信仰、活动和营养随机传播与实施研究：全县范围的采用、覆盖范围和效果。
Faith, Activity, and Nutrition Randomized Dissemination and Implementation Study: Countywide Adoption, Reach, and Effectiveness.
机构信息
Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
出版信息
Am J Prev Med. 2018 Jun;54(6):776-785. doi: 10.1016/j.amepre.2018.02.018. Epub 2018 Apr 12.
INTRODUCTION
Faith-based organizations can contribute to improving population health, but few dissemination and implementation studies exist. This paper reports countywide adoption, reach, and effectiveness from the Faith, Activity, and Nutrition dissemination and implementation study.
DESIGN
This was a group-randomized trial. Data were collected in 2016. Statistical analyses were conducted in 2017.
SETTING/PARTICIPANTS: Churches in a rural, medically underserved county in South Carolina were invited to enroll, and attendees of enrolled churches were invited to complete questionnaires (n=1,308 participated).
INTERVENTION
Churches (n=59) were randomized to an intervention or control (delayed intervention) condition. Church committees attended training focused on creating opportunities, setting guidelines/policies, sharing messages, and engaging pastors for physical activity (PA) and healthy eating (HE). Churches also received 12 months of telephone-based technical assistance. Community health advisors provided the training and technical assistance.
MAIN OUTCOMES MEASURES
The Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework guided measurement of adoption and reach. To assess effectiveness, church attendees completed post-test only questionnaires of perceptions of church environment, PA and fruit and vegetable (FV) self-efficacy, FV intake, and PA. Regression models controlled for church clustering and predominant race of congregation, as well as member age, gender, education, and self-reported cancer diagnosis.
RESULTS
Church adoption was 42% (55/132). Estimated reach was 3,527, representing 42% of regular church attendees and 15% of county residents. Intervention church attendees reported greater church-level PA opportunities, PA and HE messages, and PA and HE pastor support (p<0.0001), but not FV opportunities (p=0.07). PA self-efficacy (p=0.07) and FV self-efficacy (p=0.21) were not significantly higher in attendees of intervention versus control churches. The proportion of inactive attendees was lower in intervention versus control churches (p=0.02). The proportion meeting FV (p=0.27) and PA guidelines (p=0.32) did not differ by group.
CONCLUSIONS
This innovative dissemination and implementation study had high adoption and reach with favorable environmental impacts, positioning it for broader dissemination.
TRIAL REGISTRATION
This study is registered at www.clinicaltrials.gov NCT02868866.
简介
信仰组织可以为改善人口健康做出贡献，但传播和实施研究很少。本文报告了信仰、活动和营养传播和实施研究的全县采用、覆盖范围和效果。
设计
这是一项群组随机试验。数据于 2016 年收集。统计分析于 2017 年进行。
地点/参与者：南卡罗来纳州一个农村医疗服务不足的县的教堂受邀参加，参加注册教堂的与会者被邀请完成问卷（共有 1308 人参加）。
干预措施
教堂（n=59）被随机分配到干预或对照组（延迟干预）。教堂委员会参加了以创造机会、制定准则/政策、分享信息以及鼓励牧师参与体育活动（PA）和健康饮食（HE）为重点的培训。教堂还接受了 12 个月的电话技术援助。社区健康顾问提供培训和技术援助。
主要结果测量
采用范围、效果/有效性、采用、实施、维持（RE-AIM）框架指导了采用和覆盖范围的测量。为了评估效果，教堂与会者仅完成了关于教堂环境、PA 和水果和蔬菜（FV）自我效能感、FV 摄入量和 PA 的感知后测问卷。回归模型控制了教堂聚类和会众的主要种族，以及成员的年龄、性别、教育程度和自我报告的癌症诊断。
结果
教堂采用率为 42%（55/132）。估计的覆盖范围为 3527 人，代表 42%的定期教堂与会者和 15%的县居民。干预教堂与会者报告了更多的教堂级 PA 机会、PA 和 HE 信息以及 PA 和 HE 牧师支持（p<0.0001），但 FV 机会（p=0.07）则不然。干预组与会者的 PA 自我效能感（p=0.07）和 FV 自我效能感（p=0.21）均无显著高于对照组。干预组与对照组相比，不活跃与会者的比例较低（p=0.02）。达到 FV（p=0.27）和 PA 指南（p=0.32）的比例在组间没有差异。
结论
这项创新的传播和实施研究具有很高的采用率和覆盖率，并具有有利的环境影响，为更广泛的传播奠定了基础。
试验注册
本研究在 www.clinicaltrials.gov 上注册，NCT02868866。
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