Getting Ready for Scale-Up of an Effective Older Adult Physical Activity Program: Characterizing the Adaptation Process

Gray, Samantha M.; McKay, Heather; Hoy, Christa L.; Lau, Erica Y.; Ahn, Rei; Lusina-Furst, Sarah; Sims‐Gould, Joanie

doi:10.1007/s11121-019-01085-3

Cited by 11 publications

(32 citation statements)

References 37 publications

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“…Adaptions to interventions are common in the process of scale-up [3,11,12] and are often necessary to ensure that interventions can be delivered with the resources of agencies responsible for their implementation. They can also assist the successful expansion of evidence-based practice into larger, uncontrolled environments by improving intervention fit within diverse contexts (e.g., different political climate, economic conditions, public interest) [13].…”

Section: Introductionmentioning

confidence: 99%

How effective are physical activity interventions when they are scaled-up: a systematic review

Lane

McCrabb

Nathan

et al. 2021

Int J Behav Nutr Phys Act

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Background The ‘scale-up’ of effective physical activity interventions is required if they are to yield improvements in population health. The purpose of this study was to systematically review the effectiveness of community-based physical activity interventions that have been scaled-up. We also sought to explore differences in the effect size of these interventions compared with prior evaluations of their efficacy in more controlled contexts, and describe adaptations that were made to interventions as part of the scale-up process. Methods We performed a search of empirical research using six electronic databases, hand searched reference lists and contacted field experts. An intervention was considered ‘scaled-up’ if it had been intentionally delivered on a larger scale (to a greater number of participants, new populations, and/or by means of different delivery systems) than a preceding randomised control trial (‘pre-scale’) in which a significant intervention effect (p < 0.05) was reported on any measure of physical activity. Effect size differences between pre-scale and scaled up interventions were quantified ([the effect size reported in the scaled-up study / the effect size reported in the pre-scale-up efficacy trial] × 100) to explore any scale-up ‘penalties’ in intervention effects. Results We identified 10 eligible studies. Six scaled-up interventions appeared to achieve significant improvement on at least one measure of physical activity. Six studies included measures of physical activity that were common between pre-scale and scaled-up trials enabling the calculation of an effect size difference (and potential scale-up penalty). Differences in effect size ranged from 132 to 25% (median = 58.8%), suggesting that most scaled-up interventions typically achieve less than 60% of their pre-scale effect size. A variety of adaptations were made for scale-up – the most common being mode of delivery. Conclusion The majority of interventions remained effective when delivered at-scale however their effects were markedly lower than reported in pre-scale trials. Adaptations of interventions were common and may have impacted on the effectiveness of interventions delivered at scale. These outcomes provide valuable insight for researchers and public health practitioners interested in the design and scale-up of physical activity interventions, and contribute to the growing evidence base for delivering health promotion interventions at-scale. Trial registration PROSPERO CRD42020144842.

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Section: Introductionmentioning

confidence: 99%

How effective are physical activity interventions when they are scaled-up: a systematic review

Lane

McCrabb

Nathan

et al. 2021

Int J Behav Nutr Phys Act

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“…46 The participants' positive relationship with their activity coach and interactions with other participants influenced feelings of social connectedness during CTM. 47,48 Sharing information and experiences, learning from their peers, and engaging with others who share familiar experiences also contributed to feelings of social connection. 35 It seems imperative to maintain social and mental health benefits; to do so, programs that support these outcomes must be ongoing.…”

Section: Discussionmentioning

confidence: 99%

Status Quo or Drop-Off: Do Older Adults Maintain Benefits From Choose to Move—A Scaled-Up Physical Activity Program—12 Months After Withdrawing the Intervention?

