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Wilson HK, Wieler C, Bell DL, Bhattarai AP, Castillo-Hernandez IM, Williams ER, Evans EM, Berg AC. Implementation of the Diabetes Prevention Program in Georgia Cooperative Extension According to RE-AIM and the Consolidated Framework for Implementation Research. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:34-45. [PMID: 36930404 PMCID: PMC10021035 DOI: 10.1007/s11121-023-01518-0] [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: 02/26/2023] [Indexed: 03/18/2023]
Abstract
Increased dissemination of the CDC's Diabetes Prevention Program (DPP) is imperative to reduce type 2 diabetes. Due to its nationwide reach and mission to improve health, Cooperative Extension (Extension) is poised to be a sustainable DPP delivery system. However, research evaluating DPP implementation in Extension remains scant. Extension professionals delivered the DPP in a single-arm hybrid type II effectiveness-implementation study. Semi-structured interviews with Extension professionals were conducted at three time points. The Consolidated Framework for Implementation Research (CFIR) guided interview coding and analysis. Constructs were rated for magnitude and valence and evaluated as facilitators or barriers of RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) outcomes. The program reached 119 participants, was adopted by 92% (n = 12/13) of trained Extension professionals and was implemented according to CDC standards: all programs exceeded the minimum 22-session requirement (26 ± 2 sessions). The program was effective in achieving weight loss (5.0 ± 5.2%) and physical activity (179 ± 122 min/week) goals. At post-intervention, eight professionals (67%) had begun or planned to maintain the intervention within the next 6 months. Several facilitators were identified, including Extension leadership structure, organizational compatibility, and technical assistance calls. Limited time to recruit participants was the primary barrier. Positive RE-AIM outcomes, facilitated by contextual factors, indicate Extension is an effective and sustainable DPP delivery system. Extension and other DPP implementers should plan strategies that promote communication, the program's evidence-base, recruitment time, and resource access. Researchers should explore DPP implementation in real-world settings to determine overall and setting-specific best practices, promote intervention uptake, and reduce diabetes.
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Affiliation(s)
- Hannah K Wilson
- Department of Nutrition, Dietetics and Exercise Science, Concordia College, Moorhead, MN, 56562, USA
| | - Caroline Wieler
- Department of Nutritional Sciences, University of Georgia, Athens, GA, 30602, USA
| | - Darci L Bell
- Department of Nutritional Sciences, University of Georgia, Athens, GA, 30602, USA
| | - Ajit P Bhattarai
- Department of Organizational Learning and Performance, Idaho State University, Pocatello, ID, 83209, USA
| | - Isaura M Castillo-Hernandez
- Human Movement Sciences Research Center, School of Physical Education and Sports, University of Costa Rica, San José, 11502, Costa Rica
| | - Ewan R Williams
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Ellen M Evans
- Department of Kinesiology, University of Georgia, Athens, GA, 30602, USA
| | - Alison C Berg
- Department of Nutritional Sciences, University of Georgia, Athens, GA, 30602, USA.
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Frazier MC, Balis LE, Armbruster SD, Estabrooks PA, Harden SM. Adaptations to a statewide walking program: Use of iterative feedback cycles between research and delivery systems improves fit for over 10 years. Transl Behav Med 2024; 14:45-53. [PMID: 37682753 PMCID: PMC10782918 DOI: 10.1093/tbm/ibad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Abstract
FitEx is an 8-week, group-based physical activity and fruit and vegetable consumption program co-created and implemented with the Cooperative Extension System. Effectiveness and delivery personnel perceptions of the program are promising; however, ongoing adaptations are required to continuously meet shifting needs of both researchers and delivery systems. We applied the APDER iterative cycles of implementation over 15 years to understand dynamic and ongoing adaptations as well as implications for FitEx sustainability. Each year, an IRPP between delivery (FitEx deliverers) and research (FitEx developers) systems shared feedback on program core elements and strategies for adaptation through regular team meetings, emails, and evaluations. While the core elements (delivering to groups, goal setting, feedback, and self-monitoring) of FitEx remained consistent, changes were made to address logistical factors, emergent research questions, and technological advancements. For example, program deliverers suggested decreasing training time and making program content available on demand rather than through traditional in-person training. Using APDER with a long-standing IRPP allowed the delivery system to provide feedback to program developers to co-create ongoing adaptations and data-driven decisions. Future work in response to shifting needs includes Fitbit integration and technological updates to the usability of the FitEx platform. Our aim is to report the 15+ years of applying the Assess, Plan, Do, Evaluate, Report (APDER) process with an integrated research-practice partnership (IRPP) for co-creation of ongoing adaptations of FitEx and to share methods for capturing relevant data for decision-making to integrate health promotion programs in community settings.
