A process for converting an in-person training to increase church capacity to implement physical activity and healthy eating practices and policies to an online format

The implementation of evidence-based public health programs into practice is critical for improving health, but trainings for organizational change agents are often not scalable. To describe the process of converting a training that targets faith-based organizational capacity development from an in-person to an online format. We engaged in an iterative process to convert the training delivery mode from in-person to online that included assessing stakeholder support, consulting the literature on best practices, seeking a design team, consolidating content, designing engaging lessons, and building an online site. Feedback from end-users and other audiences was incorporated throughout. Pilot participants with characteristics like intended training users were then recruited via community and faith-based partner networks. They rated their agreement with statements about the effectiveness as well as design and functionality of each lesson and the overall training (1 = strongly disagree, 5 = strongly agree) and participated in a structured follow-up interview. Nine pilot participants (representing 9 churches in 7 states; 6 African American, 5 with health ministries) rated the online lessons favorably (all ratings ≥ 4.5). Most (90.4%) perceived the lesson duration to be "just right" and spent 52.5 ± 9.9 minutes/lesson. Participants evaluated the overall training positively (all ratings ≥ 4.7). Lesson content, resources, multimedia, and program ideas were most-liked aspects of lessons, while content, staff responsiveness, discussion board, and pace were most-liked aspects of the overall training in open-ended and interview responses. This paper shares a replicable process for converting training modalities from in-person to online with the goal of increased scalability.

Developing criteria for research translation decision-making in community settings: a systematic review and thematic analysis informed by the Knowledge to Action Framework and community input

Background

There is a pressing need to translate empirically supported interventions, products, and policies into practice to prevent and control prevalent chronic diseases. According to the Knowledge to Action (K2A) Framework, only those interventions deemed “ready” for translation are likely to be disseminated, adopted, implemented, and ultimately institutionalized. Yet, this pivotal step has not received adequate study. The purpose of this paper was to create a list of criteria that can be used by researchers, in collaboration with community partners, to help evaluate intervention readiness for translation into community and/or organizational settings.

Methods

The identification and selection of criteria involved reviewing the K2A Framework questions from the “decision to translate” stage, conducting a systematic review to identify characteristics important for research translation in community settings, using thematic analysis to select unique research translation decision criteria, and incorporating researcher and community advisory board feedback.

Results

The review identified 46 published articles that described potential criteria to decide if an intervention appears ready for translation into community settings. In total, 17 unique research translation decision criteria were identified. Of the 8 themes from the K2A Framework that were used to inform the thematic analysis, all 8 were included in the final criteria list after research supported their importance for research translation decision-making. Overall, the criteria identified through our review highlighted the importance of an intervention’s public health, cultural, and community relevance. Not only are intervention characteristics (e.g., evidence base, comparative effectiveness, acceptability, adaptability, sustainability, cost) necessary to consider when contemplating introducing an intervention to the “real world,” it is also important to consider characteristics of the target setting and/or population (e.g., presence of supporting structure, support or buy-in, changing sociopolitical landscape).

Conclusions

Our research translation decision criteria provide a holistic list for identifying important barriers and facilitators for research translation that should be considered before introducing an empirically supported intervention into community settings. These criteria can be used for research translation decision-making on the individual and organizational level to ensure resources are not wasted on interventions that cannot be effectively translated in community settings to yield desired outcomes.

The FAN program plan: Creating a healthy church environment for physical activity and healthy eating

Background

Faith, Activity, & Nutrition (FAN) helps churches create a healthier environment for physical activity (PA) and healthy eating (HE) through policy, systems, and environmental changes.

Objective

The purpose of this paper is to describe the implementation, evaluation, and revision of the FAN Program Plan across a two-phase study to help churches create guidelines and policies for PA and HE.

Methods

In Phase 1, church committees attended trainings led by Community Health Advisors (CHA) where they assessed current practices to PA and HE. Committees used the FAN Program Plan to outline an implementation plan to increase opportunities, programs, messages, pastor support, and guidelines/practices for PA and HE. FAN Program Plans were submitted to the research team for review. Findings from Phase 1 plans directed revisions in program materials for Phase 2, where the submission and review processes were repeated.

Results

Review of Phase 1 FAN Program Plans (53/54 churches submitted a Program Plan) revealed that church committees confused guidelines/practices with programs and had trouble differentiating programs for PA and HE from providing opportunities (i.e., building PA/HE into existing events). The CHA training, FAN church committee training, FAN Program Plan, and other documents were revised to use the term "guidelines (policies)" instead of "guidelines/practices." In addition, CHAs facilitated a training section on guidelines (policies) to committees, and a guidelines (policies) section was added in the FAN Program Plan and other program documents. These changes in Phase 2 were helpful for differentiating policies from programs and programs from opportunities in FAN Program Plans (53/115 churches submitted a Program Plan), although some confusion remained.

Conclusions

This study underscored challenges churches may have in setting policies for PA and HE and discusses strategies to address these challenges in future faith-based initiatives.

