Using a customer discovery process to enhance the potential dissemination and scalability of a family healthy weight program for rural communities and small towns.

AIM: Customer discovery, an entrepreneurial and iterative process to understand the context and needs of potential adoption agencies, may be an innovative strategy to improve broader dissemination of evidence-based interventions. This paper describes the customer discovery process for the Building Healthy Families (BHF) Online Training Resources and Program Package (BHF Resource Package) to support rural community adoption of an evidence-based, family healthy weight program. METHODS: The customer discovery process was completed as part of a SPeeding Research-tested INTerventions (SPRINT) training supported by the U.S. Centers for Disease Control and Prevention. Customer discovery interviews (n=47) were conducted with people that could be potential resource users, economic buyers, and BHF adoption influencers to capture multiple contextual and needs-based factors related to adopting new evidence-based interventions. Qualitative analyses were completed in an iterative fashion as each interview was completed. RESULTS: The BHF Resource Package was designed to be accessible to a variety of implementation organizations. However, due to different resources being available in different rural communities, customer discovery interviews suggested that focusing on rural health departments may be a consistent setting for intervention adoption. We found that local health departments prioritize childhood obesity but lacked the training and resources necessary to implement effective programming. Several intervention funding approaches were also identified including (1) program grants from local and national foundations, (2) healthcare community benefit initiatives, and (3) regional employer groups. Payment plans recommended in the customer discovery interviews included a mix of licensing and technical support fees for BHF delivery organizations, potential insurance reimbursement, and family fees based on ability to pay. Marketing a range of BHF non-weight related outcomes was also recommended during the customer discovery process to increase the likelihood of BHF scale-up and sustainability. CONCLUSIONS: Engaging in customer discovery provided practical directions for the potential adoption, implementation, and sustainability of the BHF Resource Package. However, the inconsistent finding that health departments are both the ideal implementation organization, but also see childhood obesity treatment as a clinical service, is concerning.

Reach and Weight Loss Among Comparison Group Participants Who Enrolled in the Active Intervention After a Diabetes Prevention Trial.

We examined participation rates, engagement, and weight-loss outcomes of comparison group participants in a diabetes prevention trial who enrolled in a digitally delivered diabetes prevention program (ie, an active intervention) after the original trial ended. We evaluated these outcomes by using the Wilcoxon signed-rank test and 1-sample z test. We found a high participation rate (73%) among comparison group participants and comparable weight-loss outcomes at 12 months (6.8 lb) after initiating participation in the active intervention relative to intervention group participants during the original trial. Findings support providing evidence-based interventions for comparison or control group participants post-trial. Findings also support examining the cost-effectiveness of post-trial interventions, regardless of the limitations of acquiring post-trial data on weight in an uncontrolled setting.

Leveraging Multi-Sectoral Partnership for Colorectal Cancer Education and Screening in the African American Community: A Protocol and Preliminary Results.

Colorectal cancer (CRC) awareness and screening rates are still low in African Americans (AAs), especially for those who do not have regular access to health care. We established a multi-sector community partnership between academia, health system, cancer advocacy, and local county treasurer's office (CTO), to test a pilot CRC screening intervention using a tailored educational brochure and fecal immunochemical test (FIT). Participants were recruited at a local CTO in an urban midwestern region. Once eligible, participants were assigned to 2-by-2 intervention arms by educational strategy (brochure vs. no brochure) and FIT provision strategy (direct provision by onsite staff vs. indirect provision via phone/online request). We compared the effect of different strategies on FIT return rates. Of 1500 individuals approached, 212 were eligible for the study. The final sample consisted of 209 participants who were predominantly men (57%) and AAs (85%). No differences were found in the return rates by educational brochure (24% [brochure] vs. 23% [no brochure]; p = 0.82). In regard to FIT provision strategy, direct FIT provision yielded higher return rates than indirect provision (31% vs. 15%; p = 0.01). When the four groups were compared, direct provision with education brochure yielded the highest return rates (33.9%), followed by direct provision only (27.5%), indirect provision only (18%), and indirect provision with a brochure (12.2%). For community-based CRC screening intervention using stool-based test, the direct provision of FIT kits with educational brochure outperforms the other three strategies.

