Balis Laura E, Strayer Thomas E, Ramalingam NithyaPriya, Harden Samantha M
Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States.
Extension, University of Wyoming, Lander, WY, United States.
Front Public Health. 2018 Dec 10;6:357. doi: 10.3389/fpubh.2018.00357. eCollection 2018.
A number of effective physical activity programs for older adults exist, but are not widely delivered within community settings, such as the Cooperative Extension System. The purpose of this paper was to determine if an evidence-based intervention (EBI) developed in one state Extension system could be scaled-out to a new state system. The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework was used to guide an iterative evaluation of three translational stages. Stage 1: Before program adoption, Extension health educators were surveyed and interviewed to assess physical activity programming perceptions and factors that may influence their decision to attend training or deliver the program in practice. Results indicated that a virtual, scalable training protocol would be necessary and that training needed to include hands-on instruction and be catered to those who were less confident in physical activity program delivery. Stage 2: Training attendees were surveyed pre- and post-training on factors related to the adoption-decision making process and contacted post-training to assess program delivery status. Training did not influence perceptions of the program, intent to deliver, or confidence in delivering the program. Stage 3: During program implementation, the program was evaluated through the RE-AIM framework by surveying across three key stakeholder groups: (1) program participants, (2) potential delivery personnel, and (3) Extension administrators. Findings indicate that the program has the potential to reach a large and representative proportion of the target audience, especially in rural areas. However, adoption and implementation rates among Extension health educators and community partners were low and data collection for effectiveness, implementation, and maintenance was a challenge. Overall, the results indicate initial struggles to translating and evaluating the program in a large, rural state. Implications for practice include making system-level changes to increase physical activity program adoption rates among Extension health educators and improve data collection and program evaluation through this community-based organization. More work is needed to identify infrastructure support and capacity to scale-out EBIs.
有许多针对老年人的有效体育活动项目，但这些项目在社区环境中并未得到广泛推广，比如合作推广系统。本文的目的是确定在一个州推广系统中开发的循证干预措施（EBI）能否推广到一个新的州系统。采用RE-AIM（覆盖范围、有效性、采用率、实施情况、维持情况）框架来指导对三个转化阶段的迭代评估。阶段1：在项目采用之前，对推广健康教育工作者进行了调查和访谈，以评估他们对体育活动项目的看法以及可能影响他们参加培训或在实践中实施该项目的决定的因素。结果表明，需要一个虚拟的、可扩展的培训方案，并且培训需要包括实践指导，并且要针对那些对体育活动项目实施缺乏信心的人。阶段2：在培训前后对培训参与者进行了关于采用决策过程相关因素的调查，并在培训后联系他们以评估项目实施情况。培训并未影响对该项目的看法、实施意愿或实施该项目的信心。阶段3：在项目实施期间，通过对三个关键利益相关者群体进行调查，利用RE-AIM框架对该项目进行评估：（1）项目参与者，（2）潜在实施人员，（3）推广管理人员。研究结果表明，该项目有潜力覆盖很大一部分具有代表性的目标受众，尤其是在农村地区。然而，推广健康教育工作者和社区合作伙伴的采用率和实施率较低，收集有效性、实施情况和维持情况的数据是一项挑战。总体而言，结果表明在一个大型农村州对该项目进行转化和评估存在初步困难。对实践的启示包括进行系统层面的变革，以提高推广健康教育工作者对体育活动项目的采用率，并通过这个社区组织改进数据收集和项目评估。需要开展更多工作来确定推广循证干预措施所需的基础设施支持和能力。
