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Day KR, Bernhart JA, Wilcox S. Barriers and Facilitators to 24-Month Maintenance of the Faith, Activity, and Nutrition Program in the U.S. JOURNAL OF RELIGION AND HEALTH 2024:10.1007/s10943-024-02012-9. [PMID: 38528275 DOI: 10.1007/s10943-024-02012-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/27/2024]
Abstract
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.
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Affiliation(s)
- Kelsey R Day
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - John A Bernhart
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Conley C, Hardison-Moody A, Randolph S, Gonzalez-Guarda R, Fisher EB, Lipkus I. Dyadic Peer Support to Improve Diet and Physical Activity Among African American Church Members: An Exploratory Study. JOURNAL OF RELIGION AND HEALTH 2023; 62:2609-2626. [PMID: 36662410 PMCID: PMC10498378 DOI: 10.1007/s10943-023-01743-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
This study examined how African American church members communicated and cooperated as dyads to attain health goals. Participants completed nine weeks of group classes then worked as dyads for nine weeks. Communication logs and interviews were used to assess: (1) dyad communication and (2) dyad cooperation. Thirty-two dyads from three churches completed the study. Dyads communicated an average of two times per week. Dyads experienced challenges and provided encouragement. Findings indicate African American church members cooperate and communicate as family, friend, and acquaintance dyads to achieve health goals.
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Affiliation(s)
- Cherie Conley
- Institute for Healthcare Policy & Innovation, University of Michigan at Ann Arbor, 2800 Plymouth Road, North Campus Research Complex Building 14, Suite G100-30, Ann Arbor, MI, 48109, USA.
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Bernhart JA, Turner-McGrievy GM, Wilson MJ, Sentman C, Wilcox S, Rudisill C. NEW Soul in the neighborhood-reach and effectiveness of a dissemination and implementation feasibility study. Transl Behav Med 2023; 13:123-131. [PMID: 36689305 PMCID: PMC10068901 DOI: 10.1093/tbm/ibac080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
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.
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Affiliation(s)
- John A Bernhart
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Gabrielle M Turner-McGrievy
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Mary J Wilson
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Claudia Sentman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
| | - Caroline Rudisill
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
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Ahmed AM, Hardy CM, Bowman T, Akinyele O, Tipre M, Richardson MB, Baskin ML, Niranjan SJ. Training and Dissemination of Lung Cancer Education Curriculum Among Community Health Advisors in the Deep South: a Program Evaluation. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:538-544. [PMID: 35254629 DOI: 10.1007/s13187-022-02149-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 05/20/2023]
Abstract
Lung cancer is the leading cause of cancer mortality in the USA. In the rural Black Belt region of Alabama, high rates of lung cancer incidence and mortality coupled with disproportionate lack of access to health services stresses the need for navigating high risk and disproportionately affected groups towards successfully obtaining lung cancer screenings. We utilized our well-accepted Community Health Advisor (CHA) model for education and awareness. This study seeks to evaluate the results of the Alabama Lung Cancer Awareness, Screening, and Education (ALCASE) training on CHAs, program evaluation, and lessons learned. A total of 202 participants were eligible and enrolled for CHA training. One hundred thirty CHAs were included for the final analyses. Descriptive statistics were computed; differences in pre-test and post-test scores were compared across demographic characteristics of the participants using paired t-test/one-way ANOVA. Of the 130 CHAs, 46% were 65 years or older; 98% were African Americans, and 87% were female; 17% of participants were cancer survivors. The mean post-test scores were 2.2 points greater than mean pre-test scores, and the difference was significant (mean (SD): pre-test = 20.8 (2.8) versus post-test = 23 (2.2); p = 0.001). No notable difference in pre-test and post-test scores were observed by CHA's demographic characteristics except by their county of residence or work (p = 0.0019). We demonstrate the capability and value of successfully recruiting and training motivated community members to be able to serve educators to better reach medically underserved and historically excluded communities.
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Affiliation(s)
- Amir M Ahmed
- University of Alabama School of Medicine, Birmingham, AL, USA
| | - Claudia M Hardy
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tara Bowman
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Olusean Akinyele
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Meghan Tipre
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Molly B Richardson
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monica L Baskin
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soumya J Niranjan
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 1720 2nd Avenue South, 540A, Birmingham, AL, 35294, USA.
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Saunders RP, Wilcox S, Hutto B. Influence of implementation strategies on implementation outcomes in a statewide dissemination of Faith, Activity, and Nutrition (FAN). HEALTH EDUCATION RESEARCH 2022; 37:420-433. [PMID: 36149635 DOI: 10.1093/her/cyac025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/19/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- Ruth P Saunders
- Prevention Research Center and Department of Health Promotion, Education, and Behavior, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
| | - Sara Wilcox
- Prevention Research Center and Department of Exercise Science, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
| | - Brent Hutto
- Prevention Research Center, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
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Escoffery C, Foster M, Fernández ME, Haardörfer R, Mullen PD. Are Training and Experience Adapting Evidence-Based Interventions Associated With Self-Efficacy and Attitudes? A Cross-Sectional Survey of Students and Practitioners With Varying Levels of Adaptation Experience. Health Promot Pract 2022; 23:1105-1115. [PMID: 33906509 PMCID: PMC10804319 DOI: 10.1177/15248399211006490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Increasing use of evidence-based interventions (EBIs) in local settings will help reduce the research-practice gap and improve health equity. Because adaptation to new settings and populations is essential to effective EBI use, frameworks to guide practice are receiving more attention; most, however, only provide broad guidelines without instructions for making adaptations in practice. Therefore, practitioners may need additional training or technical assistance (TA) to implement and adapt EBIs. This study explores whether practitioners' and students' general EBI training or TA and level of adaptation experience are associated with self-efficacy in adapting EBIs and with attitudes toward EBI use. We analyzed baseline survey data of participants in an evaluation of IM-Adapt Online, a newly developed decision support tool. We asked about previous training on EBIs, general and specific adaptation behaviors, and attitudes toward EBIs and found an association between previous training or TA in using EBIs with higher self-efficacy for using and adapting EBIs. Respondents with prior EBI training were significantly more likely to have higher self-efficacy in EBI behaviors across subdomains and in total than those without training. Respondents reported lowest self-efficacy for planning adaptations (M = 3.35) and assessing fit of EBIs to their local context (M = 3.41). This study suggests the importance of EBI adaptation training and TA to increase adoption and adaptation of EBIs, subsequently. More adaptation-specific training is warranted to assist students, practitioners, and researchers undertaking the adaptation process and implement EBIs. Future training on EBI adaptation can help practitioners tailor EBIs to meet the specific needs of their populations.
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Ralston PA, Young-Clark I, Wickrama K(A, Coccia C, Lemacks JL, Battle AM, Hart C, Ilich JZ. Dissemination trial for Health for Hearts United: Model development, preliminary outcomes and lessons learned. Contemp Clin Trials Commun 2022; 29:100979. [PMID: 36052174 PMCID: PMC9424356 DOI: 10.1016/j.conctc.2022.100979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 07/22/2022] [Accepted: 08/09/2022] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Penny A. Ralston
- , Center on Better Health and Life for Underserved Populations, Florida State University, P.O. Box 3064191, Tallahassee, FL, 32306-1491, USA
| | - Iris Young-Clark
- , Center on Better Health and Life for Underserved Populations, Florida State University, USA
| | - Kandauda (A.S.) Wickrama
- Georgia Athletic Association Endowed Professor of Human Development and Family Science Research, University of Georgia, USA
| | - Catherine Coccia
- , Department of Dietetics & Nutrition, Florida International University, USA
| | - Jennifer L. Lemacks
- College of Nursing and Health Professions, University of Southern Mississippi, USA
| | | | | | - Jasminka Z. Ilich
- , Institute for Successful Longevity, Consulting Faculty, Center on Better Health and Life for Underserved Populations, Florida State University, USA
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Abstract
African Americans experience high rates of obesity and food insecurity in part due to structural racism, or overlapping discriminatory systems and practices in housing, education, employment, health care, and other settings. Nutrition education and nutrition-focused policy, systems, and environmental changes may be able to address structural racism in the food environment. This scoping review aimed to summarize the available literature regarding nutrition interventions for African Americans that address structural racism in the food environment and compare them to the "Getting to Equity in Obesity Prevention" framework of suggested interventions. An electronic literature search was conducted with the assistance of a research librarian encompassing 6 databases-MEDLINE, PyscINFO, Agricola, ERIC, SocINDEX, and ProQuest Dissertations & Theses. A total of 30 sources were identified detailing interventions addressing structural barriers to healthy eating. The majority of nutrition interventions addressing structural racism consisted of policy, systems, and/or environmental changes in combination with nutrition education, strategies focused on proximal causes of racial health disparities. Only two articles each targeted the "reduce deterrents" and "improve social and economic resources" aspects of the framework, interventions which may be better suited to addressing structural racism in the food environment. Because African Americans experience high rates of obesity and food insecurity and encounter structural barriers to healthy eating in the food environment, researchers and public health professionals should address this gap in the literature.
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Sutherland RL, Jackson JK, Lane C, McCrabb S, Nathan NK, Yoong SL, Lum M, Byaruhanga J, McLaughlin M, Brown A, Milat AJ, Bauman And AE, Wolfenden L. A systematic review of adaptations and effectiveness of scaled-up nutrition interventions. Nutr Rev 2021; 80:962-979. [PMID: 34919715 PMCID: PMC8907487 DOI: 10.1093/nutrit/nuab096] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Rachel L Sutherland
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jacklyn K Jackson
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Cassandra Lane
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sam McCrabb
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nicole K Nathan
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sze Lin Yoong
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Melanie Lum
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Judith Byaruhanga
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Matthew McLaughlin
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Alison Brown
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J Milat
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Adrian E Bauman And
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Luke Wolfenden
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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10
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Wilcox S, Jake-Schoffman DE, Saunders RP, Kinnard D, Kaczynski AT, Hutto B, James KL. 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. Transl Behav Med 2021; 11:419-429. [PMID: 32221601 DOI: 10.1093/tbm/ibaa025] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC.,Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Danielle E Jake-Schoffman
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL
| | - Ruth P Saunders
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Deborah Kinnard
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Andrew T Kaczynski
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Brent Hutto
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Katherine L James
- South Carolina Conference of the United Methodist Church, Columbia, SC
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11
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Lemacks JL, Abbott LS, Greer T, Gunn R, Bryant A, Bradford L, Ralston PA. The church bridge project focus group results: African American perspectives of weight management programs to improve nutrition and physical activity behaviors. BMC Nutr 2021; 7:39. [PMID: 34275482 PMCID: PMC8287692 DOI: 10.1186/s40795-021-00442-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/18/2021] [Indexed: 12/03/2022] Open
Abstract
Background The prevalence of obesity is disproportionately high among African Americans in the Southern US. More information is needed about factors that influence participation in nutrition and physical activity programs to promote healthy weight. Objective The purpose of this study is to explore the weight management perceptions of young to middle aged adult African Americans. Methods The Church Bridge Project intervention participants were recruited for two focus groups. Qualitative data were recorded, transcribed and a thematic content analysis was conducted to identify major themes. Results Barriers included technology learning curve/burden and competing priorities. Facilitators included support, limited cost, convenience, and health. Participants perceived the term “weight management” program as overwhelming and defeating. Conclusion The Church Bridge Project model confirmed social support and disease prevention as key factors for weight management. Further work should substantiate social support as a key factor to guide minority health efforts.
