Improving physical activity program adoption using integrated research-practice partnerships: an effectiveness-implementation trial

Abstract

Integrated research-practice partnerships (IRPPs) may improve adoption of evidence-based programs. The aim of this study is to compare adoption of an IRPP-developed physical activity (PA) program (Fit Extension, FitEx) to a typical efficacy-effectiveness-dissemination pipeline model program (Active Living Every Day, ALED). Guided by the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework, a randomized controlled trial assigned health educators (HEs) to FitEx (n = 18) or ALED (n = 18). Fourteen HEs adopted FitEx, while two HEs adopted ALED (χ 2 = 21.8; p < 0.05). FitEx HEs took less time to deliver (p < 0.05), stated greater intentions for continued program delivery (p < 0.05), and reached more participants (n = 1097 total; 83 % female; 70 % Caucasian; M age = 44 ± 11.8) per HE than ALED (n = 27 total; 60 % female; 50 % Caucasian; M age = 41 ± 11.3). No significant difference existed in FitEx or ALED participants' increased PA (M increase = 9.12 ±29.09 min/ day; p > 0.05). IRPP-developed programs may improve PA program adoption, implementation, and maintenance and may also result in programs that have higher reach-without reducing effectiveness. KeywordsTranslation, Physical activity, RE-AIM, Researchpractice Regular physical activity plays an important role in the prevention, onset, and management of many adverse chronic health conditions [1]. Conversely, physical inactivity is one of the primary behavioral causes of death in the USA [2] and contributes to the 483.8 billion dollars spent each year for the management and treatment of cardiovascular diseases and diabetes [3]. Unfortunately, less than half of the adult population is active at a recommended level [4] of moderate intensity for at least 30 min/day, 5 days or more per week [5]. While interventions (programs, policy, and practice) exist that aim to increase physical activity, there is a lack of translation of effective evidence-based programs into practice [6].Reasons for this lack of translation are related to both research and practice. First, using research reporting guidelines that are predominantly focused on internal validity (e.g., CONSORT Statement [7]) results in a body of literature that values the strong internal validity but attributes only a passing focus on issues of external validity [8]. In fact, a series of reviews of intervention studies published in leading journals that targeted physical activity (as well as nutrition and smoking) bears this out, showing that external validity (e.g., participant's representativeness, organizational adoption, and program sustainability) was rarely reported [9][10][11]. Second, a linear (or top down) model of dissemination, which highlights the researcher as the expert and developer of products, and the delivery system as a simple receptor of evidence-based programs are a common depiction of translation of research to practice [12]. A linear model has a number of drawbacks for translation of research to practice: (1) it fails to address the organizational and community ca...

Making a move in exercise referral: co-development of a physical activity referral scheme

“…10 Consequently, evidence of effectiveness is scarce and systematic reviews have been deemed an unfair assessment of the potential of ERSs to impact public health. 11 To improve implementation and effectiveness of interventions to support long-term PA behaviour change, there is a need for ecologically valid, multistakeholder developed interventions 12,13 that reflect the pragmatic needs of end-users. 14 The Medical Research Council recommends a phased approach to the development of complex interventions, 15 starting with a development phase, followed by piloting to ensure the intervention is refined sufficiently, before undergoing an effectiveness trial.…”

Uptake of evidence-based physical activity programs: comparing perceptions of adopters and nonadopters

“…Health educators trained in the FitEx program were more likely to implement [41], and those unable to implement during the trial period, shared plans for future implementation. They perceived the program to be a better fit within their system compared to those trained in the researchdeveloped program.…”

Physical activity promotion and translational research

“…Across the studies in this issue, I was also struck by the focus on partnerships and integration within systems that can support program, policy, and environmental changes for physical activity promotion [7,[9][10][11][12]. Whether it be partnerships to adapt an evidencebased intervention for a system like cooperative extension [12] or for a high need and underserved population [13]-these approaches add needed external validity to the research enterprise and may be more likely to effectively change behavior and be sustained in practice [14].…”

“…Whether it be partnerships to adapt an evidencebased intervention for a system like cooperative extension [12] or for a high need and underserved population [13]-these approaches add needed external validity to the research enterprise and may be more likely to effectively change behavior and be sustained in practice [14]. Research-practice partnerships are necessary to also achieve the recommendations for improving access to physical activity interventions to improve mental health outcomes [11].…”

“…The use of RE-AIM also demonstrates the complexity of translational physical activity research where research can be focused on intervening at any one level of RE-AIM while assessing other dimensions as secondary outcomes. For example, Harden and colleagues used RE-AIM to evaluate an intervention with the primary outcome of community adoption and monitored reach, effectiveness, implementation time, and likely organizational maintenance as secondary outcomes [12]. This also is relevant to the recommendations made by Hoffman and colleagues that highlight the need to understand intervention reach, effectiveness, and costs to determine the degree to which community-wide interventions can be adopted [10].…”