research approaches. Participants were African-American adults (aged ≥45 years; n=211 at baseline) randomly selected from the churches, stratified by age and sex.

INTERVENTION

Health for Hearts United intervention was developed by the 3 treatment churches. The 18-month intervention was implemented in 3 6-month phases, framed around 3 conceptual components, which included 4 types of programs and 4 key messages.

MAIN OUTCOME MEASURES

Fruit and vegetable consumption was assessed using a single item (fruit and vegetable intake) and the National Cancer Institute Fruit and Vegetable Screener. Fat consumption was determined using a single item (fat intake) and the National Cancer Institute Fat Screener. Background characteristics included age, sex, educational level, and marital status.

RESULTS

Significant time effects only were found for daily fruit and vegetable intake (p<0.001), fat intake (p<0.001), and the Fat Screener (p<0.001) with dietary improvements in both treatment and comparison groups across the intervention phases. Fruit and Vegetable Screener results showed that time (p<0.001) and the interaction between time and treatment (p<0.01) were significant, with increases in fruit and vegetable consumption over time for both the treatment and comparison groups and with the increase differing between groups. Post hoc analysis revealed that the treatment group had greater increases in fruit and vegetable consumption than the comparison group between Phases 1 and 3 (p=0.03).

CONCLUSIONS

Dietary behaviors of mid-life and older African Americans can be improved and sustained over 24 months using a church-based heart health intervention, with similar improvements noted for both comparison and treatment participants.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.govNCT03339050.

Rural-urban differences e-cigarette ever use, the perception of harm, and e-cigarette information seeking behaviors among U.S. adults in a nationally representative study

Adults living in rural areas, compared to their urban counterparts, are at an increased risk of using tobacco-related products and mortality due to tobacco-related diseases. The harms and benefits of e-cigarette use are mixed, and similarly obscure messaging about these harms and benefits have a critical influence on e-cigarette uptake and perceptions. However, little is known about rural-urban differences in the prevalence of adult e-cigarette daily usage. Using the Health Information National Trends Survey-Food and Drug Administration (HINTS-FDA) cycles 1 and 2, we conducted weighted logistic regressions to assess rural-urban differences in the prevalence of adult e-cigarette daily usage, perceived harm, and e-cigarette information seeking behaviors. This analysis included adults aged 18 years and older in the United States (N = 4229). Both rural and urban respondents reported a similar history of e-cigarette use. Rural respondents were significantly more likely than urban respondents to trust religious organizations and leaders and tobacco companies for information about e-cigarettes. Rural and urban respondents were equally as likely to believe e-cigarettes are addictive, perceive e-cigarette use as harmful, and believe e-cigarettes are more harmful than tobacco cigarettes. Respondents were equally as likely to look for information on e-cigarettes, the health effects of e-cigarettes, and cessation; and, to seek e-cigarette information from healthcare professionals, family and friends, and health organizations and groups. Given our findings, it will be pertinent to continue to research the potential harms of e-cigarette use and develop accurate health communication messages to avoid rural-urban disparities observed for cigarette smoking-related outcomes.

Rural physical activity interventions in the United States: a systematic review and RE-AIM evaluation

Background

Previous reviews of rural physical activity interventions were focused on intervention effectiveness and had reported overall mixed findings. The purpose of this systematic review was to apply the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate the extent to which rural physical activity interventions in the U.S. have reported on dimensions of internal and external validity and to offer suggestions for future physical activity interventions for rural U.S. populations.

Methods

Pubmed, PsychINFO, CINAHL, PAIS, and Web of Science were searched through February 2019 to identify physical activity intervention studies conducted in rural regions in the U.S. with adult populations. Titles, abstracts, and full texts of articles were reviewed against inclusion and exclusion criteria. Data extraction from included articles included a summary of study details, rural classification system used, and the presence or absence of a total 61 RE-AIM indicators, including reach (n = 13), efficacy/effectiveness (n = 10), adoption (n = 21), implementation (n = 9), and maintenance (n = 8).

Results

A total of 40 full-text articles representing 29 unique studies were included. Classifications of rurality included self-statements by authors (n = 19, 65.5%), population/census-based definitions (n = 3, 10.3%), Rural Urban Continuum Codes (n = 3, 10.3%), Rural Urban Commuting Area codes (n = 2, 6.9%), the 2014 Alabama Rural Health Association classification system (n = 1, 3.4%) and the U.S. Office of Management and Budget classification system (n = 1, 3.4%). Individual studies reported between 14.8 to 52.5% of total RE-AIM indicators. Studies reported 15.4 to 84.6% indicators for reach; 20.0 to 70.0% indicators for efficacy/effectiveness; 4.8 to 47.6% indicators for adoption; 11.1 to 88.9% indicators for implementation; and 0 to 25.0% indicators for maintenance.

Conclusions

We found an overall poor reporting of components related to external validity, which hinders the generalizability of intervention findings, and a lack of consistency in the definition of rurality. Future research should focus on balancing factors of internal and external validity, and should aim to develop a greater understanding of how rurality influences health and behavior to provide contextual knowledge needed to advance the translation of physical activity interventions into practice in rural communities and reduce rural health disparities.

Trial registration

The review protocol was registered with PROSPERO: CRD42019116308.