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Affiliation(s)
- Jennifer L Lemacks
- School of Kinesiology and Nutrition, The University of Southern Mississippi, 118 College Drive #5142, Hattiesburg, MS, 39406-0001, USA.
| | - Laurie S Abbott
- College of Nursing, The Florida State University, Tallahassee, MS, USA
| | - Tammy Greer
- School of Psychology, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Renee Gunn
- School of Kinesiology and Nutrition, The University of Southern Mississippi, 118 College Drive #5142, Hattiesburg, MS, 39406-0001, USA
| | - Ashley Bryant
- School of Kinesiology and Nutrition, The University of Southern Mississippi, 118 College Drive #5142, Hattiesburg, MS, 39406-0001, USA
| | - LaShaundrea Bradford
- School of Kinesiology and Nutrition, The University of Southern Mississippi, 118 College Drive #5142, Hattiesburg, MS, 39406-0001, USA
| | - Penny A Ralston
- Center on Better Health and Life for Undeserved Populations, The Florida State University, Tallahassee, FL, USA
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12
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Williams LB, Shelton BJ, Gomez ML, Al-Mrayat YD, Studts JL. Using Implementation Science to Disseminate a Lung Cancer Screening Education Intervention Through Community Health Workers. J Community Health 2021; 46:165-173. [PMID: 32594413 DOI: 10.1007/s10900-020-00864-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
National lung cancer screening with low dose computed tomography (LDCT) uptake is suboptimal. One factor contributing to slow uptake is lack of awareness. Trained Community Health Workers (CHWs) may be effective in increasing lung cancer screening awareness among disparate populations, however little is known about the processes necessary to scale an intervention for implementation by CHWs in a new area. We examined implementation processes with the RE-AIM framework and pilot tested a CHW-delivered lung cancer education intervention based on the Health Belief Model. We measured pre-post participant knowledge, attitudes and beliefs regarding cancer screening, lung cancer stigma, and intent to obtain LDCT screening. We used community-engaged strategies to collaborate with a local health system, to identify CHWs. CHWs were trained to recruit participants and deliver the one-session lung cancer education intervention. Seven CHWs and eight community sites participated. Participants (n = 77) were female (53%) primarily low income (62.9%); tobacco use was high (36.9%). Post intervention changes in lung cancer screening knowledge (p = < .0001), attitudes regarding lung cancer screening benefit (p = .034) and lung cancer stigma. (p = .024) We learned important lessons that will be useful in subsequent scaling. Collaborating with a local health system is a promising method to disseminate a lung cancer screening education intervention.
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Affiliation(s)
- Lovoria B Williams
- College of Nursing, University of Kentucky, 751 Rose St. 531 College of Nursing Building, Lexington, KY, 40536-0232, USA.
| | - Brent J Shelton
- College of Medicine, Cancer Biostatistics within the Division of Medical Oncology, University of Kentucky, Lexington, KY, USA
| | - Maria L Gomez
- College of Nursing, University of Kentucky, 751 Rose St. 531 College of Nursing Building, Lexington, KY, 40536-0232, USA
| | - Yazan D Al-Mrayat
- College of Nursing, University of Kentucky, 751 Rose St. 531 College of Nursing Building, Lexington, KY, 40536-0232, USA
| | - Jamie L Studts
- Department of Behavioral Science, University of Kentucky, College of Medicine, Lexington, KY, USA
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13
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Frerichs L, Bess K, Young TL, Hoover SM, Calancie L, Wynn M, McFarlin S, Cené CW, Dave G, Corbie-Smith G. A Cluster Randomized Trial of a Community-Based Intervention Among African-American Adults: Effects on Dietary and Physical Activity Outcomes. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 21:344-354. [PMID: 31925605 DOI: 10.1007/s11121-019-01067-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Evidence of the effectiveness of community-based lifestyle behavior change interventions among African-American adults is mixed. We implemented a behavioral lifestyle change intervention, Heart Matters, in two rural counties in North Carolina with African-American adults. Our aim was to evaluate the effect of Heart Matters on dietary and physical activity behaviors, self-efficacy, and social support. We used a cluster randomized controlled trial to compare Heart Matters to a delayed intervention control group after 6 months. A total of 143 African-American participants were recruited and 108 completed 6-month follow-up assessments (75.5%). We used mixed regression models to evaluate changes in outcomes from baseline to 6-month follow-up. The intervention had a significant positive effect on self-reported scores of encouragement of healthy eating, resulting in an increase in social support from family of 6.11 units (95% CI [1.99, 10.22]) (p < .01). However, intervention participants also had an increase in discouragement of healthy eating compared to controls of 5.59 units (95% CI [1.46, 9.73]) among family (p < .01). There were no significant differences in changes in dietary behaviors. Intervention participants had increased odds (OR = 2.86, 95% CI [1.18, 6.93]) of increased frequency of vigorous activity for at least 20 min per week compared to control participants (p < .05). Individual and group lifestyle behavior counseling can have a role in promoting physical activity levels among rural African-American adults, but more research is needed to identify the best strategies to bolster effectiveness and influence dietary change. Trial Registration: Clinical Trials, NCT02707432. Registered 13 March 2016.
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Affiliation(s)
- Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1102C McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA.
| | - Kiana Bess
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Tiffany L Young
- The North Carolina Translational Research and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lenell & Lillie Consulting, LLC, New Bern, NC, USA
| | - Stephanie M Hoover
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Larissa Calancie
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Mysha Wynn
- Project Momentum, Inc., Rocky Mount, USA
| | | | - Crystal W Cené
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Gaurav Dave
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Giselle Corbie-Smith
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Department of Social Medicine and Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
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14
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Mazzucca S, Arredondo EM, Hoelscher DM, Haire-Joshu D, Tabak RG, Kumanyika SK, Brownson RC. Expanding Implementation Research to Prevent Chronic Diseases in Community Settings. Annu Rev Public Health 2021; 42:135-158. [PMID: 33467924 PMCID: PMC9152846 DOI: 10.1146/annurev-publhealth-090419-102547] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Chronic disease prevention continues to be inadequate, overall and in achieving health equity, in spite of the many evidence-based practices and policies (EBPPs) available to address risk behaviors such as unhealthful eating, lack of physical activity, and tobacco use. Although clinical settings are needed for EBPPs that involve medical procedures such as immunization or early detection, dissemination of EBPPs can be effective in a variety of settings such as schools and childcare centers, worksites, social service organizations, and religious organizations. More implementation research is needed to meet challenges of effective application of EBPPs in such community settings, in which primary missions, capacity, cultures, and values do not focus on health services delivery. To address health equity, consideration of social and economic contexts of people reached in these settings is essential. This review presents lessons learned from past studies to guide future implementation research and practice across diverse settings and geographies.
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Affiliation(s)
- Stephanie Mazzucca
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
| | - Elva M Arredondo
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, California 92123-4311, USA;
| | - Deanna M Hoelscher
- Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health, University of Texas, Austin, Texas 78701, USA;
| | - Debra Haire-Joshu
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
| | - Rachel G Tabak
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
| | - Shiriki K Kumanyika
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania 19104, USA;
| | - Ross C Brownson
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
- Department of Surgery, Division of Public Health Sciences; and Alvin J. Siteman Cancer Center, School of Medicine, Washington University in St. Louis, St. Louis, Missouri 63110, USA
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15
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Bernhart JA, Wilcox S, Saunders RP, Hutto B, Stucker J. Program Implementation and Church Members' Health Behaviors in a Countywide Study of the Faith, Activity, and Nutrition Program. Prev Chronic Dis 2021; 18:E05. [PMID: 33444524 PMCID: PMC7845546 DOI: 10.5888/pcd18.200224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- John A Bernhart
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Public Health Research Center, 1st Fl, 921 Assembly St, Columbia, SC 29208. E-mail:
| | - Ruth P Saunders
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Brent Hutto
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Jessica Stucker
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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16
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Farmer N, Powell-Wiley TM, Middleton KR, Roberson B, Flynn S, Brooks AT, Kazmi N, Mitchell V, Collins B, Hingst R, Swan L, Yang S, Kakar S, Harlan T, Wallen GR. A community feasibility study of a cooking behavior intervention in African-American adults at risk for cardiovascular disease: DC COOKS (DC Community Organizing for Optimal culinary Knowledge Study) with Heart. Pilot Feasibility Stud 2020; 6:158. [PMID: 33088581 PMCID: PMC7574184 DOI: 10.1186/s40814-020-00697-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Cooking interventions have increased in popularity in recent years. Evaluation by meta-analyses and systematic reviews show consistent changes in dietary quality reports and cooking confidence, but not of cardiovascular (CVD) biomarkers. Interventions evaluating or reporting behavioral mechanisms as an explanatory factor for these outcomes has been sparse. Moreover, evaluations of cooking interventions among communities with health disparities or food access limitations have received little attention in the literature. Methods This study will occur over two phases. Phase 1 will assess acceptability among the target population of African-American adults living within an urban food desert. Phase 2 will consist of a 6-week cooking intervention delivered at a community kitchen setting. Pre and post intervention visits for clinical examinations and biomarker collection will be conducted, as well as dietary and cooking skill assessments. Primary outcomes include cooking behavior and feasibility measures. Secondary outcomes are related to dietary quality, psychosocial factors, CVD biomarkers, and food environment measures. Discussion This study seeks to demonstrate feasibility of a community-based cooking intervention and to provide necessary information to plan future interventions that identify cooking behavior as an outcome of participation in cooking interventions among African-American adults, especially in relation to dietary and biomarker outcomes. Trial registration This study was registered at ClinicalTrials.gov (NCT04305431) on March 12, 2020.
