Implementation and impact of a Dementia Friends pilot.

INTRODUCTION: Dementia Friends is a dementia awareness program that trains lay leaders (called "dementia champions") to give presentations about dementia to combat stigma in their community. OBJECTIVE: In this mixed methods study, we aimed to evaluate the impact and implementation of a pilot Dementia Friends program in Washington State to assess whether it improved attitudes towards people living with dementia. METHOD: Fifteen champions were recruited, who organized 22 Dementia Friends sessions, reaching 214 Dementia Friends participants. We collected data through interviews with champions and surveys administered to Dementia Friends participants before, immediately after, and 1-month after attending a Dementia Friends session. The survey collected demographic information and measured respondent attitudes towards people living with dementia using the Dementia Attitudes Scale. RESULTS: Quantitative analysis showed that Dementia Attitude scores improved after a Dementia Friends session; this improvement was maintained through the 1-month follow-up. In qualitative analysis of champion interviews, we identified several suggestions regarding implementation of the Dementia Friends program, which could strengthen the program and better support champions in their role, such as increasing logistical assistance during participant recruitment. CONCLUSION: Dementia Friends sessions were effective in improving participant attitudes towards people living with dementia and inspiring ongoing action towards building Dementia-Friendly communities. Champions found deep meaning in their role, but would benefit from increased support to make the volunteer role more sustainable. Our findings can inform efforts to successfully deliver Dementia Friends in other locations.

Development and Feasibility Testing of the Clinical-Community Linkage Self-Assessment Survey for Community Organizations.

Introduction: Clinical-community linkages (CCLs) can improve health, but few instruments exist to evaluate these partnerships. To address this gap, we develop and test the Clinical-Community Linkage Self-Assessment Survey (CCL Self-Assessment). Materials and Methods: We built on an existing framework and conducted a literature review to guide the design of our survey, and obtained feedback from academic, clinical, and community-based experts. To pretest the instrument, we conducted 10 think-aloud interviews with community-based health-promotion organizations. We performed feasibility testing with 38 staff from 20 community organizations, followed by criterion-validity testing. Results: The 15-item final instrument includes five domains: Nature of the Relationship, Communication, Referral Process, Feedback Loop, and Timeliness. Expert feedback included keeping the CCL Self-Assessment brief and actionable. Think-aloud interviews produced a range of revisions related to item wording, instructions, brevity, and formatting. Feasibility testing showed high response rate and ease of administration. Sites scoring high on the CCL Self-Assessment also scored high on the criterion measure. Discussion: We demonstrate feasibility, as well as face, content, construct, and criterion validity. Initial results suggest the CCL Self-Assessment survey may be used by community organizations to identify strengths and weaknesses of their linkages. Next steps include additional statistical validation and testing to determine how the CCL Self-Assessment survey works in the field as well as providing specific tools to improve linkages.

Clinical-community linkages as a strategy for increasing evidence-based program reach: Results of the PT-REFER randomized controlled trial with older adults and YMCA associations.

BACKGROUND: Most older adults do not meet recommended guidelines for physical activity. Referrals from physical therapists (PTs) to community- and evidence-based physical-activity programs like Enhance®Fitness have potential to address this gap. We tested an intervention intended to increase referrals of older adults to Enhance®Fitness programs offered at YMCAs. MATERIALS AND METHODS: We developed a capacity-building intervention that included a structured toolkit and technical-assistance calls. From April 2016 to September 2018, using stratified randomization, we conducted a trial with 20 YMCA Associations randomized into intervention and control arms. The primary outcome was the number of new Enhance®Fitness enrollees during the trial period. Using both quantitative and qualitative methods, we also conducted process and intermediate-outcome evaluations to assess intervention implementation and Association outreach activities, barriers, and facilitators. RESULTS: The intervention was implemented as intended, but PT outreach was similar for both intervention and control YMCA Associations. The intervention arm had similar enrollment (1695 new enrollees) to the control arm (1326 new enrollees; 95% confidence interval, -47%-199%, P = 0.61). Interviews revealed that barriers, including lack of staff and time for outreach, limited capacity for Enhance®Fitness program growth, and competing priorities, outweighed facilitators, including existing partnerships, presence of an outreach team, senior leadership support, and infrastructure for referrals. CONCLUSIONS: YMCA Associations in the intervention arm were unable to increase their outreach to PTs and enrollment in Enhance®Fitness. Our evaluation findings indicate that community organizations that prioritize program growth, have support at all organizational levels, and allocate staff and time for outreach and partnership development may be more successful in creating sustainable linkages with clinical partners and increasing evidence-based-program reach.

