1
|
Knudsen SDP, Roland CB, Alomairah SA, Jessen AD, Molsted S, Clausen TD, Løkkegaard E, Stallknecht B, Bønnelycke J, Bendix JM, Maindal HT. Physical activity in pregnancy: a mixed methods process evaluation of the FitMum randomised controlled trial interventions. BMC Public Health 2022; 22:2283. [PMID: 36474181 PMCID: PMC9724308 DOI: 10.1186/s12889-022-14717-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Physical activity (PA) at moderate intensity is recommended for healthy pregnant women. The three-arm FitMum randomised controlled trial showed that it was possible to increase PA level during pregnancy with structured supervised exercise training (EXE) compared to standard care. Motivational counselling on PA (MOT) did not increase PA. This process evaluation aims to understand the implementation and mechanisms of impact of EXE and MOT. METHODS A mixed methods process evaluation was conducted using the UK Medical Research Council's process evaluation framework by assessing implementation (reach, fidelity, and dose) and mechanisms of impact of the two interventions provided to pregnant women in FitMum. Data was collected both quantitatively (n = 220) and qualitatively (n = 20). RESULTS The FitMum trial reached educated pregnant women (80% having an educational level ≥ bachelor's degree) with high autonomy of everyday life. Most participants (58%) were recruited at their first-trimester ultrasonic scan. Reasons to participate were personal (91%) and altruistic (56%). The intervention dose was delivered as intended with high fidelity in the original physical intervention setup and in the altered online setup during the COVID-19 restrictions. A low dose received in EXE (1.3 [95% CI, 1.1; 1.5] sessions/week) was partly explained by the pre-scheduled EXE sessions favouring participants with a flexible everyday life and a supportive social network. Dose received in EXE increased during online intervention delivery. Participants in MOT received 5.2 [4.7; 5.7] of 7 sessions. Mechanisms of impact comprised a perception of intervention commitment among participants in EXE due to the scheduled EXE sessions, whereas participants in MOT considered themselves as PA self-determined. PA was considered as constrained activities in EXE and included in daily activities in MOT. CONCLUSION The FitMum interventions was delivered with high fidelity. During COVID-19, the dose received in EXE increased compared to the previous physical setup. Mechanisms of impact as commitment, perception of empowerment and perception of PA as well as the paradox between prioritising PA and family and the need of a flexible everyday life need to be considered when offering pregnant women PA interventions. Future interventions should consider a combination of physical and online exercise training for pregnant women.
Collapse
Affiliation(s)
- Signe de Place Knudsen
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark. .,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Caroline Borup Roland
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Saud Abdulaziz Alomairah
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Anne Dsane Jessen
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stig Molsted
- Department of Clinical Research, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tine D Clausen
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ellen Løkkegaard
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bente Stallknecht
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Bønnelycke
- Department of Visual Culture and Performance Design, Roskilde University, Roskilde, Denmark
| | - Jane M Bendix
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Clinical Research, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Steno Diabetes Center Copenhagen, Herlev, Denmark
| |
Collapse
|
2
|
D'Lima D, Soukup T, Hull L. Evaluating the Application of the RE-AIM Planning and Evaluation Framework: An Updated Systematic Review and Exploration of Pragmatic Application. Front Public Health 2022; 9:755738. [PMID: 35155336 PMCID: PMC8826088 DOI: 10.3389/fpubh.2021.755738] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background RE-AIM is one of the most widely applied frameworks to plan and evaluate the implementation of public health and health behavior change interventions. The objective of this review is to provide an updated synthesis of use of the RE-AIM (Reach Effectiveness Adoption Implementation and Maintenance) planning and evaluation framework and explore pragmatic use (i.e., partial application of the framework) and how this is reported. Methods Systematic review. MEDLINE (R) and PsycINFO were searched, via the Ovid interface, between January 2011 and December 2017. Studies that applied RE-AIM as a planning and/or evaluation framework were included. Results One hundred fifty-seven articles met inclusion criteria. One hundred forty-nine reported using RE-AIM for evaluation, three for planning and five for planning and evaluation. Reach was the most frequently reported dimension (92.9%), followed by implementation (90.3%), adoption (89.7%), effectiveness (84.5%), and maintenance (77.4%). One hundred forty-seven/one hundred fifty-seven articles originated from high-income economy countries. Within a sub-set analysis (10% of included articles), 9/15 articles evaluated all dimensions. Of the 6/15 articles that did not evaluate all dimensions, five provided no justification for pragmatic application. Conclusions RE-AIM has gained increased use in recent years and there is evidence that it is being applied pragmatically. However, the rationale for pragmatic use is often not reported. Systematic Review Registration PROSPERO (CRD42017054616).