Effectiveness of incentives to improve the reach of health promotion programs- a systematic review and meta-analysis.

The reach (i.e., enrollment, engagement, and retention) of health promotion evidence-based programs (EBPs) at the participant level has been challenging. Incentives based on behavioral economics may be used to improve EBP reach. We aimed to systematically review and synthesize the evidence of the effectiveness of incentives as a dissemination strategy to increase EBP reach. We conducted a literature search in PubMed, SCOPUS, EMBASE, Cochrane Review and Cochrane CENTRAL for articles published between January 2000 and March 2020 to identify incentive strategies used to increase program reach among health promotion EBPs. Inclusion criteria included studies published in English, experimental or quasi-experimental designs, comparison of incentive to non-incentive or control strategies, and reported on reach (n = 35 health promotion studies). Monetary incentives using cash and a fixed schedule of reinforcement were the most used incentive schemes (71%). Incentives alone or combined with other strategies as a multicomponent approach were effective in improving program enrollment, engagement, and retention. Specifically, incentive strategies were associated with higher odds of program enrollment (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.82-4.24; n = 10) and retention (OR, 2.54, 95% CI, 1.34-4.85; n = 9) with considerable heterogeneity (I2 = 94% and 91%, respectively). Incentives are a promising individual-level dissemination strategy to improve the reach of health promotion EBPs. However, understanding the optimal amount, type, frequency, and target of incentives, and how incentives fit in a multicomponent approach in different contexts requires further research.

Qualitative comparative analysis of the implementation fidelity of a workplace sedentary reduction intervention.

BACKGROUND: Stand and Move at Work was a 12-month, multicomponent, peer-led (intervention delivery personnel) worksite intervention to reduce sedentary time. Although successful, the magnitude of reduced sedentary time varied by intervention worksite. The purpose of this study was to use a qualitative comparative analysis approach to examine potential explanatory factors that could distinguish higher from lower performing worksites based on reduced sedentary time. METHODS: We assessed 12-month changes in employee sedentary time objectively using accelerometers at 12 worksites. We ranked worksites based on the magnitude of change in sedentary time and categorized sites as higher vs. lower performing. Guided by the integrated-Promoting Action on Research Implementation in Health Services framework, we created an indicator of intervention fidelity related to adherence to the protocol and competence of intervention delivery personnel (i.e., implementer). We then gathered information from employee interviews and surveys as well as delivery personnel surveys. These data were aggregated, entered into a truth table (i.e., a table containing implementation construct presence or absence), and used to examine differences between higher and lower performing worksites. RESULTS: There were substantive differences in the magnitude of change in sedentary time between higher (-75.2 min/8 h workday, CI95: -93.7, -56.7) and lower (-30.3 min/8 h workday, CI95: -38.3, -22.7) performing worksites. Conditions that were present in all higher performing sites included implementation of indoor/outdoor walking route accessibility, completion of delivery personnel surveys, and worksite culture supporting breaks (i.e., adherence to protocol). A similar pattern was found for implementer willingness to continue role and employees using face-to-face interaction/stair strategies (i.e., delivery personnel competence). However, each of these factors were also present in some of the lower performing sites suggesting we were unable to identify sufficient conditions to predict program success. CONCLUSIONS: Higher intervention adherence and implementer competence is necessary for greater program success. These findings illustrate the need for future research to identify what factors may influence intervention fidelity, and in turn, effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02566317 . Registered 2 October 2015, first participant enrolled 11 January 2016.

Evaluating the reach, effectiveness, adoption, implementation and maintenance of the Resistance Training for Teens program.

