Department of Kinesiology, The Pennsylvania State University, 23B Recreation Building, University Park, PA, 16802, USA.
Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
Int J Behav Nutr Phys Act. 2019 Dec 27;16(1):140. doi: 10.1186/s12966-019-0903-5.
Previous reviews of rural physical activity interventions were focused on intervention effectiveness and had reported overall mixed findings. The purpose of this systematic review was to apply the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate the extent to which rural physical activity interventions in the U.S. have reported on dimensions of internal and external validity and to offer suggestions for future physical activity interventions for rural U.S.
Pubmed, PsychINFO, CINAHL, PAIS, and Web of Science were searched through February 2019 to identify physical activity intervention studies conducted in rural regions in the U.S. with adult populations. Titles, abstracts, and full texts of articles were reviewed against inclusion and exclusion criteria. Data extraction from included articles included a summary of study details, rural classification system used, and the presence or absence of a total 61 RE-AIM indicators, including reach (n = 13), efficacy/effectiveness (n = 10), adoption (n = 21), implementation (n = 9), and maintenance (n = 8).
A total of 40 full-text articles representing 29 unique studies were included. Classifications of rurality included self-statements by authors (n = 19, 65.5%), population/census-based definitions (n = 3, 10.3%), Rural Urban Continuum Codes (n = 3, 10.3%), Rural Urban Commuting Area codes (n = 2, 6.9%), the 2014 Alabama Rural Health Association classification system (n = 1, 3.4%) and the U.S. Office of Management and Budget classification system (n = 1, 3.4%). Individual studies reported between 14.8 to 52.5% of total RE-AIM indicators. Studies reported 15.4 to 84.6% indicators for reach; 20.0 to 70.0% indicators for efficacy/effectiveness; 4.8 to 47.6% indicators for adoption; 11.1 to 88.9% indicators for implementation; and 0 to 25.0% indicators for maintenance.
We found an overall poor reporting of components related to external validity, which hinders the generalizability of intervention findings, and a lack of consistency in the definition of rurality. Future research should focus on balancing factors of internal and external validity, and should aim to develop a greater understanding of how rurality influences health and behavior to provide contextual knowledge needed to advance the translation of physical activity interventions into practice in rural communities and reduce rural health disparities.
The review protocol was registered with PROSPERO: CRD42019116308.
之前关于农村体力活动干预的综述主要关注干预效果，报道的结果总体上存在差异。本系统综述的目的是应用实施、可达性、有效性、接受度、实施和维持（RE-AIM）框架，评估美国农村体力活动干预在内部和外部有效性方面报告的程度，并为美国农村地区未来的体力活动干预提供建议。
通过 Pubmed、PsychINFO、CINAHL、PAIS 和 Web of Science 检索，截至 2019 年 2 月，以确定美国农村地区进行的以成年人群体为对象的体力活动干预研究。对文章的标题、摘要和全文进行了审查，以确定是否符合纳入和排除标准。纳入文章的数据提取包括研究细节摘要、使用的农村分类系统以及存在或不存在总共 61 个 RE-AIM 指标，包括可达性（n=13）、有效性/效果（n=10）、接受度（n=21）、实施（n=9）和维持（n=8）。
共纳入 40 篇全文，代表 29 项研究。农村分类包括作者的自我陈述（n=19，65.5%）、人口/普查定义（n=3，10.3%）、农村城市连续体代码（n=3，10.3%）、农村城市通勤区代码（n=2，6.9%）、2014 年阿拉巴马农村健康协会分类系统（n=1，3.4%）和美国管理和预算办公室分类系统（n=1，3.4%）。个别研究报告了 14.8%至 52.5%的总 RE-AIM 指标。研究报告的可达性指标为 15.4%至 84.6%；有效性/效果指标为 20.0%至 70.0%；接受度指标为 4.8%至 47.6%；实施指标为 11.1%至 88.9%；维持指标为 0%至 25.0%。
我们发现，与外部有效性相关的组成部分报告总体较差，这阻碍了干预结果的推广，而且农村的定义也不一致。未来的研究应注重平衡内部和外部有效性的因素，并应致力于更好地了解农村地区如何影响健康和行为，以提供推进农村社区体力活动干预实践和减少农村健康差距所需的背景知识。
该综述方案已在 PROSPERO 注册：CRD42019116308。