Collapse
Affiliation(s)
- Danielle D'Lima
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, United Kingdom
| | - Tayana Soukup
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
| | - Louise Hull
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
- *Correspondence: Louise Hull
| |
Collapse
|
3
|
Agbejule OA, Hart NH, Ekberg S, Koczwara B, Ladwa R, Simonsen C, Pinkham EP, Chan RJ. Bridging the research to practice gap: a systematic scoping review of implementation of interventions for cancer-related fatigue management. BMC Cancer 2021; 21:809. [PMID: 34261438 PMCID: PMC8278687 DOI: 10.1186/s12885-021-08394-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cancer-related fatigue (CRF) is one of the most common and distressing symptoms in people with cancer. Although efficacy of interventions for CRF have been extensively investigated, less has been done to ensure successful translation into routine clinical practice. The aim of this systematic scoping review was to synthesise knowledge surrounding the implementation of CRF interventions, summarise the processes and outcomes of implementation strategies used, and identify opportunities for further research. METHODS PubMed, Cochrane CENTRAL, EMBASE and CINAHL databases were searched (up to December 2020). The Cochrane Effective Practice and Organisation of Care (EPOC) Group taxonomy and the RE-AIM Framework were used to guide the evaluation of implementation strategies and outcomes, respectively. RESULTS Six studies were included. Three used an implementation framework (PARIHS, KTA, Cullens & Adams' Implementation Guide) to guide implementation. Overall, the implementation strategies used across all studies were reported to have directly resulted in immediate changes at the clinician level (e.g., increased clinician behaviours, self-efficacy, attitudes, knowledge of CRF management). No clear relationship was found between the use of implementation models and the number or type of implementation strategies used. For outcomes, Effectiveness and Implementation were the most highly reported RE-AIM measures followed by Reach then Maintenance. Adoption was the least reported. CONCLUSIONS Despite the high prevalence of CRF and evidence-based interventions for managing CRF, there is limited evidence informing the sustainable implementation of these interventions. This systematic scoping review emphasises the lack of quality CRF implementation studies presently available in the literature leading to a disconnect between effective CRF interventions, routine clinical care, and cancer survivors at present. This review highlights the need for robust study designs guided by established frameworks to methodically design and evaluate the implementation of CRF management interventions in the future.
Collapse
Affiliation(s)
- Oluwaseyifunmi Andi Agbejule
- Cancer and Palliative Care Outcomes Centre, School of Nursing, N Block, Kelvin Grove Campus,, Queensland University of Technology (QUT), Kelvin Grove, Queensland, 4059, Australia.
| | - Nicolas H Hart
- Cancer and Palliative Care Outcomes Centre, School of Nursing, N Block, Kelvin Grove Campus,, Queensland University of Technology (QUT), Kelvin Grove, Queensland, 4059, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, 6027, Australia
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, 6959, Australia
| | - Stuart Ekberg
- Cancer and Palliative Care Outcomes Centre, School of Nursing, N Block, Kelvin Grove Campus,, Queensland University of Technology (QUT), Kelvin Grove, Queensland, 4059, Australia
| | - Bogda Koczwara
- Flinders University and Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5048, Australia
| | - Rahul Ladwa
- Princess Alexandra Hospital, Metro South Hospital and Health Services, Woolloongabba, Queensland, 4102, Australia
- School of Medicine, University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Camilla Simonsen
- Cancer and Palliative Care Outcomes Centre, School of Nursing, N Block, Kelvin Grove Campus,, Queensland University of Technology (QUT), Kelvin Grove, Queensland, 4059, Australia
- Princess Alexandra Hospital, Metro South Hospital and Health Services, Woolloongabba, Queensland, 4102, Australia
| | - Elizabeth P Pinkham
- Cancer and Palliative Care Outcomes Centre, School of Nursing, N Block, Kelvin Grove Campus,, Queensland University of Technology (QUT), Kelvin Grove, Queensland, 4059, Australia
- Princess Alexandra Hospital, Metro South Hospital and Health Services, Woolloongabba, Queensland, 4102, Australia
- School of Health and Behavioural Science, University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Raymond Javan Chan
- Cancer and Palliative Care Outcomes Centre, School of Nursing, N Block, Kelvin Grove Campus,, Queensland University of Technology (QUT), Kelvin Grove, Queensland, 4059, Australia
- Princess Alexandra Hospital, Metro South Hospital and Health Services, Woolloongabba, Queensland, 4102, Australia
| |
Collapse
|
4
|
