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Porter GC, Hill JL, Heelan KA, Bartee RT, Golden CA, Malmkar A, Abbey BA, Estabrooks PA. Using a customer discovery process to enhance the potential dissemination and scalability of a family healthy weight program for rural communities and small towns. Int J Behav Nutr Phys Act 2024; 21:57. [PMID: 38745324 PMCID: PMC11093725 DOI: 10.1186/s12966-024-01605-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/01/2024] [Indexed: 05/16/2024] Open
Abstract
AIM Customer discovery, an entrepreneurial and iterative process to understand the context and needs of potential adoption agencies, may be an innovative strategy to improve broader dissemination of evidence-based interventions. This paper describes the customer discovery process for the Building Healthy Families (BHF) Online Training Resources and Program Package (BHF Resource Package) to support rural community adoption of an evidence-based, family healthy weight program. METHODS The customer discovery process was completed as part of a SPeeding Research-tested INTerventions (SPRINT) training supported by the U.S. Centers for Disease Control and Prevention. Customer discovery interviews (n=47) were conducted with people that could be potential resource users, economic buyers, and BHF adoption influencers to capture multiple contextual and needs-based factors related to adopting new evidence-based interventions. Qualitative analyses were completed in an iterative fashion as each interview was completed. RESULTS The BHF Resource Package was designed to be accessible to a variety of implementation organizations. However, due to different resources being available in different rural communities, customer discovery interviews suggested that focusing on rural health departments may be a consistent setting for intervention adoption. We found that local health departments prioritize childhood obesity but lacked the training and resources necessary to implement effective programming. Several intervention funding approaches were also identified including (1) program grants from local and national foundations, (2) healthcare community benefit initiatives, and (3) regional employer groups. Payment plans recommended in the customer discovery interviews included a mix of licensing and technical support fees for BHF delivery organizations, potential insurance reimbursement, and family fees based on ability to pay. Marketing a range of BHF non-weight related outcomes was also recommended during the customer discovery process to increase the likelihood of BHF scale-up and sustainability. CONCLUSIONS Engaging in customer discovery provided practical directions for the potential adoption, implementation, and sustainability of the BHF Resource Package. However, the inconsistent finding that health departments are both the ideal implementation organization, but also see childhood obesity treatment as a clinical service, is concerning.
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Affiliation(s)
- Gwenndolyn C Porter
- University of Nebraska Medical Center, Department of Health Promotion, Omaha, NE, 68198-4365, USA.
| | - Jennie L Hill
- University of Utah, Population Health Sciences, Salt Lake City, UT, 84108, USA
| | - Kate A Heelan
- University of Nebraska at Kearney, Kinesiology and Sport Sciences Department, Kearney, NE, 68849, USA
| | - R Todd Bartee
- University of Nebraska at Kearney, Department of Biology, Kearney, NE, 68849, USA
| | - Caitlin A Golden
- University of Utah, Population Health Sciences, Salt Lake City, UT, 84108, USA
| | - Ali Malmkar
- University of Nebraska at Kearney, Kinesiology and Sport Sciences Department, Kearney, NE, 68849, USA
| | - Bryce A Abbey
- University of Nebraska at Kearney, Kinesiology and Sport Sciences Department, Kearney, NE, 68849, USA
| | - Paul A Estabrooks
- University of Utah, Department of Health and Kinesiology, Salt Lake City, UT, 84112, USA
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Bartee RT, Heelan KA, Golden CA, Hill JL, Porter GC, Abbey BA, George K, Foster N, Estabrooks PA. Adaptations of an Effective Evidence-Based Pediatric Weight Management Intervention. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:72-84. [PMID: 37477808 PMCID: PMC11133101 DOI: 10.1007/s11121-023-01557-7] [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] [Accepted: 05/22/2023] [Indexed: 07/22/2023]
Abstract
Current childhood obesity treatment programs do not address medically underserved populations or settings where all members of an interdisciplinary team may not exist-either within one organization or within the community. In this paper, we describe the use of a community-academic partnership to iteratively adapt Epstein's Traffic Light Diet (TLD), into Building Healthy Families (BHF), a community-placed evidence-based pediatric weight management intervention (PWMI) and evaluate its effectiveness in reducing BMI z scores. Nine cohorts of families completed BHF. Participants included children aged 6-12 years with obesity (M = 9.46, SD = 1.74). The Framework for Reporting Adaptations and Modifications-Expanded guided our classification of modifications across BHF cohorts. Using the FRAME reporting structure, the changes that were documented were (1) planned and occurred pre-implementation, (2) based on decisions from local stakeholders (e.g., school administrator, members of the implementation team), and (3) specific to changes in content and context-with a focus on implementation and potential for local scale-up. The nature of the adaptations included adding elements (whole of family approach), removing elements (calorie counting), and substituting elements (steps for minutes of physical activity). Across 9 cohorts, 84 families initiated the BHF program, 69 families successfully completed the 12-week program, and 45 families returned for 6-month follow-up assessments. Results indicated that the BMI z score in children was reduced by 0.31 ± 0.17 at 6 months across all cohorts. Reduction in BMI z score ranged from 0.41 in cohort 4 to 0.13 in cohort 5. Iterative adaptations to BHF were completed to improve the fit of BHF to the setting and participants and have contributed to a sustained community PWMI that adheres to the underlying principles and core elements of other evidence-based PWMIs. Monitoring adaptations and related changes to outcomes can play a role in long-term sustainability and effectiveness.
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Affiliation(s)
- R T Bartee
- Department of Biology, University of Nebraska at Kearney, Kearney, NE, USA.
| | - K A Heelan
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, Kearney, NE, USA
| | - C A Golden
- School of Medicine, Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - J L Hill
- School of Medicine, Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - G C Porter
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - B A Abbey
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, Kearney, NE, USA
| | - K George
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, Kearney, NE, USA
| | - N Foster
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - P A Estabrooks
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
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French ML, Christensen JT, Estabrooks PA, Hernandez AM, Metos JM, Marcus RL, Thorpe A, Dvorak TE, Jordan KC. Evaluation of the Effectiveness of a Bilingual Nutrition Education Program in Partnership with a Mobile Health Unit. Nutrients 2024; 16:618. [PMID: 38474746 DOI: 10.3390/nu16050618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
There are limited reports of community-based nutrition education with culinary instruction that measure biomarkers, particularly in low-income and underrepresented minority populations. Teaching kitchens have been proposed as a strategy to address social determinants of health, combining nutrition education, culinary demonstration, and skill building. The purpose of this paper is to report on the development, implementation, and evaluation of Journey to Health, a program designed for community implementation using the RE-AIM planning and evaluation framework. Reach and effectiveness were the primary outcomes. Regarding reach, 507 individuals registered for the program, 310 participants attended at least one nutrition class, 110 participants completed at least two biometric screens, and 96 participants attended at least two health coaching appointments. Participants who engaged in Journey to Health realized significant improvements in body mass index, blood pressure, and triglycerides. For higher risk participants, we additionally saw significant improvements in total and LDL cholesterol. Regarding dietary intake, we observed a significant increase in cups of fruit and a decrease in sugar sweetened beverages consumed per day. Our findings suggest that Journey to Health may improve selected biometrics and health behaviors in low-income and underrepresented minority participants.
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Affiliation(s)
- Madeleine L French
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Joshua T Christensen
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84112, USA
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Paul A Estabrooks
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Alexandra M Hernandez
- Osher Center for Integrative Health, University of Utah Health, Salt Lake City, UT 84112, USA
| | - Julie M Metos
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Robin L Marcus
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | - Alistair Thorpe
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84112, USA
| | - Theresa E Dvorak
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Kristine C Jordan
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112, USA
- Osher Center for Integrative Health, University of Utah Health, Salt Lake City, UT 84112, USA
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Frazier MC, Balis LE, Armbruster SD, Estabrooks PA, Harden SM. Adaptations to a statewide walking program: Use of iterative feedback cycles between research and delivery systems improves fit for over 10 years. Transl Behav Med 2024; 14:45-53. [PMID: 37682753 PMCID: PMC10782918 DOI: 10.1093/tbm/ibad052] [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: 09/10/2023] Open
Abstract
FitEx is an 8-week, group-based physical activity and fruit and vegetable consumption program co-created and implemented with the Cooperative Extension System. Effectiveness and delivery personnel perceptions of the program are promising; however, ongoing adaptations are required to continuously meet shifting needs of both researchers and delivery systems. We applied the APDER iterative cycles of implementation over 15 years to understand dynamic and ongoing adaptations as well as implications for FitEx sustainability. Each year, an IRPP between delivery (FitEx deliverers) and research (FitEx developers) systems shared feedback on program core elements and strategies for adaptation through regular team meetings, emails, and evaluations. While the core elements (delivering to groups, goal setting, feedback, and self-monitoring) of FitEx remained consistent, changes were made to address logistical factors, emergent research questions, and technological advancements. For example, program deliverers suggested decreasing training time and making program content available on demand rather than through traditional in-person training. Using APDER with a long-standing IRPP allowed the delivery system to provide feedback to program developers to co-create ongoing adaptations and data-driven decisions. Future work in response to shifting needs includes Fitbit integration and technological updates to the usability of the FitEx platform. Our aim is to report the 15+ years of applying the Assess, Plan, Do, Evaluate, Report (APDER) process with an integrated research-practice partnership (IRPP) for co-creation of ongoing adaptations of FitEx and to share methods for capturing relevant data for decision-making to integrate health promotion programs in community settings.