Partnerships for Blood Pressure Control in Washington State, December 2016-July 2017.

According to recent guidelines, 46% of U.S. adults have high blood pressure (i.e., hypertension). Traditionally addressed in clinical settings, only 54% of adults successfully manage their hypertension. Community-clinical partnerships that facilitate medication adherence and lifestyle changes are promising avenues to achieve population-level blood pressure control. We examined partnerships for blood pressure control in Washington State, their facilitators and barriers, and ways public health departments could foster partnerships. We conducted 41 semistructured interviews with clinic staff, community-based organization (CBO) staff, pharmacy staff, and community health workers (CHWs). The Centers for Disease Control and Prevention-adapted Himmelman Collaboration Continuum, which describes five levels of partnership intensity, guided our thematic analysis. We found variation across sectors in partnership frequency and intensity. Clinic and pharmacy staff reported fewer partnerships than CBO staff and CHWs, and mostly either low or very high intensity partnerships. CBO staff and CHWs described partnerships at each intensity level. Trust and having a shared mission facilitated partnerships. Competition, lack of time, limited awareness of resources, and lack of shared health records constituted barriers to partnership. Bringing potential partners together to discuss shared goals, increasing technological integration, and building awareness of resources may help bridge clinical and community silos and improve population-level blood pressure control.

Exploring the impact of workforce turnover on the sustainability of evidence-based programs: A scoping review.

Background: Evidence-based programs (EBPs) are used across disciplines to integrate research into practice and improve outcomes at the individual and/or community level. Despite widespread development and implementation of EBPs, many programs are not sustained beyond the initial implementation period due to many factors, including workforce turnover. This scoping review summarizes research on the impact of workforce turnover on the sustainability of EBPs and recommendations for mitigating these impacts. Methods: We searched 10 databases for articles that focused on an EBP and described an association between workforce turnover and the sustainment or sustainability of the program. We created a data abstraction tool to extract relevant information from each article and applied the data abstraction tool to all included articles to create the dataset. Data were mapped and analyzed using the program sustainability framework (PSF). Results and Discussion: A total of 30 articles were included in this scoping review and mapped to the PSF. Twenty-nine articles described impacts of workforce turnover and 18 articles proposed recommendations to address the impacts. The most frequent impacts of workforce turnover included increased need for training, loss of organizational knowledge, lack of EBP fidelity, and financial stress. Recommendations to address the impact of workforce turnover included affordable and alternative training modalities, the use of champions or volunteers, increasing program alignment with organizational goals, and generating diverse funding portfolios. Conclusion: The sustainment of EBPs is critical to ensure and maintain the short- and long-term benefits of the EBP for all participants and communities. Understanding the impacts of workforce turnover, a determinant of sustainability, can create awareness among EBP-implementing organizations and allow for proactive planning to increase the likelihood of program sustainability.

Older Adult Health-Related Support Networks: Implications for the Design of Digital Communication Tools.