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Affiliation(s)
- Nicole Farmer
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD USA.,Intramural Research Program, National Institute on Minority Health and Health Disparities, Bethesda, MD USA
| | | | - Brenda Roberson
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Sharon Flynn
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Alyssa T Brooks
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Narjis Kazmi
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Valerie Mitchell
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Billy Collins
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD USA
| | - Rachel Hingst
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Lucy Swan
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Shanna Yang
- National Institutes of Health, Clinical Center, Bethesda, MD USA
| | - Seema Kakar
- George Washington University School of Health Sciences, Washington, DC, USA
| | - Timothy Harlan
- George Washington University School of Health Sciences, Washington, DC, USA
| | - Gwenyth R Wallen
- National Institutes of Health, Clinical Center, Bethesda, MD USA
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17
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Applying Principles from Prevention and Implementation Sciences to Optimize the Dissemination of Family Feeding Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197038. [PMID: 32993021 PMCID: PMC7579193 DOI: 10.3390/ijerph17197038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/11/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022]
Abstract
Because families are the primary food socialization agent for children, they are a key target for nutrition interventions promoting healthy eating development. Although researchers and clinicians have developed and tested successful family nutrition interventions, few have gained widespread dissemination. Prevention and implementation science disciplines can inform the design, testing, and dissemination of feeding interventions to advance the goals of widespread adoption and population health impact. We review concepts and frameworks from prevention science and dissemination and implementation (D&I) research that are useful to consider in designing, implementing, and evaluating feeding interventions. Risk and protective factor frameworks, types of translation processes, and implementation dimensions are explained. Specifically, we address how research–practice partnerships can reduce time to dissemination, how designing for modularity can allow for contextual adaptation, how articulating core components can strengthen fidelity and guide adaptation, and how establishing technical assistance infrastructure supports these processes. Finally, we review strategies for building capacity in D&I research and practice for nutrition professionals. In sum, the research and knowledge bases from prevention and implementation sciences offer guidance on designing and delivering family interventions in ways that maximize the potential for their broad dissemination, reducing time to translation and optimizing interventions for real-world settings.
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Haughton J, Takemoto ML, Schneider J, Hooker SP, Rabin B, Brownson RC, Arredondo EM. Identifying barriers, facilitators, and implementation strategies for a faith-based physical activity program. Implement Sci Commun 2020; 1:51. [PMID: 32885207 PMCID: PMC7427873 DOI: 10.1186/s43058-020-00043-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/24/2020] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Jessica Haughton
- Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA 92123 USA
| | | | - Jennifer Schneider
- Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA 92123 USA
| | - Steven P Hooker
- College of Health and Human Services, San Diego State University, San Diego, CA USA
| | - Borsika Rabin
- Department of Family Medicine and Public Health, University of California, San Diego, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO USA.,Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO USA
| | - Elva M Arredondo
- School of Public Health, San Diego State University, San Diego, CA USA
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Brown L, Sharma M, Leggett S, Sung JH, Bennett RL, Azevedo M. Efficacy testing of the SAVOR (Sisters Adding Fruits and Vegetables for Optimal Results) intervention among African American women: A randomized controlled trial. Health Promot Perspect 2020; 10:270-280. [PMID: 32802764 PMCID: PMC7420176 DOI: 10.34172/hpp.2020.41] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/15/2020] [Indexed: 01/09/2023] Open
Abstract
Background: In the United States, only about 15% of individuals meet daily fruit intake recommendations of 2 cups per day and only 10% meet the vegetable intake recommendations of3 cups per day. African American women are a high-risk group. In this study, a fourth-generation multi-theory model (MTM) of health behavior change was used to design and evaluate a SistersAdding Fruits and Vegetables for Optimal Results (SAVOR) intervention for AA women. Methods: The study utilized a randomized controlled trial (RCT) with measurements taken at pretest, posttest (after the three-week intervention) and follow-up (at the end of eight weeks).SAVOR (n=26) was compared to an equivalent knowledge-based intervention (n=28). Process evaluation was done for program fidelity and satisfaction. A validated 38-item self-reported questionnaire was used to measure changes in MTM constructs and past 24-hour consumption of fruits and vegetables. Results: The SAVOR intervention resulted in improvement of mean consumption of fruits and vegetables in the experimental group from pre-test (2.78) to posttest (4.77) to recommended levels at follow-up (5.04) while in the comparison group they remained at around 3 (P<0.0001)Statistically significant changes (P<0.05) were noted for all MTM constructs except for participatory dialogue. Conclusion: The SAVOR intervention was found to be efficacious and established the robustness of MTM. SAVOR can be replicated for future effectiveness trials.
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Affiliation(s)
- LaVonne Brown
- Behavioral & Environmental Health, School of Public Health, Jackson State University, MS, USA
| | - Manoj Sharma
- Behavioral & Environmental Health, School of Public Health, Jackson State University, MS, USA
| | - Sophia Leggett
- Behavioral & Environmental Health, School of Public Health, Jackson State University, MS, USA
| | - Jung Hye Sung
- Behavioral & Environmental Health, School of Public Health, Jackson State University, MS, USA
| | - Russell L Bennett
- Behavioral & Environmental Health, School of Public Health, Jackson State University, MS, USA
| | - Mario Azevedo
- Behavioral & Environmental Health, School of Public Health, Jackson State University, MS, USA
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Wilcox S, Saunders RP, Jake-Schoffman D, Hutto B. The Faith, Activity, and Nutrition (FAN) Dissemination and Implementation Study: 24-Month Organizational Maintenance in a Countywide Initiative. Front Public Health 2020; 8:171. [PMID: 32528919 PMCID: PMC7247868 DOI: 10.3389/fpubh.2020.00171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/20/2020] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
- Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Ruth P Saunders
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Danielle Jake-Schoffman
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, United States
| | - Brent Hutto
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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21
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Swindle T, Curran GM, Johnson SL. Implementation Science and Nutrition Education and Behavior: Opportunities for Integration. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:763-774.e1. [PMID: 30982567 PMCID: PMC6904925 DOI: 10.1016/j.jneb.2019.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 05/05/2023]
Abstract
Implementation science (IS) is the study of approaches designed to increase adoption and sustainability of research evidence into routine practice. This article provides an overview of IS and ideas for its integration with nutrition education and behavior practice and research. Implementation science application in nutrition education and behavior practice can inform real-word implementation efforts. Research opportunities include advancing common approaches to implementation measurement. In addition, the article provides suggestions for future studies (eg, comparative effectiveness trials comparing implementation strategies) to advance the knowledge base of both fields. An example from ongoing research is included to illustrate concepts and methods of IS.
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Affiliation(s)
- Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Geoff M Curran
- Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Susan L Johnson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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22
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Maxwell AE, Santifer R, Chang LC, Gatson J, Crespi CM, Lucas-Wright A. Organizational readiness for wellness promotion - a survey of 100 African American church leaders in South Los Angeles. BMC Public Health 2019; 19:593. [PMID: 31101096 PMCID: PMC6525409 DOI: 10.1186/s12889-019-6895-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/25/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Churches are an important asset and a trusted resource in the African American community. We needed a better understanding of their readiness to engage in health promotion before launching a large-scale health promotion effort in partnership with South Los Angeles churches. METHODS In 2017, we conducted surveys with leaders of 100 churches. Surveys were conducted face-to-face (32%) or by telephone (68%) with senior pastors (one per church) and lasted on average 48 min. We compared small (less than 50 active members), medium (50-99 active members) and large churches (at least 100 active members), and assessed which church characteristics were associated with the implementation of wellness activities. RESULTS Medium and large churches conducted significantly more wellness activities than small churches and were more likely to have wellness champions and health policies. Regardless of church size, insufficient budget was the most commonly cited barrier to implement wellness activities (85%). A substantial proportion of churches was not sure how to implement wellness activities (61%) and lacked volunteers (58%). Forty-five percent of the variation in the number of wellness activities in the last 12 months was explained by church characteristics, such as size of congregation, number of paid staff, leadership engagement, having a wellness ministry and barriers. CONCLUSIONS Many churches in South Los Angeles are actively engaged in health promotion activities, despite a general lack of resources. We recommend a comprehensive assessment of church characteristics in intervention studies to enable the use of strategies (e.g., stratification by size) that reduce imbalances that could mask or magnify study outcomes. Our data provide empirical support for the inner settings construct of the Consolidated Framework for Implementation Research in the context of health promotion in African American churches.
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Affiliation(s)
- Annette E Maxwell
- University of California Los Angeles Fielding School of Public Health & Jonsson Comprehensive Cancer Center; UCLA Kaiser Permanente Center for Health Equity, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA.
| | - Rhonda Santifer
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - L Cindy Chang
- University of California Los Angeles Fielding School of Public Health & Jonsson Comprehensive Cancer Center; UCLA Kaiser Permanente Center for Health Equity, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA.,Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Juana Gatson
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Catherine M Crespi
- University of California Los Angeles Fielding School of Public Health & Jonsson Comprehensive Cancer Center; UCLA Kaiser Permanente Center for Health Equity, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA
| | - Aziza Lucas-Wright
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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23
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Nam S, Jung S, Whittemore R, Latkin C, Kershaw T, Redeker NS, Jeon S, Vlahov D. Social Network Structures in African American Churches: Implications for Health Promotion Programs. J Urban Health 2019; 96:300-310. [PMID: 30747370 PMCID: PMC6458228 DOI: 10.1007/s11524-018-00339-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The prevalence of obesity among African Americans is higher than among other racial/ethnic groups. African American churches hold a central role in promoting health in the community; yet, church-based interventions have had limited impact on obesity. While recent studies have described the influence of social networks on health behaviors, obesity interventions informed by social network analysis have been limited. We conducted a cross-sectional study with 281 African American men and women from three churches in northeast urban cities in the USA. Data were collected on sociodemographic and clinical factors and anthropometrics. Using a social network survey applying a name generator, we computed network level metrics. Exponential random graph models (ERGM) were performed to examine whether each structural property found in the empirical (observed) networks occurred more frequently than expected by chance by comparing the empirical networks to the randomly simulated networks. Overall, church friendship networks were sparse (low density). We also found that while friendship ties were more reciprocated between dyads in church networks, and there were more tendencies for clustering of friendships (significant positive transitive closure) than in random networks, other characteristics such as expansiveness (number of actors with a great number of friends) did not differ from what would be expected by chance in random networks. These data suggest that interventions with African American churches should not assume a unitary network through which a single intervention should be used.
