PROMOTING PHYSICAL ACTIVITY AMONG LATINAS IN FAITH BASED SETTINGS: - - PowerPoint PPT Presentation
PROMOTING PHYSICAL ACTIVITY AMONG LATINAS IN FAITH BASED SETTINGS: ENHANCING THE ORGANIZATION Elva M. Arredondo, Ph.D. Jessica Haughton, MPH, MA Faith in Action Faith in Action ( Fe en Accin ) was a two-group randomized controlled trial
NCI: R01CA138894
Characteristics (n=436) M (SD) / % Mean age (SD) 44.4 (9.6) Married or coupled (%) 77.4 % Employed (%) 65.7 % Household income (< 2,000) (%) 63.3 % Education (< HS) (%) 54.9 % Country of Birth (Mexico) (%) 90.8 % Mean years in the US (SD) 21.0 (10.3) Mean BMI (SD) 30.3 (6.22) Mean waist circumference (SD) 94.9 (14.7)
Table 1: Mixed effects models evaluating intervention for primary and secondary outcomes Condition Diff (inter-control)
Intervention Control Adj Mean SE Adj Mean SE Diff in adj p-value
MVPA (accelerometer) 4.93 0.05 4.78 0.03 0.15 .03 Leisure time MVPA self report 4.86 0.05 4.47 0.09 0.39 .003 BMI 30.2 0.14 30.6 0.14
.03 Waist circumference 95.2 0.5 96.5 0.5
.08 Behavioral strategies for PA 4.84 0.21 3.77 0.16 1.07 <.0001 Calories from fat 29.5 0.2 29.5 0.2 .97
1Mixed effects or generalized linear mixed models were used to adjust for the clustering effects of churches and to account for repeated measures over M2 and M3. If the time by
condition interaction term was not significant, the term was dropped and the condition main effect was tested. All analyses were adjusted for the baseline measure of the outcome, age, marital status, employment and education. 2 Negative binomial error distribution. Results are shown in logged units. 3 Binomial error distribution (Logistic model)
Beard M, Chuang E, Haughton J, Arredondo, EM. Determinants of Implementation Effectiveness in a Physical Activity Program for Church Going Latina Women. Fam Community Health. 2016,39(4):225-33.
Intervention level Data collection instrument Framework Method Promotoras Surveys Focus groups Schell et al/CFIR CFIR In person (self-administered) In person Participants Surveys Interviews Schell et al Schell et al/CFIR Mailed (self-administered) Phone Church leaders Church staff (former Fe churches and new Catholic and Evangelical churches) Interviews CFIR In person
Schell, S. F., Luke, D. A., Schooley, M. W., Elliott, M. B., Herbers, S. H., Mueller, N. B., & Bunger, A. C. (2013). Public health program capacity for sustainability: a new framework. Implementation Science, 8(15). Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidates framework for advancing implementation science. Implementation Science, 4(50). doi:10.1186/1748-5908-4-50
Aim 1 Aim 1. Examine pre-implementation strategies of an organizational-enhanced EBI promoting PA among Catholic and non-Catholic (Evangelical) churches. We will use the consolidated framework for Implementation Research (CFIR) to inform the development of the organizational enhanced PA intervention and conduct semi- structured interviews and surveys with church leadership to adapt the current EBI to non-Catholic denominations (e.g., Evangelical). Also, we will identify program champions, develop the technical support manual, and church leadership training. Furthermore, we will identify factors associated with organizational readiness and program
kinesiology departments, YMCA) that may support program activities. Primary Implementation Aim Aim 2 Aim 2. Facilitate implementation of an organizational enhanced-EBI promoting PA among Catholic and non-Catholic (e.g., Evangelical) churches. We will engage church leadership and promotoras to facilitate its implementation, adoption, and delivery with strong fidelity, and sustain its use for 10 months following the active implementation phase. We will use mixed methods approach to examine barriers and facilitators to adoption, fidelity and sustainability. Hypothesis: We hypothesize that churches that have greater church leadership engagement will have lower barriers to adoption, greater fidelity and sustainability compared to the churches that have lower church leadership engagement. Primary Intervention Effectiveness Aim Aim 3 Aim 3. Test the effectiveness of an organizational-enhanced EBI on the individual (e.g., PA levels), social (e.g., social cohesion), organizational (e.g., leadership support, presence of a health ministry), and community (e.g., perceived safety) levels in the implementation of the intervention. Hypothesis: We hypothesize that churches that have greater church leadership engagement will have greater physical activity changes, greater social cohesion, leadership engagement, and community engagement.
Level Intervention strategy Intervention outcome
Individual Motivational interviewing calls Program satisfaction/ number of calls completed Health handouts Knowledge/ number of handouts distributed PA classes MVPA (accelerometer, self-report) Social Motivational Interviewing calls Increased motivation Noche familiar gatherings Attendance and participation Organizational Signed MOU Readiness/ commitment Health ministry Does one exist? Promotoras’ standing meeting with leaders Number of meetings Role modeling/ program support Involvement of church leader(s) Promote program from pulpit Number of promotions Bulletin advertising (branding) Number of times in bulletin Promotora network events Number of events and attendance Challenges across church sites Number of events
Implementation strategy Actor Action targeted Temporality Dose Outcome Training stakeholders Promotoras Motivational interviewing Beginning Initial training Certification Leading PA classes Beginning Initial training Certification Meeting with church staff Continuously Once a week Adoption Developing a business or fundraising model Beginning Initial training Sustainment Leadership skills Continuously Throughout Sustainment Church leader(s) Knowledge about program and PA Beginning 1 day Adoption Using mass media Promotoras and church staff Information in bulletin about program Monthly Blurb in bulletin: testimonials, star participant, most improved, photos from events Penetration Obtain formal commitment Church leader(s) Signed MOU Beginning One time Adoption Promotoras Application to be a health coach; completion of training Beginning Full participation in training Adoption Model and stimulate change Church leader(s) Role model behaviors Continuously Announcements during sermons; participation in program activities Penetration Create a learning collaborative Promotoras Networking meetings and booster trainings Quarterly Every three months and location rotates Fidelity
Powell, B. J., Garcia, K. G., & Fernandez, M.E. (In Press). Implementation Strategies. In D. Chambers, C Vinson, and W Norton (Eds.), Optimizing the cancer control continuum: Advancing implementation research. New York: Oxford University Press. Proctor, E., Silmere, H., Raghaven, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65-76.
Investigative team Elva M. Arredondo (PI), PhD Don Slymen, PhD John P. Elder, PhD, MPH Jim Sallis, PhD Guadalupe X. Ayala, PhD, MPH Sherry Ryan, PhD Matthew Allison, MD, MPH (biomarker study) Project Manager: Jessica Haughton, MPH, MA Evaluation Coordinator: Martha Solórzano, MPH Doctoral Student/Data Manager: Lilian Perez, PhD, MPH Physical Activity Specialist: Jacqueline Montañez Cancer Prevention RA: Carolina López de la Torre, MPH Evaluation Research Assistants: Regina Flores, Stephanie Ruiz, Karina Parra, Farah Palomas, Melissa Estrada-Maravilla Physical Activity Promotoras Promotoras Cancer Prevention Promotoras Promotoras Student interns Participants Catholic Diocese of San Diego Funding agency: NCI R01CA138894