Roland CB, Knudsen SDP, Alomairah SA, Andersen AD, Bendix J, Clausen TD, Molsted S, Jensen AK, Teilmann G, Jespersen AP, Larsen JE, Hall GV, Andersen E, Barrès R, Mortensen OH, Maindal HT, Tarnow L, Løkkegaard ECL, Stallknecht B. Structured supervised exercise training or motivational counselling during pregnancy on physical activity level and health of mother and offspring: FitMum study protocol. BMJ Open 2021; 11:e043671. [PMID: 33741668 PMCID: PMC7986889 DOI: 10.1136/bmjopen-2020-043671] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/30/2020] [Accepted: 02/25/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION A physically active lifestyle during pregnancy improves maternal and offspring health but can be difficult to follow. In Denmark, less than 40% of pregnant women meet physical activity (PA) recommendations. The FitMum study aims to explore strategies to increase PA during pregnancy among women with low PA and assess the health effects of PA. This paper presents the FitMum protocol, which evaluates the effects of structured supervised exercise training or motivational counselling supported by health technology during pregnancy on PA level and health of mother and offspring. METHODS AND ANALYSIS A single-site three-arm randomised controlled trial that aims to recruit 220 healthy, pregnant women with gestational age (GA) no later than week 15 and whose PA level does not exceed one hour/week. Participants are randomised to one of three groups: structured supervised exercise training consisting of three weekly exercise sessions, motivational counselling supported by health technology or a control group receiving standard care. The interventions take place from randomisation until delivery. The primary outcome is min/week of moderate-to-vigorous intensity PA (MVPA) as determined by a commercial activity tracker, collected from randomisation until GA of 28 weeks and 0-6 days, and the secondary outcome is gestational weight gain (GWG). Additional outcomes are complementary measures of PA; clinical and psychological health parameters in participant, partner and offspring; analyses of blood, placenta and breastmilk samples; process evaluation of interventions; and personal understandings of PA. ETHICS AND DISSEMINATION The study is approved by the Danish National Committee on Health Research Ethics (# H-18011067) and the Danish Data Protection Agency (# P-2019-512). Findings will be disseminated via peer-reviewed publications, at conferences, and to health professionals via science theatre performances. TRIAL REGISTRATION NUMBER NCT03679130. PROTOCOL VERSION This paper was written per the study protocol version 8 dated 28 August 2019.
Collapse
Affiliation(s)
- Caroline Borup Roland
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Signe de Place Knudsen
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Saud Abdulaziz Alomairah
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Public Health, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Anne Dsane Andersen
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Jane Bendix
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Tine D Clausen
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Stig Molsted
- Department of Clinical Research, Nordsjaellands Hospital, Hillerod, Denmark
| | - Andreas Kryger Jensen
- Department of Clinical Research, Nordsjaellands Hospital, Hillerod, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Grete Teilmann
- Department of Paediatrics, Nordsjaellands Hospital, Hillerod, Denmark
| | - Astrid Pernille Jespersen
- The Saxo Institute, University of Copenhagen, Centre for Health Research in the Humanities, Copenhagen, Denmark
| | - Jakob Eg Larsen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | - Gerrit van Hall
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Clinical Metabolomics Core Facility, Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Emil Andersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Romain Barrès
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Ole Hartvig Mortensen
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health, Aarhus Universitet, Aarhus, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Lise Tarnow
- Steno Diabetes Center Copenhagen, Holbaek, Denmark
| | - Ellen Christine Leth Løkkegaard
- Department of Gynaecology and Obstetrics, Nordsjaellands Hospital, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Bente Stallknecht
- Department of Biomedical Sciences, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| |
Collapse
|
5
|
Gamble A, Beech BM, Blackshear C, Cranston KL, Herring SJ, Moore JB, Welsch MA. Recruitment planning for clinical trials with a vulnerable perinatal adolescent population using the Clinical Trials Transformative Initiative framework and principles of partner and community engagement. Contemp Clin Trials 2021; 104:106363. [PMID: 33737198 PMCID: PMC8180492 DOI: 10.1016/j.cct.2021.106363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/03/2021] [Accepted: 03/13/2021] [Indexed: 12/11/2022]
Abstract