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Affiliation(s)
- Soohyun Nam
- Yale University, School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA.
| | - Sunyoung Jung
- Yale University, School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
| | - Robin Whittemore
- Yale University, School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
| | - Carl Latkin
- Yale University, School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
| | - Trace Kershaw
- Yale University, School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
| | - Nancy S Redeker
- Yale University, School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
| | - Sangchoon Jeon
- Yale University, School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
| | - David Vlahov
- Yale University, School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
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24
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Paxton RJ, Garner W, Dean LT, Logan G, Allen-Watts K. Health Behaviors and Lifestyle Interventions in African American Breast Cancer Survivors: A Review. Front Oncol 2019; 9:3. [PMID: 30723698 PMCID: PMC6349825 DOI: 10.3389/fonc.2019.00003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 01/02/2019] [Indexed: 11/13/2022] Open
Abstract
Background: African American breast cancer survivors have a higher incidence of estrogen receptor negative and basal-like (e.g., triple negative) tumors, placing them at greater risk for poorer survival when compared to women of other racial and ethnic groups. While access to equitable care, late disease stage at diagnosis, tumor biology, and sociodemographic characteristics contribute to health disparities, poor lifestyle characteristics (i.e., inactivity, obesity, and poor diet) contribute equally to these disparities. Lifestyle interventions hold promise in shielding African American survivors from second cancers, comorbidities, and premature mortality, but they are often underrepresented in studies promoting positive behaviors. This review examined the available literature to document health behaviors and lifestyle intervention (i.e., obesity, physical activity, and sedentary behavior) studies in African American breast cancer survivors. Methods: We used PubMed, Academic Search Premier, and Scopus to identify cross-sectional and intervention studies examining the lifestyle behaviors of African American breast cancer survivors. Identified intervention studies were assessed for risk of bias. Other articles were identified and described to provide context for the review. Results: Our systematic review identified 226 relevant articles. The cross-sectional articles indicated poor adherence to physical activity and dietary intake and high rates of overweight and obesity. The 16 identified intervention studies indicated reasonable to modest study adherence rates (>70%), significant reductions in weight (range -1.9 to -3.6%), sedentary behavior (-18%), and dietary fat intake (range -13 to -33%) and improvements in fruit and vegetable intake (range +25 to +55%) and physical activity (range +13 to +544%). The risk of bias for most studies were rated as high (44%) or moderate (44%). Conclusions: The available literature suggests that African American breast cancer survivors adhere to interventions of various modalities and are capable of making modest to significant changes. Future studies should consider examining (a) mediators and moderators of lifestyle behaviors and interventions, (b) biological outcomes, and (c) determinants of enhanced survival in this population.
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Affiliation(s)
- Raheem J Paxton
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
| | - William Garner
- Department of Life and Health Sciences, University of North Texas at Dallas, Dallas, TX, United States
| | - Lorraine T Dean
- Department of Epidemiology, John Hopkins School of Public Health, Baltimore, MD, United States
| | - Georgiana Logan
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
| | - Kristen Allen-Watts
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States
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25
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The effectiveness of peer-supported interventions for encouraging dietary behaviour change in adults: a systematic review. Public Health Nutr 2018; 22:624-644. [PMID: 30501679 DOI: 10.1017/s1368980018003294] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE There is an urgent need to find effective methods of supporting individuals to make dietary behaviour changes. Peer-supported interventions (PSI) have been suggested as a cost-effective strategy to support chronic disease self-management. However, the effect of PSI on dietary behaviour is unclear. The present systematic review aimed to assess the effectiveness of PSI for encouraging dietary behaviour change in adults and to consider intervention characteristics linked with effectiveness. DESIGN Electronic databases were searched until June 2018 for randomised controlled trials assessing the effectiveness of PSI compared with an alternative intervention and/or control on a dietary related outcome in adults. Following title and abstract screening, two reviewers independently screened full texts and data were extracted by one reviewer and independently checked by another. Results were synthesised narratively. SETTING Randomised controlled trials.ParticipantsAdult studies. RESULTS The fifty-four included studies varied in participants, intervention details and results. More PSI reported a positive or mixed effect on diet than no effect. Most interventions used a group model and were lay-led by peer supporters. Several studies did not report intervention intensity, fidelity and peer training and support in detail. Studies reporting positive effects employed more behaviour change techniques (BCT) than studies reporting no effect; however, heterogeneity between studies was considerable. CONCLUSIONS As evidence was mixed, further interventions need to assess the effect of PSI on dietary behaviour, describe intervention content (theoretical basis, BCT, intensity and peer training/support) and include a detailed process evaluation.
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Schoenthaler AM, Lancaster KJ, Chaplin W, Butler M, Forsyth J, Ogedegbe G. Cluster Randomized Clinical Trial of FAITH (Faith-Based Approaches in the Treatment of Hypertension) in Blacks. Circ Cardiovasc Qual Outcomes 2018; 11:e004691. [DOI: 10.1161/circoutcomes.118.004691] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Antoinette M. Schoenthaler
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine (A.M.S., M.B., J.F., G.O.)
| | - Kristie J. Lancaster
- Department of Nutrition and Food Studies, Steinhardt School of Culture, Education, and Human Development, New York University (K.J.L.)
| | - William Chaplin
- Department of Psychology, St. John’s University College of Liberal Arts and Sciences, Queens, NY (W.C.)
| | - Mark Butler
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine (A.M.S., M.B., J.F., G.O.)
| | - Jessica Forsyth
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine (A.M.S., M.B., J.F., G.O.)
| | - Gbenga Ogedegbe
- Department of Population Health, Center for Healthful Behavior Change, New York University School of Medicine (A.M.S., M.B., J.F., G.O.)
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Nápoles AM, Stewart AL. Transcreation: an implementation science framework for community-engaged behavioral interventions to reduce health disparities. BMC Health Serv Res 2018; 18:710. [PMID: 30208873 PMCID: PMC6134771 DOI: 10.1186/s12913-018-3521-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/04/2018] [Indexed: 12/22/2022] Open
Abstract
Background Methods for translating evidence-based behavioral interventions into real-world settings seldom account for the special issues in reaching health disparity populations. Main text The objective of this article is to describe an innovative “transcreational” framework for designing and delivering interventions in communities to reduce health disparities. We define transcreation as the process of planning, delivering, and evaluating interventions so that they resonate with the community experiencing health disparities, while achieving intended health outcomes. The Transcreation Framework for Community-engaged Behavioral Interventions to Reduce Health Disparities comprises seven steps: 1) identify community infrastructure and engage partners; 2) specify theory; 3) identify multiple inputs for new program; 4) design intervention prototype; 5) design study, methods, and measures for community setting; 6) build community capacity for delivery; and 7) deliver transcreated intervention and evaluate implementation processes. Communities are engaged from the start and interventions are delivered by community-based interventionists and tested in community settings. The framework applies rigorous scientific methods for evaluating program effectiveness and implementation processes. It incorporates training and ongoing technical assistance to assure treatment fidelity and build community capacity. Conclusions This framework expands the types of scientific evidence used and balances fidelity to evidence and fit to the community setting. It can guide researchers and communities in developing and testing behavioral interventions to reduce health disparities that are likely to be sustained because infrastructure development is embedded in the research.
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Affiliation(s)
- Anna María Nápoles
- National Institute on Minority Health and Health Disparities, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USA.
| | - Anita L Stewart
- University of California San Francisco, 3333 California Street, Suite 350E, San Francisco, CA, 94118, USA
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28
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Wilcox S, Saunders RP, Kaczynski AT, Forthofer M, Sharpe PA, Goodwin C, Condrasky M, Kennedy VL, Jake-Schoffman DE, Kinnard D, Hutto B. Faith, Activity, and Nutrition Randomized Dissemination and Implementation Study: Countywide Adoption, Reach, and Effectiveness. Am J Prev Med 2018; 54:776-785. [PMID: 29656913 PMCID: PMC6203293 DOI: 10.1016/j.amepre.2018.02.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Faith-based organizations can contribute to improving population health, but few dissemination and implementation studies exist. This paper reports countywide adoption, reach, and effectiveness from the Faith, Activity, and Nutrition dissemination and implementation study. DESIGN This was a group-randomized trial. Data were collected in 2016. Statistical analyses were conducted in 2017. SETTING/PARTICIPANTS Churches in a rural, medically underserved county in South Carolina were invited to enroll, and attendees of enrolled churches were invited to complete questionnaires (n=1,308 participated). INTERVENTION Churches (n=59) were randomized to an intervention or control (delayed intervention) condition. Church committees attended training focused on creating opportunities, setting guidelines/policies, sharing messages, and engaging pastors for physical activity (PA) and healthy eating (HE). Churches also received 12 months of telephone-based technical assistance. Community health advisors provided the training and technical assistance. MAIN OUTCOMES MEASURES The Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework guided measurement of adoption and reach. To assess effectiveness, church attendees completed post-test only questionnaires of perceptions of church environment, PA and fruit and vegetable (FV) self-efficacy, FV intake, and PA. Regression models controlled for church clustering and predominant race of congregation, as well as member age, gender, education, and self-reported cancer diagnosis. RESULTS Church adoption was 42% (55/132). Estimated reach was 3,527, representing 42% of regular church attendees and 15% of county residents. Intervention church attendees reported greater church-level PA opportunities, PA and HE messages, and PA and HE pastor support (p<0.0001), but not FV opportunities (p=0.07). PA self-efficacy (p=0.07) and FV self-efficacy (p=0.21) were not significantly higher in attendees of intervention versus control churches. The proportion of inactive attendees was lower in intervention versus control churches (p=0.02). The proportion meeting FV (p=0.27) and PA guidelines (p=0.32) did not differ by group. CONCLUSIONS This innovative dissemination and implementation study had high adoption and reach with favorable environmental impacts, positioning it for broader dissemination. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02868866.
