Department of Health Education and Health Sociology, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
Graduate School of Public Health, Teikyo University, Itabashi-Ku, Tokyo, Japan.
Int J Behav Nutr Phys Act. 2024 Nov 25;21(1):131. doi: 10.1186/s12966-024-01684-6.
Intervention trials that have demonstrated significant effects may not always replicate those effects when scaled up. This study aimed to test whether scaling-up a successful cluster randomized trial (the COMMUNICATE study, 9 intervention communities), which promoted population-level physical activity (PA), could promote PA in a broader citywide setting (29 communities) after two years, as a mid-term evaluation of the six-year scaled-up trial.
This is a single-arm, pre-post comparison of a multi-strategic community-wide intervention covering the entire Unnan City, Japan. The intervention for middle-aged and older people consisted of three components: information delivery, education, and support delivery. The intervention method followed the COMMUNICATE study but adapted and introduced new initiatives tailored to local resources. A baseline survey (n = 3,718) among randomly selected residents aged 40-79 years in 2016 and a follow-up survey with the same respondents two years later were conducted. The primary outcome was the change in the percentage of people who practiced the recommended levels of PA, analyzed with a generalized linear mixed model to account for clusters at individual and community levels. Additionally, we examined the dose-response relation of the effect based on the intervention doses in each community. The RE-AIM framework assessed intervention dissemination and implementation.
The two-year intervention was implemented in all communities, reaching and involving various groups. The rate of people engaged in PA significantly increased in two years (adjusted change: + 8.0 percentage points [95% confidence interval: 6.1, 10.0]). Based on the type of PA, only muscle-strengthening activity showed a significant increase (+ 11.5% points [9.6, 13.5]), whereas walking (-1.8% points [-3.6, 0.1]) and flexibility activities (+ 0.3% points [-1.5, 2.0]) did not. The increase in PA in higher-dose areas was not significantly different but slightly larger than that in lower-dose areas (+ 8.4% points vs. + 7.6% points, adjusted difference in change: 0.8% points [-3.8, 5.5]).
The scaled-up citywide intervention promoted PA, especially muscle-strengthening activity. Collaboration with diverse organizations in different settings is crucial for multi-faceted interventions and requires balancing uncertainty in its implementation quality and quantity owing to collaborative decision-making.
UMIN-CTR, UMIN000024682. Registered 02 November 2016, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000028377.
已经证明有效的干预试验在扩大规模后并不总是能复制这些效果。本研究旨在测试在两年后，在更广泛的全市范围内（29 个社区）推广一项成功的群组随机试验（COMMUNICATE 研究，9 个干预社区），该试验促进了人群水平的身体活动（PA），是否可以促进身体活动，这是对六年扩大规模试验的中期评估。
这是一项在日本船井市进行的多策略全市范围干预的单臂、前后对照研究。针对中年和老年人的干预措施包括三个组成部分：信息传递、教育和支持服务。干预方法遵循 COMMUNICATE 研究，但适应并引入了针对当地资源的新举措。在 2016 年，对随机抽取的 40-79 岁居民进行了基线调查（n=3718），两年后对同一受访者进行了随访调查。主要结果是采用广义线性混合模型分析推荐的 PA 水平的参与者比例的变化，该模型考虑了个体和社区层面的聚类。此外，我们还根据每个社区的干预剂量检验了效果的剂量反应关系。RE-AIM 框架评估了干预的传播和实施情况。
两年的干预措施在所有社区中实施，覆盖了各种群体。两年后，参与 PA 的人数显著增加（调整后的变化：+8.0 个百分点[95%置信区间：6.1，10.0]）。根据 PA 的类型，只有肌肉强化活动显示出显著增加（+11.5 个百分点[9.6，13.5]），而步行（-1.8 个百分点[-3.6，0.1]）和灵活性活动（+0.3 个百分点[-1.5，2.0]）则没有。高剂量地区的 PA 增加并不显著，但略高于低剂量地区（+8.4 个百分点比+7.6 个百分点，调整后的差异变化：0.8 个百分点[-3.8，5.5]）。
全市范围的扩大干预措施促进了 PA，尤其是肌肉强化活动。在不同环境中与不同组织的合作对于多方面的干预措施至关重要，并且需要在实施质量和数量方面平衡由于协作决策而导致的不确定性。
UMIN-CTR，UMIN000024682。于 2016 年 11 月 2 日注册，https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000028377。
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