Sarah F. Griffin

Active for Life : Final Results from the Translation of Two Physical Activity Programs

BACKGROUND Most evidence-based programs are never translated into community settings and thus never make a public health impact. DESIGN Active for Life (AFL) was a 4-year translational initiative using a pre-post, quasi-experimental design. Data were collected from 2003 to 2007. Analyses were conducted in 2005 and 2008. SETTING/PARTICIPANTS Nine lead organizations at 12 sites participated. Active Choices participants (n=2503) averaged 65.8 years (80% women, 41% non-Hispanic white). Active Living Every Day (ALED) participants (n=3388) averaged 70.6 years (83% women, 64% non-Hispanic white). INTERVENTION In AFL, Active Choices was a 6-month telephone-based and ALED a 20-week group-based lifestyle behavior change program designed to increase physical activity, and both were grounded in social cognitive theory and the transtheoretical model. The interventions were evaluated in Years 1, 3, and 4. An adapted shortened ALED program was evaluated in Year 4. MAIN OUTCOME MEASURE Moderate- to vigorous-intensity physical activity, assessed with the CHAMPS self-reported measure. RESULTS Posttest survey response rates were 61% for Active Choices and 70% for ALED. Significant increases in moderate- to vigorous-intensity physical activity, total physical activity, and satisfaction with body appearance and function, and decreases in BMI were seen for both programs. Depressive symptoms and perceived stress, both low at pretest, also decreased over time in ALED. Results were generally consistent across years and sites. CONCLUSIONS Active Choices and ALED were successfully translated across a range of real-world settings. Study samples were substantially larger, more ethnically and economically diverse, and more representative of older adults health conditions than in efficacy studies, yet the magnitude of effect sizes were comparable.

A qualitative study of parental modeling and social support for physical activity in underserved adolescents

This study obtained qualitative data to assess how parental role modeling and parental social support influence physical activity in underserved (minority, low-income) adolescents. Fifty-two adolescents (22 males, 30 females; ages 10-14 years, 85% African-American) participated in a focus group (6-10 per group, same gender). Focus groups were audiotaped, transcribed and coded by independent raters. Inter-rater reliabilities indicated adequate agreement [inter-rater reliability (r) = 0.84]. Themes were identified for parental role modeling and parental social support. Regarding parental role modeling, adolescents reported that parents engaged in a variety of different types of physical activities with their children such as walking, cycling and playing basketball; however, activity was infrequent. Sex differences were noted in parental social support indicating that female adolescents reported receiving more emotional and negative support for physical activity (being required to play outside with a sibling), while boys reported receiving more tangible types of support for physical activity. Adolescents also generated ideas on how to increase parental social support and in particular tangible support was highlighted as important by both males and females. This study suggests that future interventions should focus on improving parental engagement and tangible support that involve direct participation from parents in physical activities with their adolescents.

Physical activity influences in a disadvantaged African American community and the communities' proposed solutions

The purpose of this assessment is to increase our understanding of how safety and environmental factors influence physical activity among African American residents living in a low-income, high-crime neighborhood and to get input from these residents about how to best design physical activity interventions for their neighborhood. Twenty-seven African American adult residents of a low-income, high-crime neighborhood in a suburban southeastern community participated in three focus groups. Participants were asked questions about perceptions of what would help them, their families, and their neighbors be more physically active. Two independent raters coded the responses into themes. Participants suggested three environmental approaches in an effort to increase physical activity: increasing law enforcement, community connectedness and social support, and structured programs. Findings suggest that safety issues are an important factor for residents living in disadvantaged conditions and that the residents know how they want to make their neighborhoods healthier.

An overview of the Positive Action for Today's Health (PATH) trial for increasing walking in low income, ethnic minority communities

BACKGROUND Ethnic minorities and lower-income adults have among the highest rates of obesity and lowest levels of regular physical activity (PA). The Positive Action for Todays Health (PATH) trial compares three communities that are randomly assigned to different levels of an environmental intervention to improve safety and access for walking in low income communities. DESIGN AND SETTING Three communities matched on census tract information (crime, PA, ethnic minorities, and income) were randomized to receive either: an intervention that combines a police-patrolled-walking program with social marketing strategies to promote PA, a police-patrolled-walking only intervention, or no-walking intervention (general health education only). Measures include PA (7-day accelerometer estimates), body composition, blood pressure, psychosocial measures, and perceptions of safety and access for PA at baseline, 6, 12, 18, and 24 months. INTERVENTION The police-patrolled walking plus social marketing intervention targets increasing safety (training community leaders as walking captains, hiring off-duty police officers to patrol the walking trail, and containing stray dogs), increasing access for PA (marking a walking route), and utilizes a social marketing campaign that targets psychosocial and environmental mediators for increasing PA. MAIN HYPOTHESES/OUTCOMES: It is hypothesized that the police-patrolled walking plus social marketing intervention will result in greater increases in moderate-to-vigorous PA as compared to the police-patrolled-walking only or the general health intervention after 12 months and that this effect will be maintained at 18 and 24 months. CONCLUSIONS Implications of this community-based trial are discussed.

