An i-PARIHS evaluation of implementation fidelity for a worksite - PowerPoint PPT Presentation

An i-PARIHS evaluation of implementation fidelity for a worksite sedentary behavior intervention Matthew Buman, PhD Co-Investigators: Sarah Mullane*, Sarah Rydell, Meynard Toledo, Paul Estabrooks, Mark Pereira R01CA198971

Physical actvity AND sedentary behavior are important for all- cause mortality Inactve ¼ U.S. pop Sedentary Actve Lifestyle Ekelund U et al. Sedentary Lifestyle Lancet 2016;388:1302– 1310. PMID: 27475271 Half U.S. pop A harmonised meta- analysis of data from Meetjng Below Exceeding PA guidelines PA guidelines PA guidelines more than 1 million men and women.

2018 HHS Physical Activity Guidelines for Americans https://health.gov/paguidelines/second-edition/

Recent 2018 US Physical Activity Guidelines Advisory Council Statement (Health Promotion) https://health.gov/paguidelines/second-edition/report/

Why the workplace for sedentary behavior? • Work has become more sedentary in recent decades due to technological advances • American workers spend 70-80% of their working day sitting • Sedentary behavior is ubiquitous, socially- reinforced, and habitual (and typically embedded in the workplace culture)

Stand & Move at Work Group Randomized Trial Design: 12-month intervention • N worksites: 24, 632 office-based workers • Healthcare/industry, government, and education sectors • Region: Arizona and Minnesota Length: 12 months + 24 month follow-up Outcomes: 0, 3, 12 (primary), and 24 month (follow-up) • activPAL 3c micro • Cardiometabolic, productivity NIH National Cancer Institute (R01CA198971)

Study design MOVE+ comparison STAND+ intervention Ergotron Workfit-T Behavioral target: Move more during Behavioral target: MOVE+ goal + the workday, with a goal of >30 increase standing time by 50%/day min/day.

Intervention components ADVOCATE REQUIRED

Reduction in workplace sedentary time • Sedentary time was reduced by 66 ± 14 min/workday (p<0.001) • No changes outside of work • No compensation activPAL micro

Reduction in musculoskeletal symptoms Nordic Questionnaire 12-month change in total symptom score STAND+: -1.7 ± 0.71, p<.05 MOVE+: 0.7 ± 0.75, p=0.40 Difference: -2.3 ± 1.06, p<.05

Clinically-meaningful reduction in cardiometabolic risk (dysglycemic group only) Absolute change in dysglycemic group (N=95) Full sample Glucose -7.73 (-19.2 to 3.75) (mg/dL) TG (mg/dL) -17.6 (-48.5 to 13.2) HDL (mg/dL) 0.16 (-2.88 to 3.21) SBP (mm Hg) -0.26 (-0.69 to 0.18) Dysglycemic HbA1c (%) -0.26 (-0.69 to 0.18) sample Weight (kg) -3.50 (-6.61 to -0.38) Body fat (%) -1.67 (-3.21 to -0.13)

Purpose This study aimed to conduct a retrospective evaluation of implementation outcomes from the Stand & Move at Work trial using the Integrated – Promoting Action on Research Implementation in Health Services (iPARIHS) framework.

iPARIHS framework (Integrated – Promoting Action on Research Implementation in Health Services)

Data Sources Efficacy trial: behavioral outcomes, readiness  interviews, reach, fidelity Discovery interviews (SPRINT) of worksite  wellness practitioners and thought leaders (N=42) Pilot implementation strategies in two additional  worksites

Results: Large variability in efficacy among STAND+ worksites Sedentary behavior (min/8h workday) Top 25% Bottom 25% Change in sitting -86.6[7.6] -26.9[2.4] Change in standing 82.5[8.0] 23.4[5.8] Change in LPA 2.7[5.0] 2.7[3.9]

Results: Fidelity

Results: Innovation

Results: Recipient ADVOCATE REQUIRED

Results: Context

Summary of findings

Conclusions Even among efficacious interventions, large variability in efficacy can exist  which may be explained by varying levels of implementation fidelity.  Expert facilitation may be a key driver for improving both adherence and competence components of intervention fidelity. Future workplace interventions should consider level of training of worksite staff  to deliver interventions, and when necessary include expert-based facilitation from trained staff. Future work should experimentally test delivery strategies comparing expert- vs.  novice-based facilitation to understand differences in intervention effectiveness.

Sarah Mullane, PhD Funded by NIH R01CA198971 Coordinators: PIs: Matthew Buman, Arizona State University Sarah Mullane, Arizona State University Sarah Rydell, University of Minnesota Mark Pereira, University of Minnesota THANKS to the entire Stand & Move Team

Thank you! Matthew Buman, PhD mbuman@asu.edu