Community readiness for adopting a physical activity program for people with arthritis in West Virginia

Effectiveness and Implementation of an EnhanceFitness Physical Activity Intervention Specifically in Adults With Arthritis: A RE-AIM Evaluation

BACKGROUND AND OBJECTIVES

This study evaluated the effectiveness of the evidence-based, EnhanceFitness (EF) physical activity (PA) intervention in improving arthritis symptoms, physical and mental function, and PA in adults with arthritis.

RESEARCH DESIGN AND METHODS

This was a community-based, randomized, controlled effectiveness trial that switched to a nonrandomized controlled trial. Participants were sedentary/low-active adults, aged ≥18 years, with self-reported physician-diagnosed arthritis, who were assigned to an immediate or delayed group (12-week, wait-list control group). Classes were held thrice weekly for 12 weeks at 17 community sites in 4 urban and 5 rural West Virginia counties. Data were collected at baseline, 12 weeks, and 24 weeks. The RE-AIM Framework evaluated EF's: (1) reach (enrollment); (2) effectiveness (outcomes); (3) adoption (proportion of sites/instructors that delivered EF); (4) implementation (attendance, fidelity, adverse events, and satisfaction); and (5) maintenance (EF continuation). Outcomes were analyzed using linear mixed-effects regression.

RESULTS

There were 323 adults with a mean age of 68.3 years (range 27-95). Reach was 74%; site and instructor adoption rates were 100% and 55%, respectively; attendance (1.8 sessions per week) and fidelity were good; injury rate was low (3.8%); participants were highly satisfied and experienced improvements in arthritis symptoms and physical function; and 27% of instructors and 18% of sites continued EF.

DISCUSSION AND IMPLICATIONS

EnhanceFitness was safe and effective in improving arthritis symptoms and physical function in sedentary/low-active adults with arthritis, across the adult age spectrum, under real-world conditions, in both urban and rural communities.Clinical Trial Registration: NCT00526201.

Community and Organizational Readiness to Adopt a Physical Activity Intervention in Micropolitan Settings

BACKGROUND

Assessing community and organizational readiness is key to successfully implementing programs. The purpose of this study was to assess the baseline readiness of micropolitan communities to adopt an evidence-based physical activity (PA) intervention by exploring three dimensions: (1) attitudes and current efforts toward prevention, (2) community and organizational climate that facilitates (or impedes) change, and (3) capacity to implement change.

METHOD

Data were collected from community leaders in 14 communities through an online survey in June 2021 (n = 149). Data were analyzed in aggregate using descriptive statistics for multiple-choice responses and content analysis for open ended responses. One-way repeated analyses of variance were used to compare mean score differences.

RESULTS

In reference to their attitudes prior to the pandemic, respondents said that addressing PA was "somewhat a priority" in their professional positions (M = 2.01, SD = 0.94), their organizations (M = 2.08, SD = 0.91), and their communities (M = 2.28, SD = 0.88). Current PA efforts included statewide initiatives, community sponsored events/clubs, and youth sports leagues. The community climate included both PA facilitators (mainly outdoor PA resources) and barriers (cost, lack of social services, and an unsupportive PA environment). Individual-level capacity (M = 2.94; SD = 1.21) to adopt a PA program was regarded lower than the community's capacity (M = 3.95; SD = 0.82), and perceptions of capacity at the community level improved even more if technical assistance (M = 3.96; SD = 0.84) or financial support (M = 4.12; SD = 0.80) were provided.

CONCLUSION

Readiness varied by dimension, suggesting the need for tailored implementation supports including technical assistance and financial support.

Evaluation of community readiness for change prior to a participatory physical activity intervention in Germany

A lack of communities' readiness for change is reported as a major barrier toward an effective implementation of health promoting interventions in community settings. Adding an alternative readiness assessment approach to existing research practice, this study aimed to investigate how a selected community could be evaluated in-depth regarding its readiness for change based on multiple key informant perspectives, with the intention of using this knowledge for the preparation of improved local physical activity (PA) interventions for men above 50 years of age. We conducted semi-structured face-to-face key informant interviews with stakeholders and relevant persons from a local German community (N = 15). The interview guide was based on a comprehensive summary of community readiness dimensions. After verbatim transcription, we conducted thematic analysis to synthesize the complex results regarding community readiness related to PA. The data supported that the community disposed of a variety of resources regarding PA and showed signs of readiness for change. However, a certain degree of saturation regarding PA programs existed. The need for health enhancing PA interventions for men was only partly recognized. The local authority considered PA to be particularly important in the context of mobility and traffic safety. Including multiple stakeholders contributed to a balanced and in-depth assessment of community readiness and was helpful for determining starting points for tailored PA interventions due to the detection of complex relationships and structures. The study delivers preliminary evidence that a qualitative multi-perspective community readiness assessment adds value to quantified single-perspective readiness assessment research practice.

