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Dissemination and Implementation Science Methods and Measures for Physical Activity Interventions in Community Settings

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (15 January 2023) | Viewed by 20968

Special Issue Editors


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Guest Editor
Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute, State University, Blacksburg, VA 24060, USA
Interests: physical activity; RE-AIM framework; group dynamics; research–practice partnership; mixed-methods; premortem methodology; dissemination; translation; science communication; older adult physical activity promotion; OBY/GYN cancer and health

E-Mail Website
Guest Editor
Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77230-1436, USA
Interests: community-engaged research; physical activity; energy balance; health disparities; rural cancer control; implementation science; mixed-methods research

E-Mail Website
Guest Editor
Physical Activity for Treatment and Prevention Lab - Health and Exercise Science, Colorado State University, Fort Collins, CO 80524, USA
Interests: clinical exercise physiology; social ecological determinants of physical activity adoption and maintenance; translation of exercise and physical activity intervention into clinic- and community-based settings

E-Mail Website
Guest Editor
Pacific Institute for Research and Evaluation, Louisville Center, Louisville, KY 40202, USA
Interests: translation; community settings; physical activity guidelines in LMIC; international partnerships; participatory methodologies; pragmatic measures

Special Issue Information

Dear Colleagues,

Dissemination and implementation science (DIS) is a growing field that aims to understand the processes and outcomes of selecting, adapting, delivering, evaluating, and sustaining evidence-based interventions. Much of DIS has been applied in clinical settings, and more recently, attention has been given to community-specific barriers, facilitators, processes, and outcomes. This Special Issue of the International Journal of Environmental Research and Public Health invites papers that report answers to significant DIS-related research questions through the application of robust methods and measures.

Example papers may be related to:

  1. Novel methods and measures to understand community member and community organizational-level processes in the adoption and integration of physical activity interventions (e.g., community–academic partnerships or community coalition roles);
  2. Adaptation of clinical DIS methods and measures in community settings;
  3. Mixed-methods approaches to DIS research questions in community settings;
  4. How DIS methods and measures capture health equity issues and solutions for physical activity interventions in community settings;
  5. Multilevel community-based physical activity interventions for chronic disease prevention, management, and survivorship;
  6. Implementation strategies that increase the adoption and implementation of physical activity policies or built environment interventions.

Dr. Samantha M. Harden
Dr. Scherezade K. Mama
Dr. Heather Leach
Dr. Laura E. Balis
Guest Editors

Keywords

  • knowledge translation
  • implementation
  • de-implementation
  • exercise
  • sedentary behavior

Published Papers (9 papers)