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Affiliation(s)
- Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
| | - Ruth P Saunders
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Andrew T Kaczynski
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Melinda Forthofer
- Department of Public Health Sciences, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Patricia A Sharpe
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Cheryl Goodwin
- Fairfield Behavioral Health Services, Winnsboro, South Carolina
| | - Margaret Condrasky
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, South Carolina
| | | | - Danielle E Jake-Schoffman
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Deborah Kinnard
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Brent Hutto
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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29
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Enhancing capacity among faith-based organizations to implement evidence-based cancer control programs: a community-engaged approach. Transl Behav Med 2018; 7:517-528. [PMID: 28733726 DOI: 10.1007/s13142-017-0513-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Evidence-based interventions (EBIs) to promote cancer control among Latinos have proliferated in recent years, though adoption and implementation of these interventions by faith-based organizations (FBOs) is limited. Capacity building may be one strategy to promote implementation. In this qualitative study, 18 community key informants were interviewed to (a) understand existing capacity for health programming among Catholic parishes, (b) characterize parishes' resource gaps and capacity-building needs implementing cancer control EBIs, and (c) elucidate strategies for delivering capacity-building assistance to parishes to facilitate implementation of EBIs. Semi-structured qualitative interviews were conducted. Key informants concurred about the capacity of Catholic parishes to deliver health programs, and described attributes of parishes that make them strong partners in health promotion initiatives, including a mission to address physical and mental health, outreach to marginalized groups, altruism among members, and existing engagement in health programming. However, resource gaps and capacity building needs were also identified. Specific recommendations participants made about how existing resources might be leveraged to address challenges include to: establish parish wellness committees; provide "hands-on" learning opportunities for parishioners to gain program planning skills; offer continuous, tailored, on-site technical assistance; facilitate relationships between parishes and community resources; and provide financial support for parishes. Leveraging parishes' existing resources and addressing their implementation needs may improve adoption of cancer control EBIs.
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Indig D, Lee K, Grunseit A, Milat A, Bauman A. Pathways for scaling up public health interventions. BMC Public Health 2017; 18:68. [PMID: 28764785 PMCID: PMC5540381 DOI: 10.1186/s12889-017-4572-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 07/06/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To achieve population-wide health improvement, public health interventions found effective in selected samples need to be 'scaled up' and implemented more widely. The pathways through which interventions are scaled up are not well characterised. The aim of this paper is to identify examples of public health interventions which have been scaled up and to develop a conceptual framework which quantifies and describes this process. METHODS A multi-stage international literature search was undertaken to identify examples of public health interventions in high income countries that have been scaled up or implemented at scale. Initial abstract review identified articles which met all the criteria of being a: 1) public health intervention; 2) chronic disease prevention focus; 3) program delivered at a wide geographical scale (state, national or international). Interventions were reviewed and coded into a conceptual framework pathway to document their scaling up process. For each program, an in-depth review of the identified articles was undertaken along with a broad internet based search to determine the outcomes of the dissemination process. A conceptual framework of scaling up pathways was developed that involved four stages (development, efficacy testing, real world trial and dissemination) to which the 40 programs were mapped. RESULTS The search identified 40 public health interventions that showed evidence of being scaled up. Four pathways were identified to capture the different scaling up trajectories taken which included: 'Type I - Comprehensive' (55%) which passed through all four stages, 'Type II - Efficacy omitters' (5%) which did not conduct efficacy testing, 'Type III - Trial omitters' (25%) which did not conduct a real world trial, and 'Type IV - At scale dissemination' (15%) which skipped both efficacy testing and a real world trial. CONCLUSIONS This is the first study to classify and quantify the potential pathways through which public health interventions in high income countries are scaled up to reach the broader population. Mapping these pathways not only demonstrates the different trajectories that occur in scaling up public health interventions, but also allows the variation across scaling up pathways to be classified. The policy and practice determinants leading to each pathway remain for future study, especially to identify the conditions under which efficacy and replication stages are missing.
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Affiliation(s)
- Devon Indig
- The Australian Prevention Partnership Centre and School of Public Health, University of Sydney, Sydney, Australia
| | - Karen Lee
- School of Public Health, University of Sydney, Sydney, Australia
| | - Anne Grunseit
- The Australian Prevention Partnership Centre and School of Public Health, University of Sydney, Sydney, Australia
| | - Andrew Milat
- School of Public Health, University of Sydney, Sydney, Australia
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, 73 Miller Street, North Sydney NSW, Sydney, 2060 Australia
| | - Adrian Bauman
- The Australian Prevention Partnership Centre and School of Public Health, University of Sydney, Sydney, Australia
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Saunders DM, Leak J, Carver ME, Smith SA. Application of a faith-based integration tool to assess mental and physical health interventions. JOURNAL OF THE GEORGIA PUBLIC HEALTH ASSOCIATION 2017; 7:26-38. [PMID: 29354795 PMCID: PMC5771442 DOI: 10.21633/jgpha.7.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background To build on current research involving faith-based interventions (FBIs) for addressing mental and physical health, this study a) reviewed the extent to which relevant publications integrate faith concepts with health and b) initiated analysis of the degree of FBI integration with intervention outcomes. Methods Derived from a systematic search of articles published between 2007 and 2017, 36 studies were assessed with a Faith-Based Integration Assessment Tool (FIAT) to quantify faith-health integration. Basic statistical procedures were employed to determine the association of faith-based integration with intervention outcomes. Results The assessed studies possessed (on average) moderate, inconsistent integration because of poor use of faith measures, and moderate, inconsistent use of faith practices. Analysis procedures for determining the effect of FBI integration on intervention outcomes were inadequate for formulating practical conclusions. Conclusions Regardless of integration, interventions were associated with beneficial outcomes. To determine the link between FBI integration and intervention outcomes, additional analyses are needed.
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Affiliation(s)
| | - Jean Leak
- Refreshing Springs Outreach Sykesville, MD
| | | | - Selina A Smith
- Department of Family Medicine, Medical College of Georgia at Augusta University, Augusta, GA
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A pilot study of a Community Health Agent-led type 2 diabetes self-management program using Motivational Interviewing-based approaches in a public primary care center in São Paulo, Brazil. BMC Health Serv Res 2017; 17:32. [PMID: 28086870 PMCID: PMC5237239 DOI: 10.1186/s12913-016-1968-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/22/2016] [Indexed: 12/30/2022] Open
Abstract
Background Rates of noncommunicable diseases (NCDs) such as type 2 diabetes are escalating in low and middle-income countries such as Brazil. Scalable primary care-based interventions are needed to improve self-management and clinical outcomes of adults with diabetes. This pilot study examines the feasibility, acceptability, and outcomes of training community health agents (CHAs) in Motivational Interviewing (MI)-based counseling for patients with poorly controlled diabetes in a primary care center in São Paulo, Brazil. Methods Nineteen salaried CHAs participated in 32 h of training in MI and behavioral action planning. With support from booster training sessions, they used these skills in their regular monthly home visits over a 6 month period with 57 diabetes patients with baseline HbA1cs > 7.0%. The primary outcome was patients’ reports of the quality of diabetes care as measured by the Portuguese version of the Patient Assessment of Chronic Illness Care (PACIC) scale. Secondary outcomes included changes in patients’ reported diabetes self-management behaviors and in A1c, blood pressure, cholesterol and triglycerides. We also examined CHAs’ fidelity to and experiences with the intervention. Results Patients reported improvements over the 6 month period in quality of diabetes care received (PACIC score improved 33 (+/−19) to 68 (+/−21) (p < .001)). They reported increases in physical activity (p = .001), consumption of fruits and vegetables (p < .001) and medication adherence (p = .002), but no decreases in consumption of high-fat foods (p = .402) or sweets (p = .436). Participants had mean 6-month A1c levels 0.34% points lower than at baseline (p = .08) and improved mean LDL (−16.1 mg/dL, p = .005) and triglyceride levels (−38.725 mg/dL, p = .002). Of the 16 CHAs observed in fidelity assessments, 13 were categorized as medium- or high-performing on MI skills, while 3 were low-performing. CHAs expressed enthusiasm about learning new skills, and many described a shift from advice-giving to encouraging patients to define their own goals. Conclusion In resource-scarce settings, it is essential to fully utilize existing primary care resources to stem the epidemic of diabetes and other NCDs. Our pilot results support the potential of training CHAs to incorporate effective diabetes self-management support into their routine patient encounters. Trial registration NCT02994095 12/14/2016 Registered retrospectively.
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Batada A, Grier-McEachin J, Avery K. Partnering on the PRAISE Program: Putting Health Equity into Practice. Health Equity 2017; 1:7-14. [PMID: 30283830 PMCID: PMC6071877 DOI: 10.1089/heq.2016.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: The purpose of Preventive Health Education Resulting in Action Inspiring Success for Everyone (PRAISE) was to develop a community-driven program to encourage and support churches in sustainable health promotion and assessment efforts to improve African Americans' health knowledge and behaviors in Asheville, North Carolina. Methods: The PRAISE program provided technical support toward gaining recognition and an award for health promotion activities to 10 churches in year 1 and 5 additional churches in year 2. The Results-Based Accountability© (RBA) framework involved documentation of church health promotion activities and surveys of a convenience sample of congregants at nine churches before (presurvey, n=270) and after (postsurvey, n=241) the intervention. Differences in frequency of conduct of and participation in church health promotion activities and in congregant health knowledge and behaviors were assessed in 2015 and 2016. Results: Fourteen of the churches engaged in at least one health promotion activity and more than half offered healthier foods at gatherings, offered exercise opportunities, and held at least three health education activities. Seventy-two percent of congregants reported participating in at least one church health activity at postsurvey compared with 58% at presurvey. The proportion of congregants who had personal health knowledge and the proportion that rated their health as good or better were higher at postsurvey. Conclusion: Building on years of trust and collaboration among churches, local community organizations, and an academic partner, PRAISE in its first 2 years suggests that a community-driven approach can support health promotion and healthy behaviors, advancing health equity efforts.
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Affiliation(s)
- Ameena Batada
- Department of Health and Wellness, University of North Carolina Asheville, Asheville, North Carolina
| | - JeWana Grier-McEachin
- Asheville Buncombe Institute of Parity Achievement (ABIPA), Asheville, North Carolina
| | - Kathey Avery
- Asheville Buncombe Institute of Parity Achievement (ABIPA), Asheville, North Carolina
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Escribano S, Espada JP, Orgilés M, Morales A. Implementation fidelity for promoting the effectiveness of an adolescent sexual health program. EVALUATION AND PROGRAM PLANNING 2016; 59:81-87. [PMID: 27614301 DOI: 10.1016/j.evalprogplan.2016.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 06/07/2016] [Accepted: 08/17/2016] [Indexed: 06/06/2023]
Abstract
The goal of the present study was to examine COMPAS program (Competencies for adolescents with a healthy sexuality) outcomes based on implementation fidelity: dose, adherence, and acceptance. Participants were 716 adolescents aged 14-16 years (46.5% boys). Two fidelity groups were established: high (n=83) and low (n=312), with the remaining sample serving as a non-program control group (n=321). Knowledge about sexually transmitted infections (STIs), attitudes towards HIV, intention to use condoms, and sexual behavior were evaluated. Results indicated that adolescents receiving the intervention displayed improved STI knowledge (p<0.001) and improved attitudes toward HIV (p<0.05) as compared to the control group. Between the two intervention groups, a high-fidelity group intended to engage more in safe sex behaviors (p=0.05) and displayed greater STI knowledge (p=0.05) as compared to the low-fidelity group. The present study revealed improved efficiency when applying prevention programs with implementation fidelity.
