Statewide dissemination of a rural, non-chain restaurant intervention: adoption, implementation and maintenance.

The obesity epidemic calls for greater dissemination of nutrition-related programs, yet there remain few studies of the dissemination process. This study, guided by elements of the RE-AIM model, describes the statewide dissemination of a simple, point-of-purchase restaurant intervention. Conducted in rural counties of the Midwest, United States, the study targeted randomly selected, non-chain, family-style restaurants. Owners were recruited through mail, then telephone follow-up. Data were collected through telephone at baseline, and 3, 6, 12 and 18 months post-adoption. Using mixed methods, measures captured the program adoption rate, characteristics of adopters and non-adopters, program implementation and maintenance issues, and owner and customer satisfaction. Analyses involved descriptive statistics and summaries of qualitative data. The program adoption rate was 28%. Adopters were similar to responding non-adopters demographically, but varied in attitudes. The majority of restaurants maintained the program for at least 12 months. Adopters and their customers expressed satisfaction with the program. With some adjustments, the RE-AIM model was helpful in guiding evaluation of this process. Results provide implications for future dissemination of this and other programs with regard to research procedures and potential barriers that may be encountered. Research on alternative strategies for widespread dissemination of such programs is needed in this and other settings.