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Affiliation(s)
- Mary C Frazier
- Translational Biology, Medicine, and Health Program, Virginia Tech, Roanoke, VA, USA
| | - Laura E Balis
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | - Shannon D Armbruster
- Division of Gynecologic Oncology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Paul A Estabrooks
- Department of Health & Kinesiology, College of Health, University of Utah, Salt Lake City, UT, USA
| | - Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
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Ostermeier E, Burke SM, Gilliland J, Tucker P. Implementation models and frameworks used to guide community-based physical activity programs for children: a scoping review. BMC Public Health 2023; 23:1604. [PMID: 37612686 PMCID: PMC10463798 DOI: 10.1186/s12889-023-16465-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/06/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The implementation of community-based programs is key to effective, sustainable initiatives that can support population-level changes in children's physical activity. The purpose of this scoping review was to explore the implementation models and frameworks used to develop (process models), explore (determinant frameworks), and/or evaluate (evaluation frameworks) community-based physical activity programs for children. Also, the foundational components of the implementation models and frameworks and practical application in real-world settings were described. METHODS The methodological framework developed by Arksey and O'Malley (2005) and the updated recommendations from Levac, Colquhoun and O'Brien (2010) were used to search, identify, and summarize applicable studies. This review also met the requirements in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Reviews Checklist (PRISMA-ScR). A detailed search of six databases and three academic journals was conducted. Information about the article, the program, and the implementation model/framework were extracted and summarized. RESULTS The search retrieved 42,202 articles, of which 27 met the inclusion criteria. Eleven process models, one determinant framework, and two evaluation frameworks were identified. Nineteen components were developed from the models and frameworks. Tailoring, situational analysis, and element identification were common components among the identified models and frameworks. CONCLUSIONS Since the execution of interventions is vital for creating successful health-promoting initiatives, researchers and program developers should consider using implementation models and frameworks to guide their community-based physical activity programs. Further research examining the application of new and existing implementation models and frameworks in developing, exploring, and evaluating community-level programs is warranted.
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Affiliation(s)
- Emma Ostermeier
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Shauna M Burke
- School of Health Studies, Western University, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
| | - Jason Gilliland
- School of Health Studies, Western University, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
- Human Environments Analysis Laboratory, Department of Geography and Environment, Western University, London, ON, Canada
- Department of Geography & Environment, Western University, London, ON, Canada
- Department of Epidemiology & Biostatistics, Western University, London, ON, Canada
- Department of Paediatrics, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Patricia Tucker
- Children's Health Research Institute, London, ON, Canada.
- Lawson Health Research Institute, London, ON, Canada.
- School of Occupational Therapy, Faculty of Health Sciences, Elborn College, Western University, 1201 Western Rd, ON, N6G 1H1, London, Canada.
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Berreta K, Nguyen C, Stoner AM, Ridgeway L, Wilson A, Fadel N, Biber D. A RE-AIM Analysis of a Mental Health App for Undergraduate and Medical Students during the COVID-19 Pandemic: A Retrospective Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6266. [PMID: 37444113 PMCID: PMC10341913 DOI: 10.3390/ijerph20136266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/06/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE The purpose of this study was to use the RE-AIM framework to evaluate the implementation of a mental health app designed for undergraduate and medical students during the COVID-19 pandemic. PARTICIPANTS Medical (n = 270) and undergraduate students (n = 1386) from five universities in the Appalachian region in the United States participated in this study. METHODS Universities from the United States were recruited to deploy the Sharpen app for medical and undergraduate students. The Sharpen app provided psychoeducational modules in mental health literacy, social-emotional learning, mindfulness-based stress reduction, and suicide prevention to promote protective factors for students. The utilization of the Sharpen app was analyzed using the RE-AIM framework using a retrospective, cross-sectional design. RESULTS Reach: A total of 12.72% of medical students and 6.00% of undergraduate students participated in the study. EFFICACY Medical students viewed significantly more pages, had a significantly higher unique page view average, and a statistically significant exit percentage when compared to undergraduate students. Adoption: A total of 100% of the universities that were recruited participated in the study. IMPLEMENTATION Five out of six implementation criteria were included, indicating high implementation. Maintenance: All of the universities continued using the Sharpen app following the end of data collection, resulting in a 100% maintenance rate. CONCLUSIONS The RE-AIM framework indicated usability and maintenance by medical and undergraduate students. Future research needs to implement a more rigorous design to determine the impact of the Sharpen app on mental health outcomes in medical and undergraduate students.
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Affiliation(s)
- Krisdaniel Berreta
- Department of Preventive Medicine and Public Health, Edward Via College of Osteopathic Medicine, Spartanburg, SC 29303, USA
| | - Cynthia Nguyen
- Department of Preventive Medicine and Public Health, Edward Via College of Osteopathic Medicine, Spartanburg, SC 29303, USA
| | - Alexis M. Stoner
- Department of Preventive Medicine and Public Health, Edward Via College of Osteopathic Medicine, Spartanburg, SC 29303, USA
| | - Lindsey Ridgeway
- Student Affairs, Edward Via College of Osteopathic Medicine, Spartanburg, SC 29303, USA
| | | | - Natalie Fadel
- Department of Psychiatry and Neuro-Behavioral Sciences, Edward Via College of Osteopathic Medicine, Spartanburg, SC 29303, USA
| | - Duke Biber
- Department of Health Promotion and Physical Education, Kennesaw State University, Kennesaw, GA 30144, USA
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Fioratti I, Santos VS, Fernandes LG, Rodrigues KA, Soares RJ, Saragiotto BT. Translation, cross-cultural adaptation and measurement properties of three implementation measures into Brazilian-Portuguese. Arch Physiother 2023; 13:7. [PMID: 36967380 PMCID: PMC10041794 DOI: 10.1186/s40945-023-00160-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/21/2023] [Indexed: 03/28/2023] Open
Abstract
BACKGROUND To translate and cross-culturally adapt into Brazilian-Portuguese, and to test the measurement properties of the following items of implementation outcome measures: Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM) and Feasibility of Intervention Measure (FIM). METHODS This was a measurement properties study in accordance with the Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN). We conducted a translation and cross-cultural adaptation of three implementation measures according to guidelines for translation and cross-cultural adaptation, then we collected information from patients who had participated in remotely delivered physical therapy treatment for musculoskeletal condition. The patients answered the translated versions of the implementation outcome measures. The measurement properties of the three implementation outcome measures were collected in a test-retest assessment, with an interval of 7 to 14 days.. The measurement properties evaluated in this study were interpretability, measured using Ceiling and Floor Effects, reliability in test-retest evaluation, measured using Cronbach's Alpha Coefficient, internal consistency, measured using Intraclass Correlation Coefficient and construct validity, measured using Pearson Correlation. RESULTS We included 104 participants (76 female). The average age of the sample was 56.8 (SD 14.8) years old. The items of implementation outcome measures (AIM, IAM, and FIM) showed 66.39%, 63.11%, and 63.93% of ceiling effects. The items of implementation outcome measures showed adequate internal consistency measured using Cronbach's Alpha Coefficient (AIM: 0.89, IAM: 0.91, FIM: 0.93) and values of Standard Error of Measurement between 5 and 10%, showing good measurement error. The results of AIM and IAM was classified as moderate reliability and the FIM as substantial reliability. In a total 96 correlations, > 75% of correlations met our prior hypothesis. CONCLUSION The three Brazilian-Portuguese versions of items of implementation outcome measures had adequate internal consistency, measurement error and construct validity. The three implementation outcome measures showed moderate to substantial reliability values. The Ceiling Effect was observed in the three measures, showing maximum values in more than 15% of the evaluations.
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Affiliation(s)
- Iuri Fioratti
- grid.412268.b0000 0001 0298 4494Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Verônica S. Santos
- grid.412268.b0000 0001 0298 4494Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Lívia G. Fernandes
- grid.412268.b0000 0001 0298 4494Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Karina A. Rodrigues
- grid.412286.b0000 0001 1395 7782Department of Physical Therapy, Universidade de Taubaté, São Paulo, Brazil
| | - Renato J. Soares
- grid.412286.b0000 0001 1395 7782Department of Physical Therapy, Universidade de Taubaté, São Paulo, Brazil
| | - Bruno T. Saragiotto
- grid.412268.b0000 0001 0298 4494Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- grid.117476.20000 0004 1936 7611Discipline of Physiotherapy, University of Technology Sydney, Sydney, Australia
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Estabrooks PA, Glasgow RE. Developing a dissemination and implementation research agenda for aging and public health: The what, when, how, and why? Front Public Health 2023; 11:1123349. [PMID: 36815160 PMCID: PMC9939692 DOI: 10.3389/fpubh.2023.1123349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 01/13/2023] [Indexed: 02/09/2023] Open
Affiliation(s)
- Paul A. Estabrooks
- Department of Health and Kinesiology, College of Health, University of Utah, Salt Lake City, UT, United States
| | - Russell E. Glasgow
- ACCORDS Dissemination & Implementation Science Program and Department of Family Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, United States
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Niven A, Ainge JA, Allison M, Gorely T, Kelly P, Ozakinci G, Ryde GC, Tomaz SA, Warne S, Whiteford V, Greenwood C. Building partnerships: A case study of physical activity researchers and practitioners collaborating to build evidence to inform the delivery of a workplace step count challenge. Front Sports Act Living 2023; 4:1067127. [PMID: 36685059 PMCID: PMC9845875 DOI: 10.3389/fspor.2022.1067127] [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: 10/11/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023] Open
Abstract
Background Walking is an integral part of Scotland's National Physical Activity Strategy, and the charity Paths for All's Workplace Step Count Challenge is a flagship programme within this strategy to promote physical activity. Effectively promoting physical activity requires collaborative engagement between stakeholders. However, there is limited guidance on how to do this. The aim of this case study is to share an example of a partnership between Paths for All and researchers to inform the development and delivery of the Workplace Step Count Challenge. Method An overview of the partnership, example activities, reflections on opportunities and challenges, and suggestions for future partnership working are considered. Results The partnership has evolved and strengthened over time through building trust. Many of the research activities provide an evidence base for the intervention. This work is mutually beneficial providing support for the work of the organisation, and opportunities for researchers to undertake "real world" research, leading to formal outputs and funding. The "real world" nature is challenging to integrate the most robust research designs. Recommendations for developing future partnerships were identified. Conclusion Promoting physical activity effectively requires partnership working, and this paper provides insight into how such partnerships can work to inform future collaborations.
