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Gaskin DJ, Zare H, Ibe CA, Yang M, Jones W, Gaston M, Porter G, Woods DL, Balamani M, Jones N, Rose VA, Williams RA, Rohde C. The impact of the Prime Time Sister Circles® (PTSC) on blood pressure of low-income mid-life African American women in the United States. J Public Health Policy 2023; 44:616-633. [PMID: 37899483 PMCID: PMC10709469 DOI: 10.1057/s41271-023-00450-5] [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: 10/09/2023] [Indexed: 10/31/2023]
Abstract
There is a pressing need to develop and evaluate culturally tailored, community-based interventions that address hypertension management among low-income African American women. We employed a randomized controlled trial to test the effectiveness of the Prime Time Sister Circles® Program in reducing blood pressure and body mass index among low-income African American women ages with hypertension. Study participants (N = 339) were African American women aged 40-75 years who were diagnosed with hypertension and received their primary care at government funded health centers in Washington, D.C. Compared to the usual care group, Prime Time Sister Circles® participation was associated with a reduction in systolic BP by - 2.45 (CI - 6.13, 1.23) mmHg, a reduction in diastolic BP by - 3.66 mmHg (CI - 6.32, - 0.99), and a change in BMI by - 0.26 (CI - 2.00, 1.48) from baseline to 15 months. The results suggest that culturally tailored community-based interventions can improve hypertension management in low-income women.
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Affiliation(s)
- Darrell J Gaskin
- Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins University, Baltimore, MD, USA.
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway Ste 441, Baltimore, MD, 21205-1900, USA.
| | - Hossein Zare
- Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins University, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Global Health Services and Administration, University of Maryland Global Campus, Adelphi, MD, USA
| | - Chidinma A Ibe
- Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins University, Baltimore, MD, USA
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Manshu Yang
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Wehmah Jones
- American Institutes for Research, Washington, DC, USA
| | - Marilyn Gaston
- The Gaston & Porter Health Improvement Center, Inc., Washington, DC, USA
| | - Gayle Porter
- The Gaston & Porter Health Improvement Center, Inc., Washington, DC, USA
| | - Denise L Woods
- The Gaston & Porter Health Improvement Center, Inc., Washington, DC, USA
| | | | - Nicole Jones
- Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins University, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Richard Allen Williams
- David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Charles Rohde
- Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins University, Baltimore, MD, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Implementation of an Evidence-Based, Tai Ji Quan Fall Prevention Program in Rural West Virginia Churches: A RE-AIM Evaluation. J Aging Phys Act 2023; 31:33-47. [PMID: 35690393 DOI: 10.1123/japa.2021-0274] [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: 07/14/2021] [Revised: 03/23/2022] [Accepted: 04/03/2022] [Indexed: 02/03/2023]
Abstract
This study implemented a 16-week Tai Ji Quan: Moving for Better Balance® intervention for older adults in churches in hard-to-reach, medically underserved, rural communities, and evaluated the process using the RE-AIM Framework. Community-dwelling adults, aged 55 years, or older, were eligible. Data (N = 237) were collected at baseline, 16 weeks, and 32 weeks on falls efficacy, depression, physical/mental health-related quality of life, aerobic activity, gait speed, mobility, balance, and leg strength. Generalized/linear mixed models determined if outcomes improved. Eighteen churches sponsored 16 classes. Church adoption was 94%, instructor adoption was 86%, reach was 90%, and fidelity was good/fair. All outcomes improved except physical health-related quality of life and gait speed. Thirty-six percent of participants, 28% of churches, and 37% of instructors continued Tai Ji Quan: Moving for Better Balance at 32 weeks. Compared with two prior RE-AIM evaluations, adoption and reach rates, improvements in outcomes, and satisfaction were comparable; attendance, program completion, and continuation rates were lower.
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D'Lima D, Soukup T, Hull L. Evaluating the Application of the RE-AIM Planning and Evaluation Framework: An Updated Systematic Review and Exploration of Pragmatic Application. Front Public Health 2022; 9:755738. [PMID: 35155336 PMCID: PMC8826088 DOI: 10.3389/fpubh.2021.755738] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background RE-AIM is one of the most widely applied frameworks to plan and evaluate the implementation of public health and health behavior change interventions. The objective of this review is to provide an updated synthesis of use of the RE-AIM (Reach Effectiveness Adoption Implementation and Maintenance) planning and evaluation framework and explore pragmatic use (i.e., partial application of the framework) and how this is reported. Methods Systematic review. MEDLINE (R) and PsycINFO were searched, via the Ovid interface, between January 2011 and December 2017. Studies that applied RE-AIM as a planning and/or evaluation framework were included. Results One hundred fifty-seven articles met inclusion criteria. One hundred forty-nine reported using RE-AIM for evaluation, three for planning and five for planning and evaluation. Reach was the most frequently reported dimension (92.9%), followed by implementation (90.3%), adoption (89.7%), effectiveness (84.5%), and maintenance (77.4%). One hundred forty-seven/one hundred fifty-seven articles originated from high-income economy countries. Within a sub-set analysis (10% of included articles), 9/15 articles evaluated all dimensions. Of the 6/15 articles that did not evaluate all dimensions, five provided no justification for pragmatic application. Conclusions RE-AIM has gained increased use in recent years and there is evidence that it is being applied pragmatically. However, the rationale for pragmatic use is often not reported. Systematic Review Registration PROSPERO (CRD42017054616).
