Health Educator Participation in Virtual Micro-Credentialing Increases Physical Activity in Public Health Competencies

A Mixed Method Evaluation of Practitioners' Perspectives on Implementation Strategies for Healthy Eating and Active Living Policy, Systems, and Environmental Changes

CONTEXT

The National Cooperative Extension System is a leader in delivering healthy eating and active living (HEAL) policy, systems, and environmental (PSE) changes; however, these interventions are challenging, and technical assistance efforts often misalign with implementation science concepts.

OBJECTIVE

The study objective was to understand the importance of implementation strategies and tailoring needs to support Louisiana Nutrition and Community Health (NCH) practitioners' delivery of rural HEAL PSE changes.

DESIGN

An explanatory sequential mixed method study design was used, including a survey to rank the importance of implementation strategies for HEAL PSE changes and a follow-up interview. A review of available implementation strategies (practice activities/resources) for Louisiana HEAL PSE changes was also conducted.

SETTING

This study occurred within Louisiana and focused on NCH practitioners' ongoing HEAL PSE change efforts throughout the state, with emphasis on rural community settings.

PARTICIPANTS

All NCH practitioners were eligible to participate. "Practitioners" included Extension NCH administrators and agents/educators directly delivering HEAL PSE changes.

MAIN OUTCOMES

The main quantitative outcome was the ranked importance of implementation strategies to support NCH practitioners' delivery of HEAL PSE changes. For explanatory interviews, perceptions of higher and lower ranked implementation strategies and tailoring opportunities were of interest. The alignment of available activities/resources with possible implementation strategies was also assessed.

RESULTS

Highly ranked implementation strategies focused on engaging dedicated community partners and community members and starting small to ensure success, generate buy-in, and demonstrate feasibility. Opportunities for capacity building in these areas were identified. A lower ranked implementation strategy, changing organizational structures, was considered less likely to occur but possibly necessary to improve job satisfaction, retention, and return on investment. Available activities/resources overlapped with a few available implementation strategies.

CONCLUSIONS

This study identified opportunities to use implementation science concepts to improve program support for NCH practitioners delivering complex HEAL PSE changes.

Using implementation strategies in community settings: an introduction to the Expert Recommendations for Implementing Change (ERIC) compilation and future directions

In this commentary, we introduce public health practitioners and researchers to implementation science through an established compilation of implementation strategies. We provide terminology and examples for community settings so public health practitioners and researchers can use implementation strategies and document efforts using standard terminology. We also discuss the need for future work to determine the extent to which these implementation strategies work and are most useful in community settings, and ultimately, how health behaviors are impacted. We intend this commentary to serve as a dissemination strategy for implementation strategies and to contribute to knowledge in the growing field of implementation science in community settings.

Intervention Characteristics Considered in Health Educators' Adoption Decision-Making Process

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.