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Affiliation(s)
- Ailsa Niven
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom,Correspondence: Ailsa Niven
| | - James A. Ainge
- School of Psychology & Neuroscience, University of St Andrews, St Andrews, United Kingdom
| | - Mary Allison
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Trish Gorely
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, United Kingdom
| | - Paul Kelly
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Gozde Ozakinci
- Division of Psychology, University of Stirling, Stirling, United Kingdom
| | - Gemma C. Ryde
- BHF Glasgow Cardiovascular Research Centre, University of Kings College, Glasgow, United Kingdom
| | - Simone A. Tomaz
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - Samuel Warne
- Population and Behavioural Science Division, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Victoria Whiteford
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, BC, Canada
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Kim J, Estabrooks P, Aggarwal A, McMillan A, Alshehri K. Developing a co-production strategy to facilitate the adoption and implementation of evidence-based colorectal cancer screening interventions for rural health systems: a pilot study. Implement Sci Commun 2022; 3:131. [PMID: 36514119 PMCID: PMC9745718 DOI: 10.1186/s43058-022-00375-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Evidence-based colorectal cancer screening (CRCS) interventions have not been broadly adopted in rural primary care settings. Co-production of implementation strategies through a bundled approach may be promising in closing this gap by helping rural healthcare practitioners select and implement the best fitting CRCS interventions to the local context. This paper describes the process and outcomes of co-development and delivery of the bundled implementation strategy to improve adoption and implementation of CRCS interventions with two rural clinics. METHODS We used a bundle of implementation strategies with a core focus on academic-clinical partnership development (strategy 1) and Plan-Do-Study-Act cycles (strategy 2) to identify clinical partner interests/preferences on delivery methods and content needed to facilitate intervention identification and implementation that improves CRCS. We also developed an implementation blueprint for each clinic (strategy 3) through an online blueprinting process based on adapted "Putting Public Health Evidence in Action" (PPHEA) training curriculum. Clinic physicians and staff (n = 7) were asked to evaluate the bundled approach based on overall reactions and perceptions of innovation characteristics using 5-point Likert scale. After completing the bundled approach, we collected implementation outcomes and limited intervention effectiveness of the CRCS evidence-based interventions (EBIs) developed through the process. RESULTS Our co-production strategy yielded a prototype online blueprinting process consisting of 8 distance-learning PPHEA modules that guide selection and implementation of EBIs tailored to CRCS. Modules were delivered to clinic participants with minor adaptations, using PDSA cycle to improve quality of module contents and formats. Overall, participants in both clinics reported positive reactions toward the bundled approach. Both clinics reported improvements in how they perceived the characteristics of the innovation (the bundled approach) to tailor selected CRCS EBIs. As a result of the bundled strategies, each clinic selected and adopted specific EBI(s) with the varying degrees of implementation and CRCS outcomes. CONCLUSIONS The bundle of implementation strategies used were feasible and acceptable in rural primary care practices to facilitate the use of EBIs to improve CRCS.
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Affiliation(s)
- Jungyoon Kim
- Department of Health Services Research and Administration, University of Nebraska Medical Center, College of Public Health, 984350 Nebraska Medical Center, Omaha, NE, 98168, USA.
| | - Paul Estabrooks
- Department of Health & Kinesiology, College of Health, University of Utah, Salt Lake City, USA
| | - Alisha Aggarwal
- Janssen Pharmaceutical Companies of Johnson and Johnson, Horsham, USA
| | - Analisa McMillan
- College of Public Health, University of Nebraska Medical Center, Omaha, USA
| | - Khalid Alshehri
- Department of Health Services Research and Administration, University of Nebraska Medical Center, College of Public Health, 984350 Nebraska Medical Center, Omaha, NE, 98168, USA
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Balis LE, Houghtaling B, Harden SM. Using implementation strategies in community settings: an introduction to the Expert Recommendations for Implementing Change (ERIC) compilation and future directions. Transl Behav Med 2022; 12:965-978. [PMID: 36039843 DOI: 10.1093/tbm/ibac061] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
In this commentary, we introduce public health practitioners and researchers to implementation science through an established compilation of implementation strategies. We provide terminology and examples for community settings so public health practitioners and researchers can use implementation strategies and document efforts using standard terminology. We also discuss the need for future work to determine the extent to which these implementation strategies work and are most useful in community settings, and ultimately, how health behaviors are impacted. We intend this commentary to serve as a dissemination strategy for implementation strategies and to contribute to knowledge in the growing field of implementation science in community settings.
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Affiliation(s)
- Laura E Balis
- Louisville Center, Pacific Institute for Research and Evaluation, Louisville, Kentucky, USA
| | - Bailey Houghtaling
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska, USA.,Louisiana State University (LSU) and LSU Agricultural Center, Baton Rouge, Louisiana, USA
| | - Samantha M Harden
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virgina, USA
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12
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Balis LE, Grocke-Dewey M. Built environment approaches: Extension personnel's preferences, barriers, and facilitators. Front Public Health 2022; 10:960949. [PMID: 36311640 PMCID: PMC9614838 DOI: 10.3389/fpubh.2022.960949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/30/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Interventions that modify the built environment can increase population physical activity levels and prevent chronic disease. The national Cooperative Extension System is poised to implement built environment approaches (i.e., pedestrian/bicycle infrastructure and enhanced access to physical activity spaces), but implementation strategies (i.e., methods or techniques to move research to practice) are needed to improve uptake. Effective implementation strategies address relevant barriers and capitalize on facilitators. The purpose of this study was to understand 1) barriers and facilitators to implementing built environment approaches in two state Extension systems, 2) preferences for built environment approaches, and 3) preferences for implementation strategies. Methods A cross-sectional online survey was used to understand Extension personnel's preferences for and barriers and facilitators to built environment approaches through a mixed-methods study design. This work was informed by anthropological inquiry as the overall research philosophy, and by the Health Impact Pyramid, Leeman et al.'s classification of implementation strategies, and the Consolidated Framework for Implementation Research as the theoretical frameworks. The survey was distributed to eligible Extension personnel (n = 42) in two states. Quantitative data analysis consisted of numbers/proportions and Friedman tests. Qualitative analysis was completed through a rapid deductive approach to quickly produce actionable results. Results Fourteen respondents (33%) completed the survey. Most had not implemented physical activity interventions in their communities or had implemented only individual-level interventions, though were interested in implementing built environment approaches. Benches, playground improvements, and crosswalks were the most desired approaches, while facilitation, assessing community strengths and needs, and technical assistance were desired implementation strategies. The most common barriers were relative priority and available resources; facilitators were external policy and incentives and implementation climate. Discussion Extension personnel are receptive to built environment approaches and engaged with community coalitions. Yet, invested parties prefer individual-level interventions, and agents perceive a lack of resources for implementation. Implementation strategies that build capacity in both the Extension system and community coalitions may address these barriers through increasing relative priority and sharing existing resources. This work is a first step toward compiling implementation strategies to address relevant barriers to built environment approaches in community settings.
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Affiliation(s)
- Laura E. Balis
- Louisville Center, Pacific Institute for Research and Evaluation, Louisville, KY, United States
| | - Michelle Grocke-Dewey
- Department of Health and Human Development, Montana State University, Bozeman, MT, United States
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13
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Watanabe-Galloway S, Kim J, LaCrete F, Samson K, Foster J, Farazi E, LeVan T, Napit K. Cross-sectional survey study of primary care clinics on evidence-based colorectal cancer screening intervention use. J Rural Health 2022; 38:845-854. [PMID: 34784067 PMCID: PMC9108125 DOI: 10.1111/jrh.12631] [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: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to examine differences between urban and rural primary care clinics in the use of colorectal cancer (CRC) screening methods and evidence-based interventions to promote CRC screening. METHODS This was a cross-sectional survey of primary care clinics in Nebraska. Surveys in paper form were sent out and followed up with telephone interviews to nonrespondents. Of the 375 facilities, 263 (70.1%) responded to the survey. FINDINGS Over 30% of urban clinics indicated that 80% or more of their patients were meeting the CRC guidelines compared to 18.3% of rural clinics (P = .03). Rural clinics were more likely than urban clinics to prefer the use of colonoscopy alone or in combination with stool tests (P = .02). The most common interventions for CRC screening included one-on-one patient education and use of computer-based pop-ups to remind providers. CONCLUSIONS In conclusion, we found some important differences between rural and urban primary care clinics in the implementation of CRC screening. Given that there is evidence for differences in preference for CRC screening methods (colonoscopy vs stool-based tests) between rural and urban community members, it is important to assess the effectiveness of different types of CRC screening interventions by comparing rural and urban primary care clinic patient populations.