BACKGROUND: Physical activity guidelines recommend young people engage in regular muscle-strengthening activities (e.g., resistance training [RT]). However, few school-based physical activity interventions have been delivered at-scale or promoted RT. The aim of this study was to evaluate the reach, effectiveness, adoption, implementation and maintenance of the Resistance Training for Teens (RT for Teens) program. METHODS: Data were collected between August 2015 and October 2020. RE-AIM was operationalized as: (i) Reach: number and characteristics of students estimated to be exposed to the program; (ii) Effectiveness: impact of the program on student-level outcomes measured in a subsample of 750 students from 17 schools; (iii) Adoption: number and representativeness of schools with one or more teachers trained to deliver the program; (iv) Implementation: extent to which the program was delivered as intended; and (v) Maintenance: extent to which the program was sustained in schools. RESULTS: The estimated program reach was ~ 10,000 students, out of a total student population of ~ 200,000 (~ 5%). Students were from diverse socioeconomic and ethnic backgrounds. Improvements in muscular fitness, RT self-efficacy, perceived cardiorespiratory fitness and flexibility, and participation in muscle-strengthening physical activities were documented. A total of 30 workshops were delivered, involving 468 teachers from 249 schools from diverse geographical regions. Implementation varied considerably, with teachers adapting the program to suit the context of their school and student cohorts. However, RT skill development and the promotion of muscular fitness were the session components delivered most during sessions. Teachers' adherence to the SAAFE (Supportive, Active, Autonomous, Fair and Enjoyable) teaching principles was high. Approximately 30% of teachers (144/476) registered to use the RT for Teens app. At the school-level, 37% (93/249) of schools had at least one registered user (teacher and/or student). A total of 2,336 workouts and 3,116 fitness tests were completed by registered users. Of the 249 schools represented, 51 (20.5%) sent an additional (previously untrained) teacher to a second workshop. CONCLUSIONS: The RT for Teens program had broad reach and adoption. However, intervention delivery varied considerably across schools and additional support strategies are required to optimize intervention implementation and maintain program delivery over time. Future studies will benefit from the utilization of accepted frameworks, recommendations and guidelines for implementation research. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12621000352808), retrospectively registered 1st February 2021.

A Dissemination Strategy to Identify Communities Ready to Implement a Pediatric Weight Management Intervention in Medically Underserved Areas.

PURPOSE AND OBJECTIVES: We developed a competitive application process to test the feasibility of a fund and contract dissemination strategy to identify and engage communities that demonstrated the necessary resources and motivation to adopt, implement, and sustain a pediatric weight management intervention, Building Healthy Families, in rural and micropolitan (<50,000 residents) communities in Nebraska. INTERVENTION APPROACH: From April through December 2019, a community advisory board with representation from rural and micropolitan clinical, public health, education, and recreational organizations collaboratively developed a request for applications, as a fund and contract dissemination strategy, to encourage community adoption of Building Healthy Families. EVALUATION METHODS: Quantitative assessments included determining the distribution of requests for applications, evaluating organizational readiness to change assessment (ORCA) ratings (on a scale of 1 to 5, from strongly disagree to strongly agree that the organization is ready to change), and reviewing community advisory board member ratings of applications. We gathered qualitative data from community narratives provided in response to the request for applications and community advisory board reviews of the applications. RESULTS: The request for applications was distributed to all 93 counties in Nebraska. Of the 8 communities that submitted a letter of intent, 7 submitted a community narrative. Across the 8 communities, 31 ORCAs were completed by the organizational decision makers (n = 15) and staff members (n = 16) who would be responsible for screening, recruiting, or implementing the intervention. Overall mean ORCA scores varied by ratings of evidence (4.1-4.6), context (4.2-4.9), and facilitation (4.3-4.8), indicating a high degree of readiness. Community advisory board ratings of applications ranged from 2.3 to 3.4 of 4 points. Qualitative data indicated that lower community narrative scores were primarily caused by weak implementation and sustainability plans. IMPLICATIONS FOR PUBLIC HEALTH: Findings provide guidance for translating pediatric weight management programs in medically underserved geographic areas by maximizing the probability of successful adoption and implementation through a fund and contract dissemination strategy.