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Affiliation(s)
- Danielle D'Lima
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, United Kingdom
| | - Tayana Soukup
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
| | - Louise Hull
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
- *Correspondence: Louise Hull
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Sutherland RL, Jackson JK, Lane C, McCrabb S, Nathan NK, Yoong SL, Lum M, Byaruhanga J, McLaughlin M, Brown A, Milat AJ, Bauman And AE, Wolfenden L. A systematic review of adaptations and effectiveness of scaled-up nutrition interventions. Nutr Rev 2021; 80:962-979. [PMID: 34919715 PMCID: PMC8907487 DOI: 10.1093/nutrit/nuab096] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Context Public health nutrition interventions shown to be effective under optimal research conditions need to be scaled up and implemented in real-world settings. Objectives The primary aim for this review was to assess the effectiveness of scaled-up public health nutrition interventions with proven efficacy, as examined in a randomized controlled trial. Secondary objectives were to: 1) determine if the effect size of scaled-up interventions were comparable to the prescale effect, and; 2) identify any adaptations made during the scale-up process. Data sources Six electronic databases were searched and field experts contacted. Study selection An intervention was considered scaled up if it was delivered on a larger scale than a preceding randomized controlled trial (“prescale”) in which a significant intervention effect (P ≤ 0.05) was reported on a measure of nutrition. Data extraction Two reviewers independently performed screening and data extraction. Effect size differences between prescale and scaled-up interventions were quantified. Adaptations to scale-up studies were coded according to the Adaptome model. Results Ten scaled-up nutrition interventions were identified. The effect size difference between prescale trials and scaled-up studies ranged from –32.2% to 222% (median, 50%). All studies made adaptations between prescale to scaled-up interventions. Conclusion The effects of nutrition interventions implemented at scale typically were half that achieved in prior efficacy trials. Identifying effective scale-up strategies and methods to support retainment of the original prescale effect size is urgently needed to inform public health policy. Systematic Review Registration PROSPERO registration no.CRD42020149267.
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Affiliation(s)
- Rachel L Sutherland
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jacklyn K Jackson
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Cassandra Lane
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sam McCrabb
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nicole K Nathan
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sze Lin Yoong
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Melanie Lum
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Judith Byaruhanga
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Matthew McLaughlin
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Alison Brown
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew J Milat
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Adrian E Bauman And
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Luke Wolfenden
- R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, A.E. Bauman, and L. Wolfenden are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia. R.L. Sutherland, J.K. Jackson, C. Lane, S. McCrabb, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. R.L. Sutherland, C. Lane, N.K. Nathan, S.L. Yoong, M. Lum, J. Byaruhanga, M. McLaughlin, A. Brown, and L. Wolfenden are with the Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia. S.L. Yoong is with the School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia. A.J. Milat and A.E. Bauman are with the School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Resnick B, Boltz M, Galik E, Fix S, Holmes S, Zhu S, Barr E. Testing the Implementation of Function-focused Care in Assisted Living Settings. J Am Med Dir Assoc 2021; 22:1706-1713.e1. [PMID: 33132018 PMCID: PMC8081737 DOI: 10.1016/j.jamda.2020.09.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the Function-Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) intervention. DESIGN FFC-AL-EIT was a randomized controlled pragmatic trial including 85 sites and 794 residents. INTERVENTION FFC-AL-EIT was implemented by a Research Nurse Facilitator working with a facility champion and stakeholder team for 12 months to increase function and physical activity among residents. FFC-AL-EIT included (Step I) Environment and Policy Assessments; (Step II) Education; (Step III) Establishing Resident Function-Focused Care Service Plans; and (Step IV) Mentoring and Motivating. SETTING AND PARTICIPANTS The age of participants was 89.48 years [standard deviation (SD) = 7.43], and the majority were female (n = 561; 71%) and white (n = 771; 97%). METHODS Resident measures, obtained at baseline, 4, and 12 months, included function, physical activity, and performance of function-focused care. Setting outcomes, obtained at baseline and 12 months, included environment and policy assessments and service plans. RESULTS Reach was based on 85 of 90 sites that volunteered (94%) participating. Effectiveness was based on less decline in function (P < .001), more function-focused care (P = .012) and better environment (P = .032) and policy (P = .003) support for function-focused care in treatment sites. Adoption was supported with 10.00 (SD = 2.00) monthly meetings held, 77% of settings engaged in study activities as or more than expected, and direct care workers providing function-focused care (63% to 68% at 4 months and 90% at 12 months). The intervention was implemented as intended, and education was received based on a mean knowledge test score of 88% correct. Evidence of maintenance from 12 to 18 months was noted in treatment site environments (P = .35) and policies continuing to support function-focused care (P = .28)]. CONCLUSIONS AND IMPLICATIONS The Evidence Integration Triangle is an effective implementation approach for assisted living. Future work should continue to consider innovative approaches for measuring RE-AIM outcomes.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA.