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Affiliation(s)
| | - Jungyoon Kim
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Frantzlee LaCrete
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kaeli Samson
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jason Foster
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Evi Farazi
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tricia LeVan
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Krishtee Napit
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
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14
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Balis LE, Vincent J. Implementation Strategies to Support Built Environment Approaches in Community Settings. Health Promot Pract 2022; 24:502-513. [PMID: 35549927 DOI: 10.1177/15248399221081835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Built environment approaches are recommended to improve population physical activity levels. Implementation strategies are needed to improve uptake, but little is known about effective strategies to translate research to practice in community settings. PURPOSE Inform implementation strategies through understanding delivery agents' perceptions of (1) built environment approaches, (2) a toolkit developed to support implementation, and (3) other required implementation strategies. METHOD A toolkit was developed to detail the process of partnering to change the built environment and provide examples of built environment approaches (e.g., walking paths, traffic calming). Data were collected through focus groups (N = 3) with Extension Agents (n = 46) in 2020. The semi-structured focus group script was based on the Consolidated Framework for Implementation Research and the Technology Acceptance model. Rapid content analysis techniques and a deductive, grounded theory approach were used to interpret the data. Results. Focus groups generated meaning units coded into themes of perceptions of the intervention (subthemes: barriers, resources needed, and facilitators) and perceptions of the toolkit (subthemes: components to add, positive perceptions, and helpful components). The most common resources needed were coalition guidance and funding. CONCLUSION Agents experience barriers and facilitators to implementing built environment approaches and have specific needs for support. Based on the results, we created implementation strategies: (1) Places for Physical Activity toolkit, (2) Coalition Coaching, and (3) Mini-Grants. Future work is needed to investigate the effectiveness of these implementation strategies.
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Affiliation(s)
- Laura E Balis
- Pacific Institute for Research and Evaluation, Louisville, KY, USA
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15
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Dysart A, Harden SM. Mindfulness and Understanding of Self-Care for Leaders of Extension: Promoting Well-Being for Health Educators and Their Clients. Front Public Health 2022; 10:862366. [PMID: 35646779 PMCID: PMC9136216 DOI: 10.3389/fpubh.2022.862366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background Mindfulness and self-care, practiced through a variety of methods like meditation and exercise, can improve overall sense of holistic well-being (i.e., flourishing). Increasing mindfulness and self-care may lead to increased flourishing and job satisfaction among the nation-wide Cooperative Extension system delivery personnel (agents) through a theory-based online program and an extended experiential program. Methods Cooperative Extension agents from two states were invited to participate in MUSCLE via statewide listservs. Participants were invited to attend sessions and complete competency checks and between-session assignments each week. The study was conducted using Zoom. Pre- and post- program surveys included validated scales for flourishing and physical activity status. Due to high demand for mindfulness programing during the onset of the COVID-19 pandemic, experiential “Mindful Meet-up” 30-minute sessions were held on Zoom. Dissemination and implementation of the two differing interventions (i.e., MUSCLE and Mindful Meet-ups) were examined. Results MUSCLE (more intensive program with assignments and competency checks) had lower reach, and did not show statistically increased flourishing or physical activity. Mindful Meet-ups had higher attendance and proportional reach during the beginning of the pandemic, but no practical measure of flourishing or physical activity behaviors. Unsolicited qualitative feedback was encouraging because the interventions were well-received and participants felt as though they were more mindful. Conclusions While agents anecdotally reported personal improvements, capturing data on outcomes was challenging. Complementing outcome data with implementation and dissemination outcomes allowed for a richer picture to inform intervention decision-making (i.e., offering the same or new programming depending on participant needs).
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16
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Michaud TL, Hill JL, Heelan KA, Bartee RT, Abbey BM, Malmkar A, Masker J, Golden C, Porter G, Glasgow RE, Estabrooks PA. Understanding implementation costs of a pediatric weight management intervention: an economic evaluation protocol. Implement Sci Commun 2022; 3:37. [PMID: 35382891 PMCID: PMC8981827 DOI: 10.1186/s43058-022-00287-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Understanding the cost and/or cost-effectiveness of implementation strategies is crucial for organizations to make informed decisions about the resources needed to implement and sustain evidence-based interventions (EBIs). This economic evaluation protocol describes the methods and processes that will be used to assess costs and cost-effectiveness across implementation strategies used to improve the reach, adoption, implementation, and organizational maintenance of an evidence-based pediatric weight management intervention- Building Health Families (BHF). Methods A within-trial cost and cost-effectiveness analysis (CEA) will be completed as part of a hybrid type III effectiveness-implementation trial (HEI) designed to examine the impact of an action Learning Collaborative (LC) strategy consisting of network weaving, consultee-centered training, goal-setting and feedback, and sustainability action planning to improve the adoption, implementation, organizational maintenance, and program reach of BHF in micropolitan and surrounding rural communities in the USA, over a 12-month period. We discuss key features of implementation strategy components and the associated cost collection and outcome measures and present brief examples on what will be included in the CEA for each discrete implementation strategy and how the results will be interpreted. The cost data will be collected by identifying implementation activities associated with each strategy and using a digital-based time tracking tool to capture the time associated with each activity. Costs will be assessed relative to the BHF program implementation and the multicomponent implementation strategy, included within and external to a LC designed to improve reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) of BHF. The CEA results will be reported by RE-AIM outcomes, using the average cost-effectiveness ratio or incremental cost-effectiveness ratio. All the CEAs will be performed from the community perspective. Discussion The proposed costing approach and economic evaluation framework for dissemination and implementation strategies and EBI implementation will contribute to the evolving but still scant literature on economic evaluation of implementation and strategies used and facilitate the comparative economic analysis. Trial registration ClinicalTrials.gov NCT04719442. Registered on January 22, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00287-1.
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17
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Strayer E T, Balis LE, Kennedy LE, Ramalingam NS, Wilson ML, Harden SM. Intervention Characteristics Considered in Health Educators' Adoption Decision-Making Process. HEALTH EDUCATION & BEHAVIOR 2022; 50:416-429. [PMID: 34991406 DOI: 10.1177/10901981211067170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is well known that perceptions of intervention characteristics (e.g., cost, source, evidence strength and quality) are a critical link from dissemination to implementation. What is less known is the process by which researchers understand the characteristics most valued by key intermediaries (i.e., real-world decision-makers), particularly in the federal system of Cooperative Extension. In Extension, university-based specialists are available to assist county-based agents in program selection, delivery, and evaluation. For this work, a sequential explanatory mixed-methods design was used to conduct surveys and semi-structured interviews, informed by the Diffusion of Innovations theory and Consolidated Framework for Implementation Research. Educators and specialists were recruited across 47 states to identify characteristics of health promotion interventions that facilitate the adoption decision-making process. Analysis of intervention attribute importance survey data was conducted through a one-way ANOVA with Bonferroni post hoc test to determine individual variable differences between responses. Interviews underwent a conventional content analysis. In total, 121 educators and 47 specialists from 33 states completed the survey. Eighteen educators and 10 specialists completed interviews. Educators and specialists valued components such as the community need for the intervention, and potential reach compared with other components including previous delivery settings and external funding of the intervention (p < .05). Qualitative data indicated divergence between educators and specialists; educators valued understanding the intervention cost (time and training) and specialists valued the evidence base and external funding available. Intervention developers should communicate information valued by different stakeholders to improve the adoption of evidence-based interventions.
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Affiliation(s)
- Thomas Strayer E
- Vanderbilt University Medical Center, Nashville, TN, USA.,Virginia Tech, Blacksburg, VA, USA
| | - Laura E Balis
- Virginia Tech, Blacksburg, VA, USA.,Pacific Institute for Research and Evaluation, Louisville, KY, USA
| | - Lauren E Kennedy
- Virginia Tech, Blacksburg, VA, USA.,Michigan State University, East Lansing, MI, USA
| | | | - Meghan L Wilson
- Virginia Tech, Blacksburg, VA, USA.,Bluefield University, Bluefield, VA, USA
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18
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Bélanger M, Carpenter JG, Sabiston CM, Vanderloo LM, Trono C, Gallant F, Thibault V, Doré I, O'Loughlin J. Identifying priorities for sport and physical activity research in Canada: an iterative priority-setting study. CMAJ Open 2022; 10:E269-E277. [PMID: 35318251 PMCID: PMC8946649 DOI: 10.9778/cmajo.20210114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a need for better alignment between research on sport and physical activity and the needs of those who are in a position to implement the findings. To facilitate advancement and alignment, we identified the top research priorities of sport and physical activity knowledge users from various sectors. METHODS For this priority-setting study, we used an iterative process of data collection and analysis. Sport and physical activity knowledge users from multiple sectors participated in a workshop (September 2019), which included small working group exercises followed by large-group syntheses leading to the identification of issues that required better understanding. We then sent an online questionnaire to participants for content validation and interim prioritization, to reduce the number of priorities (December 2019 to January 2020). A new questionnaire containing a shortened list of research priorities was sent to an expanded group of respondents to further streamline the list of priorities (January-March 2020). RESULTS The 24 workshop participants identified 68 issues, of which 21 were retained by the 18 participants in the interim priority-setting questionnaire. The final prioritization questionnaire was completed by 33 stakeholder groups; this step produced a final list of 8 top research priorities. The final priorities identified for sport and physical activity research related to financial support, suboptimal promotion, dropout, best interventions, participation among Indigenous populations, volunteer engagement, safe and inclusive experiences, and knowledge exchange. INTERPRETATION The 8 priorities identified in this study provide guidance to Canadian sport and physical activity researchers. Research efforts on these priorities will reflect pressing issues as identified by representatives of all sport and physical activity sectors.