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Affiliation(s)
- Silvia Escribano
- Miguel Hernández University, Avenida de la Universidad, s/n, 03202, Elche (Alicante), Spain.
| | - José P Espada
- Miguel Hernández University, Avenida de la Universidad, s/n, 03202, Elche (Alicante), Spain
| | - Mireia Orgilés
- Miguel Hernández University, Avenida de la Universidad, s/n, 03202, Elche (Alicante), Spain
| | - Alexandra Morales
- Miguel Hernández University, Avenida de la Universidad, s/n, 03202, Elche (Alicante), Spain
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Allen JD, Leyva B, Hilaire DM, Reich AJ, Martinez LS. Priorities, concerns and unmet needs among Haitians in Boston after the 2010 earthquake. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:687-698. [PMID: 25736232 PMCID: PMC5053234 DOI: 10.1111/hsc.12217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 01/11/2015] [Indexed: 06/04/2023]
Abstract
In January 2010, a massive earthquake struck Haiti. The devastation not only affected those living in Haiti at the time but also those Haitians living in the United States (U.S.). Few studies have assessed the degree of impact of the earthquake in U.S. Haitian communities. The purpose of this study was to elicit information about health priorities, concerns and resources needed to improve the delivery of health and social care for Haitians in Boston, MA. We conducted six focus groups among 78 individuals in the spring of 2011. Participants were recruited through community organisations, including churches, Haitian social service centres, restaurants and by word of mouth. Analysis of qualitative data revealed an enormous psychological, emotional, financial and physical toll experienced by Boston-area Haitians following the earthquake. Participants described increased distress, depressive episodes, headaches and financial hardship. They also noted insufficient resources to meet the increased needs of those living in the U.S., and those who had immigrated after the earthquake. Most participants cited an increased need for mental health services, as well as assistance with finding employment, navigating the immigration system, and balancing the health and financial needs of families in the U.S. and in Haiti. Despite this, many reported that the tragedy created a sense of unity and solidarity within the Haitian community. These findings corroborate the need for culturally and linguistically appropriate mental health services, as well as for employment, immigration and healthcare navigation services. Participants suggested that interventions be offered through Haitian radio and television stations, as well as group events held in churches. Further research should assess the need for and barriers to utilisation of mental health services among the Haitian community. A multi-faceted approach that includes a variety of outreach strategies implemented through multiple channels may offer a means of improving awareness of and access to health and social services.
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Affiliation(s)
- Jennifer D Allen
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
- Department of Public Health and Community Medicine, Tufts University, Medford, Massachusetts, USA.
| | - Bryan Leyva
- The Warren Alpert Medical School of Brown University, Rhode Island, USA
| | - Dany M Hilaire
- University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Amanda J Reich
- Community Health, Tufts University, Medford, Massachusetts, USA
| | - Linda Sprague Martinez
- Department of Public Health and Community Medicine, Tufts University, Medford, Massachusetts, USA
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Allen JD, Torres MI, Tom LS, Leyva B, Galeas AV, Ospino H. Dissemination of evidence-based cancer control interventions among Catholic faith-based organizations: results from the CRUZA randomized trial. Implement Sci 2016; 11:74. [PMID: 27193768 PMCID: PMC4870813 DOI: 10.1186/s13012-016-0430-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The CRUZA randomized trial tested the efficacy of an organizational-level intervention to increase the capacity of Catholic faith-based organizations (FBOs) serving Latinos to implement evidence-based strategies (EBS) for cancer control. METHODS Thirty-one Catholic parishes were enrolled. Twenty were randomized to a "capacity enhancement" (CE) intervention and 11 to a "standard dissemination" (SD) condition. Each received a Program Implementation Manual and Toolkit of materials culturally adapted for FBOs with Latino audiences for five types of EBS recommended by the US Preventive Services Community Guide. CE parishes were offered a menu of capacity-building activities over a 3-month period, while SD parishes were provided a one-time consultation by an Intervention Specialist. Baseline and follow-up surveys compared the number and types of EBS offered. RESULTS At baseline, only one parish had offered any cancer-related program in the prior year, yet a third (36 %) had offered some other type of health program or service. At post-intervention follow-up, all parishes offered a greater number of EBS. The only statistically significant difference between CE and SD groups was the number of parishes offering small media interventions (90 % in CE, 64 % in SD; p < 0.05). CONCLUSIONS All parishes increased the number of cancer control activities offered to their members. These findings suggest that Catholic parishes may already have capacity to implement EBS if they are appropriately adapted and packaged and may only require low levels of support to carry out programming. Further research is needed to examine the extent to which program offerings continued after the period of grant funding. TRIAL REGISTRATION Clinicaltrials.gov NCT01740219 .
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Affiliation(s)
- Jennifer D Allen
- Community Health Program and Department of Public Health and Community Medicine, Tufts University, Medford, MA, USA. .,Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Maria Idalí Torres
- Mauricio Gaston Institute for Latino Community Development and Public Policy, University of Massachusetts, Boston, MA, USA
| | - Laura S Tom
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Bryan Leyva
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ana V Galeas
- Mauricio Gaston Institute for Latino Community Development and Public Policy, University of Massachusetts, Boston, MA, USA
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Whitt-Glover MC, Borden SL, Alexander DS, Kennedy BM, Goldmon MV. Recruiting African American Churches to Participate in Research: The Learning and Developing Individual Exercise Skills for a Better Life Study. Health Promot Pract 2015; 17:297-306. [PMID: 26724311 DOI: 10.1177/1524839915623499] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Physical activity among African Americans (AA) is low; effective intervention strategies are needed. Community-based settings are useful for delivering health-related interventions in racial/ethnic minority communities. This article describes strategies used to recruit churches for participation in a 22-month intervention designed to increase physical activity levels in AA women. Initial recruitment efforts, led by AA study staff, included direct mailers, phone calls, and in-person meetings with church representatives. After 10 months, only five churches were enrolled. Seven community members with existing partnerships/contacts in the faith community were subsequently hired and an additional 26 churches were enrolled within 6 months. Overall response rate was 45%, and churches required 3.5 ± 3.0 months of multiple contacts prior to enrollment. The main primary contacts within churches were individuals with personal interest in the program and pastors. Prior relationship between the research team and churches did not appear to influence church enrollment as much as community member recruiters. The current study identifies several potential strategies that may be useful for increasing success in efforts to recruit AA churches into studies. Additional research is warranted that tests and compares a variety of recruitment strategies to determine the most successful strategies for recruitment in different populations.
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Affiliation(s)
| | - Shanice L Borden
- Gramercy Research Group, Winston-Salem, NC, USA East Carolina University, Greenville, NC, USA
| | - Dayna S Alexander
- Gramercy Research Group, Winston-Salem, NC, USA UNC Eshelman School of Pharmacy, Asheville, NC, USA
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Allen JD, Torres MI, Tom LS, Rustan S, Leyva B, Negron R, Linnan LA, Jandorf L, Ospino H. Enhancing organizational capacity to provide cancer control programs among Latino churches: design and baseline findings of the CRUZA Study. BMC Health Serv Res 2015; 15:147. [PMID: 25889628 PMCID: PMC4427966 DOI: 10.1186/s12913-015-0735-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 02/12/2015] [Indexed: 04/21/2023] Open
Abstract
Background Faith-based organizations (FBOs) have been successful in delivering health promotion programs for African Americans, though few studies have been conducted among Latinos. Even fewer have focused on organizational change, which is required to sustain community-based initiatives. We hypothesized that FBOs serving Latinos would be more likely to offer evidence-based strategies (EBS) for cancer control after receiving a capacity enhancement intervention to implement health programs, and designed the CRUZA trial to test this hypothesis. This paper describes the CRUZA design and baseline findings. Methods We identified Catholic parishes in Massachusetts that provided Spanish-language mass (n = 65). A baseline survey assessed organizational characteristics relevant to adoption of health programs, including readiness for adoption, “fit” between innovation and organizational mission, implementation climate, and organizational culture. In the next study phase, parishes that completed the baseline assessment will be recruited to a randomized cluster trial, with the parish as the unit of analysis. Both groups will receive a Program Manual and Toolkit. Capacity Enhancement parishes will also be offered technical support, assistance forming health committees and building inter-institutional partnerships, and skills-based training. Results Of the 49 parishes surveyed at baseline (75%), one-third (33%) reported having provided at least one health program in the prior year. However, only two program offerings were cancer-specific. Nearly one-fifth (18%) had an active health ministry. There was a high level of organizational readiness to adopt cancer control programs, high congruence between parish missions and CRUZA objectives, moderately conducive implementation climates, and organizational cultures supportive of CRUZA programming. Having an existing health ministry was significantly associated with having offered health programs within the past year. Relationships between health program offerings and other organizational characteristics were not statistically significant. Conclusions Findings suggest that many parishes do not offer cancer control programs, yet many may be ready to do so. However, the perceptions about existing organizational practices and policies may not be conducive to program initiation. A capacity enhancement intervention may hold promise as a means of increasing health programming. The efficacy of such an intervention will be tested in phase two of this study.