Formative Process Evaluation for Implementing a Social Marketing Intervention to Increase Walking Among African Americans in the Positive Action for Today’s Health Trial

OBJECTIVES Evaluating programs targeting physical activity may help to reduce disparate rates of obesity among African Americans. We report formative process evaluation methods and implementation dose, fidelity, and reach in the Positive Action for Todays Health trial. METHODS We applied evaluation methods based on an ecological framework in 2 community-based police-patrolled walking programs targeting access and safety in underserved African American communities. One program also targeted social connectedness and motivation to walk using a social marketing approach. Process data were systematically collected from baseline to 12 months. RESULTS Adequate implementation dose was achieved, with fidelity achieved but less stable in both programs. Monthly walkers increased to 424 in the walking-plus-social marketing program, indicating expanding program reach, in contrast to no increase in the walking-only program. Increased reach was correlated with peer-led Pride Strides (r = .92; P < .001), a key social marketing component, and program social interaction was the primary reason for which walkers reported participating. CONCLUSIONS Formative process evaluation demonstrated that the walking programs were effectively implemented and that social marketing increased walking and perceived social connectedness in African American communities.

Sustainability of evidence-based community-based physical activity programs for older adults: lessons from Active for Life

Program sustainability in community and healthcare settings is critical to realizing the translation of research into practice. The purpose of this study is to describe the implementation and assessment of an intervention to increase organizational maintenance of evidence-based physical activity programs and the factors that impede or facilitate sustainability. All organizations implemented a sustainability action plan that included identifying factors related to sustainability, examining resources available, identifying program modifications to enhance sustainability, and long-term action planning. A mixed methods approach was used. Organizational (n = 12 sites) ability to demonstrate program effectiveness, align priorities with the organizational mission, and integrate the program within the existing infrastructure were strengths related to sustainability. Sites were more optimistic about program sustainability when they had less reliance on internal financial, but more reliance on internal human resources to run the program post-funding. The study resulted in a number of tools that can help community organizations plan for sustainability of physical activity programs.

Review and Application of Current Literature Related to Culinary Programs for Nutrition Educators

This review provides evidence for inclusion of cooking activities within adult nutrition education programs. Issues affecting diet-related health behaviors including fruit, vegetable, and sodium intake, barriers to consumption of produce, home fruit and vegetable availability and accessibility, and cooking behavior are examined. Nutrition education interventions are developed within a theoretical framework, and therefore a review of these theories as applied to nutrition education programs is appropriate. Dietitian-led nutrition education programs that target healthy eating behaviors and cooking skills are assessed, with findings indicating that an increase in cooking knowledge and skill can lead to improved produce consumption.

Understanding the Challenges Encountered and Adaptations Made by Community Organizations in Translation of Evidence-Based Behavior Change Physical Activity Interventions: A Qualitative Study

Purpose. Designing programs for mid-life to older adults whose sedentary behaviors are associated with increased health risks is crucial. The U.S. Task Force on Community Preventive Services strongly recommends individually adapted behavior change programs as one approach to increasing physical activity in communities. The purpose of this study is to report challenges organizations faced when translating two evidence-based programs in real-world settings, adaptations made, and whether or not fidelity was negatively impacted by these adaptations. Design: A grounded theory approach to qualitative research was used. Setting and Participants: Nine community organizations across the country participated. Two organizations had more than one site participating, for a total of 12 sites from nine organizations. Within those organizations, 2796 participants were part of the program during the first 2 years. Participants were underactive (i.e., not meeting Centers for Disease Control and Prevention and American College of Sports Medicine recommendations) mid- to older-aged adults. Methods: Community organizations participated in monthly conference calls, and program information was entered into an electronic database regularly. Data obtained from the calls and database were used for analyses. Results: Challenges and adaptations emerged in three categories: (1) program logistics, (2) program theory, and (3) program philosophy. Conclusion: Challenges were present for community organizations; however, with some level of adaptation, the community organizations were able to effectively deliver and maintain fidelity in two evidence-based physical activity programs to a large and diverse group of mid- to older-aged adults.

A Content Analysis of Nutrition Education Curricula Used With Low-Income Audiences Implications for Questionnaire Development

In developing recommendations for core measures/items for the evaluation of the Youth Expanded Food and Nutrition Education Program (EFNEP), three nutrition education curricula, implemented by land grant universities, were content analyzed. Selection criteria included the following: Curriculum content must include all EFNEP core content areas and must be implemented in more than one state with school children in third through fifth grades. Content analysis strategies were employed to identify and describe common areas/themes and mediators of behaviors addressed across the selected curricula. Content analysis coding was based on a list of behavioral mediators, which have empirical associations with nutrition, physical activity, and food safety. The most evident approaches identified across the three curricula were to enhance motivation, teach cognitive knowledge, and practice behavioral skills. The presence of self-regulation and environmental theory–based strategies was limited in all three curricula. In addition, multiple themes for nutrition, physical activity, and food safety were commonly addressed across curricula with multiple educational strategies. Based on these findings, recommendations for developing content appropriate measures and items for an outcome evaluation tool for Youth EFNEP are provided.

Updating the FORECAST formative evaluation approach and some implications for ameliorating theory failure, implementation failure, and evaluation failure

Historically, there has been considerable variability in how formative evaluation has been conceptualized and practiced. FORmative Evaluation Consultation And Systems Technique (FORECAST) is a formative evaluation approach that develops a set of models and processes that can be used across settings and times, while allowing for local adaptations and innovations. FORECAST integrates specific models and tools to improve limitations in program theory, implementation, and evaluation. In the period since its initial use in a federally funded community prevention project in the early 1990s, evaluators have incorporated important formative evaluation innovations into FORECAST, including the integration of feedback loops and proximal outcome evaluation. In addition, FORECAST has been applied in a randomized community research trial. In this article, we describe updates to FORECAST and the implications of FORECAST for ameliorating failures in program theory, implementation, and evaluation.