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

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

Sep 10, 2022 250 likes •504 views

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

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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

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Physical actvity AND sedentary behavior are important for all- cause mortality

Ekelund U et al. Lancet 2016;388:1302– 1310. PMID: 27475271 A harmonised meta- analysis of data from more than 1 million men and women.

Meetjng PA guidelines Exceeding PA guidelines Below PA guidelines Actve Sedentary Lifestyle Inactve Sedentary Lifestyle ¼ U.S. pop Half U.S. pop

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2018 HHS Physical Activity Guidelines for Americans

https://health.gov/paguidelines/second-edition/

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Recent 2018 US Physical Activity Guidelines Advisory Council Statement (Health Promotion)

https://health.gov/paguidelines/second-edition/report/

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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)

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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)

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Study design

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

Ergotron Workfit-T

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Intervention components

ADVOCATE REQUIRED

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Reduction in workplace sedentary time

activPAL micro

  • Sedentary time was reduced by

66 ± 14 min/workday (p<0.001)

  • No changes outside of work
  • No compensation
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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

Reduction in musculoskeletal symptoms

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Clinically-meaningful reduction in cardiometabolic risk (dysglycemic group only)

Absolute change in dysglycemic group (N=95) Glucose (mg/dL)

  • 7.73 (-19.2 to 3.75)

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)

HbA1c (%)

  • 0.26 (-0.69 to 0.18)

Weight (kg)

  • 3.50 (-6.61 to -0.38)

Body fat (%)

  • 1.67 (-3.21 to -0.13)

Full sample Dysglycemic sample

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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.

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

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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

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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]

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Results: Fidelity

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Results: Innovation

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Results: Recipient

ADVOCATE REQUIRED

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Results: Context

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Summary of findings

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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.

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PIs: Matthew Buman, Arizona State University Mark Pereira, University of Minnesota Coordinators: Sarah Mullane, Arizona State University Sarah Rydell, University of Minnesota Funded by NIH R01CA198971

THANKS to the entire Stand & Move Team

Sarah Mullane, PhD

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