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Research

15 pages, 376 KiB  
Article
Individual and Contextual Factors Associated with Classroom Teachers’ Intentions to Implement Classroom Physical Activity
by Gabriella M. McLoughlin, Hannah G. Calvert and Lindsey Turner
Int. J. Environ. Res. Public Health 2023, 20(4), 3646; https://doi.org/10.3390/ijerph20043646 - 18 Feb 2023
Cited by 2 | Viewed by 1273
Abstract
Classroom-based physical activity (CPA) is an evidence-based practice that improves student physical activity outcomes, but national data suggest implementation is insufficient in US classrooms. The purpose of this study was to examine individual and contextual factors associated with elementary school teachers’ intentions to [...] Read more.
Classroom-based physical activity (CPA) is an evidence-based practice that improves student physical activity outcomes, but national data suggest implementation is insufficient in US classrooms. The purpose of this study was to examine individual and contextual factors associated with elementary school teachers’ intentions to implement CPA. We collected input survey data from 181 classroom teachers (10 schools; 98.4% participation among eligible teachers) across three separate cohorts to examine associations between individual and contextual constructs and future CPA implementation intentions. Data were analyzed using multilevel logistic regression. Individual-level characteristics of perceived autonomy for using CPA, perceived relative advantage/compatibility of CPA, and general openness to educational innovations were positively associated with intentions to implement CPA (p < 0.05). Teacher perceptions of contextual factors such as administrator support for CPA were also associated with implementation intentions. This study adds to prior evidence about the importance of theoretically determined constructs for understanding behavioral intentions among front-line implementers such as classroom teachers. Additional research is needed to evaluate interventions designed to change malleable factors, including teachers’ perceptions, as well as changing school environments so that teachers perceive more autonomy to use CPA and have the training and resources that build skills for implementation. Full article
18 pages, 1721 KiB  
Article
First-Year Implementation of the EXercise for Cancer to Enhance Living Well (EXCEL) Study: Building Networks to Support Rural and Remote Community Access to Exercise Oncology Resources
by Chad W. Wagoner, Julianna Dreger, Melanie R. Keats, Daniel Santa Mina, Margaret L. McNeely, Colleen Cuthbert, Lauren C. Capozzi, George J. Francis, Linda Trinh, Daniel Sibley, Jodi Langley, Joy Chiekwe, Manuel Ester, Aude-Marie Foucaut and S. Nicole Culos-Reed
Int. J. Environ. Res. Public Health 2023, 20(3), 1930; https://doi.org/10.3390/ijerph20031930 - 20 Jan 2023
Cited by 6 | Viewed by 2680
Abstract
Barriers to exercise-oncology programs remain for those living with and beyond cancer in rural and remote communities, including geographic isolation and access to programs. The EXercise for Cancer to Enhance Living Well (EXCEL) study was designed to support exercise-oncology implementation in rural and [...] Read more.
Barriers to exercise-oncology programs remain for those living with and beyond cancer in rural and remote communities, including geographic isolation and access to programs. The EXercise for Cancer to Enhance Living Well (EXCEL) study was designed to support exercise-oncology implementation in rural and remote communities across Canada. The purpose of this analysis was to evaluate the first-year reach, adoption, and implementation of the EXCEL study. Reach outcomes included participant characteristics, study enrolment, and referral type (self vs. healthcare-provider [HCP] referral). Adoption outcomes included the number of clinical contacts, trained qualified exercise professionals (QEPs), and QEPs delivering EXCEL exercise classes. Implementation outcomes included retention, adherence, assessment completion rates, and adverse-event reporting. A total of 290 individuals living with cancer enrolled in EXCEL in year one, with an 81.4% retention to the study intervention. Most participants self-referred to EXCEL (75.8%). EXCEL’s HCP network consisted of 163 clinical contacts, and the QEP network included 45 trained QEPs, 22 of whom delivered EXCEL classes. Adherence to the exercise intervention was 78.2%, and only one adverse event (mild) was reported. Fitness assessment and patient-reported outcome completion rates were above 85% pre- and post-intervention. EXCEL has developed HCP and QEP networks supporting exercise referral and online delivery, and the intervention is meeting feasibility markers. These implementation findings will inform the continued gathering of feedback across stakeholders to ensure that best evidence informs best practices. Full article
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16 pages, 653 KiB  
Article
A Novel Policy Alignment and Enhancement Process to Improve Sustainment of School-Based Physical Activity Programming
by Penelope J. Friday, Lexie R. Beemer, Diane Martindale, Amy Wassmann, Andria B. Eisman, Thomas Templin, Ronald F. Zernicke, Lynn Malinoff, Anna Schwartz, Tiwaloluwa A. Ajibewa, Michele W. Marenus and Rebecca E. Hasson
