Building system-wide capacity to reach those in need of interven8on - - PowerPoint PPT Presentation

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Building system-wide capacity to reach those in need of interven8on - - PowerPoint PPT Presentation

Feb 14, 2023 192 likes •414 views

Building system-wide capacity to reach those in need of interven8on A collabora)ve partnership approach to understanding uptake and sustainability of physical ac)vity promo)on in a statewide and na)onal system. SAMANTHA HARDEN, PHD ASSISTANT

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Building system-wide capacity to reach those in need of interven8on

A collabora)ve partnership approach to understanding uptake and sustainability of physical ac)vity promo)on in a statewide and na)onal system.

SAMANTHA HARDEN, PHD ASSISTANT PROFESSOR AND EXERCISE SPECIALIST HUMAN NUTRITION, FOODS, AND EXERCISE AND VIRGINIA COOPERATIVE EXTENSION VIRGINIA TECH

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NITHYA RAMALINGAM REBECCA DAVIS IAN PASQUARELLI LINDA JACKSON COLE APRIL PAYNE EMILY WELLS CRYSTAL BARBER TERRI ABSTON REBECCA WILDER

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Objec8ves

ü Describe Coopera)ve Extension ü Share process and outcomes of establishing a research-prac)ce partnership with health educators of Coopera)ve Extension ü Demonstrate success of the partnership

ü Results of two trials as evaluated by the RE-AIM framework (reach, effec)veness, adop)on, implementa)on, maintenance)

ü Defend the use of a research-prac)ce partnership to increase the uptake and sustainability of interven)ons in prac)ce

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Coopera8ve Extension

Available in every state and territory of the U.S. Mission is to bring University-developed evidence to the people Family and Consumer Sciences (FCS) founded in 1914 Employ county-based FCS agents for health promoDon programming

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“This same system of Extension can do for the na)on’s health what it did for American agriculture.”

Only 13 states include ‘physical acDvity’ outcomes in their strategic plan

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Typical Efficacy- Effec8veness- Dissemina8on Pipeline

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Integrated Research-Prac8ce Partnership Model

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Behavior change posi)vely impacts the

  • rganiza)on

Need to shiP focus from individual- level targets(self-efficacy, effec)veness) to popula)on-level targets (uptake, sustainability)

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NITHYA RAMALINGAM REBECCA DAVIS IAN PASQUARELLI LINDA JACKSON COLE APRIL PAYNE EMILY WELLS CRYSTAL BARBER TERRI ABSTON REBECCA WILDER

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Adop8on Randomized Controlled Trial

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“Those who delivered the programs were not significantly different on demographic or health- related characteris)cs as compared to those who did not deliver the program.” Harden, S.M., Johnson, S.B., Almeida, F.A. et al. Behav. Med. Pract. Policy Res. (2016). doi:10.1007/s13142-015-0380-6

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Implementa)on

  • Time
  • FitEx took 134 ±162 h to deliver, or an average of 7 min per par)cipant
  • ALED took 33±49 h, or an average of 1.2 h per par)cipant.
  • Adapta)on
  • ALED None reported
  • Fit Ex Numerous small changes in feedback )ming and structure

Harden, S.M., Johnson, S.B., Almeida, F.A. et al. Behav. Med. Pract. Policy Res. (2016). doi:10.1007/s13142-015-0380-6

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Effec)veness

FitEx (n= 81) ALED (n=27) Overall FitEx (n =1070) Inac)ve, % Baseline 37 37 29 Post-program 8 5 6 Insufficiently Ac)ve, % Baseline 28 28 36 Post-program 45 47 43 Ac)ve, % Baseline 35 35 35 Post-program 47 47 51 Harden, S.M., Johnson, S.B., Almeida, F.A. et al. Behav. Med. Pract. Policy Res. (2016). doi:10.1007/s13142-015-0380-6

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Reach

  • Fit Ex ~75 par)cipants per health educator
  • ALED ~15 par)cipants per health educator

Maintenance

  • FitEx delivered for 3 years post ini)al evalua)on
  • Health educators significantly more likely to intend to deliver the program in the following year when

compared to their ALED counterparts

Descrip)ve Informa)on

ALED > male < work ours || WHY || Harden, S.M., Johnson, S.B., Almeida, F.A. et al. Behav. Med. Pract. Policy Res. (2016). doi:10.1007/s13142-015-0380-6

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AN 8-WEEK, IN PERSON, GROUP-BASED STRENGTH-TRAINING PROGRAM TARGETING OLDER, SEDENTARY ADULTS

Wilson M, Davis R, Harden SM. Informed adapta)ons of a group dynamics-based, strength-training program for older adults through a research-prac)ce partnership. Under Review: Health Promo)on Prac)ce

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Iden)fy a physical ac)vity program that promotes balance, flexibility, and strength training to improve funcDonal fitness, allowing older adults’ to age in place and live comfortably independent longer.

