Evaluating Fidelity to the National Extension Dining with Diabetes Program: Challenges and Opportunities

The objective of this study was to evaluate fidelity to the Dining with Diabetes (DWD) program. Data were gathered cross-sectionally in 2019 using class profile forms (i.e., checklists) containing items reflecting the core components of DWD: delivery personnel, curriculum, hands-on cooking, and goal setting. Fidelity was calculated as the proportion of core components completed as intended. Educators (N = 9) completed class profile forms for 10 complete DWD programs (i.e., all four classes). Fidelity to components of completed DWD programs and individual DWD classes was high (over 70% in each category). Overall, fidelity was high, and adaptations reported likely did not detract from effectiveness (e.g., a 2-hour class lasted 2.5 hours). However, the response rate was low and may not reflect those who deliver with lower fidelity. Assessing fidelity should be incorporated as a standard part of community-based diabetes management program evaluation; these data can inform changes to programs to make them more effective in the “real world.

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

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

Beyond Evaluation: Using the RE-AIM Framework for Program Planning in Extension

Extension professionals need to apply sound frameworks to program planning and evaluation in order to demonstrate strong population health impact and value. Pragmatic application of the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework addresses the who, what, when, where, how, and why of a program\u27s implementation. This article suggests pragmatic questions and example applications for each of the RE-AIM dimensions specifically for Extension professionals. This adapted RE-AIM tool can help Extension practitioners in all disciplines better plan and evaluate their programs and demonstrate the public value of Extension

Goat Yoga: Preliminary Implications for Health, Agriculture, and 4-H

Goat yoga, an event that combines yoga and interactions with goats, may serve as a cross-initiative program that can promote both health and agriculture. This article describes the potential impact of goat yoga and the results of a pilot program. Adult attendees of the pilot event completed a questionnaire assessing knowledge of and intentions to be involved with yoga, goats, and 4-H. Participants increased their knowledge of each area and indicated intentions to use goat products and to visit the goat barn at the county fair. Future work is needed to establish effects of goat yoga within Extension, and, if successful, embed these practices at a large scale

What Does It Take: The Roles, Responsibilities, and Fidelity to Implement a Physical Activity in Public HealthTraining

Cooperative Extension Service (Extension) Agents are tasked with incorporating physical activity promotion in their work. Physical activity training interventions rarely report specific structures (dose, content) and measures (fidelity, resource cost). The study’s purpose was to evaluate the feasibility and resource costs of Physical Activity in Cooperative Extension (PACE), a training to increase physical activity in public health competency. PACE is a virtual, 9-week, 18-hour general capacity-building training based on the Interactive Systems Framework. Fidelity was calculated as the proportion of objectives delivered as intended and total time to deliver core components. Resource cost was calculated as the time spent on each implementation strategy and responsibility and total time spent delivering PACE. Fidelity was 93% (39/42 planned objectives delivered as intended). PACE required 183 hours to implement, with session delivery (45 hours) and participant communication (40 hours) requiring the most time. Overall, time spent included 37 hours per delivery team member and 18 hours per PACE participant. The personnel time spent was within the standard time spent on other Extension training protocols and perceived as feasible. Fidelity to session components was high and easy to track. Future work should determine the scalability and sustainability of PACE within Extension nationally

Move More, Sit Less: Applying the Physical Activity Guidelines for Americans to Extension Programs

Extension enhances the lives of Americans by translating research-based information related to existing needs into programming that is practical and accessible to the general public. Evidence clearly indicates that physical activity is correlated to positive health outcomes, but despite this conclusion, the majority of Americans do not meet the recommendations for physical activity. The 2nd Edition of the Physical Activity Guidelines for Americans provides guidance for Extension professionals to implement physical activity interventions. We recommend training and technical assistance strategies based on the Interactive Systems Framework to integrate physical activity promotion into all Extension areas

Unifying Multi-State Efforts Through a Nationally Coordinated Extension Diabetes Program