Predictors of implementation in the Faith, Activity, and Nutrition dissemination and implementation study: application of the Consolidated Framework for Implementation Research (CFIR) in a statewide initiative

Faith-based organizations, with broad reach and trust, are well-positioned to promote health. The purpose of the study was to examine 12-month implementation and its predictors in the statewide Faith, Activity, and Nutrition (FAN) dissemination and implementation (D&I) study. Churches (n = 93; 42% predominantly African American) in the [South Carolina] Conference of the United Methodist Church trained by Community Health Advisors participated in the study. Church FAN coordinators (n = 92) completed implementation surveys regarding opportunities, policies, messages, and pastor support for physical activity (PA) and healthy eating (HE) at baseline and 12 months. FAN coordinators and pastors (n = 93) completed CFIR-based measures at baseline, immediate post-training, and 12 months. Repeated measures ANOVAs tested change in PA and HE implementation composite scores; Cohen's d indicated magnitude of change. Mixed model linear regression tested whether CFIR items predicted 12-month implementation, controlling for baseline implementation. PA (d = 1.42) and HE (d = 2.05) implementation increased significantly over time. PA and HE implementation were significantly greater in predominantly African American (versus White) congregations, and HE implementation was greater in churches with <500 members. FAN coordinators' ratings of the inner setting (networks/communication, culture, tension for change, organizational rewards, readiness, and congregant needs) and implementation process (engaging opinion leaders and champions) domains were most predictive of implementation outcomes. Few pastor ratings related to implementation outcomes. This study identified constructs, guided by CFIR, that may be important for understanding PA and HE implementation in churches. Future studies will need to test them for replication. Greater changes in implementation outcomes among African American churches underscores the potential of promoting health equity through this setting.

Community Health Advisors' Characteristics and Behaviors, Role Performance, and Volunteer Satisfaction in a Church-Based Healthy Eating and Physical Activity Intervention

Community Health Advisors (CHAs) contribute to health promotion program effectiveness, but their role in faith-based programs is understudied, and little is known about their role performance or satisfaction. In a dissemination and implementation study, 19 CHAs were trained to provide healthy eating (HE) and physical activity (PA) program training to church committees. Of these, 17 CHAs trained 347 attendees from 115 churches. Thirteen CHAs remained for the 12-month period and provided telephone-based technical assistance (TA) to churches. To evaluate their experiences and satisfaction, CHAs completed questionnaires at baseline and 12 months. Staff observers and church committee members evaluated CHAs' effectiveness as trainers. There were no significant changes in the CHAs' own body mass index, PA, fruit and vegetable intake, or self-rated health but significant increases in their perceived knowledge of PA (p = 0.01) and HE (p = 0.02). CHAs reported high agreement regarding the quality of their training for the role and moderate volunteer satisfaction on average but thought that the time required of them was somewhat more than expected, though they were interested in volunteering for a future, similar role. Church committee members agreed with CHAs' effectiveness as trainers and the helpfulness of the TA calls. Staff observers rated CHAs' as having covered 87.8% of church training content and agreed that, on average, the CHAs were effective trainers. Assessing CHAs' availability, clear communication about the time requirements, and over-recruitment to offset attrition and decrease the workload may be needed to improve retention and support satisfaction.

The Faith, Activity, and Nutrition (FAN) Dissemination and Implementation Study, Phase 1: Implementation Monitoring Methods and Results

Faith-based settings offer opportunities for reaching populations at risk for chronic conditions and are optimal settings for dissemination and implementation (D&I) research. Faith, Activity, and Nutrition (FAN) is an evidence-based program designed to promote physical activity (PA) and healthy eating (HE) through church policy, systems, and environmental change. We report implementation fidelity for Phase 1 of the FAN D&I project, a countywide effort. The group randomized study included pre- and postintervention assessments of core PA and HE components. We compared implementation in early intervention ( n = 35) versus delayed intervention (control, n = 19) churches; assessed individual church implementation; and examined the effects of level of implementation on church member outcomes. Implementation assessments were conducted with the FAN coordinator via telephone survey. Study outcomes were assessed with church members 8 to 12 months following baseline assessment via self-administered surveys. We found significantly higher levels of implementation for PA opportunities, PA and HE guidelines, PA and HE messages, and PA and HE pastor support in intervention versus control churches and showed church-level variation in PA and HE implementation. PA self-efficacy varied by level of implementation; high and low implementers did not differ in proportion of church members physically inactive, although low implementers had fewer members inactive than controls. The high level of implementation in intervention churches shows promise for broader dissemination of FAN.

Sumter County on the Move! Evaluation of a Walking Group Intervention to Promote Physical Activity Within Existing Social Networks

BACKGROUND

Social network-driven approaches have promise for promoting physical activity in community settings. Yet, there have been few direct investigations of such interventions. This study tested the effectiveness of a social network-driven, group-based walking intervention in a medically underserved community.