A Thematic Analysis on the Implementation of Nutrition Policies at Food Pantries Using the RE-AIM Framework.

Food pantries are responsible for the direct distribution of food to low-income households. While food pantries may be concerned about the nutritional quality of the food they are serving, they may have limited resources to adopt and implement nutrition policies to support efforts to promote high nutritional quality of the food served. Guided by the RE-AIM (Reach, Effectiveness or Efficacy, Adoption, Implementation, Maintenance) framework, this qualitative study explored the degree of implementation of nutrition policies at food pantries, as well as the barriers to implementation in those pantries that had not adopted a nutrition policy. Semistructured interviews were conducted with 10 food pantry directors: seven pantries with a formal nutrition policy and three with an informal nutrition policy. Using a thematic analysis method, results demonstrated themes from the interviews with policy-adopting pantries to be barriers, enforcement, delivery of the policy, unexpected consequences, and fidelity to the policy. A targeted intervention that builds on this research and focuses on building the capacity of food pantries to develop, adopt, and implement nutrition policies as well as helping to increase fidelity to the policy would be beneficial to continue to improve the food donated and distributed at food pantries. By supporting food pantries in the development, adoption, and implementation of nutrition policies, researchers can play an important role in improving the quality of food in the emergency food network.

Capacity Development and Evaluation of a Parent Advisory Team Engaged in Childhood Obesity Research.

Guided by community-based participatory research principles, this mixed-methods process evaluation explored the experience and capacity of a newly formed Parental Advisory Team (PAT) engaged in childhood obesity research in a medically underserved region. Following the successful completion of a 3-month evidence-based childhood obesity treatment program (iChoose), 13 parents/caregivers who completed iChoose consented to participate in the PAT. Between June 2015 and March 2016, the PAT had nine monthly meetings and completed mixed-methods capacity assessments. They engaged in activities related to understanding iChoose outcomes, defining their role and purpose as a partnership, initiating content development, and pilot testing maintenance intervention components for future iChoose efforts. Assessments included a quantitative survey administered at baseline and 9 months, and a qualitative interview completed at 9 months. Results indicated that PAT members' perceptions of the identified capacity dimensions were positive at baseline (3.8-4.3 on a 5-point scale) and remained positive at follow-up (3.9-4.4 on a 5-point scale); changes were not statistically significant. Qualitative data revealed that PAT members were satisfied with group participation and desired to enhance their role in subsequent iChoose research. Understanding and promoting parental engagement in the research process fills an important gap in childhood obesity literature.

Association Between Weight Loss and Glycemic Outcomes: A Post Hoc Analysis of a Remote Patient Monitoring Program for Diabetes Management.

Background: Evidence-based guidelines for the management of type 2 diabetes (T2D) consist of blood glucose monitoring, medication adherence, and lifestyle modifications that may particularly benefit from reminders, consultation, education, and behavioral reinforcements through remote patient monitoring (RPM). Objectives: To identify predictors of weight loss and to examine the association between weight loss and hemoglobin A1C (HbA1C) outcomes for T2D patients who were enrolled in an RPM program for diabetes management. Materials and Methods: The study applied logistic and ordinary least-squares regression models to examine the relationship between baseline characteristics and the likelihood of weight loss during the RPM, and how the magnitude of weight loss was related to changes in HbA1C outcomes for 1,103 T2D patients who went through 3 months of RPM from 2014 to 2017. Results: Older patients were 3% more likely to have weight loss (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02-1.05), whereas patients with higher baseline HbA1C had 9% reduced odds (OR, 0.91; 95% CI, 0.85-0.97) of experiencing weight loss. For every pound of weight lost, there was a 0.02-point (95% CI, 0.01-0.03) reduction on the HbA1C measured at the end of the RPM. Moreover, compared with those who had weight loss of ≤3%, participants who had lost 5-7%, or >7% of their baseline weight had a 0.37- and 0.58-point reduction in HbA1C, respectively. Conclusions: This study revealed a notable relationship between weight loss and positive HbA1C outcomes for T2D patients in an RPM-facilitated diabetes management program, which pointed to the potential of integrating evidence-based lifestyle modification programs into future telemedicine programs to improve diabetes management outcomes.