BACKGROUND AND OBJECTIVES: Digital communication tools facilitate the provision of health-related social support to older adults. However, little is known about what design features make such tools most useful and feasible. The purpose of this study was to describe health-related social support networks of older adults and outline recommendations for the design of tools that facilitate the giving and receiving of support. RESEARCH DESIGN AND METHODS: We collected data through validated instruments and semistructured qualitative interviews with 88 older adults. We calculated descriptive statistics for the quantitative data and analyzed qualitative data using directed content analysis. RESULTS: Health-related support networks described by our sample of generally healthy older adults varied in size from 0 to 10 members. Some networks did not include any family members, and others did not include any friends. Seventy-four percent of network members lived in the same state as the older adult participant, but only 15% of them lived with the participant. Emotional support was the main type of health-related support provided, followed by instrumental, informational, and appraisal support. DISCUSSION AND IMPLICATIONS: Health-related support networks of older adults are varied and complex. Our results suggest that digital communication tools to promote and leverage support from network members should facilitate the involvement of friends and family regardless of their physical location, allow for the transparent allocation of concrete tasks to prevent overburdening any one network member, and facilitate sharing of personal health information with family and friends while ensuring privacy and autonomy.

Community Readiness for Increasing Older Adult Physical Activity Levels in Kazakhstan.

Introduction: Physical activity is proven to be a significant element of successful aging, but many seniors worldwide fail to achieve the recommended levels. This study aimed to assess the readiness of the community in Nur-Sultan, Kazakhstan, to act on the issue of physical inactivity among older adults. Methods: In order to achieve this purpose, we conducted qualitative interviews with key informants in the community and applied a validated community readiness tool. Results: The results suggest that the local community is at early stages of readiness to act on the issue of older adult physical inactivity. We identified a number of barriers that prevented seniors from leading active lifestyles, which included community misconceptions about older adult physical activity, family centeredness in older adulthood, scarcity of resources, passive support from the leadership, and lack of efforts in the community. Research findings also highlighted the importance of conducting in-depth analysis of key informant responses in addition to calculating readiness scores, when using the community readiness tool. Conclusions: Community-specific strategies for enhancing the level of physical activity among seniors are required to offset the disease burden associated with aging and to prolong life expectancy in Kazakhstan, and it is of paramount importance to tailor potential efforts as to address the current readiness of the community and its needs.

Provider-Patient Communication and Involvement in Physical Activity Programs Among Patients Receiving Physical Therapy Services: A Qualitative Study.

Objectives: To describe how physical therapy providers and their patients interact and communicate about physical activity (PA), and explore the barriers and facilitators to patient involvement in PA programs. Method: We conducted 39 direct observations of patient visits with physical therapy providers and 30 telephone interviews with physical therapists (PTs). We conducted a thematic analysis of observation field notes and interview transcripts. Results: PTs and patients engaged in several behaviors to build rapport, discussed PA type and frequency, and exchanged advice and information about PA. Barriers to patient participation in PA programs included low instrumental support, physical limitations, lack of motivation and confidence, and lack of knowledge about available programs. Facilitators included emotional support from friends, peers, and family, and encouragement and information-sharing from providers. Discussion: PTs play an important role in improving older adult PA and could be instrumental in reducing barriers to PA participation.

Building community-clinical linkages to increase older adult physical activity: The PT-REFER trial protocol and participant baseline characteristics.

BACKGROUND: Physical activity is important for maintaining older adult health, but a majority of older adults are not meeting recommended physical activity levels. This paper describes the protocol and participant baseline characteristics for a trial (named "PT-REFER") to test an intervention focused on developing community-clinical linkages to increase older adult referrals from physical therapy clinics to an evidence-based group exercise program (Enhance®Fitness) (EF) offered by YMCA associations. METHODS: We designed a two-arm cluster-randomized controlled trial with YMCA associations. We conducted formative research with YMCA staff and physical therapists to inform intervention format and content. The primary outcome is the number of new participants enrolled in EF over the course of 30 months. We also collect process information on cost and implementation though structured surveys and semi-structured qualitative interviews. RESULTS: The PT-REFER intervention creates a learning collaborative for YMCA associations, which are tasked with implementing a number of capacity- and partnership-building activities over the course of seven months, and participating in monthly group technical assistance calls. We recruited 20 YMCA associations from 13 states. At baseline, the average number of EF sites per association was 3.9 and the monthly average number of new EF participants was 3.7. CONCLUSIONS: This study will test an approach to increasing the capacity of YMCAs for conducting outreach to physical therapy clinics, and evaluate the factors that may influence its implementation. As a result, it has the potential to contribute to our understanding of how to develop viable and sustainable community-clinical linkages for older adult health.

