Beginning With the End in Mind: Contextual Considerations for Scaling-Out a Community-Based Intervention.

NithyaPriya Ramalingam,Thomas E. Strayer,Laura E. Balis,Samantha M. Harden

doi:10.3389/fpubh.2018.00357

Abstract

Introduction: 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.Methods and results: 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.Conclusion: 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.

Highlights

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
Before the program was adopted, a mixed-methods design based on RE-AIM was used to capture perceptions of Extension health educators who could deliver the program in practice
While the work here is presented in stages, it is important to note that these processes are continuous steps in order to ensure that the researchers, Extension health educators, and community partners engaged in a reflective and action-oriented manner

Summary

Introduction

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. Delivering (and sustaining) evidence-based interventions (EBI) in community practice is challenging. County-based delivery personnel in the landgrant university Cooperative Extension Service (Extension) have the autonomy to select open-access (i.e., open to all, without restriction due to sex, socioeconomic status, or, more notably, health condition) interventions for their county residents [2]. As only 12% of this population is meeting physical activity recommendations, and new efforts within Extension are geared toward promoting physical activity [3,4,5], it is necessary to understand existing programs, their impacts, and how to scale-out interventions [6] across Extension state systems. Scale-out is an extension of scale-up and uniquely refers to the deliberate use of strategies to implement, test, improve, and sustain an EBI as it is delivered to new populations and/or through new delivery systems that differ from those in effectiveness trials.” [(6) p. 3]

Methods

Results

Discussion

Conclusion