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Affiliation(s)
- Jennifer D Allen
- Dana-Farber Cancer Institute, Boston, MA, USA. .,Department of Public Health and Community Medicine, Tufts University, 112 Packard Ave, Medford, MA, 02155, USA.
| | - Maria Idali Torres
- Mauricio Gaston Institute for Latino Community Development and PublicPolicy, University of Massachusetts, Boston, MA, USA.
| | - Laura S Tom
- Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Sarah Rustan
- Mauricio Gaston Institute for Latino Community Development and PublicPolicy, University of Massachusetts, Boston, MA, USA.
| | - Bryan Leyva
- National Cancer Institute, Bethesda, MD, USA.
| | - Rosalyn Negron
- Mauricio Gaston Institute for Latino Community Development and PublicPolicy, University of Massachusetts, Boston, MA, USA.
| | - Laura A Linnan
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Lina Jandorf
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Alia KA, Wilson DK, McDaniel T, St George SM, Kitzman-Ulrich H, Smith K, Heatley V, Wise C. Development of an innovative process evaluation approach for the Families Improving Together (FIT) for weight loss trial in African American adolescents. EVALUATION AND PROGRAM PLANNING 2015; 49:106-16. [PMID: 25614139 PMCID: PMC4372476 DOI: 10.1016/j.evalprogplan.2014.12.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 12/15/2014] [Accepted: 12/21/2014] [Indexed: 05/12/2023]
Abstract
UNLABELLED This study demonstrates how a multi-theoretical, multilevel process evaluation was used to assess implementation of the Families Improving Together (FIT) for weight loss intervention. FIT is a randomized controlled trial evaluating a culturally tailored, motivational plus family-based program on weight loss in African American adolescents and their parents. Social Cognitive, Self Determination, Family Systems theories and cultural tailoring principles guided the conceptualization of essential elements across individual/family, facilitator, and group levels. Data collection included an observational rating tool, attendance records, and a validated psychosocial measure. RESULTS Attendance records (0=absent, 1=present, criteria=≥70%) indicated that 71.5% of families attended each session. The survey (1=false, 6=true, criteria=≥4.5) indicated that participants perceived a positive group climate (M=5.16, SD=0.69). A trained evaluator reported that facilitator dose delivered (0=no, 1=yes, criteria=≥75%) was high (99.6%), and fidelity (1=none to 4=all, criteria=≥3) was adequate at facilitator (M=3.63, SD=0.41) and group levels (M=3.35, SD=0.49). Five cultural topics were raised by participants related to eating (n=3) and physical activity (n=2) behaviors and were integrated as part of the final curriculum. DISCUSSION Results identify areas for program improvement related to delivery of multi-theoretical and cultural tailoring elements. Findings may inform future strategies for implementing effective weight loss programs for ethnic minority families.
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Affiliation(s)
- Kassandra A Alia
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, USA.
| | - Tyler McDaniel
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Sara M St George
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Heather Kitzman-Ulrich
- Department of Behavioral and Community Health, University of North Texas, Fort Worth, TX, USA
| | - Kelsey Smith
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - VaShawn Heatley
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Courtney Wise
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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Folta SC, Lichtenstein AH, Seguin RA, Goldberg JP, Corbin MA, Wiker N, Gauker J, Chui K, Nelson ME. The StrongWomen-Healthy Hearts program in Pennsylvania: RE-AIM analysis. Transl Behav Med 2015; 5:94-102. [PMID: 25729458 PMCID: PMC4332910 DOI: 10.1007/s13142-014-0286-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Dissemination of evidence-based programs is needed to reduce CVD risk among midlife and older women. The aim of this study is to examine the public health impact of StrongWomen-Healthy Hearts in Pennsylvania using the RE-AIM framework. Reach, adoption, implementation, and maintenance were assessed using qualitative and quantitative measures; effectiveness was assessed using a pretest-posttest within-participants design. Reach into the target population was 5 in 100,000. Compared to the target population, a greater percentage of participants were white, married, middle-class, and had a graduate degree. Effectiveness was demonstrated (weight loss -2.0 kg, p < 0.001). Adoption among trained leaders was high (83.3 %), as was fidelity in implementation (average score 9.3 of 10). No leaders maintained the program. To increase impact of the StrongWomen-Healthy Hearts Program, it will be important to lower the costs and modify the recruitment and training strategies to better reach low-income and minority women. Such strategies may also improve program maintenance.
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Affiliation(s)
- Sara C Folta
- />John Hancock Research Center on Physical Activity, Nutrition, and Obesity Prevention, Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA USA
| | | | - Rebecca A Seguin
- />Division of Nutritional Sciences, Cornell University, Ithaca, NY USA
| | - Jeanne P Goldberg
- />John Hancock Research Center on Physical Activity, Nutrition, and Obesity Prevention, Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA USA
| | | | - Nancy Wiker
- />Penn State Cooperative Extension, University Park, PA USA
| | - Jodi Gauker
- />Chester County Economic Development Council, Exton, PA USA
| | - Kenneth Chui
- />Department of Public Health and Community Medicine, School of Medicine, Tufts University, Medford, MA USA
| | - Miriam E Nelson
- />John Hancock Research Center on Physical Activity, Nutrition, and Obesity Prevention, Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA USA
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McClelland JW, Jayaratne KSU, Bird C. Use of song as an effective teaching strategy for nutrition education in older adults. J Nutr Gerontol Geriatr 2015; 34:22-33. [PMID: 25803602 DOI: 10.1080/21551197.2014.998327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The objective of this study was to explore whether singing an educational song would be effective in improving older adults' knowledge about nutrition. We used a randomized controlled design to determine whether singing an educational song would result in increased nutrition knowledge in a low-income population of older adults compared to a control group of similar adults who did not sing the song. Eighteen congregate nutrition sites were randomly assigned to the treatment or control group. Analysis via independent samples t -test showed the knowledge gain mean scores for the treatment group were significantly ( P < 0.05) greater than those of the control group. This study supports a unique new approach to increasing nutrition knowledge of older adults by using music.
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Affiliation(s)
- Jacquelyn W McClelland
- a Department of Youth, Family, and Community Sciences , North Carolina State University , Raleigh , North Carolina , USA
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Glanz K, Escoffery C, Elliott T, Nehl EJ. Randomized Trial of Two Dissemination Strategies for a Skin Cancer Prevention Program in Aquatic Settings. Am J Public Health 2014; 105:1415-23. [PMID: 25521872 DOI: 10.2105/ajph.2014.302224] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared 2 strategies for disseminating an evidence-based skin cancer prevention program. METHODS We evaluated the effects of 2 strategies (basic vs enhanced) for dissemination of the Pool Cool skin cancer prevention program in outdoor swimming pools on (1) program implementation, maintenance, and sustainability and (2) improvements in organizational and environmental supports for sun protection. The trial used a cluster-randomized design with pools as the unit of intervention and outcome. The enhanced group received extra incentives, reinforcement, feedback, and skill-building guidance. Surveys were collected in successive years (2003-2006) from managers of 435 pools in 33 metropolitan areas across the United States participating in the Pool Cool Diffusion Trial. RESULTS Both treatment groups improved their implementation of the program, but pools in the enhanced condition had significantly greater overall maintenance of the program over 3 summers of participation. Furthermore, pools in the enhanced condition established and maintained significantly greater sun-safety policies and supportive environments over time. CONCLUSIONS This study found that more intensive, theory-driven dissemination strategies can significantly enhance program implementation and maintenance of health-promoting environmental and policy changes. Future research is warranted through longitudinal follow-up to examine sustainability.
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Affiliation(s)
- Karen Glanz
- Karen Glanz is with Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia. Cam Escoffery, Tom Elliott, and Eric J. Nehl are with Rollins School of Public Health, Emory University, Atlanta, GA
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Compernolle S, De Cocker K, Lakerveld J, Mackenbach JD, Nijpels G, Oppert JM, Rutter H, Teixeira PJ, Cardon G, De Bourdeaudhuij I. A RE-AIM evaluation of evidence-based multi-level interventions to improve obesity-related behaviours in adults: a systematic review (the SPOTLIGHT project). Int J Behav Nutr Phys Act 2014; 11:147. [PMID: 25480391 PMCID: PMC4266878 DOI: 10.1186/s12966-014-0147-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 11/17/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework. METHODS Electronic databases (PubMed, Embase, and The Cochrane Library) were searched to identify intervention studies published between January 2000 and October 2013. The following inclusion criteria were used: (1) the study included at least one outcome measure assessing obesity-related behaviours (i.e. diet, physical activity or sedentary behaviour), (2) the study collected data over at least one year and (3) the study's intervention targeted adults, was conducted in a specified geographical area or worksite, and was multi-level (i.e. targeting both individual and environmental level). Evidence of RE-AIM of the selected interventions was assessed. Potential public health impact of an intervention was evaluated if information was provided on at least four of the five RE-AIM dimensions. RESULTS Thirty-five multi-level interventions met the inclusion criteria. RE-AIM evaluation revealed that the included interventions generally had the potential to: reach a large number of people (on average 58% of the target population was aware of the intervention); achieve the assumed goals (89% found positive outcomes); be broadly adopted (the proportion of intervention deliverers varied from 9% to 92%) and be sustained (sixteen interventions were maintained). The highest potential public health impact was found in multi-level interventions that: 1) focused on all levels at the beginning of the planning process, 2) guided the implementation process using diffusion theory, and 3) used a website to disseminate the intervention. CONCLUSIONS Although most studies underreported results within the RE-AIM dimensions, the reported Reach, Effectiveness, Adoption, Implementation and Maintenance were positively evaluated. However, more information on external validity and sustainability is needed in order to take informed decisions on the choice of interventions that should be implemented in real-world settings to accomplish long-term changes in obesity-related behaviours.
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Affiliation(s)
- Sofie Compernolle
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Katrien De Cocker
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. .,Research Foundation Flanders (FWO), B-1000, Ghent, Belgium.
| | - Jeroen Lakerveld
- The EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
| | - Joreintje D Mackenbach
- The EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
| | - Giel Nijpels
- The EMGO Institute for Health and Care Research, Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.
| | - Jean-Michel Oppert
- Université Paris 13, Sorbonne Paris Cité - UREN (Unité de Recherche en Epidémiologie Nutritionnelle), U557 Inserm; U1125 Inra; Cnam, Centre for Research on Human Nutrition Ile-de-France (CRNH IdF), Bobigny, France. .,Université Pierre et Marie Curie-Paris 6, Department of Nutrition Pitié-Salpêtrière Hospital (AP-HP), (CRNH IdF), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
| | - Harry Rutter
- European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK.
| | - Pedro J Teixeira
- Interdisciplinary Center for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.
| | - Greet Cardon
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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Lancaster KJ, Carter-Edwards L, Grilo S, Shen C, Schoenthaler AM. Obesity interventions in African American faith-based organizations: a systematic review. Obes Rev 2014; 15 Suppl 4:159-76. [PMID: 25196412 DOI: 10.1111/obr.12207] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 01/14/2023]
Abstract
African Americans, especially women, have higher obesity rates than the general US population. Because of the importance of faith to many African Americans, faith-based organizations (FBOs) may be effective venues for delivering health messages and promoting adoption of healthy behaviours. This article systematically reviews interventions targeting weight and related behaviours in faith settings. We searched literature published through July 2012 for interventions in FBOs targeting weight loss, diet and/or physical activity (PA) in African Americans. Of 27 relevant articles identified, 12 were randomized controlled trials; seven of these reported a statistically significant change in an outcome. Four of the five quasi-experimental and single-group design studies reported a statistically significant outcome. All 10 pilot studies reported improvement in at least one outcome, but most did not have a comparison group. Overall, 70% of interventions reported success in reducing weight, 60% reported increased fruit and vegetable intake and 38% reported increased PA. These results suggest that interventions in African American FBOs can successfully improve weight and related behaviours. However, not all of the findings about the success of certain approaches were as expected. This review identifies gaps in knowledge and recommends more rigorous studies be conducted to strengthen the comparative methodology and evidence.
