Beginning With the End in Mind: Contextual Considerations for Scaling-Out a Community-Based Intervention

Abstract

Introduction: A number of effective physical activity programs for older adults exist, but are not widely delivered within community settings, such as the Cooperative Extension System. The purpose of this paper was to determine if an evidence-based intervention (EBI) developed in one state Extension system could be scaled-out to a new state system.Methods and results: The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework was used to guide an iterative evaluation of three translational stages. Stage 1: Before program adoption, Extension health educators were surveyed and interviewed to assess physical activity programming perceptions and factors that may influence their decision to attend training or deliver the program in practice. Results indicated that a virtual, scalable training protocol would be necessary and that training needed to include hands-on instruction and be catered to those who were less confident in physical activity program delivery. Stage 2: Training attendees were surveyed pre- and post-training on factors related to the adoption-decision making process and contacted post-training to assess program delivery status. Training did not influence perceptions of the program, intent to deliver, or confidence in delivering the program. Stage 3: During program implementation, the program was evaluated through the RE-AIM framework by surveying across three key stakeholder groups: (1) program participants, (2) potential delivery personnel, and (3) Extension administrators. Findings indicate that the program has the potential to reach a large and representative proportion of the target audience, especially in rural areas. However, adoption and implementation rates among Extension health educators and community partners were low and data collection for effectiveness, implementation, and maintenance was a challenge.Conclusion: Overall, the results indicate initial struggles to translating and evaluating the program in a large, rural state. Implications for practice include making system-level changes to increase physical activity program adoption rates among Extension health educators and improve data collection and program evaluation through this community-based organization. More work is needed to identify infrastructure support and capacity to scale-out EBIs.

RE-AIM Planning and Evaluation Framework: Adapting to New Science and Practice With a 20-Year Review

“…In some cases, the decision to capture all five dimensions is made a priori to understand individual impacts, contextual implications, and feasibility of ongoing data collection. This is demonstrated in two recent applications of RE-AIM before, during, and after program implementation—and on limited funds (74, 75). Both applications highlighted the need for stakeholder buy-in (54) and operationalization (67) of each dimension that holds value for these stakeholders.…”

Cooperative Extension Gets Moving, but How? Exploration of Extension Health Educators’ Sources and Channels for Information-Seeking Practices

“…However, Extension’s full potential for intervention translation has been hindered through program duplication and a lack of knowledge about how information reaches delivery personnel. 4 -6 In order to improve programming translation in Extension, a dissemination intervention could focus on the communication of intervention information. However, the extant literature is yet to identify Extension professionals’ information sources (operationalized here as where the information is located) and channels (operationalized here as how the information is communicated) used at the national level.…”

Evaluating “Take the Stairs, Wyoming!” Through the RE-AIM Framework: Challenges and Opportunities

“…One of the main barriers in this study was the lack of adherence to data collection by Extension health educators. Indeed, Extension struggles with program evaluation; collecting empirical data on behavior change as a program outcome is still relatively novel to the system (8,9,24,25). In the case of PSEs, which are also fairly new to Extension and more difficult to evaluate than direct education interventions, matching evaluation methods to staff resources and expectations is key (Balis et al, under review).…”

“…However, evaluating PSEs can be challenging, as it is difficult to determine who is influenced by PSEs and track changes in their behavior. Evaluation of health promotion interventions (both PSEs and individual-level interventions) can be especially challenging in low-resource community settings (i.e., those that may not have funding or personnel dedicated to program evaluation) (8,9). One challenge is that PSEs that were not designed and tested in community settings may include evaluations that are difficult to replicate (e.g., using many hours of observation pre-and post-intervention) (10).…”

“…The reach, effectiveness, adoption, implementation, maintenance framework (RE-AIM) has been suggested for robustly evaluating PSEs (14), as well as for planning and evaluating Extension programs (15,16). RE-AIM has been used for pragmatic program evaluation in community settings (8) and may help practitioners overcome the challenges to evaluating PSEs by providing a comprehensive evaluation framework. The purpose of this paper is to describe the use of RE-AIM as a planning and evaluation framework for a physical activity PSE delivered through University of Wyoming Extension (UWE).…”