Predictors of Improvement in Physical Function in Older Adults in an Evidence-Based Physical Activity Program (EnhanceFitness).

BACKGROUND AND PURPOSE: Declines in strength, flexibility, and balance in older adults can lead to injuries and loss of independence and are particularly common in those of greater age and in worse health. EnhanceFitness (EF) is a nationally disseminated, evidence-based group exercise program for older adults that has been shown to improve function through cardiovascular, strength, flexibility, and balance exercises. This article examines changes in, and predictors of, participant physical function from baseline through 2 program cycles of EF as measured by 3 physical function tests: arm curls, chair stands, and 8-foot up-and-go. METHODS: We analyzed data on participants who attended at least 2 consecutive 16-week program cycles between January 2005 and June 2016. We ran 3 random-effects linear regression models, 1 for each physical function test, and accounted for missing data and clustering by class site. Independent variables included attendance, demographics, and health status. RESULTS AND DISCUSSION: A total of 7483 participants completed baseline and 2 sets of follow-up physical function tests. For all 3 physical function tests, participants showed some degree of improved physical function at each follow-up, and greater program attendance predicted clinically significant improvements. Some participants had less improvement: females, those less active at baseline, older than 75 years, not married or partnered, or in fair or poor health, those who had experienced at least 1 fall, and those with a disability. CONCLUSION: EnhanceFitness program providers may need to implement additional measures to support the participants who could benefit most from EF, such as targeting messaging, coordinating with referring providers to emphasize attendance and general activity in specific participants, and offering additional support to groups who show less improvement during classes. The evidence presented here may inform clinical decision making for older adult patients and increase health care provider confidence in EF and similar exercise programs, thereby providing a mechanism to maintain and continue functional gains made in clinical or rehabilitation settings.

Bridging the Gap After Physical Therapy: Clinical-Community Linkages With Older Adult Physical Activity Programs.

BACKGROUND AND OBJECTIVES: Many barriers exist to older adult participation in physical activity, despite known benefits. Referrals from physical therapists (PTs) through clinical-community linkages offer novel, promising opportunities to increase older adult engagement in appropriate community-based physical activity programs. We assessed the capacity of PTs to participate in such linkages. RESEARCH DESIGN AND METHODS: We collected qualitative data using semistructured phone interviews (n = 30) with PTs across 14 states. We conducted thematic analysis using a priori themes based on the 2008 Bridging Model of Etz and colleagues: capacity to assess patient risk, ability to provide brief counseling, capacity and ability to refer, and awareness of community resources. RESULTS: Risk assessment and counseling were already part of routine practice for our respondents, but counseling could be further facilitated if PTs had more skills to engage less-motivated patients. PTs expressed a desire to refer their patients to community programs; however, barriers to referrals included lack of knowledge of and trust in community programs, and limited infrastructure for communicating with potential partners. DISCUSSION AND IMPLICATIONS: PTs have the capacity to develop patient referral linkages with community-based physical activity programs. PT session length and content facilitates patient risk assessment and behavioral counseling. Integrating motivational techniques can help PTs engage less-motivated patients in physical activity. Systemic improvements should include innovations in communication infrastructure, identifying clinic-level champions, and in-person outreach initiated by organizations that deliver community physical activity programs.

Champions of an Older Adult Exercise Program: Believers, Promoters, and Recruiters.