| | - Marie Boltz
- College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Steven Fix
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Sarah Holmes
- Lamy Center, University of Maryland, Baltimore, MD, USA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Eric Barr
- University of Maryland School of Nursing, Baltimore, MD, USA
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Alsukait RF, Folta SC, Chui K, Seguin RA, Sinclair CG, Hudson LB. Healthy Hearts for an Abundant Life: Feasibility of a Culturally Adapted Cardiovascular Disease Prevention Curriculum for African American Women. Health Equity 2021; 5:398-407. [PMID: 34235364 PMCID: PMC8237101 DOI: 10.1089/heq.2021.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study tested the feasibility of implementing Healthy Hearts for an Abundant Life (HHAL), a cultural adaptation for African American (AA) women of the evidence-based cardiovascular disease prevention program Strong Women-Healthy Hearts (SWHH). Methods: Using a quasi-experimental pre-post study design, this 12-week program was implemented in four faith-based organizations between 2017 and 2018. Eligible participants were AA women between 40 and 65 years who had a body mass index of 25 or higher and were currently sedentary. HHAL program participants met weekly for 2-h sessions led by program leaders. The curriculum has four modules: total health; relationships, family, and networks; material security and the environment; and emotional wellness. Each class included walking for 30 min, goal-setting session, and a group dialog called "making it work" for building collective efficacy. Results: Of the 27 participants (mean age=54.2±5.9), 24 completed postassessments (93% retention rate). All outcome measures proved feasible and weekly program attendance was 73%. Findings from in-depth interviews show high satisfaction with the program and suggest extending the class time and adding cooking demonstrations. Conclusions: The culturally adapted HHAL proved feasible and was positively received by the participants. Future studies will evaluate the effectiveness of the program.
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Affiliation(s)
- Reem F. Alsukait
- Community Health Department, King Saud University, Riyadh, Saudi Arabia
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Kenneth Chui
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Rebecca A. Seguin
- College of Agriculture and Life Sciences, Texas A&M University, College Station, Texas, USA
| | - Christine G. Sinclair
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Linda B. Hudson
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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7
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Lane C, McCrabb S, Nathan N, Naylor PJ, Bauman A, Milat A, Lum M, Sutherland R, Byaruhanga J, Wolfenden L. How effective are physical activity interventions when they are scaled-up: a systematic review. Int J Behav Nutr Phys Act 2021; 18:16. [PMID: 33482837 PMCID: PMC7821550 DOI: 10.1186/s12966-021-01080-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/05/2021] [Indexed: 12/18/2022] Open
Abstract
Background The ‘scale-up’ of effective physical activity interventions is required if they are to yield improvements in population health. The purpose of this study was to systematically review the effectiveness of community-based physical activity interventions that have been scaled-up. We also sought to explore differences in the effect size of these interventions compared with prior evaluations of their efficacy in more controlled contexts, and describe adaptations that were made to interventions as part of the scale-up process. Methods We performed a search of empirical research using six electronic databases, hand searched reference lists and contacted field experts. An intervention was considered ‘scaled-up’ if it had been intentionally delivered on a larger scale (to a greater number of participants, new populations, and/or by means of different delivery systems) than a preceding randomised control trial (‘pre-scale’) in which a significant intervention effect (p < 0.05) was reported on any measure of physical activity. Effect size differences between pre-scale and scaled up interventions were quantified ([the effect size reported in the scaled-up study / the effect size reported in the pre-scale-up efficacy trial] × 100) to explore any scale-up ‘penalties’ in intervention effects. Results We identified 10 eligible studies. Six scaled-up interventions appeared to achieve significant improvement on at least one measure of physical activity. Six studies included measures of physical activity that were common between pre-scale and scaled-up trials enabling the calculation of an effect size difference (and potential scale-up penalty). Differences in effect size ranged from 132 to 25% (median = 58.8%), suggesting that most scaled-up interventions typically achieve less than 60% of their pre-scale effect size. A variety of adaptations were made for scale-up – the most common being mode of delivery. Conclusion The majority of interventions remained effective when delivered at-scale however their effects were markedly lower than reported in pre-scale trials. Adaptations of interventions were common and may have impacted on the effectiveness of interventions delivered at scale. These outcomes provide valuable insight for researchers and public health practitioners interested in the design and scale-up of physical activity interventions, and contribute to the growing evidence base for delivering health promotion interventions at-scale. Trial registration PROSPERO CRD42020144842. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01080-4.