Recruitment planning is needed to establish a foundation for obesity prevention research with high risk, disadvantaged perinatal adolescent populations. In the context of developing clinical trial protocols, investigators partnered with Mississippi's Nutrition Program for Women, Infants and Children (WIC) and adopted the Clinical Trials Transformative Initiative (CTTI) framework for recruitment planning to identify and mitigate challenges to recruitment early in the clinical trial development process. The recruitment protocol consisted of 20 passive strategies grounded in principles of partner and community engagement and was flexible, accommodating, altruistic, community-focused, and minimally burdensome to partners and participants. The recruitment goal included 150 adolescent-coparticipant dyads and 145 dyads (96.7%) were successfully recruited. Investigators demonstrated the feasibility of recruiting a disadvantaged and vulnerable perinatal adolescent population that is underrepresented in health research, in one of the most persistently impoverished and poor health regions in the U.S. Four important aspects of recruitment planning using the CTTI framework are discussed including: (1) establishing partnerships with trusted community resources is a paramount investment; (2) dedicating time and resources to know and go to your community is invaluable; (3) fostering trust by offering convenient, continuous and clear communication; and (4) encouraging collaboration and participation through limiting partner and participant burden. Establishing organizational and community partnership requires a substantial amount of invaluable time and fosters recruitment success. Following the CTTI recommendations for recruitment planning led to a robust recruitment protocol that will be used in future intervention trials with an understudied perinatal adolescent population with high risk for poor maternal and fetal health outcomes.
Collapse
Affiliation(s)
- Abigail Gamble
- Department of Preventive Medicine, Department of Pediatrics, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, United States of America.
| | - Bettina M Beech
- Strategic Initiatives and Population Health Research, Office of the Provost, College of Medicine, University of Houston, 4302 University Drive, Houston, TX 77204, United States of America.
| | - Chad Blackshear
- Department of Data Science, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, United States of America.
| | - Katherine L Cranston
- Medical Student Research Program, School of Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, United States of America.
| | - Sharon J Herring
- Program for Maternal Health Equity, Center for Urban Bioethics, Lewis Katz School of Medicine at Temple University, 3223 N. Broad Street, Philadelphia, PA 19140, United States of America.
| | - Justin B Moore
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, 425 Vine Street, Winston-Salem, NC, 27101, United States of America.
| | - Michael A Welsch
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS 39216, United States of America.
| |
Collapse
|
6
|
Internal and External Validity of Social Media and Mobile Technology-Driven HPV Vaccination Interventions: Systematic Review Using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework. Vaccines (Basel) 2021; 9:vaccines9030197. [PMID: 33652809 PMCID: PMC7996801 DOI: 10.3390/vaccines9030197] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/12/2021] [Accepted: 02/23/2021] [Indexed: 12/26/2022] Open
Abstract
Social media human papillomavirus (HPV) vaccination interventions show promise for increasing HPV vaccination rates. An important consideration for the implementation of effective interventions into real-world practice is the translation potential, or external validity, of the intervention. To this end, we conducted a systematic literature review to describe the current body of evidence regarding the external validity of social media HPV vaccination-related interventions. Constructs related to external validity were based on the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework. Seventeen articles published between 2006 and 2020 met the inclusion criteria. Three researchers independently coded each article using a validated RE-AIM framework. Discrepant codes were discussed with a fourth reviewer to gain consensus. Of these 17 studies, 3 were pilot efficacy studies, 10 were randomized controlled trials (RCTs) to evaluate effectiveness, 1 was a population-based study, and 3 did not explicitly state which type of study was conducted. Reflecting this distribution of study types, across all studies the mean level of reporting RE-AIM dimensions varied with reach recording 90.8%, effectiveness (72.1%), adoption (40.3%), implementation (45.6%), and maintenance (26.5%). This review suggests that while the current HPV vaccination social media-driven interventions provide sufficient information on internal validity (reach and effectiveness), few have aimed to gather data on external validity needed to translate the interventions into real world implementation. Our data suggest that implementation research is needed to move HPV vaccination-related interventions into practice. Included in this review are recommendations for enhancing the design and reporting of these HPV vaccination social media-related interventions.