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Affiliation(s)
- Mathieu Bélanger
- Department of Family and Emergency Medicine (Bélanger) and Faculty of Medicine and Health Sciences (Gallant, Thibault), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Goguen Carpenter, Gallant, Thibault), Moncton, NB; Faculty of Kinesiology and Physical Education (Sabiston), University of Toronto; ParticipACTION (Vanderloo), Toronto, Ont.; Sport for Life (Trono), Victoria, BC; School of Kinesiology and Physical Activity Sciences (Doré), Faculty of Medicine, and Department of Social and Preventive Medicine (Doré, O'Loughlin), École de santé publique, Université de Montréal, Montréal, Que.
| | - Julie Goguen Carpenter
- Department of Family and Emergency Medicine (Bélanger) and Faculty of Medicine and Health Sciences (Gallant, Thibault), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Goguen Carpenter, Gallant, Thibault), Moncton, NB; Faculty of Kinesiology and Physical Education (Sabiston), University of Toronto; ParticipACTION (Vanderloo), Toronto, Ont.; Sport for Life (Trono), Victoria, BC; School of Kinesiology and Physical Activity Sciences (Doré), Faculty of Medicine, and Department of Social and Preventive Medicine (Doré, O'Loughlin), École de santé publique, Université de Montréal, Montréal, Que
| | - Catherine M Sabiston
- Department of Family and Emergency Medicine (Bélanger) and Faculty of Medicine and Health Sciences (Gallant, Thibault), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Goguen Carpenter, Gallant, Thibault), Moncton, NB; Faculty of Kinesiology and Physical Education (Sabiston), University of Toronto; ParticipACTION (Vanderloo), Toronto, Ont.; Sport for Life (Trono), Victoria, BC; School of Kinesiology and Physical Activity Sciences (Doré), Faculty of Medicine, and Department of Social and Preventive Medicine (Doré, O'Loughlin), École de santé publique, Université de Montréal, Montréal, Que
| | - Leigh M Vanderloo
- Department of Family and Emergency Medicine (Bélanger) and Faculty of Medicine and Health Sciences (Gallant, Thibault), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Goguen Carpenter, Gallant, Thibault), Moncton, NB; Faculty of Kinesiology and Physical Education (Sabiston), University of Toronto; ParticipACTION (Vanderloo), Toronto, Ont.; Sport for Life (Trono), Victoria, BC; School of Kinesiology and Physical Activity Sciences (Doré), Faculty of Medicine, and Department of Social and Preventive Medicine (Doré, O'Loughlin), École de santé publique, Université de Montréal, Montréal, Que
| | - Carolyn Trono
- Department of Family and Emergency Medicine (Bélanger) and Faculty of Medicine and Health Sciences (Gallant, Thibault), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Goguen Carpenter, Gallant, Thibault), Moncton, NB; Faculty of Kinesiology and Physical Education (Sabiston), University of Toronto; ParticipACTION (Vanderloo), Toronto, Ont.; Sport for Life (Trono), Victoria, BC; School of Kinesiology and Physical Activity Sciences (Doré), Faculty of Medicine, and Department of Social and Preventive Medicine (Doré, O'Loughlin), École de santé publique, Université de Montréal, Montréal, Que
| | - François Gallant
- Department of Family and Emergency Medicine (Bélanger) and Faculty of Medicine and Health Sciences (Gallant, Thibault), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Goguen Carpenter, Gallant, Thibault), Moncton, NB; Faculty of Kinesiology and Physical Education (Sabiston), University of Toronto; ParticipACTION (Vanderloo), Toronto, Ont.; Sport for Life (Trono), Victoria, BC; School of Kinesiology and Physical Activity Sciences (Doré), Faculty of Medicine, and Department of Social and Preventive Medicine (Doré, O'Loughlin), École de santé publique, Université de Montréal, Montréal, Que
| | - Véronique Thibault
- Department of Family and Emergency Medicine (Bélanger) and Faculty of Medicine and Health Sciences (Gallant, Thibault), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Goguen Carpenter, Gallant, Thibault), Moncton, NB; Faculty of Kinesiology and Physical Education (Sabiston), University of Toronto; ParticipACTION (Vanderloo), Toronto, Ont.; Sport for Life (Trono), Victoria, BC; School of Kinesiology and Physical Activity Sciences (Doré), Faculty of Medicine, and Department of Social and Preventive Medicine (Doré, O'Loughlin), École de santé publique, Université de Montréal, Montréal, Que
| | - Isabelle Doré
- Department of Family and Emergency Medicine (Bélanger) and Faculty of Medicine and Health Sciences (Gallant, Thibault), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Goguen Carpenter, Gallant, Thibault), Moncton, NB; Faculty of Kinesiology and Physical Education (Sabiston), University of Toronto; ParticipACTION (Vanderloo), Toronto, Ont.; Sport for Life (Trono), Victoria, BC; School of Kinesiology and Physical Activity Sciences (Doré), Faculty of Medicine, and Department of Social and Preventive Medicine (Doré, O'Loughlin), École de santé publique, Université de Montréal, Montréal, Que
| | - Jennifer O'Loughlin
- Department of Family and Emergency Medicine (Bélanger) and Faculty of Medicine and Health Sciences (Gallant, Thibault), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Goguen Carpenter, Gallant, Thibault), Moncton, NB; Faculty of Kinesiology and Physical Education (Sabiston), University of Toronto; ParticipACTION (Vanderloo), Toronto, Ont.; Sport for Life (Trono), Victoria, BC; School of Kinesiology and Physical Activity Sciences (Doré), Faculty of Medicine, and Department of Social and Preventive Medicine (Doré, O'Loughlin), École de santé publique, Université de Montréal, Montréal, Que
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Porter G, Michaud TL, Schwab RJ, Hill JL, Estabrooks PA. Reach Outcomes and Costs of Different Physician Referral Strategies for a Weight Management Program Among Rural Primary Care Patients: Type 3 Hybrid Effectiveness-Implementation Trial. JMIR Form Res 2021; 5:e28622. [PMID: 34668873 PMCID: PMC8567148 DOI: 10.2196/28622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Rural residents are at high risk for obesity; however, little resources exist to address this disproportional burden of disease. Primary care may provide an opportunity to connect primary care patients with overweight and obesity to effective weight management programming. OBJECTIVE The purpose of this study is to examine the utility of different physician referral and engagement processes for improving the reach of an evidence-based and technology-delivered weight management program with counseling support for rural primary care patients. METHODS A total of 5 rural primary care physicians were randomly assigned a sequence of four referral strategies: point-of-care (POC) referral with active telephone follow-up (ATF); POC referral, no ATF; a population health registry-derived letter referral with ATF; and letter referral, no ATF. For registry-derived referrals, physicians screened a list of patients with BMI ≥25 and approved patients for participation to receive a personalized referral letter via mail. RESULTS Out of a potential 991 referrals, 573 (57.8%) referrals were made over 16 weeks, and 98 (9.9%) patients were enrolled in the program (58/98, 59.2% female). Differences based on letter (485/991, 48.9%) versus POC (506/991, 51.1%) referrals were identified for completion (100% vs 7%; P<.001) and for proportion screened (36% vs 12%; P<.001) but not for proportion enrolled (12% vs 8%; P=.10). Patients receiving ATF were more likely to be screened (47% vs 7%; P<.001) and enrolled (15% vs 7%; P<.001) than those not receiving ATF. On the basis of the number of referrals made in each condition, we found variations in the proportion and number of enrollees (POC with ATF: 27/190, 50%; POC no ATF: 14/316, 41%; letter ATF: 30/199; 15.1%; letter no ATF: 27/286, 9.4%). Across all conditions, participants were representative of the racial and ethnic characteristics of the region (60% female, P=.15; 94% White individuals, P=.60; 94% non-Hispanic, P=.19). Recruitment costs totaled US $6192, and the overall recruitment cost per enrolled participant was US $63. Cost per enrolled participant ranged from POC with ATF (US $47), registry-derived letter without ATF (US $52), and POC without ATF (US $56) to registry-derived letter with ATF (US $91). CONCLUSIONS Letter referral with ATF appears to be the best option for enrolling a large number of patients in a digitally delivered weight management program; however, POC with ATF and letters without ATF yielded similar numbers at a lower cost. The best referral option is likely dependent on the best fit with clinical resources. TRIAL REGISTRATION ClinicalTrials.gov NCT03690557; http://clinicaltrials.gov/ct2/show/NCT03690557.
