National Dissemination of StrongWomen-Healthy Hearts: A Community-Based Program to Reduce Risk of Cardiovascular Disease Among Midlife and Older Women.

OBJECTIVES: We describe the national dissemination of an evidence-based community cardiovascular disease prevention program for midlife and older women using the RE-AIM (reach effectiveness adoption implementation maintenance) framework and share key lessons learned during translation. METHODS: In a 2010 to 2014 collaboration between the StrongWomen program and the National Extension Association of Family and Consumer Sciences, we assessed reach, adoption, implementation, and maintenance using survey methods, and we assessed effectiveness using a pretest-posttest within-participants design, with weight change as the primary outcome. RESULTS: Overall reach into the population was 15 per 10,000. Of 85 trained leaders, 41 (48%) adopted the program. During the 12-week intervention, weight decreased by 0.5 kilograms, fruit and vegetable intake increased by 2.1 servings per day, and physical activity increased by 1238 metabolic equivalent (MET)-minutes per week (all P < .001). Average fidelity score was 4.7 (out of possible 5). Eleven of 41 adopting leaders (27%) maintained the program. CONCLUSIONS: The StrongWomen-Healthy Hearts program can be implemented with high fidelity in a variety of settings while remaining effective. These data provide direction for program modification to improve impact as dissemination continues.

The StrongWomen-Healthy Hearts program in Pennsylvania: RE-AIM analysis.

Dissemination of evidence-based programs is needed to reduce CVD risk among midlife and older women. The aim of this study is to examine the public health impact of StrongWomen-Healthy Hearts in Pennsylvania using the RE-AIM framework. Reach, adoption, implementation, and maintenance were assessed using qualitative and quantitative measures; effectiveness was assessed using a pretest-posttest within-participants design. Reach into the target population was 5 in 100,000. Compared to the target population, a greater percentage of participants were white, married, middle-class, and had a graduate degree. Effectiveness was demonstrated (weight loss -2.0 kg, p < 0.001). Adoption among trained leaders was high (83.3 %), as was fidelity in implementation (average score 9.3 of 10). No leaders maintained the program. To increase impact of the StrongWomen-Healthy Hearts Program, it will be important to lower the costs and modify the recruitment and training strategies to better reach low-income and minority women. Such strategies may also improve program maintenance.

Rural Embedded Assistants for Community Health (REACH) network: first-person accounts in a community-university partnership.

Community research and action projects undertaken by community-university partnerships can lead to contextually appropriate and sustainable community improvements in rural and urban localities. However, effective implementation is challenging and prone to failure when poorly executed. The current paper seeks to inform rural community-university partnership practice through consideration of first-person accounts from five stakeholders in the Rural Embedded Assistants for Community Health (REACH) Network. The REACH Network is a unique community-university partnership aimed at improving rural health services by identifying, implementing, and evaluating innovative health interventions delivered by local caregivers. The first-person accounts provide an insider's perspective on the nature of collaboration. The unique perspectives identify three critical challenges facing the REACH Network: trust, coordination, and sustainability. Through consideration of the challenges, we identified several strategies for success. We hope readers can learn their own lessons when considering the details of our partnership's efforts to improve the delivery infrastructure for rural healthcare.