Champions, who support, market, and promote programs, are a vital part of successful program adoption, implementation, and maintenance. Enhance®Fitness (EF) is an evidence-based, community-delivered group exercise program for older adults. Using semistructured phone interviews with 20 participants, 17 instructors, and 15 staff, we explored the roles of champions in adopting, implementing, and maintaining EF at YMCA-affiliated sites. Interviews revealed EF champions play critical roles in program dissemination. Champions are outgoing, passionate, and enthusiastic about EF. They believe in the program and its benefits (believers), are "walking advertisements" (promoters), and have magnetic personalities, persuading newcomers to join (recruiters). EF champions were not purposefully selected but naturally arose during the course of program delivery. Community sites adopting evidence-based programs can foster and support champions by engaging with them, and capitalizing on their energy as an emerging resource throughout the adoption, implementation, and maintenance of programs.

Enhance®Fitness Dissemination and Implementation,: 2010-2015: A Scoping Review.

INTRODUCTION: Physical activity has many benefits for older adult physical and mental health. Enhance®Fitness (EF) is an evidence-based group exercise program delivered by community-based organizations. The purpose of this study was to review recent evidence on the dissemination and implementation of EF. METHODS: A scoping review of qualitative and quantitative studies with EF as main focus was conducted. CINAHL, PubMed, PubMed Central, SCOPUS, Web of Science, PsycINFO, and Google Scholar were searched between October and November 2015 for data-based studies on EF published in 2010-2015. Two team members abstracted each paper independently using a data abstraction tool. Results were summarized using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. RESULTS: Seventeen publications met inclusion criteria. EF has reached and is effective across a broad population base, including individuals with low SES and diverse ethnic/racial backgrounds. EF participation may be associated with reduced risk for falls requiring medical care, and is associated with fewer hospital admissions. Analyses of medical cost savings from EF participation and program implementation costs suggest economic benefits of EF implementation for communities. Organization-level maintenance is facilitated by program-specific and organizational factors, such as instructor training and funding. Individual-level maintenance is facilitated by program structure, absence of pain, and increased quality of life. CONCLUSIONS: More-rigorous evidence is needed about the association between participation in EF and conditions such as falls. Evaluation of program fidelity, adaptations, and sustainability is limited; more-systematic examination across population groups and types of organizations would help ensure older adults continue to benefit from EF participation.

Involving immigrant religious organizations in HIV/AIDS prevention: The role of bonding and bridging social capital.

Immigrant religious organizations in the United States are uniquely positioned to address critical issues beyond religion because of their moral, social and cultural prominence in community life. Increasingly, religious organizations have taken on a leadership role around health issues such as decreasing HIV/AIDS stigma and misinformation. However, there are barriers for some religious leaders and organizations in adopting new health programs, especially if the issue is seen as controversial. Our study examines how social network structures among religious members influence organizational acceptance of new information or controversial ideas, like HIV/AIDS. Using social network analysis methods on data from 2841 contacts in 20 immigrant Chinese Buddhist temples and Christian churches in New York City, we tested whether an immigrant religious organization's likelihood of being involved in HIV/AIDS activities was associated with the presence of bonding or bridging social capital. These two forms of social capital have been found to mediate the levels of exposure and openness to new ideas. We found HIV/AIDS-involved religious organizations were more likely to have lower levels of bonding social capital as indicated by members having fewer ties and fewer demographic attributes in common. We also found HIV/AIDS-involved religious organizations were more likely to have higher levels of bridging social capital as indicated by members having significantly more ties to people outside of their organization. Our study highlights the importance of looking beyond religion type and leadership attributes to social network structures among members in order to better explain organization-level receptiveness to HIV/AIDS involvement.

Community Interagency Connections for Immigrant Worker Health Interventions, King County, Washington State, 2012-2013.