Community Health Advisors' Participation in a Dissemination and Implementation Study of an Evidence-Based Physical Activity and Healthy Eating Program in a Faith-Based Setting

Community health advisors (CHAs) have been widely involved in health promotion, but few details on role expectations, retention, and evaluation have been reported. In a dissemination and implementation (D&I) study of an evidence-based healthy eating and physical activity program, 59 churches were randomized to an intervention (n = 39) or control (delayed intervention) (n = 20) condition. In a novel approach, CHAs worked with church committees rather than congregants by providing training (n = 59) and technical assistance (n = 54) to the committees to implement a program focused on structural and policy-level changes to support congregants' behavioral changes. CHA training comprised self-study via electronic training modules, in-person training, and telephone-based training. Evaluation methods were pilot test participants' and CHAs' ratings of their training; observers' ratings of CHAs' church training delivery; church committee members' ratings of the training experience, including CHAs' performance; and data from the TA database to assess CHAs' adherence to the protocol. The main challenge was the early dropout of one CHA and the reduced role of another. CHAs trained 142 intervention and 60 control church committee members in nine sessions; they covered 99% (intervention) and 90% (control) of training content, indicating high fidelity. Observers' scored CHAs' teaching and facilitation skills at 96.7% (intervention) and 80% (control) of the possible score. CHAs completed 92% of intervention and 93% of control TA calls. The great majority of church participants' comments regarding CHAs were positive. This study demonstrates that with training and support, CHAs demonstrate high levels of intervention fidelity, confidence, and competence.

Community Health Advisors' Characteristics and Behaviors, Role Performance, and Volunteer Satisfaction in a Church-Based Healthy Eating and Physical Activity Intervention

Community Health Advisors (CHAs) contribute to health promotion program effectiveness, but their role in faith-based programs is understudied, and little is known about their role performance or satisfaction. In a dissemination and implementation study, 19 CHAs were trained to provide healthy eating (HE) and physical activity (PA) program training to church committees. Of these, 17 CHAs trained 347 attendees from 115 churches. Thirteen CHAs remained for the 12-month period and provided telephone-based technical assistance (TA) to churches. To evaluate their experiences and satisfaction, CHAs completed questionnaires at baseline and 12 months. Staff observers and church committee members evaluated CHAs' effectiveness as trainers. There were no significant changes in the CHAs' own body mass index, PA, fruit and vegetable intake, or self-rated health but significant increases in their perceived knowledge of PA (p = 0.01) and HE (p = 0.02). CHAs reported high agreement regarding the quality of their training for the role and moderate volunteer satisfaction on average but thought that the time required of them was somewhat more than expected, though they were interested in volunteering for a future, similar role. Church committee members agreed with CHAs' effectiveness as trainers and the helpfulness of the TA calls. Staff observers rated CHAs' as having covered 87.8% of church training content and agreed that, on average, the CHAs were effective trainers. Assessing CHAs' availability, clear communication about the time requirements, and over-recruitment to offset attrition and decrease the workload may be needed to improve retention and support satisfaction.

Church leaders' barriers and facilitators before and after implementing a physical activity and nutrition intervention

Faith-based health promotion programs have been effective in increasing healthy eating (HE) and physical activity (PA). Very few reports exist regarding church leaders' anticipated and experienced barriers and facilitators to program implementation. Pastors (n = 38, 70%) and program coordinators (n = 54, 100%) from churches (N = 54) who attended a program training answered open-ended questions about anticipated barriers and facilitators to implementing the HE and PA parts of the Faith, Activity, and Nutrition (FAN) program. Twelve months later, pastors (n = 49, 92%) and coordinators (n = 53, 98%) answered analogous questions about their experienced barriers and facilitators to implementing the HE and PA parts of the FAN program. Responses were coded using thematic analysis. Similar themes appeared at baseline and follow-up for anticipated and experienced barriers and facilitators. The most common barriers were no anticipated barriers, resistance to change, church characteristics, and lack of participation/motivation. The most common facilitators were internal support, leadership, and communication. Few differences were found between anticipated and experienced barriers and facilitators. Understanding these perspectives, particularly overcoming resistance to change and church characteristics through strong leadership and internal support from church leaders, will improve future program development, resources, and technical assistance in faith-based and non-faith-based communities alike.

Utilizing the RE-AIM framework to understand adoption of nutrition policies at food pantries across the USA

One in five food pantries had a formal nutrition policy, and informal nutrition policies existed for half of the food pantries that responded to the survey.

The Faith, Activity, and Nutrition (FAN) Dissemination and Implementation Study, Phase 1: Implementation Monitoring Methods and Results

Faith-based settings offer opportunities for reaching populations at risk for chronic conditions and are optimal settings for dissemination and implementation (D&I) research. Faith, Activity, and Nutrition (FAN) is an evidence-based program designed to promote physical activity (PA) and healthy eating (HE) through church policy, systems, and environmental change. We report implementation fidelity for Phase 1 of the FAN D&I project, a countywide effort. The group randomized study included pre- and postintervention assessments of core PA and HE components. We compared implementation in early intervention ( n = 35) versus delayed intervention (control, n = 19) churches; assessed individual church implementation; and examined the effects of level of implementation on church member outcomes. Implementation assessments were conducted with the FAN coordinator via telephone survey. Study outcomes were assessed with church members 8 to 12 months following baseline assessment via self-administered surveys. We found significantly higher levels of implementation for PA opportunities, PA and HE guidelines, PA and HE messages, and PA and HE pastor support in intervention versus control churches and showed church-level variation in PA and HE implementation. PA self-efficacy varied by level of implementation; high and low implementers did not differ in proportion of church members physically inactive, although low implementers had fewer members inactive than controls. The high level of implementation in intervention churches shows promise for broader dissemination of FAN.