Using Integrated Research-Practice Partnerships to Move Evidence-Based Principles Into Practice.

The implementation of evidence-based physical activity interventions is improved when integrated research-practice partnerships are used. These partnerships consider both research- and practice-based evidence that moves beyond only assessing program efficacy. Our novel hypothesis is that integrated research-practice partnerships may lead to interventions that are practical and effective, reach more participants, and are more likely to be sustained in practice.

SIPsmartER delivered through rural, local health districts: adoption and implementation outcomes.

BACKGROUND: SIPsmartER is a 6-month evidenced-based, multi-component behavioral intervention that targets sugar-sweetened beverages among adults. It consists of three in-person group classes, one teach-back call, and 11 automated phone calls. Given SIPsmartER's previously demonstrated effectiveness, understanding its adoption, implementation, and potential for integration within a system that reaches health disparate communities is important to enhance its public health impact. During this pilot dissemination and implementation trial, SIPsmartER was delivered by trained staff from local health districts (delivery agents) in rural, Appalachian Virginia. SIPsmartER's execution was supported by consultee-centered implementation strategies. METHODS: In this mixed-methods process evaluation, adoption and implementation indicators of the program and its implementation strategy (e.g., fidelity, feasibility, appropriateness, acceptability) were measured using tracking logs, delivery agent surveys and interviews, and fidelity checklists. Quantitative data were analyzed with descriptive statistics. Qualitative data were inductively coded. RESULTS: Delivery agents implemented SIPsmartER to the expected number of cohorts (n = 12), recruited 89% of cohorts, and taught 86% of expected small group classes with > 90% fidelity. The planned implementation strategies were also executed with high fidelity. Delivery agents completing the two-day training, pre-lesson meetings, fidelity checklists, and post-lesson meetings at rates of 86, 75, 100, and 100%, respectively. Additionally, delivery agents completed 5% (n = 3 of 66) and 10% (n = 6 of 59) of teach-back and missed class calls, respectively. On survey items using 6-point scales, delivery agents reported, on average, higher feasibility, appropriateness, and acceptability related to delivering the group classes (range 4.3 to 5.6) than executing missed class and teach-back calls (range 2.6 to 4.6). They also, on average, found the implementation strategy activities to be helpful (range 4.9 to 6.0). Delivery agents identified strengths and weakness related to recruitment, lesson delivery, call completion, and the implementation strategy. CONCLUSIONS: In-person classes and the consultee-centered implementation strategies were viewed as acceptable, appropriate, and feasible and were executed with high fidelity. However, implementation outcomes for teach-back and missed class calls and recruitment were not as strong. Findings will inform the future full-scale dissemination and implementation of SIPsmartER, as well as other evidence-based interventions, into rural health districts as a means to improve population health.

Participatory development and pilot testing of iChoose: an adaptation of an evidence-based paediatric weight management program for community implementation.