Community Readiness for the Promotion of Physical Activity in Older Adults-A Cross-Sectional Comparison of Rural and Urban Communities

Communities can play an important role in delivering public health programs to older adults, but they differ in the provision of local structures and resources. The community readiness (CR) approach applies a stage model of change to the community level and analyzes structures and the degree of willingness to take action on a health issue. This study compared the CR regarding the promotion of physical activity as part of healthy ageing for older adults among urban and rural communities in North-West Germany. A cross-sectional CR assessment with key respondents in 23 municipalities (11 urban and 12 rural communities) was conducted using a semi-structured interview. Interviews were scored across the five CR dimensions and global CR score was calculated (scores between 1 = no awareness and 9 = professionalization). Wilcoxon rank-sum test and hierarchical regression models were used to compare urban and rural communities. In total, 118 interviews were conducted (response rate 69.8%). On average, the communities showed moderate CR scores (4.9 ± 0.3; Range: 4.3–5.4; preplanning or preparation phase). The global CR score was slightly higher in rural than in urban communities (regression coefficient = 0.29, 95% confidence interval (CI): −0.02–0.59). The rural communities showed significantly higher CR scores in the ‘Knowledge of efforts’ dimension (0.70, 95% CI: 0.26–1.14) and in the ‘Knowledge of the issue’ (0.37, 95% CI: 0.04–0.70). Rural communities display a slightly higher CR level than urban communities. In the next step, targeted capacity building activities will be initiated among communities with low CR levels.

Community Readiness to Prevent Opioid Overdose

Effective community-based actions are urgently needed to combat the ongoing epidemic of opioid overdose. Community readiness (CR) has been linked to communities' support for collective action, which in turn has been associated with the success of community-wide prevention strategies and resulting behavior change. Our study, conducted in North Carolina, assessed the relationship between CR and two indices of opioid overdose. County-level data included a survey of health directors that assessed CR to address drug overdose prevention programs, surveillance measures of opioid overdose collected from death records and emergency departments, and two indicators of general health-related status. We found that counties' rates of CR were positively associated with their opioid-related mortality (but not morbidity) and that this relationship persisted when we controlled for health status. North Carolina counties with the highest opioid misuse problems appear to be the most prepared to respond to them.

Strategies to Build Readiness in Community Mobilization Efforts for Implementation in a Multi-Year Teen Pregnancy Prevention Initiative

PURPOSE

This paper describes an assessment of community readiness to implement a community-wide teen pregnancy prevention initiative, Youth First, and presents strategies used to enhance this readiness as informed by the assessment.

METHODS

Twenty-five community stakeholder interviews were conducted to assess four domains of readiness: (1) attitudes, perception, and knowledge of teen pregnancy; (2) perceived level of readiness; (3) resources, existing and current efforts; and (4) leadership. Interview transcripts were coded and analyzed to identify key themes.

RESULTS

Stakeholders acknowledged teen pregnancy as an issue but lacked contextual information. They also perceived the community as ready to address the issue and recognized some organizations already championing efforts. However, many key players were not involved, and ongoing data collection to assess teen pregnancy and prevention efforts was limited. Though many stakeholders were ready to engage in teen pregnancy prevention efforts, they required additional information and training to appropriately address the issue.

CONCLUSIONS

In response to the assessment findings, several strategies were applied to address readiness and build Youth First partners' capacity to implement the community-wide initiative. Thus, to successfully implement community-wide prevention efforts, it is valuable to assess the level of community readiness to address health issues.

Evaluating Community Readiness to Implement Environmental and Policy-Based Alcohol Abuse Prevention Strategies in Wisconsin

BACKGROUND

Matching evidence-based alcohol prevention strategies with a community's readiness to support those strategies is the basis for the Tri-Ethnic Community Readiness Model (CRM). The purpose of this evaluation was to assess the association of a community's readiness to address alcohol abuse in their community with the implementation of environmental and policy-based strategies.

METHODS

Twenty-one substance abuse prevention coalitions in Wisconsin participated in a pre-post intervention group-only evaluation using the CRM. As part of a Substance Abuse and Mental Health Services Administration (SAMHSA) grant, all grantees were obligated by the Wisconsin Department of Health Services to implement environmental and policy-based strategies focused on one of three priority areas: young adult binge drinking, underage drinking, and alcohol-related motor-vehicle injuries and fatalities.

RESULTS

At baseline, all communities (n=21) scored at or below a Stage 4 (on a scale of 1-9) readiness level ("preparedness"). The mean change in community readiness over the three-year period (2009-2011) was significant, but was less than one complete CRM stage (0.77, p=<0.001; 95% CI: 0.49, 1.05).

CONCLUSION

These findings suggest that implementation of environmental and policy-based strategies may improve a community's progression in perceived readiness to address alcohol abuse regardless of the community's baseline level of readiness to address alcohol abuse.

RECOMMENDATION

An assessment specific for measuring community readiness for policy-related strategies should be developed. The assessment would include community-level factors (e.g. community climate) for implementing policy-related prevention strategies, and not assume a linear readiness model.