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Affiliation(s)
- Mary C Frazier
- Translational Biology, Medicine, and Health Program, Virginia Tech, Roanoke, VA, USA
| | - Laura E Balis
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | - Shannon D Armbruster
- Division of Gynecologic Oncology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Paul A Estabrooks
- Department of Health & Kinesiology, College of Health, University of Utah, Salt Lake City, UT, USA
| | - Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
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Strayer TE, Balis LE, Ramalingam NS, Harden SM. Dissemination in Extension: Health Specialists' Information Sources and Channels for Health Promotion Programming. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16673. [PMID: 36554554 PMCID: PMC9779189 DOI: 10.3390/ijerph192416673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
In the National Cooperative Extension System (herein: Extension), state-level specialists serve as key intermediaries between research, educators, and the community members they serve. There is a need to understand information seeking and sharing practices (i.e., dissemination) among specialists to increase the adoption of evidence-based health promotion programs. Specialists (N = 94) across 47 states were identified and invited to participate in this mixed methods study. A one-way ANOVA with Bonferroni corrections was used to analyze survey data. Data collected through semi-structured interviews were analyzed using an immersion crystallization approach. Forty-seven health specialists completed the survey representing 31 eligible states (65%) and were predominately female (89%), Caucasian (70%), had a doctorate (62%), and were employed within Extension for 10.2 + 9.7 years. The information sources used most frequently were academic journals and other specialists, and most used email and online meetings to communicate. Qualitative findings support the use of other specialists as a primary source of information and indicate specialists' desire for an on-demand, bi-directional, online national repository of Extension programs. This repository would facilitate the dissemination of evidence-based programming across the system and reduce program duplication as well as information burden on county-based educators.
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Affiliation(s)
- Thomas E. Strayer
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN 37208, USA
- Human Nutrition, Food, and Exercise, Virginia Tech, Blacksburg, VA 24060, USA
| | - Laura E. Balis
- Human Nutrition, Food, and Exercise, Virginia Tech, Blacksburg, VA 24060, USA
- Gretchen Swanson Center for Nutrition, Omaha, NE 68154, USA
| | - NithyaPriya S. Ramalingam
- Human Nutrition, Food, and Exercise, Virginia Tech, Blacksburg, VA 24060, USA
- Office of Postdoctoral Affairs, Oregon Health & Science University, Portland, OR 97239, USA
| | - Samantha M. Harden
- Human Nutrition, Food, and Exercise, Virginia Tech, Blacksburg, VA 24060, USA
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Kennedy LE, Strayer TE, Balis LE. Addressing Health Inequities: An Exploratory Assessment of Extension Educators' Perceptions of Program Demand for Diverse Communities. FAMILY & COMMUNITY HEALTH 2022; 45:228-237. [PMID: 35985023 DOI: 10.1097/fch.0000000000000332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Land grant universities are a key provider of community-based health promotion programs through the Cooperative Extension Service. However, Extension's current approach to addressing systemic social determinants of health is incomplete and inconsistent. The purpose of this study was to explore Extension health educators' perceptions of demand for health promotion programming targeting audiences most likely to experience health inequities. Health educators within 2 state Extension systems were invited to complete an online survey based on a capacity building model. Survey questions included rating perceptions of demand for programming for health disparate populations: low-income; Black and African American; Hispanic, Latino/a, Latinx; persons with disabilities; immigrants and refugees; and lesbian, gay, bisexual, and transgender. Analysis of variance and Bonferroni post hoc testing was used to determine differences in perceived demand between populations. Ninety-six educators completed the survey. Perceived demand for low-income population programming was significantly higher than for other populations. Perceived programming demand for immigrants and refugees and lesbian, gay, bisexual, and transgender people was significantly lower than for other populations. Individual and organizational-level factors, including racism and Extension's historical scope, likely contribute to the results. Engaging historically excluded Extension audiences requires time and resources to improve the Extension system and educator capacity for relationship building, trust building, and communication.