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Affiliation(s)
- Cassandra Lane
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia. .,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia. .,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Sam McCrabb
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Adrian Bauman
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Andrew Milat
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Melanie Lum
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Judith Byaruhanga
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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8
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Seguin-Fowler RA, Strogatz D, Graham ML, Eldridge GD, Marshall GA, Folta SC, Pullyblank K, Nelson ME, Paul L. The Strong Hearts, Healthy Communities Program 2.0: An RCT Examining Effects on Simple 7. Am J Prev Med 2020; 59:32-40. [PMID: 32389532 PMCID: PMC7311302 DOI: 10.1016/j.amepre.2020.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Rural women have higher rates of cardiovascular disease than their nonrural counterparts, partially because of their social and environmental contexts. The study objective is to test a refined version of the multilevel Strong Hearts, Healthy Communities intervention, which used extensive process and outcome evaluation data from the original randomized trial to optimize effectiveness as measured by improved Simple 7 score, a composite measure of cardiovascular disease risk. STUDY DESIGN The intervention was implemented in a 6-month, delayed intervention, community-randomized trial; control participants received the program following 24-week outcome assessment. The study was conducted in 2017-2018; data analysis occurred in 2018-2019. SETTING/PARTICIPANTS The study was conducted in 11 rural, medically underserved towns in New York. Participants were women aged ≥40 years who were either (1) obese or (2) overweight and sedentary. INTERVENTION The intervention group received 24 weeks of hour-long, twice-weekly classes including strength training, aerobic exercise, and skill-based nutrition- and health-related education, as well as civic engagement activities focused on healthy food and physical activity environments. MAIN OUTCOME MEASURES Measures included weight and height; blood pressure; blood cholesterol; blood glucose; and self-reported smoking, diet, and physical activity behaviors. Individual Simple 7 components were examined, and mixed linear regression analyses were used to examine change in Simple 7 score. RESULTS A total of 182 participants were randomized. Compared with control participants, the intervention group had greater improvements in Simple 7 score (difference=1.03, 95% CI=0.44, 1.61, p<0.001) and 3 of the Simple 7 components (physical activity, healthy diet score, and BMI). CONCLUSIONS These findings highlight the importance of rigorously evaluating programs in real-world community settings and, when appropriate, revising and retesting interventions to optimize dissemination potential. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT03059472.
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Affiliation(s)
- Rebecca A Seguin-Fowler
- Texas A&M AgriLife Research, Texas A&M University System, College Station, Texas; Department of Nutrition, Texas A&M University, College Station, Texas.
| | - David Strogatz
- Center for Rural Community Health, Bassett Research Institute, Cooperstown, New York
| | - Meredith L Graham
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Galen D Eldridge
- Texas A&M AgriLife Research, Texas A&M University System, College Station, Texas
| | - Grace A Marshall
- Master of Public Health Program, Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, New York
| | - Sara C Folta
- Friedman School of Nutrition, Tufts University, Boston, Massachusetts
| | - Kristin Pullyblank
- Center for Rural Community Health, Bassett Research Institute, Cooperstown, New York
| | - Miriam E Nelson
- Friedman School of Nutrition, Tufts University, Boston, Massachusetts
| | - Lynn Paul
- Montana State University Extension, Bozeman, Montana
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Washburn L, Hadden KB, Prince LY, McNeill C, Moon Z. Development and Implementation of the How to Talk to Your Doctor HANDbook Health Literacy Program in Rural Counties. Health Lit Res Pract 2019; 3:e205-e215. [PMID: 31511846 PMCID: PMC6733308 DOI: 10.3928/24748307-20190731-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/13/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Improvements in health literacy are unlikely without intervention in community settings. However, interventions appropriate for delivery in these settings are lacking, limiting reach to rural adults who are disproportionately affected by low health literacy and poor health outcomes. The How to Talk to Your Doctor (HTTTYD) HANDbook Program was developed through a research-practice partnership to educate rural residents to effectively advocate and participate in their own health care. Brief Description of Activity: We describe development of the HTTTYD HANDbook Program delivered through the Cooperative Extension Service to educate adults who are eligible for Medicaid and have low health literacy. HTTTYD HANDbook implementation is described using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework (and specifically the reach, adoption, implementation, and maintenance dimensions). Implementation: The HTTTYD HANDbook was developed using health literacy best practices with user-centered design, and it was field tested with community members with varying levels of health literacy. Reach, adoption, implementation, and maintenance of the HTTTYD HANDbook were assessed by tracking distribution of HTTTYD HANDbook Program materials, return submission of evaluation and tracking instruments, adherence to program and data collection/submission protocols, and program continuation. Results: Overall reach into the population was 6 per 10,000; about 25% were Medicaid recipients and 28.2% had low health literacy. Most participants were age 65 years or older. Of the 72 counties with program access, 52.7% requested HTTTYD HANDbook Program materials; 31% adopted the program, but only 30% of these counties adhered to program implementation and data collection protocols. Reach and adoption were higher among rural counties, and rural counties were more likely than nonrural counties to maintain the HTTTYD HANDbook Program. Lessons Learned: The HTTTYD HANDbook Program addresses barriers to engagement in patient-provider communication for rural, low-income community members. Programs can be implemented in community settings through established local organizations, such as county extension offices, to increase access for rural adults. Implementation barriers included staff turnover and transportation of program materials. Online facilitator training availability had little impact on adherence to program protocols. Organizational context and established procedures for program delivery and evaluation should be considered in adoption decisions and integrated into implementation protocols. [HLRP: Health Literacy Research and Practice. 2019;3(3):e205–e215.] Plain Language Summary: The How to Talk to Your Doctor HANDbook Program was created with people from the community to help patients prepare for doctor visits. The How to Talk to Your Doctor HANDbook Program helps patients to overcome barriers to talking to their doctor so that they can better understand how to get healthy and stay healthy.