Founda8ons of LIFT

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Agents who expressed interest in delivering strength-training program

AdopDon ImplementaDon Reach Maintenance EffecDveness

LIFT

(n= 5)

SSSH

(n= 4) 0% Intend to Deliver [all intend to deliver LIFT] EffecDveness: Presented on next slide Number of parDcipants per cohort, per agent Overall Program Cohort RetenDon Rate, %Mean +SD RepresentaDveness N = 113 parDcipants | 16 parDcipants per cohort LIFT: 75 +10 SSSH: 58+12 Decline ( n= 1) Accept ( n= 4) Decline ( n= 2) Accept ( n= 2) 100% Intend to Deliver in 2017 Age, BMI, Sex, Ethnicity were similar across the two condiDons. There were significantly more (P <.0.05) African American parDcipants in SSSH. MacGhee M, Strayer III T, Harden SM. If you build it, will the target “they” come?: Reach, representa)veness, and reten)on of older adults in a community-based strength training program. Poster Presenta)on: Thursday, 11:15am Ramalingam N, & Harden SM. Obtaining T3 data using a sequen)al, transforma)ve mixed methods approach: What’s contribu)ng to the adop)on-implementa)on gap? Poster Presenta)on: Wednesday, 5:30pm

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Pre and Post-Program Strength, Flexibility, and Balance Scores, by program

Func)onal Fitness Assessment Program Baseline Post-program (ITT) Change scores Sit and Stands M(±SD) LIFT SSSH 10.58 (±3.21) 9.40 (±4.29) 13.07 (±5.14)* 10.71 (±3.22) 2.67 (±3.73)* 1.31 (±2.17)* Arm Curls M(±SD) LIFT SSSH 13.89 (±4.0) 14.50 (±5.55) 17.65 (±6.22) 15.9 (±4.3) 3.65 (±6.03)* 1.40(±6.37) 2-minute step test M(±SD) LIFT SSSH 61.66 (±30.0) 52.6 (±22.6) 77.5 (±30.0) 72.4 (±32.3) 14.03 (±16.71)* 20.33 (±33.09)* Lower body flexibility M(±SD) LIFT SSSH 1.74 (±3.86)

  • 0.76 (±3.12)
  • 0.000 3(±2.96)

0.68 (±3.05) 1.77 (±2.97)* 1.44 (±2.53)* Upper body flexibility M(±SD) LIFT SSSH

  • 5.05 (±4.93)
  • 6.05 (±5.69)
  • 4.2 (±5.51)
  • 4.8 (±4.06)

1.24 (±3.17)* 1.25 (±1.94)* 8-foot up-and-go M(±SD) LIFT SSSH 7.68 (±3.84) 7.19 (±2.92) 7.02 (±3.25) 6.6 (±1.94)

  • .065 (±1.31)*
  • 0.06 (±1.97)

Composite balance score M(±SD) LIFT SSSH 2.44 (±1.3) 2.00 (±1.0) 2.79 (±1.5) 2.42 (±1.4) 0.35 (±1.18)* 0.42 (±0.99)*

*p<0.05

ITT: Inten)on to Treat; Paired T-test, within program significant differences (*p<0.05); One way ANOVA analysis did not detect any significant differences between programs.

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Implica8ons

Iden)fica)on of organiza)onal culture, needs, and resources is impera)ve to ensure program uptake and sustainability. Building a collabora)ve partnership allows community health workers to contribute to the development and design of interven)ons that may be tailored for the audiences they serve. Future research is needed on the collec)ve impact the partnership and its efforts will have on popula)on-level physical ac)vity changes.

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Ques8ons?

Thank you!

Thanks to all PALT and PARCI members!