Evaluating the impact of a walking program in a disadvantaged area: using the RE-AIM framework by mixed methods

Abstract

BackgroundThe positive health impact of physical activity (PA) is well known, yet a large proportion of the world’s population remains sedentary. General PA programs are common as health promotion initiatives. However, effectiveness evaluations of such PA programs on individual and organizational aspects, which could inform the decision-making process of public health bodies are still lacking, particularly in the most socially disadvantaged areas, where health promotion schemes are particularly needed. The aim of this study was to assess the effectiveness of a Guided Walking Program in a high social vulnerability context.MethodsA quasi-experimental, mixed methods study was conducted. The program had a duration of 6 months and a 6-month follow-up period after the intervention. Session frequency was five times a week, where sessions consisted of supervised PA combined with educational sessions. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was followed to assess the program. The International Physical Activity Questionnaire (IPAQ) and accelerometers were used to measure levels of PA. Focus groups were conducted to gain a comprehensive insight on the implementation domain.ResultsMost subjects in the intervention (IG) (n = 74) and control (CG) (n = 74) groups were female (IG:90.5%; CG:95.9%), aged 18–49 years (IG:44.6%; CG:43.2%), received less than 1 minimum wage (IG:74.3%; CG:83.7%) and had 0–4 years of formal education (IG:52.1%; CG:46.1%). The reach of the intervention was 0.3%. The IG showed increased levels of PA at post-intervention and 6-month follow-up. However, the difference between groups was not statistically significant. Adoption data revealed that 89.5% of the professionals in the Primary Health Care Center (health center) team perceived the benefits of the program for the population. The program was independently promoted by the health center team for a further 4 months post-intervention. The qualitative data revealed that the program was discontinued due to participants’ low adherence and human resource limitations in the unit’s operational dynamics.ConclusionsA health promotion intervention in a socially deprived setting faces challenges but can be effective and feasible to implement. The present study informs the development of future health promotion initiatives in this context.Trial registration NCT02857127. Registered: 30 July 2016 (retrospectively registered).

Supervised training in primary care units but not self-directed physical activity lowered cardiovascular risk in Brazilian low-income patients: a controlled trial

“…Despite wide advertising prior to the beginning of the program, the reach was low; of the initially contacted 1,342 patients, only 86 accepted to participate of the supervised training and 53 completed the 12-month intervention. This difficulty has been reported in other studies developed in Brazilian socially vulnerable communities (40).…”

Meta-avaliação de intervenções comunitárias de promoção da atividade física

“…et al 38 Andrad e et al 39 Byrne et al 30 P1-Utilidade No que se refere às abordagens avaliativas, metade dos estudos focou em resultados 29,[31][32][33]38,39 e a outra metade em processo e resultados. 28,30,[34][35][36][37] Os resultados do presente estudo apontaram que a utilização de abordagens multiestratégicas para avaliação de intervenções comunitárias de PAF ainda é restrita, uma vez que a análise da informação foi predominantemente quantitativa e com foco nos resultados. Tal achado foi constatado em estudos de RS, cujo objetivo foi avaliar intervenções de PS e/ou AF.…”

“…Para o julgamento da qualidade calculou-se a média dos critérios, adotando-se a seguinte classificação: excelente (9,0-10,0); bom (7,0-8,9); regular (5,0-6,9); fraco (3,0-4,9) e crítico (<3,0). Halla let al 34 Parra et al 35 Mendonça et al 31 Dubuy, et al 29 Norwood et al 32 Reis et al 33 Fernandes et al 36 Baba et al 37…”

“…Quanto aos instrumentos para mensuração da AF empregaram questionários variados. Entre os mais utilizados tivemos o Questionário Internacional de Atividade Física -IPAQ,29,31,37,38 o Sistema de Observação de Brincadeiras e Comunidades -SOPARC 34 e o questionário de Alcance, Efetividade, Adoção, Implementação e Manutenção -RE-AIM 37. Apenas dois trabalhos utilizaram pedômetro/acelerômetro (instrumentos que aferem os passos, controlam a velocidade e o ritmo de um indivíduo que marcha) como medida objetiva complementar do nível de AF 29,37.…”

Efetividade de duas intervenções com diferentes volumes de exercícios físicos na qualidade de vida em mulheres usuárias da Atenção Básica de Saúde

“…Programas de atividade física nesses locais tem demonstrado resultados positivos sobre variáveis relacionadas à saúde, como o aumento do nível de atividade física, melhora na aptidão física e na percepção de saúde [12][13][14][15] . Esses resultados demonstram a importância de realizar ações no contexto da Atenção Básica de Saúde.…”