BACKGROUND: To describe the identification, adaptation, and testing of an evidence-based pediatric weight management program for a health disparate community. METHODS: A community advisory board (CAB) of decision-makers and staff from local health care, public health, and recreation organizations engaged with academic partners to select an evidence-based program (EBP) for local implementation. Three EBPs were identified (Traffic Light, Bright Bodies, Golan and colleagues Home Environmental Model) and each EBP was rated on program characteristics, implementation and adaptation, and adoptability. Following selection of the EBP that was rated highest, the POPS-CAB made adaptations based on the program principles described in peer-reviewed publications. The adapted intervention, iChoose, was then pilot tested in 3 iterative phases delivered initially by research partners, then co-delivered by research and community partners, then delivered by community partners. The RE-AIM framework was used to plan and evaluate the iChoose intervention across all waves with assessments at baseline, post program (3 months), and follow-up (6 months). RESULTS: Bright Bodies rated highest on program characteristics and adoptability (p's < 0.05), while Home Environmental Model rated highest on implementation factors (p < 0.05). Qualitatively, the selection focused on important program characteristics and on matching those characteristics to the potential to fit within the community partner services. The adapted program-iChoose-had 18% reach and with participants that were representative of the target population on age, gender, ethnicity, and race. Effectiveness was demonstrated by modest, but significant reductions in BMI z-scores at post-program compared to baseline (MΔ = - 0.047; t = - 2.11, p = 0.046). This decrease returned to values similar to baseline 3 months (MΔ = 0.009) after the program was completed. Implementation fidelity was high and implementation fidelity did not differ between community or research delivery agents. CONCLUSION: The process to help organizations identify and select evidence-based programs appropriate for their community led to consensus on a single EBP. While iChoose was successful in initiating changes in BMI z-scores, could be implemented in a low resource community with fidelity, it was insufficient to lead to sustained child BMI z-scores. In response to these data, maintenance of program effects and delivery are the current focus of the CBPR team.

Building and Sustaining Community Capacity to Address Childhood Obesity: A 3-Year Mixed-Methods Case Study of a Community-Academic Advisory Board.

Guided by a community-based participatory research and systems-based approach, this 3-year mixed-methods case study describes the experiences and capacity development of a Community-Academic Advisory Board (CAB) formed to adapt, implement, and evaluate an evidence-based childhood obesity treatment program in a medically underserved region. The CAB included community, public health, and clinical (n = 9) and academic partners (n = 9). CAB members completed capacity evaluations at 4 points. Partners identified best practices that attributed to the successful execution and continued advancement of project goals. The methodological framework and findings can inform capacity development and sustainability of emergent community-academic collaborations.

Overweight and Obesity Among School Bus Drivers in Rural Arkansas.

INTRODUCTION: Obesity is a major public health concern. Compared with other occupational groups, transportation workers, such as school bus drivers, have higher rates of obesity. However, little is known about the body weight and related health behaviors of these drivers, and opportunities for intervention are undetermined. METHODS: We collected multilevel data from school bus drivers working from 4 school bus garages in Little Rock, Arkansas, and their work environment from January through July of 2017. Data on weight, height, sociodemographic characteristics, work factors, weight-related behaviors, and psychosocial variables were collected from 45 drivers. Analyses explored associations between body mass index (BMI; weight in kg/ height in m2) and sociodemographic characteristics, work factors, weight-related behaviors, and psychosocial variables. Two focus groups with a total of 20 drivers explored drivers' perspectives about healthy weight. Observational data at the bus and garage levels were collected through 2 "ride-alongs" and an environmental scan. RESULTS: Drivers in our sample were predominately overweight or obese (91.1%), and most did not meet dietary or physical activity guidelines. Drivers who were currently dieting had higher BMIs (36.4; standard deviation [SD], 8.2) than drivers who were not dieting (28.5; SD, 7.7); drivers who reported eating less to lose weight had higher BMIs (38.1; SD, 8.5) than those who did not report eating less (29.5; SD, 6.0). Drivers who did not meet physical activity recommendations had higher BMIs (36.5; SD, 9.8) than those who met recommendations (30.9; SD, 4.8). Structural barriers and work stress were significant barriers to achieving a healthy weight. Resources for healthful eating and physical activity were limited in the garage. CONCLUSION: Our study provides preliminary data on the prevalence, risk factors, and perceptions of overweight and obesity among school bus drivers. Study data on drivers' body weight, health-related behaviors, and psychosocial characteristics could serve as a basis for worksite interventions to improve drivers' health.