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Affiliation(s)
- Lisa Washburn
- Address correspondence to Lisa Washburn, DrPH, University of Tennessee Extension, Family & Consumer Sciences, 2621 Morgan Circle, 119 Morgan Hall, Knoxville, TN 37996-4501;
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10
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Lo SB, Ryba MM, Brothers BM, Andersen BL. Predicting implementation of an empirically supported treatment for cancer patients using the theory of planned behavior. Health Psychol 2019; 38:1075-1082. [PMID: 31512921 DOI: 10.1037/hea0000794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is a continuing gap between the availability of cancer control empirically supported treatments (ESTs) to address psychological needs of cancer patients and their dissemination to and implementation by providers in the community. The Theory of Planned Behavior (TPB), with constructs of attitudes, subjective norms, perceived behavioral control, and intentions, is used to understand the pathways to and prediction of providers' behavior, that is, implementation of a cancer control EST and its provision to patients. PURPOSE The purpose of the study was to prospectively test the TPB in predicting providers' usage of a cancer-specific EST, the biobehavioral intervention (BBI). METHOD Providers (N = 166) were trained. At training's end, providers completed measures of attitudes, perceived behavioral control, and intentions to use the BBI, and their supervisors completed measures of attitudes operationalized as subjective norms. Providers were followed up and 4 months later reported their usage of the BBI with patients in the last 2 months. Regression-based path analyses tested attitudes, perceived behavioral control, subjective norms, and intentions as predictors of BBI usage and for the possible effect of intentions as a mediator. RESULTS Provider's BBI usage was high, delivered to 65.6% of patients. Providers' attitudes toward the BBI (b = .006; 95% confidence interval [CI: .002, .010]) and subjective norms (supervisors' attitudes toward providers' EST usage; b = .021; 95% CI [.007, .034]) predicted usage. Intentions predicted usage in univariate analyses but was not a mediator for usage. CONCLUSIONS Use of theory in implementation science can test and identify variables key to implementation success. Here the TPB identified providers' and supervisors' attitudes as predictors of EST usage. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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11
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McCrabb S, Lane C, Hall A, Milat A, Bauman A, Sutherland R, Yoong S, Wolfenden L. Scaling-up evidence-based obesity interventions: A systematic review assessing intervention adaptations and effectiveness and quantifying the scale-up penalty. Obes Rev 2019; 20:964-982. [PMID: 30868745 DOI: 10.1111/obr.12845] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/07/2019] [Accepted: 02/09/2019] [Indexed: 01/06/2023]
Abstract
Maximizing the benefits of investments in obesity research requires effective interventions to be adopted and disseminated broadly across populations (scaled-up). However, interventions often need considerable adaptation to enable implementation at scale, a process that can reduce the effects of interventions. A systematic review was undertaken for trials that sought to deliver an obesity intervention to populations on a larger scale than a preceding randomized controlled trial (RCT) that established its efficacy. Ten scaled-up obesity interventions (six prevention and four treatment) were included. All trials made adaptations to interventions as part of the scale-up process, with mode of delivery adaptations being most common. A meta-analysis of body mass index (BMI)/BMI z score (zBMI) from three prevention RCTs found no significant benefit of scaled-up interventions relative to control (standardized mean difference [SMD] = 0.03; 95% CI, -0.09 to 0.15, P = 0.639 - I2 = 0.0%). All four treatment interventions reported significant improvement on all measures of weight status. Pooled BMI/zBMI data from prevention trials found significantly lower effects among scaled-up intervention trials than those reported in pre-scale-up efficacy trials (SMD = -0.11; 95% CI, -0.20 to -0.02, P = 0.018 - I2 = 0.0%). Across measures of weight status, physical activity/sedentary behaviour, and nutrition, the effects reported in scaled-up interventions were typically 75% or less of the effects reported in pre-scale-up efficacy trials. The findings underscore the challenge of scaling-up obesity interventions.
