Balis Laura E, Strayer Thomas
Division of Agriculture Cooperative Extension Service, University of Arkansas System, Little Rock, AR, United States.
Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, United States.
Front Public Health. 2019 Dec 17;7:368. doi: 10.3389/fpubh.2019.00368. eCollection 2019.
Health promotion delivery systems are increasingly being asked to implement policy, systems, and environmental interventions (PSEs). However, evaluating PSEs is challenging, especially in low-resource community settings. This paper describes the use of RE-AIM to evaluate a physical activity PSE delivered through University of Wyoming Extension and highlights challenges and opportunities in pragmatic, real-world program evaluation. Extension health educators adapted a point-of-decision prompt intervention encouraging stairway use through posters, called Take the Stairs, Wyoming! was assessed through estimates of daily traffic, was assessed through opportunistic interviews, was calculated as the number and proportion of sites that agreed to hang posters, was calculated as the proportion of sites with a poster in place at a 2-weeks follow-up visit, and was assessed through 6-months opportunistic interviews (individual level) and proportion of sites with a poster in place (organizational level). Overall, the posters were widely and most posters were as intended. However, capturing , and was challenging, as health educators found the evaluation burdensome. Therefore, it was difficult to determine if the posters were effective at increasing physical activity levels. Suggestions are provided for capturing , and data in community settings. Future efforts are needed to create evaluation tools to pragmatically measure effectiveness of PSEs on changing behaviors, as well as to prioritize program evaluation in Extension.
健康促进实施系统越来越多地被要求实施政策、系统和环境干预措施（PSEs）。然而，评估PSEs具有挑战性，尤其是在资源匮乏的社区环境中。本文描述了使用RE-AIM来评估通过怀俄明大学推广部实施的一项身体活动PSE，并强调了在实际的、现实世界的项目评估中的挑战和机遇。推广部的健康教育工作者采用了一种决策点提示干预措施，通过名为“怀俄明州，走楼梯！”的海报来鼓励人们使用楼梯。通过每日流量估计进行评估，通过机会性访谈进行评估，通过同意悬挂海报的场所数量和比例来计算，通过在两周随访时仍有海报的场所比例来计算，通过6个月的机会性访谈（个体层面）和有海报的场所比例（组织层面）来评估。总体而言，海报得到了广泛张贴，且大多数海报按预期发挥了作用。然而，获取、和具有挑战性，因为健康教育工作者发现评估负担过重。因此，很难确定这些海报是否有效地提高了身体活动水平。文中为在社区环境中获取、和数据提供了建议。未来需要努力创建评估工具，以实际衡量PSEs对改变行为的有效性，并在推广部中优先进行项目评估。