Diabetes Management Through Remote Patient Monitoring: The Importance of Patient Activation and Engagement with the Technology.

Background: The documented efficacy and promise of telemedicine in diabetes management does not necessarily mean that it can be easily translated into clinical practice. An important barrier concerns patient activation and engagement with telemedicine technology. Objective: To assess the importance of patient activation and engagement with remote patient monitoring technology in diabetes management among patients with type 2 diabetes. Methods: Ordinary least squares and logistic regression analyses were used to examine how patient activation and engagement with remote patient monitoring technology were related to changes in hemoglobin A1c (HbA1c) for 1,354 patients with type 2 diabetes monitored remotely for 3 months between 2015 and 2017. Results: Patients with more frequent and regular participation in remote monitoring had lower HbA1c levels at the end of the program. Compared to patients who uploaded their biometric data every 2 days or less frequently, patients who maintained an average frequency of one upload per day were less likely to have a postmonitoring HbA1c > 9% after adjusting for selected covariates on baseline demographics and health conditions. Conclusions: Higher levels of patient activation and engagement with remote patient monitoring technology were associated with better glycemic control outcomes. Developing targeted interventions for different groups of patients to promote their activation and engagement levels would be important to improve the effectiveness of remote patient monitoring in diabetes management.

Implementation and scale up of population physical activity interventions for clinical and community settings: the PRACTIS guide.

BACKGROUND: Few efficacious physical activity interventions are successfully translated and sustained in practice. We propose a practical guide for researchers to increase the likelihood of successful implementation and scale up of physical activity interventions in practice contexts. The guide is based on two principles: (i) differences between the research and practice context can be addressed during intervention development and implementation planning by focusing on system, delivery personnel, and intervention characteristics; and (ii) early planning for implementation barriers and facilitators can improve subsequent translation into practice. METHODS: From the published literature, we identified evidence of strategies to improve research-practice translation, along with narrative descriptions of different approaches to addressing translational challenges. These, along with constructs taken from widely cited implementation outcome, process, and mechanistic models were collated and inform the guide. RESULTS: The resultant PRACTIS guide (PRACTical planning for Implementation and Scale-up) comprised the following four iterative steps: Step 1) Characterize the parameters of the implementation setting; Step 2) Identify and engage key stakeholders across multiple levels within the delivery system(s); Step 3) Identify contextual barriers and facilitators to implementation, and; Step 4) Address potential barriers to effective implementation. CONCLUSIONS: A lack of practical guidance for researchers on how to effectively plan implementation and scale up of physical activity interventions prevents us moving quickly from evidence to action. We recommend that intervention development and adaptation for broad and sustained implementation be prioritized early in intervention planning and include active engagement from delivery organizations and stakeholders. The PRACTIS guide is also relevant for clinical and public health researchers in other areas of prevention.

Supporting maintenance of sugar-sweetened beverage reduction using automated versus live telephone support: findings from a randomized control trial.