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Affiliation(s)
- Lauren E Kennedy
- Community Behavioral Health, Michigan State University Extension, East Lansing, Michigan (Dr Kennedy); Center for Quality Aging, Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Strayer); and Louisville Center, Pacific Institute for Research and Evaluation, Louisville, Kentucky (Dr Balis)
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Strayer E T, Balis LE, Kennedy LE, Ramalingam NS, Wilson ML, Harden SM. Intervention Characteristics Considered in Health Educators' Adoption Decision-Making Process. HEALTH EDUCATION & BEHAVIOR 2022; 50:416-429. [PMID: 34991406 DOI: 10.1177/10901981211067170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is well known that perceptions of intervention characteristics (e.g., cost, source, evidence strength and quality) are a critical link from dissemination to implementation. What is less known is the process by which researchers understand the characteristics most valued by key intermediaries (i.e., real-world decision-makers), particularly in the federal system of Cooperative Extension. In Extension, university-based specialists are available to assist county-based agents in program selection, delivery, and evaluation. For this work, a sequential explanatory mixed-methods design was used to conduct surveys and semi-structured interviews, informed by the Diffusion of Innovations theory and Consolidated Framework for Implementation Research. Educators and specialists were recruited across 47 states to identify characteristics of health promotion interventions that facilitate the adoption decision-making process. Analysis of intervention attribute importance survey data was conducted through a one-way ANOVA with Bonferroni post hoc test to determine individual variable differences between responses. Interviews underwent a conventional content analysis. In total, 121 educators and 47 specialists from 33 states completed the survey. Eighteen educators and 10 specialists completed interviews. Educators and specialists valued components such as the community need for the intervention, and potential reach compared with other components including previous delivery settings and external funding of the intervention (p < .05). Qualitative data indicated divergence between educators and specialists; educators valued understanding the intervention cost (time and training) and specialists valued the evidence base and external funding available. Intervention developers should communicate information valued by different stakeholders to improve the adoption of evidence-based interventions.
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Affiliation(s)
- Thomas Strayer E
- Vanderbilt University Medical Center, Nashville, TN, USA.,Virginia Tech, Blacksburg, VA, USA
| | - Laura E Balis
- Virginia Tech, Blacksburg, VA, USA.,Pacific Institute for Research and Evaluation, Louisville, KY, USA
| | - Lauren E Kennedy
- Virginia Tech, Blacksburg, VA, USA.,Michigan State University, East Lansing, MI, USA
| | | | - Meghan L Wilson
- Virginia Tech, Blacksburg, VA, USA.,Bluefield University, Bluefield, VA, USA
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"Replanning" a Statewide Walking Program Through the Iterative Use of the Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework. J Phys Act Health 2021; 18:1310-1317. [PMID: 34433697 DOI: 10.1123/jpah.2021-0034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/03/2021] [Accepted: 06/12/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Interventions undergo adaptations when moving from efficacy to effectiveness trials. What happens beyond these initial steps-that is, when the "research" is over-is often unknown. The degree to which implementation quality remains high and impacts remain robust is underreported as these data are often less valued by community entities. Comprehensive and iterative evaluation is recommended to ensure robust outcomes over time. METHODS The reach, effectiveness, adoption, implementation, and maintenance framework was used within an assess, plan, do, evaluate, report process to determine the degree to which a statewide physical activity promotion program aligned with evidence-based core components, assess who was reached and impacts on physical activity behaviors, and make decisions for future iterations. RESULTS Walk Across Arkansas was adopted by a majority of delivery agents and was effective at increasing physical activity levels postprogram, but those effects were not maintained after 6 months. Future decisions included recruitment strategies to reach a more diverse population and a blueprint document to reduce program drift. CONCLUSIONS This article details the process of "replanning" a community-based physical activity intervention to understand public health impact and make decisions for future iterations. Pragmatic reach, effectiveness, adoption, implementation, and maintenance questions were useful throughout the assess, plan, do, evaluate, report process.
