Dunford Ashley R, Begg Stephen, Kingsley Michael, O'Halloran Paul, Perrin Byron M, Barrett Stephen
Health Promotion Department, Bendigo Health, Bendigo, VIC, 3550, Australia.
Renal Services, Bendigo Health, Bendigo, VIC, 3550, Australia.
BMC Public Health. 2025 Jul 7;25(1):2396. doi: 10.1186/s12889-025-23614-2.
Scaling up evidence-based interventions to improve physical activity (PA) is important for enhancing health outcomes. The Healthy4U (H4U) program, initially successful in improving PA and health outcomes among ambulatory hospital patients, was expanded from one regional hospital to five rural hospitals. This study retrospectively examines the feasibility of implementing H4U at Scale (H4U-AS) over 12 months.
A feasibility implementation evaluation was conducted retrospectively using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The following variables were assessed within each RE-AIM domain: Reach: Number of program participants.
Measured changes in PA (Metabolic Equivalent of Task minutes (MET-mins/week)), sedentary behaviour (hours/day spent seated), fruit and vegetable intake (serves/day), and nicotine dependence score (Fagerström Test for Nicotine Dependence (FTND)) using paired t-tests or Wilcoxon signed-rank tests. Adoption: Type of setting, program integration, and behaviour change training uptake.
Participant and hospital recruitment adherence. Maintenance: Continuation of the program.
Reach: In total, 37 participants were recruited during the 6-month recruitment period; pre- and post-data were available for 33.
PA increased from a median of 460 MET-mins/week to 840 (p < 0.001). Sedentary behaviour decreased from 8.0 h/day to 7.0 (p < 0.001). Vegetable intake increased from 3.0 serves/day to 3.5 (p = 0.001). Fruit intake did not change significantly (p = 0.228). Nicotine dependence decreased non-significantly from 5.0 to 4.5 (p = 0.08). Adoption: The program was successfully implemented in five rural hospitals; feedback from hospital representatives indicated that recruitment procedures were integrated into existing hospital workflows. To support recruitment, processes were adapted to include mailing out invites to people on elective surgery wait lists.
86% of participants completed the minimum 4 of 6 available sessions, and all hospitals recruited during the program period. Maintenance: Funding for the project was not available beyond the 12-month period. As a result, recruitment into the program was ceased.
H4U-AS suggests that implementing an evidence-based PA intervention from one regional hospital to five rural hospitals may be feasible. Participants improved PA and dietary behaviours. However, limited participant recruitment during the short recruitment period, and funding cessation, impacted the extent to which the program could be offered and evaluated at scale.
扩大基于证据的干预措施以改善身体活动（PA）对于提高健康结果至关重要。“健康4U”（H4U）项目最初在改善门诊医院患者的身体活动和健康结果方面取得了成功，现已从一家地区医院扩展到五家农村医院。本研究回顾性地考察了在12个月内大规模实施“健康4U”（H4U-AS）的可行性。
使用RE-AIM（覆盖范围、有效性、采用情况、实施情况、维持情况）框架进行回顾性可行性实施评估。在每个RE-AIM领域内评估以下变量：覆盖范围：项目参与者数量。
使用配对t检验或Wilcoxon符号秩检验评估身体活动（代谢当量任务分钟数（MET-分钟/周））、久坐行为（每天坐着的小时数）、水果和蔬菜摄入量（每天份数）以及尼古丁依赖评分（尼古丁依赖Fagerström测试（FTND））的变化。采用情况：设置类型、项目整合以及行为改变培训的参与情况。
参与者和医院招募的依从性。维持情况：项目的延续。
覆盖范围：在6个月的招募期内共招募了37名参与者；33名参与者有前后数据。
身体活动从每周中位数460 MET-分钟增加到840（p < 0.001）。久坐行为从每天8.0小时减少到7.0小时（p < 0.001）。蔬菜摄入量从每天3.0份增加到3.5份（p = 0.001）。水果摄入量没有显著变化（p = 0.228）。尼古丁依赖从5.0降至4.5，无显著下降（p = 0.08）。采用情况：该项目在五家农村医院成功实施；医院代表的反馈表明招募程序已纳入现有的医院工作流程。为支持招募，对流程进行了调整，包括向择期手术等候名单上的人邮寄邀请。
86%的参与者完成了6次可用课程中的至少4次，并且所有医院在项目期间都进行了招募。维持情况：该项目在12个月期限后没有资金。因此，停止了该项目的招募。
H4U-AS表明，从一家地区医院向五家农村医院实施基于证据的身体活动干预措施可能是可行的。参与者改善了身体活动和饮食行为。然而，在短招募期内参与者招募有限以及资金停止，影响了该项目能够大规模提供和评估的程度。