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Affiliation(s)
- Gwenndolyn Porter
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, United States
| | - Tzeyu L Michaud
- Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, NE, United States
| | - Robert J Schwab
- University of Nebraska Medical Center, Omaha, NE, United States
| | - Jennie L Hill
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Paul A Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, United States
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20
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Hill JL, Heelan KA, Bartee RT, Wichman C, Michaud T, Abbey BM, Porter G, Golden C, Estabrooks PA. A Type III Hybrid Effectiveness-Implementation Pilot Trial Testing Dissemination and Implementation Strategies for a Pediatric Weight Management Intervention: The Nebraska Childhood Obesity Research Demonstration Project. Child Obes 2021; 17:S70-S78. [PMID: 34569848 DOI: 10.1089/chi.2021.0170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Several family-based efficacious pediatric weight management interventions (PWMIs) have been developed to reduce child weight status. These programs are typically based in larger cities delivered by an interdisciplinary team in a hospital or medical center. The degree to which these efficacious PWMIs have been translated to, and are feasible in, rural or micropolitan areas is unclear. This study protocol describes a pilot Type III hybrid effectiveness-implementation (T3HEI) trial testing a multilevel strategy that focuses on the adoption, implementation, and sustainability of a PWMI online training program and resource package designed for implementation in micropolitan and rural areas. Methods: The trial design employed the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate outcomes and the Promoting Action on Research Implementation in Health Services framework to specify potential mechanisms of adoption, implementation, and sustainability. The study will test the feasibility of a fund and contract dissemination strategy in the adoption of a PWMI in four to eight rural communities, compare a learning collaborative implementation strategy including embedded training and sustainability action planning with communities who receive the PWMI online program and resources alone, and determine whether the PWMI reach, effectiveness, and maintenance are of magnitude similar to previous effectiveness trials. The dissemination and implementation process focused on an integrated research-practice partnership process model that includes a systems-based approach with multiple sectors and vertical decision-making representation. Conclusions: Our pilot T3HEI study has the potential to inform how best to move and sustain evidence-based PWMIs into practice. The findings will inform larger scale dissemination, implementation, and sustainability efforts in medically underserved areas across the country. Trial registration: This protocol is registered with clinicaltrials.gov (NCT04719442).
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Affiliation(s)
- Jennie L Hill
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kate A Heelan
- Kinesiology and Sport Sciences Department, University of Nebraska at Kearney, Kearney, NE, USA
| | - R T Bartee
- Kinesiology and Sport Sciences Department, University of Nebraska at Kearney, Kearney, NE, USA
| | - Christopher Wichman
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tzeyu Michaud
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Bryce M Abbey
- Kinesiology and Sport Sciences Department, University of Nebraska at Kearney, Kearney, NE, USA
| | - Gwenndolyn Porter
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Caitlin Golden
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Paul A Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
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21
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Mehta TG, Mahoney J, Leppin AL, Stevens KR, Yousefi-Nooraie R, Pollock BH, Shelton RC, Dolor R, Pincus H, Patel S, Moore JB. Integrating dissemination and implementation sciences within Clinical and Translational Science Award programs to advance translational research: Recommendations to national and local leaders. J Clin Transl Sci 2021; 5:e151. [PMID: 34527291 PMCID: PMC8411263 DOI: 10.1017/cts.2021.815] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/16/2022] Open
Abstract
The National Center for Advancing Translational Sciences (NCATS) has defined translation as the process of turning observations into interventions that are adopted, sustained, and improve health. Translation must attend to research and community systems and context at multiple levels, and to key stakeholders. Dissemination and implementation (D&I) sciences are informed by an understanding of the critical role of people and systems in disseminating, adopting, and sustaining innovations within real-world settings. Thus, the D&I sciences provides a set of principles that can guide the translational work of Clinical and Translational Science Award (CTSA) programs from basic research to public health. In this special communication, our cross-domain working group of the CTSA consortium, comprised of experts in methods and processes, workforce development, evaluation, stakeholder engagement, and D&I sciences, share a vision of how CTSAs can enhance translation across the translational spectrum through the integration of D&I sciences into the critical areas of methods and processes, workforce development, and evaluation. We propose a set of recommendations for NCATS national and local leaders that are intended to move D&I sciences out of a position of unfamiliarity and ancillary value and into the core identity of who CTSAs are, how they think, and what they do, to advance translation and health.
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Affiliation(s)
- Tara G. Mehta
- Center for Clinical Translational Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Jane Mahoney
- The Institute for Clinical and Translational Research, University of Wisconsin, Madison, WI, USA
| | - Aaron L. Leppin
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
| | - Kathleen R. Stevens
- National Center for Advancing Translational Sciences, University of Texas Health Science Center, San Antonio, TX, USA
| | - Reza Yousefi-Nooraie
- Clinical and Translational Science Institute, University of Rochester, Rochester, NY, USA
| | - Brad H. Pollock
- Clinical and Translational Science Center, University of California, Davis, CA, USA
| | - Rachel C. Shelton
- Irving Institute for Clinical and Translational Research, Columbia University, New York, NY, USA
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, NY, USA
| | - Rowena Dolor
- Duke Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC, USA
| | - Harold Pincus
- Irving Institute for Clinical and Translational Research, Columbia University, New York, NY, USA
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY, USA
| | - Sapana Patel
- Irving Institute for Clinical and Translational Research, Columbia University, New York, NY, USA
- New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, NY, USA
| | - Justin B. Moore
- Clinican and Translational Science Institute & Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Porter GC, Schwab R, Hill JL, Bartee T, Heelan KA, Michaud TL, Estabrooks PA. Examining the feasibility and characteristics of realistic weight management support for patients: Focus groups with rural, micropolitan, and metropolitan primary care providers. Prev Med Rep 2021; 23:101390. [PMID: 34026468 PMCID: PMC8134728 DOI: 10.1016/j.pmedr.2021.101390] [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: 10/27/2020] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 11/18/2022] Open
Abstract
The purpose of this investigation was to understand perspectives of physicians, nurses, and staff regarding the feasibility of implementing an evidence-based weight management program to support primary care practice. An exploratory aim was to examine differences in responses based on the clinic location. Ten focus groups were conducted with primary care staff from rural, micropolitan, and metropolitan clinics. The Promoting Action on Research in Health Services (PARIHS) framework was used to inform the interview guide. Transcripts were reviewed to identify common themes among PARIHS constructs (evidence, context, and facilitation). Presence of comorbidities (e.g., diabetes, hypertension) were typical prompts for provider-led discussions about patient weight. Metropolitan clinics reported the availability of health coaching, diabetes education, or dietician consultation, but no clinic reported offering a comprehensive weight management program. Participants agreed it is possible to implement a weight management program through primary care, but cited potential facilitation challenges such as costs, clinic resources, and individual patient barriers. More enthusiasm arose for a referral program with patient tracking. Program characteristics such as proven efficacy, individual tailoring, program accessibility, and patient feedback to the providers were desired. Rural focus group participants reported unique barriers (lack of local resources) and facilitators (more flexibility in practice changes) to weight management when compared to metropolitan and micropolitan focus groups. Primary care staff are interested in weight management solutions for their patients and would prefer an evidence-based program to which they could refer patients, receive feedback on patient progress, and sustainably include as part of their regular services.
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Affiliation(s)
- Gwenndolyn C. Porter
- Deaprtment of Health Promotion, College of Public Health, University of Nebraska Medical Center, United States
- Corresponding author.
| | - Robert Schwab
- Deaprtment of Health Promotion, College of Public Health, University of Nebraska Medical Center, United States
| | - Jennie L. Hill
- Deaprtment of Health Promotion, College of Public Health, University of Nebraska Medical Center, United States
| | - Todd Bartee
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, United States
| | - Kate A. Heelan
- Department of Kinesiology and Sport Sciences, University of Nebraska at Kearney, United States
| | - Tzeyu L. Michaud
- Deaprtment of Health Promotion, College of Public Health, University of Nebraska Medical Center, United States
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, United States
| | - Paul A. Estabrooks
- Deaprtment of Health Promotion, College of Public Health, University of Nebraska Medical Center, United States
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Harden SM, Balis LE, Strayer T, Wilson ML. Assess, Plan, Do, Evaluate, and Report: Iterative Cycle to Remove Academic Control of a Community-Based Physical Activity Program. Prev Chronic Dis 2021; 18:E32. [PMID: 33830914 PMCID: PMC8051858 DOI: 10.5888/pcd18.200513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
PURPOSE AND OBJECTIVES Responsive methods and measures are needed to bridge research to practice and address public health issues, such as older adults' need for multicomponent physical activity. The objective of this study was to detail the longitudinal, quasi-experimental work that spans 5 years to describe outcomes across RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) dimensions of integrating a physical activity intervention for older adults into the Cooperative Extension System through the assess, plan, do, evaluate, report (APDER) cycle. INTERVENTION APPROACH The participant-level intervention is Lifelong Improvements through Fitness Together (LIFT), an 8-week, group dynamics-based, strength-training program with 16 in-person sessions. The implementation intervention applies the iterative APDER cycle based on feedback for each dimension of RE-AIM. Each year, the APDER cycle was used to embed data collection procedures at the instructor and participant level to reveal the next evolution of the program. EVALUATION METHODS Each evolution of LIFT was measured through a pretest and posttest quasi-experimental design. Data were collected on each RE-AIM dimension through participant surveys and functional fitness assessments, number and representativeness of trainees, and process evaluation. RESULTS Overall, LIFT was expanded to 4 states with 275 instructors, reaching 816 older adults; consistently improved functional fitness outcome measures; demonstrated strong program adherence; and was seen as feasible and enjoyable by instructors and participants. LIFT is now undergoing adaptations for virtual delivery as well as updating the exercise protocol to introduce yoga postures that target flexibility and balance. IMPLICATIONS FOR PUBLIC HEALTH Overall, ongoing adaptations were necessary to ensure the program continued to fit the mission, values, and resources of the delivery system. Public health implications to support the need for ongoing adaptation include embedding pragmatic measures of adaptations and RE-AIM into standard evaluation pathways and using iterative APDER cycles.