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Affiliation(s)
- Sam McCrabb
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Cassandra Lane
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Alix Hall
- Clinical Research Design, IT, and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute (HMRI), New Lambton Heights, New South Wales, Australia
| | - Andrew Milat
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Adrian Bauman
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Clinical Research Design, IT, and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute (HMRI), New Lambton Heights, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Serene Yoong
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Clinical Research Design, IT, and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute (HMRI), New Lambton Heights, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
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12
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Seguin RA, Graham ML, Eldridge G, Nelson ME, Strogatz D, Folta SC, Paul L. Strong Hearts for New York: A multilevel community-based randomized cardiovascular disease risk reduction intervention for rural women. Contemp Clin Trials 2019; 82:17-24. [PMID: 31129372 PMCID: PMC6606389 DOI: 10.1016/j.cct.2019.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/06/2019] [Accepted: 05/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rural midlife and older women have high rates of cardiovascular disease (CVD) risk factors and lower access to healthy living resources. The Strong Hearts, Healthy Communities (SHHC) intervention, tailored to the needs of rural women, demonstrated effectiveness on many outcomes. The purpose of the Strong Hearts for New York (SHNY) study is to evaluate the efficacy of an enhanced version of the curriculum (SHHC-2.0). METHODS SHNY is a randomized controlled efficacy intervention, comparing participants receiving the SHHC-2.0 curriculum with a delayed intervention control group. SHHC, informed by formative research, includes core elements from three evidence-based programs. Changes based on extensive outcome and process evaluation data were made to create SHHC-2.0. Classes will meet twice weekly for 24 weeks and include individual, social, and environmental components. Overweight women age 40 and over will be recruited from 11 rural, medically underserved communities in New York; data will be collected at baseline and 12, 24, 36, and 48 weeks across individual, social, and environmental levels. Primary outcome is body weight. Secondary outcomes include Simple 7 (composite CVD risk score), anthropometric, physiologic, biochemical, physical activity, and dietary intake measures; healthy eating and exercise self-efficacy and attitudes; and self-efficacy of the social network of participants. DISCUSSION The aims of this study are to evaluate the efficacy of the enhanced SHHC-2.0 program for participants, changes among participants' social networks, and the difference in outcomes when participants are and are not provided with technological tools (Fitbit and body composition scale).
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Affiliation(s)
- Rebecca A Seguin
- Cornell University, Division of Nutritional Sciences, 412 Savage Hall, Ithaca, NY 14853, USA.
| | - Meredith L Graham
- Cornell University, Division of Nutritional Sciences, 413 Savage Hall, Ithaca, NY 14853, USA.
| | - Galen Eldridge
- Cornell University, Division of Nutritional Sciences, 413 Savage Hall, Ithaca, NY 14853, USA.
| | - Miriam E Nelson
- Hampshire College, 893 West St, Amherst, MA 01002, USA; Tufts University, Friedman School of Nutrition, 150 Harrison Ave, Boston, MA 02111, USA.
| | - David Strogatz
- Bassett Research Institute, One Atwell Rd, Cooperstown, NY 13326, USA.
| | - Sara C Folta
- Tufts University, Friedman School of Nutrition, 150 Harrison Ave, Boston, MA 02111, USA.
| | - Lynn Paul
- Montana State University Extension, 322 Reid Hall, Bozeman, MT 59717, USA
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13
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Sriram U, Sandreuter K, Graham M, Folta S, Pullyblank K, Paul L, Seguin R. Process Evaluation of Strong Hearts, Healthy Communities: A Rural Community-Based Cardiovascular Disease Prevention Program. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:138-149. [PMID: 30738562 PMCID: PMC6422156 DOI: 10.1016/j.jneb.2018.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/13/2018] [Accepted: 10/21/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To evaluate the implementation of a community-based cardiovascular disease prevention program for rural women: Strong Hearts, Healthy Communities (SHHC). DESIGN Mixed-methods process evaluation. SETTING/PARTICIPANTS A total of 101 women from 8 rural towns were enrolled in the SHHC program; 93 were enrolled as controls. Eligible participants were aged ≥40 years, sedentary, and overweight or obese. Local health educators (n = 15) served as program leaders within each town. OUTCOME MEASURES Reach, fidelity, dose delivered, dose received, and program satisfaction were assessed using after-class surveys, participant satisfaction surveys, interviews with program leaders, and participant focus groups. ANALYSIS Descriptive statistics, chi-square tests of independence, and thematic analysis were employed. RESULTS Intervention sites reported high levels of fidelity (82%) and dose delivered (84%). Overall reach was 2.6% and program classes were rated as effective (3.9/5). Participants were satisfied with their experience and reported benefits such as camaraderie and awareness of healthy eating and exercise strategies. Common recommendations included increasing class time and enhancing group discussion. CONCLUSIONS AND IMPLICATIONS Implementation was good in terms of fidelity, dose delivered, and satisfaction, although low reach. Findings from this research have informed a second round of implementation and evaluation of the SHHC program in rural communities.
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Affiliation(s)
- Urshila Sriram
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | | | - Meredith Graham
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Sara Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | | | - Lynn Paul
- College of Education, Health and Development, Montana State University, Bozeman, MT
| | - Rebecca Seguin
- Division of Nutritional Sciences, Cornell University, Ithaca, NY.
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14
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Oertelt-Prigione S, Dalibert L, Verdonk P, Stutz EZ, Klinge I. Implementation Strategies for Gender-Sensitive Public Health Practice: A European Workshop. J Womens Health (Larchmt) 2017; 26:1255-1261. [PMID: 28937841 DOI: 10.1089/jwh.2017.6592] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Providing a robust scientific background for the focus on gender-sensitive public health and a systematic approach to its implementation. METHODS Within the FP7-EUGenMed project ( http://eugenmed.eu ) a workshop on sex and gender in public health was convened on February 2-3, 2015. The experts participated in moderated discussion rounds to (1) assemble available knowledge and (2) identify structural influences on practice implementation. The findings were summarized and analyzed in iterative rounds to define overarching strategies and principles. RESULTS The participants discussed the rationale for implementing gender-sensitive public health and identified priorities and key stakeholders to engage in the process. Communication strategies and specific promotion strategies with distinct stakeholders were defined. A comprehensive list of gender-sensitive practices was established using the recently published taxonomy of the Expert Recommendations for Implementing Change (ERIC) project as a blueprint. CONCLUSIONS A clearly defined implementation strategy should be mandated for all new projects in the field of gender-sensitive public health. Our tool can support researchers and practitioners with the analysis of current and past research as well as with the planning of new projects.
