Translating a Fall Prevention Intervention Into Practice: A Randomized Community Trial.

OBJECTIVES: We examined whether community translation of an effective evidence-based fall prevention program via standard monetary support can produce a community-wide reduction in fall injuries in older adults and evaluated whether an enhanced version with added technical support and capacity building amplified the fall reduction effect. METHODS: We completed a randomized controlled community trial among adults aged 65 and older in (1) 10 control communities receiving no special resources or guidance on fall prevention, (2) 5 standard support communities receiving modest funding to implement Stepping On, and (3) 5 enhanced support communities receiving funding and technical support. The primary outcome was hospital inpatient and emergency department discharges for falls, examined with Poisson regression. RESULTS: Compared with control communities, standard and enhanced support communities showed significantly higher community-wide reductions (9% and 8%, respectively) in fall injuries from baseline (2007-2008) to follow-up (2010-2011). No significant difference was found between enhanced and standard support communities. CONCLUSIONS: Population-based fall prevention interventions can be effective when implemented in community settings. More research is needed to identify the barriers and facilitators that influence the successful adoption and implementation of fall prevention interventions into broad community practice.

4-H Healthy Living programs with impact: a national environmental scan.

The 4-H youth development program of the nation's 109 land-grant universities and the Cooperative Extension System is one of the largest youth development organization in the United States serving approximately six million youth. The 4-H Healthy Living initiative began in 2008 to promote achievement of optimal physical, social, and emotional well-being for youth and families. In 2013, the National 4-H Council sought to identify 4-H Healthy Living programs in the domains of healthy eating and physical activity that adhered to the national 4-H Healthy Living mission and were ready for comprehensive outcome evaluation or replication at a national level. This chapter shares findings from an environmental scan of 4-H programs and (a) identifies programs with evidence of promoting a healthy diet and physical activity, (b) describes program impacts related to healthy diet and physical activity, and (c) clarifies select program characteristics associated with reported healthy eating and/or physical activity outcomes. The RE-AIM evaluation framework is introduced as an effective approach to assessing program impact for 4-H Healthy Living and similar out-of-school time programs.

A model to translate evidence-based interventions into community practice.

There is a tension between 2 alternative approaches to implementing community-based interventions. The evidence-based public health movement emphasizes the scientific basis of prevention by disseminating rigorously evaluated interventions from academic and governmental agencies to local communities. Models used by local health departments to incorporate community input into their planning, such as the community health improvement process (CHIP), emphasize community leadership in identifying health problems and developing and implementing health improvement strategies. Each approach has limitations. Modifying CHIP to formally include consideration of evidence-based interventions in both the planning and evaluation phases leads to an evidence-driven community health improvement process that can serve as a useful framework for uniting the different approaches while emphasizing community ownership, priorities, and wisdom.

The evolution of an evaluation: a case study using the tribal participatory research model.

This article presents a case study of how the evaluation design for a dating violence prevention and/or youth development program for American Indian youth in Arizona evolved throughout the project. Particular attention is given to how the evaluation design was guided by the tribal participatory research model. A brief rationale for the project is presented along with literature on culturally competent evaluation and research with American Indians. A description of the project and the unique communities in which it was implemented is provided. The focus of the article is the process of how the evaluation plan changed and how various factors influenced this process (e.g., feedback from community stakeholders, conversations with funder, results of process evaluation, suggestions from literature, the authors' experience working in American Indian communities). The authors conclude with lessons learned for others to consider as they develop working relationships and evaluation plans in similar communities.

Zimbabwean adolescents' condom use: what makes a difference? Implications for intervention.

PURPOSE: To examine risk and resilience factors at multiple ecological levels related to Zimbabwean adolescents' practice of protected or unprotected sex. METHODS: Data were collected from adolescents in eight secondary schools in Zimbabwe. A 140-item instrument designed by the authors assessed adolescent perceptions, behaviors, and attitudes. Youth who had engaged in sexual intercourse (n = 730) were included in analyses. Risk and resilience factors related to self, peer, family, and community domains were examined. Data were analyzed separately by gender using discriminant analysis to identify factors that predict whether youth engage in safe or unsafe sex. RESULTS: Boys who engaged in safe sex were older, more likely to report their parents were there when needed, spent more time in extracurricular activities, and reported a lower drop out likelihood. Girls who engaged in safe sex worried about HIV/AIDS more than those who engaged in unsafe sex. CONCLUSIONS: Although both boys and girls need medically correct sexuality education, including education on HIV/AIDS and sexually transmitted diseases (STDs), the findings suggest that such education is not enough. Program planners must consider the influences of multiple ecological levels. Gender differences raise several issues for intervention.

Pathways of influence in out-of-school time: a community-university partnership to develop ethics.

If we wish to incorporate parents and community members as full partners in building character among youth, then the activities and programs in which youth participate during their out-of-school time are potentially important venues. This chapter describes how numerous agencies in a single community partnered with a university, with the help of the cooperative extension agent, to collect local data on how adolescents used out-of-school time, what they thought about right and wrong, and how well their own behavior comported with their understandings of what was right. Results indicated that surveyed youth characterized themselves as thinking more than acting in ethical ways. For instance, nearly half acknowledged having cheated on a test at least once in the past six months, although the vast majority thought that cheating was wrong. The three pathways the community identified for reaching youth were (1) extracurricular activities at school such as sports, yearbook, and pep club; (2) organized nonschool pursuits such as music, dance, hiking, and biking; and (3) religious activities. They found that nearly 90 percent of high school-aged respondents participated in one or another of these venues.