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Red, Yellow, and Green Light Changes: Adaptations to Extension Health Promotion Programs. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:903-912. [PMID: 33733430 DOI: 10.1007/s11121-021-01222-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
Extension professionals have high autonomy to adapt the programs they deliver. However, fidelity is typically not reported, so it is unknown what adaptations are made. It is also unknown whether agents have the necessary training to adapt programs while maintaining fidelity to the core components. The purpose of this study was to determine (1) adaptations that Extension agents and specialists are making to programs they deliver, (2) the reasons for making these adaptations, (3) timing of adaptations, and (4) Extension agents' and specialists' understanding of the adaptation process. Extension agents and specialists nationwide were invited to complete a survey which queried about adaptations based on the traffic light model, adaptome, and adaptation taxonomy. Specifically, the traffic light model assigns a color for adaptations: tailoring language or pictures (green), adding/substituting activities or session sequence (yellow), or deleting lessons and decreasing timeline or session length (red). Responses were received from 98 agents and 24 specialists. Most agents and specialists reported making green (85% and 79%, respectively), yellow (89% and 75%), and red light changes (81% and 58%). Agents were significantly more likely than specialists to change the age appropriateness of lessons or activities, respond to individual client needs, substitute activities, delete lessons or activities, decrease the length and/or number of sessions, and shorten the program timeline. Within green light changes, each of those that could increase cultural appropriateness (tailoring language, scenarios, and pictures) were reported by less than 50% of agents and specialists. Of the most common adaptations reported, the primary reasons for these decisions were difficulty retaining or engaging participants and lack of time/competing demands on time. Most adaptations were made before the program was delivered. Agents rated their confidence level in the program adaptation process as somewhat confident to confident. Dissemination and implementation strategies to improve program adaptation within Extension are needed, including participatory approaches, training on the adaptation process, bi-directional evidence-based program repositories, and organizational-level changes.
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Richards EA, Woodcox S, Forster A. Statewide Dissemination of an Evidenced-Based Email Walking Program Delivered Through Cooperative Extension. Front Public Health 2020; 8:78. [PMID: 32219090 PMCID: PMC7078235 DOI: 10.3389/fpubh.2020.00078] [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] [Received: 01/16/2020] [Accepted: 02/26/2020] [Indexed: 11/13/2022] Open
Abstract
Using the RE-AIM framework, this study evaluates the statewide dissemination of an evidenced-based, email-delivered physical activity intervention implemented through Cooperative Extension. The Get WalkIN' program is comprised of 16 email messages sent over 12 weeks. Email messages target social cognitive theory constructs of self-efficacy, goal-setting, self-monitoring, and social support. Program reach, effectiveness, adoption, implementation, and maintenance were assessed with quantitative measures in a pre-post design. Findings indicate that within the Extension system, program adoption was high and program maintenance was moderate. Program effectiveness was demonstrated with an increase of 77.1 ± 49.9 min in weekly walking post-program. This increase in walking was maintained 3 months post-program. Capturing data on the implementation process was challenging. Overall, the results indicate success in program adoption and maintenance with further efforts needed to improve follow-up data collection from participants.
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Affiliation(s)
| | - Stephanie Woodcox
- Cooperative Extension, Purdue University, West Lafayette, IN, United States
| | - Anna Forster
- School of Nursing, Purdue University, West Lafayette, IN, United States
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Harden SM, Strayer TE, Smith ML, Gaglio B, Ory MG, Rabin B, Estabrooks PA, Glasgow RE. National Working Group on the RE-AIM Planning and Evaluation Framework: Goals, Resources, and Future Directions. Front Public Health 2020; 7:390. [PMID: 31998677 PMCID: PMC6965154 DOI: 10.3389/fpubh.2019.00390] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 12/03/2019] [Indexed: 12/15/2022] Open
Abstract
The National Working Group on RE-AIM Planning and Evaluation Framework (herein Workgroup) was established in 2004 to support the application of the framework and advance dissemination and implementation science (D&I). Workgroup members developed and disseminated products and resources (and continue to do so) to advocate for consistent application of RE-AIM and allow for cross study comparisons. The purpose of this paper is to summarize key Workgroup activities, products, and services (e.g., webinars, consultations, planning tools) and enhance bidirectional communication between the Workgroup and RE-AIM users. The ultimate goal of this work is to serve as a forum for dissemination to improve the balance between RE-AIM user demand (needs) and the currently limited RE-AIM Workgroup supply (consultation and resources) to demonstrate and expand the utility of RE-AIM as a D&I planning and evaluation framework. A summary of resources is provided as well as specific examples of how the Workgroup has been responsive to user needs.