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Affiliation(s)
- Sabine Oertelt-Prigione
- 1 Institute of Legal Medicine , Charité-Universitätsmedizin Berlin, Berlin, Germany .,2 Department of Primary Care, Radboud University Medical Center , Nijmegen, the Netherlands
| | - Lucie Dalibert
- 3 Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht, the Netherlands
| | - Petra Verdonk
- 4 Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center , Amsterdam, the Netherlands
| | - Elisabeth Zemp Stutz
- 5 Swiss Tropical and Public Health Institute , Basel, Switzerland .,6 Institute for Social and Preventive Medicine, University of Basel , Basel, Switzerland
| | - Ineke Klinge
- 3 Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht, the Netherlands
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15
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Long-Term Body Weight Maintenance among StrongWomen-Healthy Hearts Program Participants. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2017; 2017:4372048. [PMID: 28352287 PMCID: PMC5352895 DOI: 10.1155/2017/4372048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 02/12/2017] [Indexed: 11/26/2022]
Abstract
Background. The repeated loss and regain of body weight, referred to as weight cycling, may be associated with negative health complications. Given today's obesity epidemic and related interventions to address obesity, it is increasingly important to understand contexts and factors associated with weight loss maintenance. This study examined BMI among individuals who had previously participated in a 12-week, evidence-based, nationally disseminated nutrition and physical activity program designed for overweight and obese middle-aged and older women. Methods. Data were collected using follow-up surveys. Complete height and weight data were available for baseline, 12-week program completion (post-program) and follow-up (approximately 3 years later) for 154 women (response rate = 27.5%; BMI characteristics did not differ between responders and nonresponders). Results. Mean BMI decreased significantly from baseline to post-program (−0.5, P < 0.001) and post-program to follow-up (−0.7, P < 0.001). Seventy-five percent of survey respondents maintained or decreased BMI post-program to follow-up. Self-efficacy and social support for healthy eating behaviors (but not physical activity) were associated with BMI maintenance or additional weight loss. Conclusions. These findings support the durability of weight loss following participation in a relatively short-term intervention.
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Lewis BA, Napolitano MA, Buman MP, Williams DM, Nigg CR. Future directions in physical activity intervention research: expanding our focus to sedentary behaviors, technology, and dissemination. J Behav Med 2017; 40:112-126. [PMID: 27722907 PMCID: PMC5296224 DOI: 10.1007/s10865-016-9797-8] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 09/20/2016] [Indexed: 12/22/2022]
Abstract
Despite the increased health risks of a sedentary lifestyle, only 49 % of American adults participate in physical activity (PA) at the recommended levels. In an effort to move the PA field forward, we briefly review three emerging areas of PA intervention research. First, new intervention research has focused on not only increasing PA but also on decreasing sedentary behavior. Researchers should utilize randomized controlled trials, common terminology, investigate which behaviors should replace sedentary behaviors, evaluate long-term outcomes, and focus across the lifespan. Second, technology has contributed to an increase in sedentary behavior but has also led to innovative PA interventions. PA technology research should focus on large randomized trials with evidence-based components, explore social networking and innovative apps, improve PA monitoring, consider the lifespan, and be grounded in theory. Finally, in an effort to maximize public health impact, dissemination efforts should address the RE-AIM model, health disparities, and intervention costs.
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Affiliation(s)
- Beth A Lewis
- School of Kinesiology, University of Minnesota, 1900 University Avenue SE, Cooke Hall, Minneapolis, MN, 55455, USA.