Int. J. Environ. Res. Public Health 2023, 20(3), 1791; https://doi.org/10.3390/ijerph20031791 - 18 Jan 2023
Cited by 3 | Viewed by 1638
Abstract
The purpose of the current study was twofold: (1) to evaluate the strength and comprehensiveness of district wellness policies in one central Michigan intermediate school district (ISD; 16 districts), and (2) to pilot a novel policy alignment and enhancement process in one district [...] Read more.
The purpose of the current study was twofold: (1) to evaluate the strength and comprehensiveness of district wellness policies in one central Michigan intermediate school district (ISD; 16 districts), and (2) to pilot a novel policy alignment and enhancement process in one district within the ISD to improve sustainment of district-wide physical activity (PA) programming. Policy evaluation and alignment were determined using WellSAT 3.0. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework was used to guide a seven-step policy alignment and enhancement process. Initial evaluation of the PA policy for the ISD revealed a strength score of 19/100 (i.e., included weak and non-specific language) and 31/100 for comprehensiveness (i.e., mentioned few components of the Comprehensive School Physical Activity Program). For the pilot school district, initial strength scores were 19/100 and 38/100 for comprehensiveness (exploration). An alignment of the tailored PA policy with current practices resulted in a 100% increase in strength (score of 38/100), and 132% increase in comprehensiveness (score of 88/100; preparation). However, district administrators encountered barriers to adopting the tailored policy and subsequently integrated the PA requirements into their curriculum guide and school improvement plan (implementation and sustainment). Future research should examine the effectiveness of our EPIS-informed policy evaluation, alignment, and enhancement process to promote widespread increases in student PA. Full article
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25 pages, 1459 KiB  
Article
Smart Walk: A Culturally Tailored Smartphone-Delivered Physical Activity Intervention for Cardiometabolic Risk Reduction among African American Women
by Rodney P. Joseph, Michael Todd, Barbara E. Ainsworth, Sonia Vega-López, Marc A. Adams, Kevin Hollingshead, Steven P. Hooker, Glenn A. Gaesser and Colleen Keller
Int. J. Environ. Res. Public Health 2023, 20(2), 1000; https://doi.org/10.3390/ijerph20021000 - 5 Jan 2023
Cited by 1 | Viewed by 2523
Abstract
This article reports the results of Smart Walk: a randomized pilot trial of an 8-month culturally tailored, smartphone-delivered physical activity (PA) intervention for African American women with obesity. Sixty participants (age range = 24–49 years; BMI range = 30–58 kg/m2) [...] Read more.
This article reports the results of Smart Walk: a randomized pilot trial of an 8-month culturally tailored, smartphone-delivered physical activity (PA) intervention for African American women with obesity. Sixty participants (age range = 24–49 years; BMI range = 30–58 kg/m2) were randomized to the Smart Walk intervention (n = 30) or a wellness comparison intervention (n = 30). Results supported the acceptability and feasibility of the intervention, as demonstrated by participant retention (85% at 4 months and 78% at 8 months), Smart Walk app use, and intervention satisfaction (i.e., 100% of PA participants completing the intervention [n = 24] reported they would recommend it to friend). Smart Walk participants also reported greater increases in moderate-to-vigorous PA (4-month between-arm difference in change [b] = 43.3 min/week; p = 0.018; Cohen’s d = 0.69; 8-month b = 56.6 min/week; p = 0.046; d = 0.63) and demonstrated clinically relevant, although not statistically significant (p-values > 0.05), baseline to 4 months improvements in cardiorespiratory fitness (b = 1.67 mL/kg/min; d = 0.40), systolic blood pressure (b = −3.33 mmHg; d = 0.22), diastolic blood pressure (b = −4.28 mmHg; d = 0.37), and pulse wave velocity (b = −0.46 m/s; d = 0.33). Eight-month cardiometabolic outcomes followed similar trends, but had high rates of missing data (45–53%) due to COVID-19 restrictions. Collectively, findings demonstrated favorable outcomes for acceptability and feasibility, while also highlighting key areas for refinement in future research. Full article
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14 pages, 1632 KiB  
Article
Feasibility and Effectiveness of a Worksite-Weight-Loss Program for Cancer Prevention among School-District Employees with Overweight and Obesity
by Che Young Lee, Michael C. Robertson, Hannah Johnston, Thuan Le, Margaret Raber, Ruth Rechis, Katherine Oestman, Alise Neff, Amber Macneish and Karen M. Basen-Engquist
Int. J. Environ. Res. Public Health 2023, 20(1), 538; https://doi.org/10.3390/ijerph20010538 - 29 Dec 2022
Cited by 1 | Viewed by 1960
Abstract
The effects of Vibrant Lives, a 6-month worksite-weight-loss program, were examined in a cohort of school-district employees with overweight or obesity. The VL Basic (VLB) participants received materials and tailored text messages, the VL Plus (VLP) participants additionally received WIFI-enabled activity monitors and [...] Read more.