The Cooperative Extension System translates research to practice and “brings the University to the people” throughout the U.S. However, the system suffers from program duplication and is challenged to scale-out effective programs. One program, Dining with Diabetes (DWD), stands out for its dissemination to multiple states. DWD is a community-based program aimed at improving diabetes management, nutrition, and physical activity behaviors. DWD was coordinated through a national working group and implemented by state Extension systems. A pragmatic, quasi-experimental study was conducted to determine the effectiveness of the national coordination model and the overall impact of DWD. Four states reported data representing 355 DWD participants. Significant differences were found in diabetes management behaviors and knowledge from pre to post- program. However, there were challenges with data analysis due to state differences in data management. We detail the transition from one state to a national workgroup, strengths and challenges of the national model, and implications for other Extension programs

Results of a Rural Traffic Calming Event to Promote Physical Activity

This article describes how community need was addressed through a traffic calming pop-up event in rural Arkansas. The event was conducted on routes connecting a neighborhood, two schools, and a municipal park. A brief survey assessed safety concerns of parents and/or guardians related to children walking or biking to school. Prior to the event, parents/guardians reported it was not safe for their children to walk or bike to school; however, the majority agreed the event made the area safer. Small-scale traffic calming events can provide evidence to stakeholders that built environment changes are an important childhood obesity prevention strategy in rural Extension work

First Things First: Assessing Needs, Comfort, and Role Clarity for Physical Activity Promotion

Extension has recently begun delivering physical activity programs, but delivering evidence-based interventions is a challenge. To increase adoption of evidence-based interventions, a better understanding of agents’ perceptions and needs is necessary. The purpose of this research was to conduct a readiness assessment to identify organizational factors and agent perceptions that speed or impede uptake of evidence-based physical activity programs. Data were gathered from agents through a sequential mixed-methods design informed by the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. A survey assessed current work status, demographic variables, physical activity levels, and time spent on programming tasks. Semi-structured focus group questions included current physical activity programs, integration of physical activity into current programs, and barriers and facilitators of physical activity programming. Agents were willing to adopt physical activity programs into their schedule but experienced barriers. Notably, agents perceived a lack of training and evaluation tools for measuring impact. As for organizational factors, “physical activity” was not in their job descriptions, and integrating physical activity with nutrition programs was perceived as a better fit within the USDA-funded system. Understanding the factors that impede adoption is critical for ensuring physical activity program uptake to influence public health behaviors

Matching barriers and facilitators to implementation strategies: recommendations for community settings

Abstract Background Implementation science aims to improve the integration of evidence-based interventions in real-world settings. While its methods and models could potentially apply to any field with evidence-based interventions, most research thus far has originated in clinical settings. Community settings often have fewer resources, missions beyond health, and a lack of support and expertise to implement evidence-based interventions when compared to many clinical settings. Thus, selecting and tailoring implementation strategies in community settings is particularly challenging, as existing compilations are primarily operationalized through clinical setting terminology. In this debate, we (1) share the process of using an existing match tool to select implementation strategies to increase uptake of nutrition and physical activity policy, systems, and environment interventions in community settings and (2) discuss the challenges of this process to argue that selecting implementation strategies in community settings has limited transferability from clinical settings and may require a unique implementation strategy compilation and pragmatic matching tool. Matching barriers to implementation strategies The impetus for this debate paper came from our work selecting implementation strategies to improve the implementation and eventual scaling of nutrition and physical activity policy, systems, and environment interventions in a community settings. We conducted focus groups with practitioners and used the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change match tool to select potential implementation strategies to overcome prominent barriers. There was limited congruence between tool outputs and optimal strategies, which may in part be due to differences in context between clinical and community settings. Based on this, we outline needs and recommendations for developing a novel and pragmatic matching tool for researchers and practitioners in community settings. Conclusions More work is needed to refine the implementation barrier-strategy matching process to ensure it is relevant, rapid, and rigorous. As leading implementation strategy scholars note, as more researchers document contextual factors and strategies selected to address them, the knowledge base will increase, and refined mapping processes can emerge