McKay¹,

Nettlefold²,

Sims‐Gould³

et al. 2021

Journal of Physical Activity and Health

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Background: Choose to Move is one of few scaled-up health-promoting interventions for older adults. The authors evaluated whether Choose to Move participants maintained their intervention-related gains in physical activity (PA), mobility, and social connectedness 12 months after the intervention ended. Methods: The authors assessed PA, mobility, loneliness, social isolation, and muscle strength via questionnaire and objective measures in 235 older adults at 0 months (baseline), 6 months (end of intervention), and 18 months (12-months postintervention). The authors fitted linear mixed models to examine the change in each outcome from 6 to 18 months (primary objective) and 0 to 18 months (secondary objective) and reported by age group (60–74 and ≥75 y). Results: In younger participants, PA decreased between 6 and 18 months, but remained significantly higher than at baseline. Intervention-related benefits in loneliness, social isolation, mobility, and muscle strength were maintained between 6 and 18 months in the younger participants. Older participants maintained their intervention benefits in loneliness, mobility, and muscle strength. When compared with baseline values, PA levels in older participants were unchanged, whereas social isolation increased. Conclusions: Older adults maintained some, but not all, health benefits of Choose to Move 12 months after the intervention ended. Long-term commitments are needed to deliver effective health-promoting interventions for older adults if benefits are to be maintained.

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“…CTM is a exible, scalable, community-based health promoting physical activity intervention for older adults (~ 65+ years), co-created with government and community partners (21). We present core components of the CTM intervention in Figure 1, and describe all aspects of CTM elsewhere (17,21,22). During a one-on-one consultation participants set personal physical activity goals, create an action plan, problem solve barriers to participation, receive social support and are provided PA and health-related information.…”

Section: Study Design and Settingmentioning

confidence: 99%

“…Pre-implementation planning comprised working with delivery partners to adapt mode of intervention delivery and/or the intervention to context (population and setting) while retaining delity to core components (22,29). Preimplementation planning informed capacity building strategies (type and structure) the CSU used to support delivery partners.…”

Section: Pre-implementation Planningmentioning

confidence: 99%

How Central Support Built Capacity to Deliver a Health Promoting Intervention for Older Adults

Sims‐Gould¹,

McKay²,

Franke³

2020

Preprint

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Background: A number of conceptual frameworks guide implementation and scale-up of evidence based (health promoting) interventions (EBIs). However, few studies delve into these frameworks to describe aspects of the delivery system--such as capacity building--that support successful scale-up. A standardized approach to capacity building is needed to develop new strategies and transfer successful strategies to new settings. Therefore, our objectives were to describe: (1) implementation strategies adopted by the central support system to build practitioners’ capacity to implement and scale-up a health promoting intervention (Choose to Move (CTM)), and (2) elements within capacity building strategies deemed essential to effectively implement CTM in diverse community contexts.Methods: CTM is a flexible, scalable, community-based health promoting physical activity (PA) and social connectedness intervention for older adults. In 2018-2020, eight health and social service societies, rural or remote municipalities, or community based organizations delivered CTM programs (n=22) that served older adults (n=322). We conducted in depth interviews with delivery partners (n=23), and a focus group with the central support system (n= 4) to assess key elements within capacity building strategies.Results: Capacity building strategies that delivery partners adopted were site selection/marketing, training, tools, technical assistance, peer networking, assessment and feedback. Essential elements that emerged within capacity building strategies were: a support system champion, activity coach skills, self efficacy and confidence; interactive assistance to answer questions and clarify materials. Key elements of central support that emerged were helping organizations-- adapt and tailor the EBI, leverage resources and strategies, maintain fidelity to the EBI, develop partnerships, train and monitor, learn from peers, increase awareness of older adult needs, increase PA programs for older adults and inform future organizational practices and processes. Central support provided a sounding board to organizations and were more successful if they were familiar with delivery partner resources and values, created buy-in and planned ahead.Conclusion: There is a key role for capacity building under the stewardship of central support units to promote implementation success. More clearly described capacity-building strategies that are designed and delivered to support implementation and scale-up would serve to advance the field, in future.

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Getting Ready for Scale-Up of an Effective Older Adult Physical Activity Program: Characterizing the Adaptation Process

Cited by 11 publications

References 37 publications

How effective are physical activity interventions when they are scaled-up: a systematic review

How effective are physical activity interventions when they are scaled-up: a systematic review

Status Quo or Drop-Off: Do Older Adults Maintain Benefits From Choose to Move—A Scaled-Up Physical Activity Program—12 Months After Withdrawing the Intervention?

How Central Support Built Capacity to Deliver a Health Promoting Intervention for Older Adults

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