The effects of Vibrant Lives, a 6-month worksite-weight-loss program, were examined in a cohort of school-district employees with overweight or obesity. The VL Basic (VLB) participants received materials and tailored text messages, the VL Plus (VLP) participants additionally received WIFI-enabled activity monitors and scales and participated in health challenges throughout the school year, and the VL Plus with Support (VLP + S) participants additionally received coaching support. The levels of program satisfaction and retention and changes in weight, physical activity (PA), and diet were compared across groups using Pearson chi-square tests, repeated-measure mixed models, and logistic regression. After the program, the VLB (n = 131), VLP (n = 87), and VLP + S (n = 88) groups had average weight losses of 2.5, 2.5, and 3.4 kg, respectively, and average increases in weekly PA of 40.4, 35.8, and 65.7 min, respectively. The VLP + S participants were more likely than the other participants to have clinically significant weight loss (≥3%; p = 0.026). Compared with the VLB participants, the VLP participants were less likely to meet the recommendations for consuming fast food (p = 0.022) and sugar-sweetened beverages (p = 0.010). The VLP and VLP + S participants reported higher program satisfaction than the VLB participants. The VL program facilitates weight loss among school-district employees with overweight and obesity by increasing their PA and healthy diet. Full article
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13 pages, 1145 KiB  
Article
Dissemination in Extension: Health Specialists’ Information Sources and Channels for Health Promotion Programming
by Thomas E. Strayer III, Laura E. Balis, NithyaPriya S. Ramalingam and Samantha M. Harden
Int. J. Environ. Res. Public Health 2022, 19(24), 16673; https://doi.org/10.3390/ijerph192416673 - 12 Dec 2022
Viewed by 1106
Abstract
In the National Cooperative Extension System (herein: Extension), state-level specialists serve as key intermediaries between research, educators, and the community members they serve. There is a need to understand information seeking and sharing practices (i.e., dissemination) among specialists to increase the adoption of [...] Read more.
In the National Cooperative Extension System (herein: Extension), state-level specialists serve as key intermediaries between research, educators, and the community members they serve. There is a need to understand information seeking and sharing practices (i.e., dissemination) among specialists to increase the adoption of evidence-based health promotion programs. Specialists (N = 94) across 47 states were identified and invited to participate in this mixed methods study. A one-way ANOVA with Bonferroni corrections was used to analyze survey data. Data collected through semi-structured interviews were analyzed using an immersion crystallization approach. Forty-seven health specialists completed the survey representing 31 eligible states (65%) and were predominately female (89%), Caucasian (70%), had a doctorate (62%), and were employed within Extension for 10.2 + 9.7 years. The information sources used most frequently were academic journals and other specialists, and most used email and online meetings to communicate. Qualitative findings support the use of other specialists as a primary source of information and indicate specialists’ desire for an on-demand, bi-directional, online national repository of Extension programs. This repository would facilitate the dissemination of evidence-based programming across the system and reduce program duplication as well as information burden on county-based educators. Full article
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11 pages, 989 KiB  
Article
Feasibility and Comparative Effectiveness for the Delivery of the National Diabetes Prevention Program through Cooperative Extension in Rural Communities
by Anna M. Gorczyca, Richard A. Washburn, Patricia Smith, Robert N. Montgomery, Lyndsie M. Koon, Mary Hastert, Kameron B. Suire and Joseph E. Donnelly
Int. J. Environ. Res. Public Health 2022, 19(16), 9902; https://doi.org/10.3390/ijerph19169902 - 11 Aug 2022
Cited by 4 | Viewed by 1966
Abstract
The U.S. Cooperative Extension Service (CE) has potential to deliver the National Diabetes Prevention Program (NDPP) to rural residents with prediabetes. However, the CE remains underutilized for the delivery of NDPP. We compared the feasibility/effectiveness of the NDPP (0–6 mos.) delivered by CE [...] Read more.
The U.S. Cooperative Extension Service (CE) has potential to deliver the National Diabetes Prevention Program (NDPP) to rural residents with prediabetes. However, the CE remains underutilized for the delivery of NDPP. We compared the feasibility/effectiveness of the NDPP (0–6 mos.) delivered by CE personnel to rural residents with prediabetes using Zoom® (CE-Zoom®) or by our research staff using Facebook® (FB). Adults (n = 31, age ~55 years) were enrolled (CE-Zoom® n = 16, FB n = 15). Attendance did not differ significantly between groups (CE Zoom® = 69%, FB = 83%, p = 0.15). Participant retention was similar in the CE Zoom® (88%) and FB groups (87%). CE-Zoom® and FB® groups provided weekly, self-monitoring data for 83% and 84% of the 24 potential weeks, respectively. Six-month weight loss was not different between groups (CE-Zoom® = −5.99 ± 8.0 kg, −5.4%, FB = −1.68 ± 3.3 kg, −1.6% p = 0.13). Participants achieving ≥5% weight loss was greater in the CE-Zoom® (44%) compared with the FB group (7%, p = 0.04). Participants achieving the NDPP program goal for physical activity (≥150 min/week) did not differ (CE-Zoom® = 75%, FB = 67%, p = 0.91). This pilot trial demonstrated the potential feasibility and effectiveness of the NDPP delivered by CE personnel in a group remote format (Zoom®) to adults with prediabetes living in rural areas. Full article