METHODS

This study used a quasi-experimental pretest-posttest design with 3 measurement time points to examine the effectiveness of Sumter County on the Move! in communities in Sumter County, SC. A total of 293 individuals participated in 59 walking groups formed from existing social networks. Participants were 86% females, 67% black, and 31% white, with a mean age of 49.5 years. Measures included perceptions of the walking groups; psychosocial factors such as self-regulation, self-efficacy, and social support; and both self-reported and objectively measured physical activity.

RESULTS

The intervention produced significant increases in goal setting and social support for physical activity from multiple sources, and these intervention effects were sustained through the final measurement point 6 months after completion of the intervention. Nonetheless, few of the desired changes in physical activity were observed.

CONCLUSION

Our mixed results underscore the importance of future research to better understand the dose and duration of intervention implementation required to effect and sustain behavior change.

Faith, Activity, and Nutrition Randomized Dissemination and Implementation Study: Countywide Adoption, Reach, and Effectiveness

INTRODUCTION

Faith-based organizations can contribute to improving population health, but few dissemination and implementation studies exist. This paper reports countywide adoption, reach, and effectiveness from the Faith, Activity, and Nutrition dissemination and implementation study.

DESIGN

This was a group-randomized trial. Data were collected in 2016. Statistical analyses were conducted in 2017.

SETTING/PARTICIPANTS

Churches in a rural, medically underserved county in South Carolina were invited to enroll, and attendees of enrolled churches were invited to complete questionnaires (n=1,308 participated).

INTERVENTION

Churches (n=59) were randomized to an intervention or control (delayed intervention) condition. Church committees attended training focused on creating opportunities, setting guidelines/policies, sharing messages, and engaging pastors for physical activity (PA) and healthy eating (HE). Churches also received 12 months of telephone-based technical assistance. Community health advisors provided the training and technical assistance.

MAIN OUTCOMES MEASURES

The Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework guided measurement of adoption and reach. To assess effectiveness, church attendees completed post-test only questionnaires of perceptions of church environment, PA and fruit and vegetable (FV) self-efficacy, FV intake, and PA. Regression models controlled for church clustering and predominant race of congregation, as well as member age, gender, education, and self-reported cancer diagnosis.

RESULTS

Church adoption was 42% (55/132). Estimated reach was 3,527, representing 42% of regular church attendees and 15% of county residents. Intervention church attendees reported greater church-level PA opportunities, PA and HE messages, and PA and HE pastor support (p<0.0001), but not FV opportunities (p=0.07). PA self-efficacy (p=0.07) and FV self-efficacy (p=0.21) were not significantly higher in attendees of intervention versus control churches. The proportion of inactive attendees was lower in intervention versus control churches (p=0.02). The proportion meeting FV (p=0.27) and PA guidelines (p=0.32) did not differ by group.

CONCLUSIONS

This innovative dissemination and implementation study had high adoption and reach with favorable environmental impacts, positioning it for broader dissemination.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT02868866.

The Faith, Activity, and Nutrition program: a randomized controlled trial in African-American churches

BACKGROUND

Faith-based interventions hold promise for promoting health in ethnic minority populations. To date, however, few of these interventions have used a community-based participatory research (CBPR) approach, have targeted both physical activity and healthy eating, and have focused on structural changes in the church.

PURPOSE

To report the results of a group randomized CBPR intervention targeting physical activity and healthy eating in African-American churches.

DESIGN

Group RCT. Data were collected from 2007 to 2011. Statistical analyses were conducted in 2012.

SETTING/PARTICIPANTS

Seventy-four African Methodist Episcopal (AME) churches in South Carolina and 1257 members within them participated in the study.

INTERVENTION

Churches were randomized to an immediate (intervention) or delayed (control) 15-month intervention that targeted organizational and environmental changes consistent with the structural ecologic model. A CBPR approach guided intervention development. Intervention churches attended a full-day committee training and a full-day cook training. They also received a stipend and 15 months of mailings and technical assistance calls to support intervention implementation.

MAIN OUTCOME MEASURES

Primary outcomes were self-reported moderate- to vigorous-intensity physical activity (MVPA), self-reported fruit and vegetable consumption, and measured blood pressure. Secondary outcomes were self-reported fat- and fiber-related behaviors. Measurements were taken at baseline and 15 months. Intent-to-treat repeated measures ANOVA tested group X time interactions, controlling for church clustering, wave, and size, and participant age, gender, and education. Post hoc ANCOVAs were conducted with measurement completers.

RESULTS

There was a significant effect favoring the intervention group in self-reported leisure-time MVPA (d=0.18, p=0.02), but no effect for other outcomes. ANCOVA analyses showed an intervention effect for self-reported leisure-time MVPA (d=0.17, p=0.03) and self-reported fruit and vegetable consumption (d=0.17, p=0.03). Trainings were evaluated very positively (training evaluation item means of 4.2-4.8 on a 5-point scale).

CONCLUSIONS

This faith-based structural intervention using a CBPR framework showed small but significant increases in self-reported leisure-time MVPA. This program has potential for broad-based dissemination and reach.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT00379925.