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Affiliation(s)
- K J Lancaster
- Steinhardt School of Culture, Education, and Human Development, Department of Nutrition, Food Studies and Public Health, New York University, New York, NY, USA
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Nothwehr F, Haines H, Chrisman M, Schultz U. Statewide dissemination of a rural, non-chain restaurant intervention: adoption, implementation and maintenance. HEALTH EDUCATION RESEARCH 2014; 29:433-441. [PMID: 24650944 PMCID: PMC4271112 DOI: 10.1093/her/cyu008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 02/18/2014] [Indexed: 06/03/2023]
Abstract
The obesity epidemic calls for greater dissemination of nutrition-related programs, yet there remain few studies of the dissemination process. This study, guided by elements of the RE-AIM model, describes the statewide dissemination of a simple, point-of-purchase restaurant intervention. Conducted in rural counties of the Midwest, United States, the study targeted randomly selected, non-chain, family-style restaurants. Owners were recruited through mail, then telephone follow-up. Data were collected through telephone at baseline, and 3, 6, 12 and 18 months post-adoption. Using mixed methods, measures captured the program adoption rate, characteristics of adopters and non-adopters, program implementation and maintenance issues, and owner and customer satisfaction. Analyses involved descriptive statistics and summaries of qualitative data. The program adoption rate was 28%. Adopters were similar to responding non-adopters demographically, but varied in attitudes. The majority of restaurants maintained the program for at least 12 months. Adopters and their customers expressed satisfaction with the program. With some adjustments, the RE-AIM model was helpful in guiding evaluation of this process. Results provide implications for future dissemination of this and other programs with regard to research procedures and potential barriers that may be encountered. Research on alternative strategies for widespread dissemination of such programs is needed in this and other settings.
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Affiliation(s)
- F Nothwehr
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA 52242, USA and Department of Nutrition, Hospitality and Retailing, Texas Tech University, Lubbock, TX 79401, USA.
| | - H Haines
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA 52242, USA and Department of Nutrition, Hospitality and Retailing, Texas Tech University, Lubbock, TX 79401, USA
| | - M Chrisman
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA 52242, USA and Department of Nutrition, Hospitality and Retailing, Texas Tech University, Lubbock, TX 79401, USA
| | - U Schultz
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA 52242, USA and Department of Nutrition, Hospitality and Retailing, Texas Tech University, Lubbock, TX 79401, USA
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Holt CL, Tagai EK, Scheirer MA, Santos SLZ, Bowie J, Haider M, Slade JL, Wang MQ, Whitehead T. Translating evidence-based interventions for implementation: Experiences from Project HEAL in African American churches. Implement Sci 2014; 9:66. [PMID: 24885069 PMCID: PMC4057552 DOI: 10.1186/1748-5908-9-66] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 05/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community-based approaches have been increasing in the effort to raise awareness and early detection for cancer and other chronic disease. However, many times, such interventions are tested in randomized trials, become evidence-based, and then fail to reach further use in the community. Project HEAL (Health through Early Awareness and Learning) is an implementation trial that aims to compare two strategies of implementing evidence-based cancer communication interventions in African American faith-based organizations. METHOD This article describes the community-engaged process of transforming three evidence-based cancer communication interventions into a coherent, branded strategy for training community health advisors with two delivery mechanisms. Peer community health advisors receive training through either a traditional classroom approach (with high technical assistance/support) or a web-based training portal (with low technical assistance/support). RESULTS We describe the process, outline the intervention components, report on the pilot test, and conclude with lessons learned from each of these phases. Though the pilot phase showed feasibility, it resulted in modifications to data collection protocols and team and community member roles and expectations. CONCLUSIONS Project HEAL offers a promising strategy to implement evidence-based interventions in community settings through the use of technology. There could be wider implications for chronic disease prevention and control.
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Affiliation(s)
- Cheryl L Holt
- Department of Behavioral and Community Health, University of Maryland, School of Public Health, 2369 School of Public Health (Building 255), College Park, MD 20742, USA
| | - Erin K Tagai
- Department of Behavioral and Community Health, University of Maryland, School of Public Health, 2369 School of Public Health (Building 255), College Park, MD 20742, USA
| | | | - Sherie Lou Z Santos
- Department of Behavioral and Community Health, University of Maryland, School of Public Health, 2369 School of Public Health (Building 255), College Park, MD 20742, USA
| | - Janice Bowie
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Muhiuddin Haider
- Maryland Institute for Applied Environmental Health, University of Maryland, School of Public Health, College Park, USA
| | - Jimmie L Slade
- Community Ministry of Prince George’s County, Upper Marlboro, USA
| | - Min Qi Wang
- Department of Behavioral and Community Health, University of Maryland, School of Public Health, 2369 School of Public Health (Building 255), College Park, MD 20742, USA
| | - Tony Whitehead
- Department of Anthropology, University of Maryland, College Park, USA
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Allen JD, Leyva B, Torres AI, Ospino H, Tom L, Rustan S, Bartholomew A. Religious beliefs and cancer screening behaviors among Catholic Latinos: implications for faith-based interventions. J Health Care Poor Underserved 2014; 25:503-26. [PMID: 24858865 PMCID: PMC4162660 DOI: 10.1353/hpu.2014.0080] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although most U.S. Latinos identify as Catholic, few studies have focused on the influence of this religious tradition on health beliefs among this population. This study explores the role of Catholic religious teachings, practices, and ministry on cancer screening knowledge, attitudes, and behaviors among Latinos. Eight focus groups were conducted with 67 Catholic Latino parishioners in Massachusetts. Qualitative analysis provided evidence of strong reliance on faith, God, and parish leaders for health concerns. Parishes were described as vital sources of health and social support, playing a central role in the community's health. Participants emphasized that their religious beliefs promote positive health behaviors and health care utilization, including the use of cancer screening services. In addition, they expressed willingness to participate in cancer education programs located at their parishes and provided practical recommendations for implementing health programs in parishes. Implications for culturally appropriate health communication and faith-based interventions are discussed.
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Evans KR, Hudson SV. Engaging the community to improve nutrition and physical activity among houses of worship. Prev Chronic Dis 2014; 11:E38. [PMID: 24625362 PMCID: PMC3958142 DOI: 10.5888/pcd11.130270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity, physical inactivity, and poor nutrition have been linked to many chronic diseases. Research indicates that interventions in community-based settings such as houses of worship can build on attendees' trust to address health issues and help them make behavioral changes. COMMUNITY CONTEXT New Brunswick, New Jersey, has low rates of physical activity and a high prevalence of obesity. An adapted community-based intervention was implemented there to improve nutrition and physical activity among people who attend houses of worship and expand and enhance the network of partners working with Rutgers Cancer Institute of New Jersey. METHODS An adapted version of Body & Soul: A Celebration of Healthy Living and Eating was created using a 3-phase model to 1) educate lay members on nutrition and physical activity, 2) provide sustainable change through the development of physical activity programming, and 3) increase access to local produce through collaborations with community partners. OUTCOME Nineteen houses of worship were selected for participation in this program. Houses of worship provided a questionnaire to a convenience sample of its congregation to assess congregants' physical activity levels and produce consumption behaviors at baseline using questions from the Health Information National Trends Survey instrument. This information was also used to inform future program activities. INTERPRETATION Community-based health education can be a promising approach when appropriate partnerships are identified, funding is adequate, ongoing information is extracted to inform future action, and there is an expectation from all parties of long-term engagement and capacity building.
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Affiliation(s)
- Kiameesha R Evans
- Office of Community Outreach, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 195 Little Albany St, Room 5533, New Brunswick, NJ 08901. E-mail:
| | - Shawna V Hudson
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
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Nápoles AM, Santoyo-Olsson J, Stewart AL. Methods for translating evidence-based behavioral interventions for health-disparity communities. Prev Chronic Dis 2013; 10:E193. [PMID: 24262025 PMCID: PMC3839588 DOI: 10.5888/pcd10.130133] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Populations composed of racial/ethnic minorities, disabled persons, and people with low socioeconomic status have worse health than their counterparts. Implementing evidence-based behavioral interventions (EBIs) to prevent and manage chronic disease and disability in community settings could help ameliorate disparities. Although numerous models of implementation processes are available, they are broad in scope, few offer specific methodological guidance, and few address the special issues in reaching vulnerable populations. Drawing from 2 existing models, we describe 7 methodological phases in the process of translating and implementing EBIs in communities to reach these vulnerable groups: establish infrastructure for translation partnership, identify multiple inputs (information gathering), review and distill information (synthesis), adapt and integrate program components (translation), build general and specific capacity (support system), implement intervention (delivery system), and develop appropriate designs and measures (evaluation). For each phase, we describe specific methodological steps and resources and provide examples from research on racial/ethnic minorities, disabled persons, and those with low socioeconomic status. Our methods focus on how to incorporate adaptations so that programs fit new community contexts, meet the needs of individuals in health-disparity populations, capitalize on scientific evidence, and use and build community assets and resources. A key tenet of our approach is to integrate EBIs with community best practices to the extent possible while building local capacity. We discuss tradeoffs between maintaining fidelity to the EBIs while maximizing fit to the new context. These methods could advance our ability to implement potentially effective interventions to reduce health disparities.
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Affiliation(s)
- Anna Maria Nápoles
- Center for Aging in Diverse Communities, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, 3333 California St, Ste 335, San Francisco, CA 94118-1944. E-mail:
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Baruth M, Wilcox S, Saunders RP. The role of pastor support in a faith-based health promotion intervention. FAMILY & COMMUNITY HEALTH 2013; 36:204-14. [PMID: 23718956 PMCID: PMC6204230 DOI: 10.1097/fch.0b013e31828e6733] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Pastor support has been viewed as an integral part of successful faith-based health promotion programs; however, few studies have systematically studied these relationships. This study examined associations between pastor support and program-related variables among African American churches taking part in a physical activity and dietary intervention. Results showed that some pastor support-related variables were associated with participant recruitment, retention, and implementation of study requirements but not to changes in health behavior outcomes. Much work remains in how to conceptualize and measure pastor support. A better understanding of the pastor's role may assist in developing more effective faith-based programs.
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Affiliation(s)
- Meghan Baruth
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
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