Collapse
|
7
|
Swindle T, Martinez A, Børsheim E, Andres A. Adaptation of an exercise intervention for pregnant women to community-based delivery: a study protocol. BMJ Open 2020; 10:e038582. [PMID: 32895286 PMCID: PMC7478046 DOI: 10.1136/bmjopen-2020-038582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Despite well-established guidelines and benefits to exercise, the majority of pregnant women in the USA fail to meet recommended activity levels. Studies need to determine feasible ways to translate clinical interventions to community settings by engaging pregnant women in widely accessible locations to ensure benefits to more women. The aim of this study is to adapt and determine feasibility, acceptability and fidelity of the research clinic-based Expecting intervention (NCT02125149) with pregnant women with obesity in community settings. METHODS AND ANALYSIS We will use the Replicating Effective Programs (REP) to guide the adaptation and implementation of the research clinic-based intervention into the community. REP provides a four-phase process for implementing evidence-based interventions including collection of feedback from community stakeholders, iterative piloting of the intervention in the community and a process for standardising the intervention across community settings. Following adaptation, the updated intervention will be piloted. The pilot study will include 60 expecting women. We will randomise half to receive the community-adapted Expecting intervention (intervention, N=30) and half to receive standard of care (control, N=30). Feasibility and Acceptability of Intervention Measures are primary outcomes as key indicators of feasibility. Secondary outcomes will include the number of intervention sessions completed, the change in the number of minutes of physical activity as measured by accelerometer, as well as change in health indicators from enrolment to time of delivery and 6 months post-delivery (ie, body mass index, blood pressure and total cholesterol). ETHICS AND DISSEMINATION This study has been approved by the Institutional Review Board (#260132). Findings will be shared with study participants and stakeholder advisors through written summaries and in-person presentations; results will also be shared through presentations at scientific conferences and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04298125; Pre-results.
Collapse
Affiliation(s)
- Taren Swindle
- Family and Preventive Medicine, University of Arkansas For Medical Sciences, Little Rock, Arkansas, USA
| | - Audrey Martinez
- Arkansas Children's Nutrition Center, Little Rock, Arkansas, USA
| | - Elisabet Børsheim
- Arkansas Children's Nutrition Center, Little Rock, Arkansas, USA
- Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Aline Andres
- Arkansas Children's Nutrition Center, Little Rock, Arkansas, USA
- Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| |
Collapse
|
8
|
Iwelunmor J, Nwaozuru U, Obiezu-Umeh C, Uzoaru F, Ehiri J, Curley J, Ezechi O, Airhihenbuwa C, Ssewamala F. Is it time to RE-AIM? A systematic review of economic empowerment as HIV prevention intervention for adolescent girls and young women in sub-Saharan Africa using the RE-AIM framework. Implement Sci Commun 2020; 1:53. [PMID: 32885209 PMCID: PMC7427963 DOI: 10.1186/s43058-020-00042-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/24/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Economic empowerment (EE) HIV prevention programs for adolescent girls and young women (AGYW) in sub-Saharan Africa are gaining traction as effective strategies to reduce HIV risk and vulnerabilities among this population. While intervention effectiveness is critical, there are numerous factors beyond effectiveness that shape an intervention's impact. The objective of this systematic review was to assess the reporting of implementation outcomes of EE HIV prevention programs for AGYW in SSA, as conceptualized in the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework. METHODS We searched PubMed, Ovid/MEDLINE, Science Direct, Ebscohost, PsycINFO, Scopus, and Web of Science for EE HIV interventions for AGYW in SSA. Study selection and data extraction were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Two researchers coded each article using a validated RE-AIM data extraction tool and independently extracted information from each article. The reporting of RE-AIM dimensions were summarized and synthesized across included interventions. RESULTS A total of 25 unique interventions (reported in 45 articles) met the predefined eligibility criteria. Efficacy/effectiveness 19(74.4%) was the highest reported RE-AIM dimension, followed by adoption 17(67.2%), reach 16(64.0%), implementation 9(38.0%), and maintenance 7(26.4%). Most interventions reported on RE-AIM components such as sample size 25(100.0%), intervention location 24(96.0%), and measures and results for at least one follow-up 24(96.0%). Few reported on RE-AIM components such as characteristics of non-participants 8(32.0%), implementation costs 3(12.0%), and intervention fidelity 0(0.0%). CONCLUSIONS Results of the review emphasize the need for future economic empowerment HIV prevention interventions for AGYW in SSA to report multiple implementation strategies and highlight considerations for translating such programs into real-world settings. Researchers should pay close attention to reporting setting-level adoption, implementation cost, and intervention maintenance. These measures are needed for policy decisions related to the full merit and worth of EE HIV interventions and their long-term sustainability for AGYW.