INTRODUCTION: Cross-sector community partnerships are a potentially powerful strategy to address population health problems, including health disparities. US immigrants - commonly employed in low-wage jobs that pose high risks to their health - experience such disparities because of hazardous exposures in the workplace. Hazardous exposures contribute to chronic health problems and complicate disease management. Moreover, prevention strategies such as worksite wellness programs are not effective for low-wage immigrant groups. The purpose of this article was to describe an innovative application of social network analysis to characterize interagency connections and knowledge needed to design and deliver a comprehensive community-based chronic disease prevention program for immigrant workers. METHODS: Using iterative sample expansion, we identified 42 agencies representing diverse community sectors (service agencies, faith-based organizations, unions, nonprofits, government agencies) pertinent to the health of Chinese immigrant workers. To capture data on shared information, resources, and services as well as organizational characteristics, we jointly interviewed 2 representatives from each agency. We used social network analysis to describe interagency network structure and the positions of agencies within the networks. RESULTS: Agency interconnections were established primarily for information sharing. In the overall interagency network, a few service-oriented agencies held central or gatekeeper positions. Strong interconnectedness occurred predominately across service, public, and nonprofit sectors. The Chinese and Pan-Asian service sectors showed the strongest interconnectedness. CONCLUSION: Network analysis yields critical understanding of community structural links and assets needed to inform decisions about actual and potential community collaborations. Alternative intervention strategies may be needed to address health disparities among immigrant workers.

Beyond Strength: Participant Perspectives on the Benefits of an Older Adult Exercise Program.

This study examines the expected and experienced benefits among participants in Enhance®Fitness (EF), an evidence-based group physical activity program for older adults. We also describe the implications for program dissemination (reach, implementation, and maintenance) within the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Twenty semistructured interviews were conducted with EF participants enrolled from 2005 to 2012. Interviews were digitally recorded, professionally transcribed, and analyzed using a deductive approach. Participants were motivated to join EF for expected physical benefits and the social environment of a group-based class. Actualized benefits of participation included physical, social, functional, and improved self-image/sense of well-being. Participants valued the practical application of class exercises to daily activities that support independent living, such as lifting objects and completing household chores. Organizations looking to implement EF or improve existing EF classes can improve program reach, implementation, and maintenance by incorporating participants' expressed motivations and valued benefits in program marketing and by improving organizational support to meet participant needs. EF class instructors can tailor their classes to engage participants based on their motivations. Understanding participants' motivations and valued benefits can improve EF dissemination by meeting participant needs with tailored class offerings and organizational needs informed by participant insights that aid program sustainability.

Implementation and Maintenance of a Community-Based Older Adult Physical Activity Program.

PURPOSE OF THE STUDY: We examine facilitators and barriers to the implementation and maintenance of Enhance®Fitness (EF), a group exercise program for older adults, at early-adopter YMCA-affiliated sites, and summarize strategies employed by EF instructors and staff to overcome challenges. DESIGN AND METHODS: This qualitative study used semi-structured phone interviews with 32 instructors, staff members, and master trainers from 24 different YMCA-affiliated sites. Interviews were digitally recorded, transcribed, and analyzed with a focus on the implementation and maintenance components of the RE-AIM framework. RESULTS: We identified a series of factors affecting the implementation and maintenance of EF at YMCA-affiliated sites, which can be categorized into program-specific (such as instructor training, the structure of the program, reporting requirements, and insurance coverage), and organizational (such as organizational support and infrastructure for program delivery, champions, and funding to cover the costs of program delivery). Strategies used to overcome challenges associated with these factors include identifying parts of the program that can be adapted, hiring staff and instructors that understand and support the program, and educating staff and instructors about the importance of evidence-based programs and of data collection for program evaluation. IMPLICATIONS: Assessing the readiness of organizations for program delivery and the match between program goals and the needs of organizations and participants would help facilitate the successful implementation and maintenance of physical activity programs in community settings.

Using Social Network Analysis to Assess Mentorship and Collaboration in a Public Health Network.