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Affiliation(s)
- Samantha M Harden
- Physical Activity Research and Community Implementation, Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Thomas Edward Strayer
- Physical Activity Research and Community Implementation, Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States.,Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, VA, United States
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, College Station, TX, United States.,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States.,Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, United States
| | - Bridget Gaglio
- Clinical Effectiveness and Decision Science Program, Patient-Centered Outcomes Research Institute, Washington, DC, United States
| | - Marcia G Ory
- Center for Population Health and Aging, Texas A&M University, College Station, TX, United States.,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Borsika Rabin
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, San Diego, CA, United States.,Adult and Child Consortium for Outcomes Research and Delivery Science Dissemination and Implementation Science Program and The Department of Family Medicine, School of Medicine, University of Colorado- Anschutz Medical Campus, Aurora, CO, United States.,Eastern Colorado QUERI and GRECC Programs, University of Colorado- Anschutz Medical Campus, Aurora, CO, United States
| | - Paul A Estabrooks
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Russell E Glasgow
- Adult and Child Consortium for Outcomes Research and Delivery Science Dissemination and Implementation Science Program and The Department of Family Medicine, School of Medicine, University of Colorado- Anschutz Medical Campus, Aurora, CO, United States.,Eastern Colorado QUERI and GRECC Programs, University of Colorado- Anschutz Medical Campus, Aurora, CO, United States
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Balis LE, Strayer T. Evaluating "Take the Stairs, Wyoming!" Through the RE-AIM Framework: Challenges and Opportunities. Front Public Health 2019; 7:368. [PMID: 31921736 PMCID: PMC6929518 DOI: 10.3389/fpubh.2019.00368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/19/2019] [Indexed: 12/23/2022] Open
Abstract
Introduction: Health promotion delivery systems are increasingly being asked to implement policy, systems, and environmental interventions (PSEs). However, evaluating PSEs is challenging, especially in low-resource community settings. This paper describes the use of RE-AIM to evaluate a physical activity PSE delivered through University of Wyoming Extension and highlights challenges and opportunities in pragmatic, real-world program evaluation. Methods: Extension health educators adapted a point-of-decision prompt intervention encouraging stairway use through posters, called Take the Stairs, Wyoming! Reach was assessed through estimates of daily traffic, effectiveness was assessed through opportunistic interviews, adoption was calculated as the number and proportion of sites that agreed to hang posters, implementation was calculated as the proportion of sites with a poster in place at a 2-weeks follow-up visit, and maintenance was assessed through 6-months opportunistic interviews (individual level) and proportion of sites with a poster in place (organizational level). Results: Overall, the posters were widely adopted and most posters were implemented as intended. However, capturing reach, effectiveness, and maintenance was challenging, as health educators found the evaluation burdensome. Therefore, it was difficult to determine if the posters were effective at increasing physical activity levels. Discussion: Suggestions are provided for capturing reach, effectiveness, and maintenance data in community settings. Future efforts are needed to create evaluation tools to pragmatically measure effectiveness of PSEs on changing behaviors, as well as to prioritize program evaluation in Extension.