BACKGROUND: Although reducing sugar-sweetened beverage (SSB) intake is an important behavioral strategy to improve health, no known SSB-focused behavioral trial has examined maintenance of SSB behaviors after an initial reduction. Guided by the RE-AIM framework, this study examines 6-18 month and 0-18 month individual-level maintenance outcomes from an SSB reduction trial conducted in a medically-underserved, rural Appalachia region of Virginia. Reach and implementation indicators are also reported. METHODS: Following completion of a 6-month, multi-component, behavioral RCT to reduce SSB intake (SIPsmartER condition vs. comparison condition), participants were further randomized to one of three 12-month maintenance conditions. Each condition included monthly telephone calls, but varied in mode and content: 1) interactive voice response (IVR) behavior support, 2) human-delivered behavior support, or 3) IVR control condition. Assessments included the Beverage Intake Questionnaire (BEVQ-15), weight, BMI, and quality of life. Call completion rates and costs were tracked. Analysis included descriptive statistics and multilevel mixed-effects linear regression models using intent-to-treat procedures. RESULTS: Of 301 subjects enrolled in the 6-month RCT, 242 (80%) were randomized into the maintenance phase and 235 (78%) included in the analyses. SIPsmartER participants maintained significant 0-18 month decreases in SSB. For SSB, weight, BMI and quality of life, there were no significant 6-18 month changes among SIPsmartER participants, indicating post-program maintenance. The IVR-behavior participants reported greater reductions in SSB kcals/day during the 6-18 month maintenance phase, compared to the IVR control participants (- 98 SSB kcals/day, 95% CI = - 196, - 0.55, p < 0.05); yet the human-delivered behavior condition was not significantly different from either the IVR-behavior condition (27 SSB kcals/day, 95% CI = - 69, 125) or IVR control condition (- 70 SSB kcals/day, 95% CI = - 209, 64). Call completion rates were similar across maintenance conditions (4.2-4.6 out of 11 calls); however, loss to follow-up was greatest in the IVR control condition. Approximated costs of IVR and human-delivered calls were remarkably similar (i.e., $3.15/participant/month or $38/participant total for the 12-month maintenance phase), yet implications for scalability and sustainability differ. CONCLUSION: Overall, SIPsmartER participants maintained improvements in SSB behaviors. Using IVR to support SSB behaviors is effective and may offer advantages as a scalable maintenance strategy for real-world systems in rural regions to address excessive SSB consumption. TRIAL REGISTRY: Clinicaltrials.gov; NCT02193009 ; Registered 11 July 2014. Retrospectively registered.

Behavioral and mental health risk factor profiles among diverse primary care patients.

Behavioral and mental health risk factors are prevalent among primary care patients and contribute substantially to premature morbidity and mortality and increased health care utilization and costs. Although prior studies have found most adults screen positive for multiple risk factors, limited research has attempted to identify factors that most commonly co-occur, which may guide future interventions. The purpose of this study was to identify subgroups of primary care patients with co-occurring risk factors and to examine sociodemographic characteristics associated with these subgroups. We assessed 12 behavioral health risk factors in a sample of adults (n=1628) receiving care from nine primary care practices across six U.S. states in 2013. Using latent class analysis, we identified four distinct patient subgroups: a 'Mental Health Risk' class (prevalence=14%; low physical activity, high stress, depressive symptoms, anxiety, and sleepiness), a 'Substance Use Risk' class (29%; highest tobacco, drug, alcohol use), a 'Dietary Risk' class (29%; high BMI, poor diet), and a 'Lower Risk' class (27%). Compared to the Lower Risk class, patients in the Mental Health Risk class were younger and less likely to be Latino/Hispanic, married, college educated, or employed. Patients in the Substance Use class tended to be younger, male, African American, unmarried, and less educated. African Americans were over 7 times more likely to be in the Dietary Risk versus Lower Risk class (OR 7.7, 95% CI 4.0-14.8). Given the heavy burden of behavioral health issues in primary care, efficiently addressing co-occurring risk factors in this setting is critical.

Pragmatic Applications of RE-AIM for Health Care Initiatives in Community and Clinical Settings.

The RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) planning and evaluation framework has been applied broadly, but users often have difficulty in applying the model because of data collection needs across multiple domains and sources. Questions in the more common "who, what, where, how, when, and why" format may be an effective guide to ensure that individual participants, organization staff, and the perspectives of the setting are considered in planning and evaluation. Such a format can also help users in typical community and clinical settings to identify which outcomes are most valued and to focus limited measurement resources. Translations of RE-AIM that are easy to understand and apply are needed for application in real-world community and clinical settings where research and evaluation resources are limited. The purpose of this article is to provide simplified, pragmatic, user-centered and stakeholder-centered recommendations to increase the use of RE-AIM in community and clinical settings and in translational research.