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Affiliation(s)
- Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
- Virginia Tech, 1981 Kraft Dr, Blacksburg, VA 24060.
| | - Laura E Balis
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
- University of Wyoming Extension, Lander, Wyoming
| | - Thomas Strayer
- Vanderbilt University Medical Center, Center for Quality Aging, Nashville, Tennessee
| | - Meghan L Wilson
- Bluefield College, Department of Biology, Bluefield, Virginia
- Edward Via College of Osteopathic Medicine, Department of Preventive Medicine and Public Health, Blacksburg, Virginia
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Red, Yellow, and Green Light Changes: Adaptations to Extension Health Promotion Programs. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:903-912. [PMID: 33733430 DOI: 10.1007/s11121-021-01222-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
Extension professionals have high autonomy to adapt the programs they deliver. However, fidelity is typically not reported, so it is unknown what adaptations are made. It is also unknown whether agents have the necessary training to adapt programs while maintaining fidelity to the core components. The purpose of this study was to determine (1) adaptations that Extension agents and specialists are making to programs they deliver, (2) the reasons for making these adaptations, (3) timing of adaptations, and (4) Extension agents' and specialists' understanding of the adaptation process. Extension agents and specialists nationwide were invited to complete a survey which queried about adaptations based on the traffic light model, adaptome, and adaptation taxonomy. Specifically, the traffic light model assigns a color for adaptations: tailoring language or pictures (green), adding/substituting activities or session sequence (yellow), or deleting lessons and decreasing timeline or session length (red). Responses were received from 98 agents and 24 specialists. Most agents and specialists reported making green (85% and 79%, respectively), yellow (89% and 75%), and red light changes (81% and 58%). Agents were significantly more likely than specialists to change the age appropriateness of lessons or activities, respond to individual client needs, substitute activities, delete lessons or activities, decrease the length and/or number of sessions, and shorten the program timeline. Within green light changes, each of those that could increase cultural appropriateness (tailoring language, scenarios, and pictures) were reported by less than 50% of agents and specialists. Of the most common adaptations reported, the primary reasons for these decisions were difficulty retaining or engaging participants and lack of time/competing demands on time. Most adaptations were made before the program was delivered. Agents rated their confidence level in the program adaptation process as somewhat confident to confident. Dissemination and implementation strategies to improve program adaptation within Extension are needed, including participatory approaches, training on the adaptation process, bi-directional evidence-based program repositories, and organizational-level changes.
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Steketee AM, Harden SM. Mom Expo: Bridging the Gap Between Local Women and Perinatal Resources. J Perinat Educ 2021; 30:108-117. [PMID: 33897235 DOI: 10.1891/j-pe-d-20-00020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The purpose of this project was to describe the implementation of a perinatal health fair intended to connect local women to holistic resources. Researchers used participatory strategies to develop the health fair with local women and perinatal educators. Researchers evaluated the health fair using pragmatic measures based on the (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Forty-two attendees were reached and 23 educators hosted booths and educational sessions. Feedback indicated strong enthusiasm for future similar events. Nearly three quarters of the time spent implementing the health fair was devoted to building relationships within the community. Overall, this project provides practical and empirical information to inform the planning, implementation, and evaluation of perinatal health fairs that establish meaningful connection between local women, perinatal educators, and health researchers.
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Golden CA, Hill JL, Heelan KA, Bartee RT, Abbey BM, Malmkar A, Estabrooks PA. A Dissemination Strategy to Identify Communities Ready to Implement a Pediatric Weight Management Intervention in Medically Underserved Areas. Prev Chronic Dis 2021; 18:E10. [PMID: 33571083 PMCID: PMC7879964 DOI: 10.5888/pcd18.200248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose and Objectives We developed a competitive application process to test the feasibility of a fund and contract dissemination strategy to identify and engage communities that demonstrated the necessary resources and motivation to adopt, implement, and sustain a pediatric weight management intervention, Building Healthy Families, in rural and micropolitan (<50,000 residents) communities in Nebraska. Intervention Approach From April through December 2019, a community advisory board with representation from rural and micropolitan clinical, public health, education, and recreational organizations collaboratively developed a request for applications, as a fund and contract dissemination strategy, to encourage community adoption of Building Healthy Families. Evaluation Methods Quantitative assessments included determining the distribution of requests for applications, evaluating organizational readiness to change assessment (ORCA) ratings (on a scale of 1 to 5, from strongly disagree to strongly agree that the organization is ready to change), and reviewing community advisory board member ratings of applications. We gathered qualitative data from community narratives provided in response to the request for applications and community advisory board reviews of the applications. Results The request for applications was distributed to all 93 counties in Nebraska. Of the 8 communities that submitted a letter of intent, 7 submitted a community narrative. Across the 8 communities, 31 ORCAs were completed by the organizational decision makers (n = 15) and staff members (n = 16) who would be responsible for screening, recruiting, or implementing the intervention. Overall mean ORCA scores varied by ratings of evidence (4.1–4.6), context (4.2–4.9), and facilitation (4.3–4.8), indicating a high degree of readiness. Community advisory board ratings of applications ranged from 2.3 to 3.4 of 4 points. Qualitative data indicated that lower community narrative scores were primarily caused by weak implementation and sustainability plans. Implications for Public Health Findings provide guidance for translating pediatric weight management programs in medically underserved geographic areas by maximizing the probability of successful adoption and implementation through a fund and contract dissemination strategy.
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Affiliation(s)
- Caitlin A Golden
- University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365.
| | - Jennie L Hill
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Kate A Heelan
- University of Nebraska at Kearney, Kearney, Nebraska
| | - R Todd Bartee
- University of Nebraska at Kearney, Kearney, Nebraska
| | - Bryce M Abbey
- University of Nebraska at Kearney, Kearney, Nebraska
| | - Ali Malmkar
- University of Nebraska at Kearney, Kearney, Nebraska
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Steketee AM, Archibald TG, Harden SM. Adjust your own oxygen mask before helping those around you: an autoethnography of participatory research. Implement Sci 2020; 15:70. [PMID: 32883350 PMCID: PMC7469339 DOI: 10.1186/s13012-020-01002-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/18/2020] [Indexed: 02/06/2023] Open
Abstract
Background There is a need to unpack the empirical, practical, and personal challenges within participatory approaches advocated to optimize implementation. The unpredictable, chaotic nature of participatory approaches complicates application of implementation theories, methods, and strategies which do not address researchers’ situatedness within participatory processes. As an implementation scientist, addressing one’s own situatedness through critical reflection is important to unearth how conscious and unconscious approaches, including ontological and epistemological underpinnings, influence the participatory context, process, and outcomes. Therefore, the aim of this exploratory work is to investigate the heretofore blind spot toward the lived experience of implementation researchers within the participatory process. Methods We developed an integrated research-practice partnership (IRPP) to inform the implementation of a gestational weight gain (GWG) control program. Within this IRPP, one investigator conducted a 12-month autoethnography. Data collection and triangulation included field notes, cultural artifacts, and systematic timeline tracking. Data analysis included ethnographic-theoretical dialogue and restorying to synthesize key events and epiphanies into a narrative. Results Analysis revealed the unpredicted evolution of the GWG program into a maternal health fair and three themes within the researchers’ lived experience: (1) permeable work boundaries, (2) individual and collective blind spots toward the ontological and epistemological underpinnings of implementation paradigms, and (3) maladaptive behaviors seemingly reinforced by the research culture. These themes contributed to the chaos of implementation and to researchers’ experience of inadequate recovery from cognitive, emotional, and practical demands. These themes also demonstrated the importance of contextual factors, subjectivity, and value-based judgments within implementation research. Conclusion Building on extant qualitative research guidelines, we suggest that researchers anchor their approach to implementation in reflexivity, intentionally and iteratively reflecting on their own situatedness. Through this autoethnography, we have elucidated several strategies based on critical reflection including examining philosophical underpinnings of research, adopting restorative practices that align with one’s values, and embracing personal presence as a foundation of scientific productivity. Within the predominant (post-) positivism paradigms, autoethnography may be criticized as unscientifically subjective or self-indulgent. However, this work demonstrates that autoethnography is a vehicle for third-person observation and first-person critical reflection that is transformative in understanding and optimizing implementation contexts, processes, and outcomes.