| | - Melissa A Napolitano
- Departments of Prevention and Community Health/Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, 3rd Floor, Washington, DC, 20052, USA
| | - Matthew P Buman
- School of Nutrition and Health Promotion, College of Health Solutions, 500 North 3rd Street, Phoenix, AZ, 85004, USA
| | - David M Williams
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-4, Providence, RI, 02912, USA
| | - Claudio R Nigg
- Department of Public Health Sciences, University of Hawaii, 1960 East-West Road, Honolulu, HI, 96822, USA
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Caperchione CM, Sabiston CM, Clark MI, Bottorff JL, Toxopeus R, Campbell KL, Eves ND, Ellard SL, Gotay C. Innovative approach for increasing physical activity among breast cancer survivors: protocol for Project MOVE, a quasi-experimental study. BMJ Open 2016; 6:e012533. [PMID: 27531738 PMCID: PMC5013483 DOI: 10.1136/bmjopen-2016-012533] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Physical activity is a cost-effective and non-pharmaceutical strategy that can help mitigate the physical and psychological health challenges associated with breast cancer survivorship. However, up to 70% of women breast cancer survivors are not meeting minimum recommended physical activity guidelines. Project MOVE is an innovative approach to increase physical activity among breast cancer survivors through the use of Action Grants, a combination of microgrants (small amounts of money awarded to groups of individuals to support a physical activity initiative) and financial incentives. The purpose of this paper is to describe the rationale and protocol of Project MOVE. METHOD AND ANALYSIS A quasi-experimental pre-post design will be used. Twelve groups of 8-12 adult women who are breast cancer survivors (N=132) were recruited for the study via face-to-face meetings with breast cancer-related stakeholders, local print and radio media, social media, and pamphlets and posters at community organisations and medical clinics. Each group submitted a microgrant application outlining their proposed physical activity initiative. Successful applicants were determined by a grant review panel and informed of a financial incentive on meeting their physical activity goals. An evaluation of feasibility will be guided by the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework and assessed through focus groups, interviews and project-related reports. Physical activity will be assessed through accelerometry and by self-report. Quality of life, motivation to exercise and social connection will also be assessed through self-report. Assessments will occur at baseline, 6 months and 1 year. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of British Columbia's Behavioural Research Ethics Board (#H14-02502) and has been funded by the Canadian Cancer Society Research Institute (project number #702913). Study findings will be disseminated widely through peer-reviewed publications, academic conferences, local community-based presentations, as well as partner organisations, including the Canadian Cancer Society.
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Affiliation(s)
- Cristina M Caperchione
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
- School of Nursing and Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, Kelowna, British Columbia, Canada
- Centre for Heart, Lung and Vascular Health, University of British Columbia, Kelowna, British Columbia, Canada
| | | | - Marianne I Clark
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
- School of Nursing and Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, Kelowna, British Columbia, Canada
| | - Joan L Bottorff
- School of Nursing and Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, Kelowna, British Columbia, Canada
- Faculty of Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Renee Toxopeus
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neil D Eves
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
- Centre for Heart, Lung and Vascular Health, University of British Columbia, Kelowna, British Columbia, Canada
| | - Susan L Ellard
- Cancer Centre of the Southern Interior, British Columbia Cancer Agency, Kelowna, British Columbia, Canada
| | - Carolyn Gotay
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Seguin RA, Eldridge G, Graham ML, Folta SC, Nelson ME, Strogatz D. Strong Hearts, healthy communities: a rural community-based cardiovascular disease prevention program. BMC Public Health 2016; 16:86. [PMID: 26822982 PMCID: PMC4730587 DOI: 10.1186/s12889-016-2751-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 01/19/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death in the United States and places substantial burden on the health care system. Rural populations, especially women, have considerably higher rates of cardiovascular disease, influenced by poverty, environmental factors, access to health care, and social and cultural attitudes and norms. METHODS/DESIGN This community-based study will be a two-arm randomized controlled efficacy trial comparing a multi-level, community program (Strong Hearts, Healthy Communities) with a minimal intervention control program (Strong Hearts, Healthy Women). Strong Hearts, Healthy Communities was developed by integrating content from three evidence-based programs and was informed by extensive formative research (e.g. community assessments, focus groups, and key informant interviews). Classes will meet twice weekly for one hour for 24 weeks and focus on individual-level skill building and behavior change; social and civic engagement are also core programmatic elements. Strong Hearts, Healthy Women will meet monthly for hour-long sessions over the 24 weeks covering similar content in a general, condensed format. Overweight, sedentary women 40 years of age and older from rural, medically underserved communities (12 in Montana and 4 in New York) will be recruited; sites, pair-matched based on rurality, will be randomized to full or minimal intervention. Data will be collected at baseline, midpoint, intervention completion, and six-month, one-year, and eighteen months post-intervention. The primary outcome is change in body weight; secondary outcomes include physiologic, anthropometric, behavioral, and psychosocial variables. In the full intervention, engagement of participants' friends and family members in partnered activities and community events is an intervention target, hypothesizing that there will be a reciprocal influence of physical activity and diet behavior between participants and their social network. Family members and/or friends will be invited to complete baseline and follow-up questionnaires about their health behaviors and environment, height and weight, and attitudes and beliefs. DISCUSSION Strong Hearts, Healthy Communities aims to reduce cardiovascular disease morbidity and mortality, improve quality of life, and reduce cardiovascular disease-related health care burden in underserved rural communities. If successful, the long-term goal is for the program to be nationally disseminated, providing a feasible model to reduce cardiovascular disease in rural settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02499731 Registered on July 1, 2015.
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Affiliation(s)
- Rebecca A Seguin
- Division of Nutritional Sciences, Cornell University, Savage Hall, Room 412, Ithaca, NY, 14853, USA.
| | - Galen Eldridge
- Montana State University Extension, 235 Culbertson Hall, Bozeman, MT, 59718, USA.
| | - Meredith L Graham
- Division of Nutritional Sciences, Cornell University, Savage Hall, Room 413, Ithaca, NY, 14853, USA.
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA.
| | - Miriam E Nelson
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA.
| | - David Strogatz
- Center for Rural Community Health, Bassett Research Institute, One Atwell Road, Cooperstown, NY, 13326, USA.
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