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14 pages, 631 KiB  
Article
Feasibility of Implementing Physical Activity Behavior Change Counseling in an Existing Cancer-Exercise Program
by Emma L. McGinnis, Laura Q. Rogers, Christine A. Fruhauf, Catherine M. Jankowski, Mary E. Crisafio and Heather J. Leach
Int. J. Environ. Res. Public Health 2021, 18(23), 12705; https://doi.org/10.3390/ijerph182312705 - 2 Dec 2021
Cited by 3 | Viewed by 2639
Abstract
Purpose: This study examined the feasibility and acceptability of implementing research-tested physical activity (PA) behavior change counseling (BCC) sessions in an existing cancer-exercise program, and the preliminary effects on cancer survivor’s self-efficacy and PA. Methods: Participants were cancer survivors undergoing or within six-months [...] Read more.
Purpose: This study examined the feasibility and acceptability of implementing research-tested physical activity (PA) behavior change counseling (BCC) sessions in an existing cancer-exercise program, and the preliminary effects on cancer survivor’s self-efficacy and PA. Methods: Participants were cancer survivors undergoing or within six-months of completing cancer treatment(s), and exercise program staff. Cancer survivors were randomized to receive the exercise program plus PABCC, or the standard exercise program. Feasibility and acceptability were assessed by recruitment, adherence, satisfaction, and a focus group with program staff. Qualitative data were analyzed using descriptive thematic analysis. Self-report questionnaires measured PA and exercise self-efficacy. Results: Recruitment was 33 out of 93 (36.7%), and n = 13 (39%) provided post-program data. Cancer survivors enjoyed PABCC sessions, but reported face-to-face delivery was an added time burden. Program staff expressed desire to implement PABCC, but perceived staff capacity and time as barriers to sustainability. Exercise self-efficacy increased by 21.5% in the PABCC group vs. 4.2% in the control. PA increased by 81.3% in the PABCC group vs. 16.6% in the control group. Conclusions: Implementing PABCC in an existing cancer-exercise program was acceptable and promising for increasing moderate to vigorous PA, but additional research is needed to enhance the feasibility and sustainability of translating efficacious behavioral interventions into existing cancer-exercise programs. Full article
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16 pages, 359 KiB  
Article
Adaptation and Validation of the Program Sustainability Assessment Tool (PSAT) for Use in the Elementary School Setting
by Alix Hall, Adam Shoesmith, Rachel C. Shelton, Cassandra Lane, Luke Wolfenden and Nicole Nathan
Int. J. Environ. Res. Public Health 2021, 18(21), 11414; https://doi.org/10.3390/ijerph182111414 - 29 Oct 2021
Cited by 7 | Viewed by 3160
Abstract
There is a lack of valid and reliable measures of determinants of sustainability specific to public health interventions in the elementary school setting. This study aimed to adapt and evaluate the Program Sustainability Assessment Tool (PSAT) for use in this setting. An expert [...] Read more.
There is a lack of valid and reliable measures of determinants of sustainability specific to public health interventions in the elementary school setting. This study aimed to adapt and evaluate the Program Sustainability Assessment Tool (PSAT) for use in this setting. An expert reference group adapted the PSAT to ensure face validity. Elementary school teachers participating in a multi-component implementation intervention to increase their scheduling of physical activity completed the adapted PSAT. Structural validity was assessed via confirmatory factor analysis. Convergent validity was assessed using linear mixed regression evaluating the associations between scheduling of physical activity and adapted PSAT scores. Cronbach’s alpha was used to evaluate internal consistency and intracluster correlation coefficients for interrater reliability. Floor and ceiling effects were also evaluated. Following adaptation and psychometric evaluation, the final measure contained 26 items. Domain Cronbach’s alpha ranged from 0.77 to 0.92. Only one domain illustrated acceptable interrater reliability. Evidence for structural validity was mixed and was lacking for convergent validity. There were no floor and ceiling effects. Efforts to adapt and validate the PSAT for the elementary school setting were mixed. Future work to develop and improve measures specific to public health program sustainment that are relevant and psychometrically robust for elementary school settings are needed. Full article
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