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Affiliation(s)
- Abby M Steketee
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive, Room 1032, Blacksburg, VA, 24060, USA.
| | - Thomas G Archibald
- Department of Agricultural, Leadership, and Community Education, Virginia Tech, 284 Litton-Reaves Hall, Mail Code 0343, Blacksburg, VA, 24061, USA
| | - Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, 1981 Kraft Drive, Room 1032, Blacksburg, VA, 24060, USA
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Harden SM, Steketee AM, Kelliher R, Mason KA, Fitzwater Boyle N. Using a Studio-Academic Partnership to Advance Public Health Within a Pragmatic Yoga Setting. J Prim Care Community Health 2020; 10:2150132719874621. [PMID: 31538842 PMCID: PMC6755627 DOI: 10.1177/2150132719874621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objectives: To explore community-based yoga studio practitioners' psychosocial variables, behaviors, and studio satisfaction. Methods: Concurrent mixed-methods study consisted of a survey for demographic variables and psychosocial variables of interest (e.g., mindfulness, self-compassion, physical activity participation) and interviews regarding reasons for participating at the yoga studio. Results: Participants (N = 138) were, on average, 35.58 ± 14.09 years old and predominantly female (91.3%), married (40.6%) or single (37%), Caucasian (75%), and college (25.4%) or graduate/medical school (45%) educated, with 54% meeting physical activity recommendations. On a 5-point Likert-type scale, participants reported being moderately cohesive (Msumscore = 3.87 ± 0.62), stressed (Msumscore = 3.2 ± 0.39), mindful (Msumscore = 3.4 ± 0.41), and self-compassionate (Msumscore = 3.26 ± 0.56). A rapid content analysis of interviews (n = 18), indicated that participants primarily practiced at the studio for the sense of community. Conclusions: Yoga practitioners reported positive perceptions and behaviors; however, opportunities remain for interventions to improve mental and physical health among individuals already attending a yoga studio. Through an academic-studio partnership, studio offerings may include low-dose evidence-based interventions to improve access to and uptake of a yoga practice.
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Transdisciplinary Approaches for the Dissemination of the SWITCH School Wellness Initiative Through a Distributed 4-H/Extension Network. CHILD & YOUTH CARE FORUM 2020. [DOI: 10.1007/s10566-020-09556-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Background
Schools provide an ideal setting for promoting healthy lifestyles in youth, but it has proven difficult to promote the adoption and implementation of evidence-based programming by school leaders. The SWITCH® (School Wellness Integration Targeting Child Health) intervention is a capacity-building process designed to help school leaders learn how to plan, implement, and sustain school wellness programs on their own.
Objective
The present study evaluates the transdisciplinary approaches used in establishing an integrated research-practice partnership with the state-wide 4-H/Extension network to support broader dissemination.
Method
The study used a mixed methods approach to evaluate the degree of engagement and motivation of 4-H leaders (N = 30) for providing ancillary support for local school wellness programming. Engagement from 4-H Staff was logged over a year-long period through tracking completion of training and ongoing engagement with aspects of SWITCH. They completed checkpoint surveys and an interview to provide perceptions of supporting school implementation of SWITCH programming. Data were analysed through Pearson bivariate correlations and constant comparative analysis.
Results
County-level 4-H staff demonstrated high engagement in SWITCH by attending training sessions and hosting structured checkpoint sessions with schools. Interview data revealed that 4-H Staff valued connections with schools and emphasized that training on SWITCH was consistent with their existing roles related to youth programming.
Conclusions
The results demonstrate the value of the sequential capacity-building process used to train 4-H Staff to facilitate school wellness programming. The transdisciplinary approaches built transferable skills and fostered relationships that directly support the broader goals of 4-H.
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Aviles J, Porter GC, Estabrooks PA, Alexander NB, Madigan ML. Potential Implementation of Reactive Balance Training within Continuing Care Retirement Communities. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2020; 5:51-58. [PMID: 33447659 DOI: 10.1249/tjx.0000000000000120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the feasibility of implementing reactive balance training (RBT) in continuing care retirement communities, as a part of typical practice in these facilities. METHODS RBT, a task-specific exercise program, consisted of repeatedly exposing participants to trip-like perturbations on a modified treadmill to improve reactive balance, and subsequently reduce fall risk. Semi-structured interviews were conducted with retirement community residents (RBT participants) and administrators, to assess the organizational context, perceptions of evidence for falls prevention, and facilitation strategies that could improve the likelihood of implementing RBT as a falls-prevention program. RESULTS Contextual factors such as leadership support, culture of change, evaluation capabilities, and receptivity to RBT among administrators and health leaders at the participating retirement communities could facilitate future implementation. The cost associated with RBT (e.g. equipment and personnel), resident recruitment, and accessibility of RBT for many residents were identified as primary barriers related to the intervention. Participants perceived observable health benefits after completing RBT, had increased awareness toward tripping, and greater confidence with respect to mobility. Across interviewees potential barriers for implementation regarding facilitation revolved around the compatibility and customizability for different participant capabilities that would need to be considered before adopting RBT. CONCLUSION RBT could fill a need in retirement communities and the findings provide areas of context, characteristics of the intervention, and facilitation approaches that could improve uptake.
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Affiliation(s)
- Jessica Aviles
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA
| | - Gwenndolyn C Porter
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE
| | - Paul A Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE
| | - Neil B Alexander
- University of Michigan and Ann Arbor Veterans Affairs Health Care System Geriatric Research Education and Clinical Center
| | - Michael L Madigan
- Grado Department of Industrial & Systems Engineering, Virginia Tech, Blacksburg, VA
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Wilson KE, Harden SM, Kleppe L, McGuire T, Estabrooks PA. The impact of pairing a wearable movement tracker with an online community weight loss intervention. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2020; 5:29-38. [PMID: 33447657 PMCID: PMC7802806 DOI: 10.1249/tjx.0000000000000116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Evidence supports the use of technology supported multicomponent interventions for promoting weight loss. Many such programs include the opportunity to synchronously pair commercially available physical activity trackers (PA-T) with a goal to enhance weight loss outcomes. However, little is known about the reach and effectiveness of allowing participants to pair a PA-T within an existing online program. PURPOSE This matched cohort, quasi-experimental study aimed to determine 1) the proportion of participants that pair a PA-T to the existing program, 2) the representativeness of participants who pair a PA-T; 3) the relationship between pairing a PA-T, overall weight loss, and the likelihood of achieving a clinically meaningful weight loss; and 4) if pairing a PA-T with program participation is related to weight loss outcomes independently or collectively when considering other indices of program engagement. METHODS Data collected over a four-year period included demographic self-report, objective weight data uploaded when participants weighed themselves at a self-serve program kiosk available to the community, and program engagement data (e.g., logins to program website). A range of analyses, including descriptive proportions, analyses of variance, and path analyses, were used to address the purposes of the study. RESULTS Participants who paired a PA-T were more likely to be women (p<.001), African American (p<.001), and have a higher BMI (p<.05). Those who paired a PA-T lost on average an extra 1% body weight and were 1.4 times more likely to lose 5% body weight. Pairing a PA-T was related to other indices of online program engagement and both directly and indirectly contributed to weight loss outcomes (p<.05). CONCLUSIONS Pairing a PA-T within an online weight loss program appeals to groups that experience disparities related to obesity and predicts improvements in weight loss. More translational studies are needed to examine the role of personal psychosocial and environmental factors that may enhance or diminish the benefit of pairing a PA-T to evidence-based, online weight loss programs.
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Zoellner JM, You W, Hill JL, Brock DJP, Yuhas M, Alexander RC, Price B, Estabrooks PA. A comparative effectiveness trial of two family-based childhood obesity treatment programs in a medically underserved region: Rationale, design & methods. Contemp Clin Trials 2019; 84:105801. [PMID: 31260792 DOI: 10.1016/j.cct.2019.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/13/2019] [Accepted: 06/27/2019] [Indexed: 12/18/2022]
Abstract
While there is a large body of literature documenting the efficacy of family-based childhood obesity (FBCO) treatment interventions, there is little evidence that these interventions have been systematically translated into regular practice - particularly in health disparate regions. To address this research-practice gap, this project was guided by a community advisory board (CAB) and the RE-AIM planning and evaluation framework within a systems-based and community-based participatory research approach. Families with overweight or obese children between 5 and 12 years old, in the medically-underserved Dan River Region, were randomly assigned to one of two FBCO treatment programs (iChoose vs. Family Connections) delivered by local Parks & Recreation staff. Both programs have previously demonstrated clinically meaningful child BMI z-score reductions, but vary in intensity, structure, and implementation demands. Two clinical CAB partners embedded recruitment methods into their regional healthcare organization, using procedures representative to what could be used if either program was taken to scale. The primary effectiveness outcome is child BMI z-scores at 6-months, with additional assessments at 3-months and at 12-months. Secondary goals are to determine: (1) reach into the intended audience; (2) effectiveness on secondary child and parent outcomes; (3) intervention adoption by organizations and staff; (4) fidelity, cost, and capacity for intervention implementation; and (5) maintenance of individual-level changes and organizational-level sustainability. This research addresses literature gaps related to the features within clinical and community settings that could improve both child weight status and the translation of FBCO interventions into typical practice in medically-underserved communities. IDENTIFIERS: Clincialtrials.gov: NCT03245775.
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Affiliation(s)
- Jamie M Zoellner
- University of Virginia (UVA), Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA.
| | - Wen You
- Virginia Tech, Department of Agricultural and Applied Economics, 304 Hutcheson Hall, 24060, USA
| | - Jennie L Hill
- Department of Epidemiology, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075, USA
| | - Donna-Jean P Brock
- University of Virginia (UVA), Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Maryam Yuhas
- University of Virginia (UVA), Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Ramine C Alexander
- Department of Family and Consumer Sciences, North Carolina A&T State University, Benbow 202-A, Greensboro, NC 27411, USA
| | - Bryan Price
- UVA Cancer Center, Community Outreach and Education, Main Street, Unit 102, Danville, VA 24541, USA
| | - Paul A Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075, USA
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Bauman AE, Smith BJ, Bellew W. Moving Research Translation on Physical Activity to Center Stage. Exerc Sport Sci Rev 2019; 47:127-128. [PMID: 31205234 DOI: 10.1249/jes.0000000000000195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Adrian E Bauman
- School of Public Health, Sydney University, Sydney, New South Wales, Australia
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