INTRODUCTION: Addressing chronic disease burden requires the creation of collaborative networks to promote systemic changes and engage stakeholders. Although many such networks exist, they are rarely assessed with tools that account for their complexity. This study examined the structure of mentorship and collaboration relationships among members of the Healthy Aging Research Network (HAN) using social network analysis (SNA). METHODS: We invited 97 HAN members and partners to complete an online social network survey that included closed-ended questions about HAN-specific mentorship and collaboration during the previous 12 months. Collaboration was measured by examining the activity of the network on 6 types of products: published articles, in-progress manuscripts, grant applications, tools, research projects, and presentations. We computed network-level measures such as density, number of components, and centralization to assess the cohesiveness of the network. RESULTS: Sixty-three respondents completed the survey (response rate, 65%). Responses, which included information about collaboration with nonrespondents, suggested that 74% of HAN members were connected through mentorship ties and that all 97 members were connected through at least one form of collaboration. Mentorship and collaboration ties were present both within and across boundaries of HAN member organizations. CONCLUSION: SNA of public health collaborative networks provides understanding about the structure of relationships that are formed as a result of participation in network activities. This approach may offer members and funders a way to assess the impact of such networks that goes beyond simply measuring products and participation at the individual level.

A Pilot Study of Determinants of Ongoing Participation in EnhanceFitness: A Community-Based Group Exercise Program for Older Adults.

BACKGROUND AND PURPOSE: Physical activity has many benefits for older adults, but adherence is often low. The purposes of this study were to (1) identify motivators and barriers for participation in EnhanceFitness (EF), a group-based exercise program; and (2) quantitatively examine the association between motivators, barriers and individual characteristics, and ongoing participation in the program. METHODS: This was a prospective, cross-sectional study. We mailed a pilot, investigator-developed survey to assess motivators and barriers to exercising to 340 adults who started a new EF class, regardless of their attendance rate. We precoded surveys on the basis of class attendance, with former participants defined as having no attendance a month or more before a 4-month fitness check. RESULTS: Of the 241 respondents (71% response rate), 61 (25%) were precoded as former participants and 180 (75%) as current participants. The mean age of respondents was 71 years and they were predominately female (89%). More than half of respondents were whites (58%), and almost half were married (46%). Former participants reported lower total motivation scores than current participants (P < .01) and had a significantly higher mean total barrier score (P < .001). The effects of 5 barriers ("Class was too hard," "Class was too easy," "I don't like to exercise," "Personal illness," and "Exercise caused pain") and 2 motivators ("I want to exercise" and "I plan exercise as part of my day") were significantly different between current and former participants. Discrete event history models show that dropout was related positively to ethnicity (whites were more likely to drop out) and health-related barriers. DISCUSSION: In newly formed EF classes, participants who drop out report more program, psychosocial, and health barriers, and fewer program and psychosocial motivators. Total barrier score and health barriers significantly predict a participant's dropping out, and white ethnicity is associated with a higher likelihood of dropping out. CONCLUSIONS: Employing strategies that address health barriers to participation could improve attendance rates for group-based exercise programs.

Participant Variation by Delivery Site Type in an Evidence-Based Physical Activity Program.

This study examined participant demographic and physical function characteristics from EnhanceFitness, an evidence-based physical activity program for older adults. The sample consisted of 19,964 older adults. Participant data included self-reported health and demographic variables, and results for three physical function tests: chair stand, arm curls, and timed up-and-go. Linear regression models compared physical function test results among eight program site types. Participants were, on average, 72 years old, predominantly female, and reported having one chronic condition. Residential site participants' physical function test results were significantly poorer on chair stand and timed up-and-go measures at baseline, and timed up-and-go at a four-month follow-up compared with the reference group (senior centers) after controlling for demographic variables and site clustering. Evidence-based health-promotion programs offered in community settings should assess demographic, health, and physical function characteristics to best serve participants' specific needs, and offer classes tailored to participant function and ability while maintaining program fidelity.