Collapse
Affiliation(s)
- Juliet Iwelunmor
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - Ucheoma Nwaozuru
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - Chisom Obiezu-Umeh
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - Florida Uzoaru
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - John Ehiri
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Avenue, Tucson, AZ 85724 USA
| | - Jami Curley
- College for Public Health and Social Justice, Saint Louis University, Salus Center, 3545 Lafayette Avenue, Saint Louis, MO 63104 USA
| | - Oliver Ezechi
- Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba, Lagos State Nigeria
| | - Collins Airhihenbuwa
- School of Public Health, Global Research Against Noncommunicable Diseases, Georgia State University, 140 Decatur Street SE, Atlanta, GA 30303 USA
| | - Fred Ssewamala
- Brown School, Washington University in Saint Louis, 1 Brookings Drive, Saint Louis, MO 63130 USA
| |
Collapse
|
9
|
Russell L, Ugalde A, Milne D, Austin D, Livingston PM. Digital Characteristics and Dissemination Indicators to Optimize Delivery of Internet-Supported Mindfulness-Based Interventions for People With a Chronic Condition: Systematic Review. JMIR Ment Health 2018; 5:e53. [PMID: 30131317 PMCID: PMC6123540 DOI: 10.2196/mental.9645] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 05/07/2018] [Accepted: 06/21/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Internet-supported mindfulness-based interventions (MBIs) are increasingly being used to support people with a chronic condition. Characteristics of MBIs vary greatly in their mode of delivery, communication patterns, level of facilitator involvement, intervention period, and resource intensity, making it difficult to compare how individual digital features may optimize intervention adherence and outcomes. OBJECTIVE The aims of this review were to (1) provide a description of digital characteristics of internet-supported MBIs and examine how these relate to evidence for efficacy and adherence to the intervention and (2) gain insights into the type of information available to inform translation of internet-supported MBIs to applied settings. METHODS MEDLINE Complete, PsycINFO, and CINAHL databases were searched for studies assessing an MBI delivered or accessed via the internet and engaging participants in daily mindfulness-based activities such as mindfulness meditations and informal mindfulness practices. Only studies using a comparison group of alternative interventions (active compactor), usual care, or wait-list were included. Given the broad definition of chronic conditions, specific conditions were not included in the original search to maximize results. The search resulted in 958 articles, from which 11 articles describing 10 interventions met the inclusion criteria. RESULTS Internet-supported MBIs were more effective than usual care or wait-list groups, and self-guided interventions were as effective as facilitator-guided interventions. Findings were informed mainly by female participants. Adherence to interventions was inconsistently defined and prevented robust comparison between studies. Reporting of factors associated with intervention dissemination, such as population representativeness, program adoption and maintenance, and costs, was rare. CONCLUSIONS More comprehensive descriptions of digital characteristics need to be reported to further our understanding of features that may influence engagement and behavior change and to improve the reproducibility of MBIs. Gender differences in determinants and patterns of health behavior should be taken into account at the intervention design stage to accommodate male and female preferences. Future research could compare MBIs with established evidence-based therapies to identify the population groups that would benefit most from internet-supported programs. TRIAL REGISTRATION PROSPERO CRD42017078665; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=78665 (Archived by WebCite at http://www.webcitation.org/71ountJpu).
Collapse
Affiliation(s)
- Lahiru Russell
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Anna Ugalde
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Donna Milne
- Melanoma and Skin Services, Peter MacCallum Cancer Center, Melbourne, Australia.,Department of Cancer Experiences Research, Peter MacCallum Cancer Center, Melbourne, Australia
| | - David Austin
- School of Psychology, Deakin University, Geelong, Australia
| | | |
Collapse
|