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Affiliation(s)
- Laura E Balis
- Division of Agriculture Cooperative Extension Service, University of Arkansas System, Little Rock, AR, United States
| | - Thomas Strayer
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, United States
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Strayer TE, Kennedy LE, Balis LE, Ramalingam NS, Wilson ML, Harden SM. Cooperative Extension Gets Moving, but How? Exploration of Extension Health Educators' Sources and Channels for Information-Seeking Practices. Am J Health Promot 2019; 34:198-205. [PMID: 31581778 DOI: 10.1177/0890117119879606] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The Cooperative Extension System (Extension) has implemented concerted efforts toward health promotion in communities across the nation by acting as an intermediary between communities and universities. Little is known about how these intermediaries communicate and learn about existing evidence-based programming. This study serves to explore this gap by learning about information sources and channels used within Extension. DESIGN Sequential explanatory mixed methods approach. SETTING National Cooperative Extension System. PARTICIPANTS Extension community-based health educators. METHODS A nationally distributed survey with follow-up semistructured interviews. Survey results were analyzed using a Kruskal-Wallis 1-way analysis of variance test paired with Bonferroni post hoc. Transcripts were analyzed by conventional content analysis. RESULTS One hundred twenty-one Extension educators from 33 states responded to the survey, and 18 of 20 invited participants completed the interviews. Educators' information seeking existed in 2 forms: (1) information sources for learning about programming and (2) channels by which this information is communicated. Extension educators reported contacting health specialists and other educators. Extension educators also reported using technological means of communication such as e-mail and Internet to reach information sources such as peers, specialists, academic journals, and so on. CONCLUSION Extension state specialists were preferred as primary sources for intervention information, and technology was acknowledged as an easy contact channel. This study identifies county-based health educators' information structures and justifies the need for future research on the role of specialists in communication efforts for educators.
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Affiliation(s)
- Thomas E Strayer
- Translational Biology, Medicine, and Health Program, Virginia Tech, Blacksburg, VA, USA
| | - Lauren E Kennedy
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Laura E Balis
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | | | - Meghan L Wilson
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
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12
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Balis LE, Harden SM. Scaling Out a 4-H Healthy Meeting Initiative: Challenges in Implementation and Comprehensive Evaluation. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:1020-1024. [PMID: 31500798 DOI: 10.1016/j.jneb.2019.05.288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 06/10/2023]
Abstract
The national Cooperative Extension System delivers a number of nutrition and physical activity interventions, but it is unknown how an intervention may translate from 1 state within the system to another. Using the reach, effectiveness, adoption, implementation, maintenance framework for program evaluation can improve intervention scale-out. Adoption is a key dimension of reach, effectiveness, adoption, implementation, maintenance: if delivery personnel do not deliver an intervention, it can have no impacts on health. Here, differences are discussed regarding adoption rates between state Extension systems when scaling out a 4-H healthy meeting intervention. This experience provides suggestions for improved scale-out of Extension programs, including state-specific adaptation and pragmatic data collection.
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Affiliation(s)
| | - Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA
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13
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Glasgow RE, Harden SM, Gaglio B, Rabin B, Smith ML, Porter GC, Ory MG, Estabrooks PA. RE-AIM Planning and Evaluation Framework: Adapting to New Science and Practice With a 20-Year Review. Front Public Health 2019; 7:64. [PMID: 30984733 PMCID: PMC6450067 DOI: 10.3389/fpubh.2019.00064] [Citation(s) in RCA: 872] [Impact Index Per Article: 174.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/05/2019] [Indexed: 01/07/2023] Open
Abstract
The RE-AIM planning and evaluation framework was conceptualized two decades ago. As one of the most frequently applied implementation frameworks, RE-AIM has now been cited in over 2,800 publications. This paper describes the application and evolution of RE-AIM as well as lessons learned from its use. RE-AIM has been applied most often in public health and health behavior change research, but increasingly in more diverse content areas and within clinical, community, and corporate settings. We discuss challenges of using RE-AIM while encouraging a more pragmatic use of key dimensions rather than comprehensive applications of all elements. Current foci of RE-AIM include increasing the emphasis on cost and adaptations to programs and expanding the use of qualitative methods to understand "how" and "why" results came about. The framework will continue to evolve to focus on contextual and explanatory factors related to RE-AIM outcomes, package RE-AIM for use by non-researchers, and integrate RE-AIM with other pragmatic and reporting frameworks.
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Affiliation(s)
- Russell E. Glasgow
- Dissemination and Implementation Science Program of ACCORDS, Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, United States,*Correspondence: Russell E. Glasgow
| | - Samantha M. Harden
- Physical Activity Research and Community Implementation, Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Bridget Gaglio
- Patient-Centered Outcomes Research Institute, Washington, DC, United States
| | - Borsika Rabin
- Dissemination and Implementation Science Program of ACCORDS, Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, United States,Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, College Station, TX, United States,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States,Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, United States
| | - Gwenndolyn C. Porter
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Marcia G. Ory
- Center for Population Health and Aging, Texas A&M University, College Station, TX, United States,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Paul A. Estabrooks
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
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