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

Systematic Review of Physical Activity Objectives in Extension Strategic Plans: Findings and Implications for Improved Public Health Impact

Extension programming that incorporates both physical activity and dietary behaviors is necessary for the prevention of certain chronic diseases, including obesity. The purpose of the study presented here was to systematically identify the presence of physical activity objectives in the strategic plan for each Extension system in the United States. Few Extension systems (13) included physical activity in their strategic plans, yet lack of inclusion of physical activity in a strategic plan may limit the degree to which a system supports physical activity objectives and outcomes. As strategic plans lead to strategic thinking, the integration of physical activity objectives may improve the public health impact of Extension programming

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

A Brief Report on a Facilitated Approach to Connect Cooperative Extension Southern Region State-Level Health Specialists

Improving the nation’s health will require collaboration among many stakeholders and systems, including representatives from Cooperative Extension Services (CES). This paper describes the process of establishing a multistate collaboration and discusses initial outcomes of a third-party facilitated participatory planning meeting. State-level specialists with expertise and responsibilities in “health” promotion participated. Satisfaction with meeting format; feasibility, acceptability, and appropriateness of the proposed approach to public health impact; and general meeting feedback were collected through a survey and cultural artifacts (e.g., notes, worksheets). Preparation and attendance costs were captured. Seventeen of the 20 attendees (85%) responded to the survey and reported the process was satisfactory and the proposed plan for moving forward was feasible, acceptable, and appropriate. The meeting cost was $1,011 per attendee. The process mobilized a multistate Extension collaborative to promote health but revealed potential cost-benefit challenges. Leveraging resources is necessary to plan, implement, and measure collaborative public health efforts. Future data on outcomes will show if the process leads to intended objectives. If successful, this approach can be replicated across CES for stronger impacts

Assessing the Pragmatic Nature of Mobile Health Interventions Promoting Physical Activity: Systematic Review and Meta-analysis

Background: Mobile health (mHealth) apps can promote physical activity; however, the pragmatic nature (ie, how well research translates into real-world settings) of these studies is unknown. The impact of study design choices, for example, intervention duration, on intervention effect sizes is also understudied. Objective: This review and meta-analysis aims to describe the pragmatic nature of recent mHealth interventions for promoting physical activity and examine the associations between study effect size and pragmatic study design choices. Methods: The PubMed, Scopus, Web of Science, and PsycINFO databases were searched until April 2020. Studies were eligible if they incorporated apps as the primary intervention, were conducted in health promotion or preventive care settings, included a device-based physical activity outcome, and used randomized study designs. Studies were assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and Pragmatic-Explanatory Continuum Indicator Summary-2 (PRECIS-2) frameworks. Study effect sizes were summarized using random effect models, and meta-regression was used to examine treatment effect heterogeneity by study characteristics. Results: Overall, 3555 participants were included across 22 interventions, with sample sizes ranging from 27 to 833 (mean 161.6, SD 193.9, median 93) participants. The study populations’ mean age ranged from 10.6 to 61.5 (mean 39.6, SD 6.5) years, and the proportion of males included across all studies was 42.8% (1521/3555). Additionally, intervention lengths varied from 2 weeks to 6 months (mean 60.9, SD 34.9 days). The primary app- or device-based physical activity outcome differed among interventions: most interventions (17/22, 77%) used activity monitors or fitness trackers, whereas the rest (5/22, 23%) used app-based accelerometry measures. Data reporting across the RE-AIM framework was low (5.64/31, 18%) and varied within specific dimensions (Reach=44%; Effectiveness=52%; Adoption=3%; Implementation=10%; Maintenance=12.4%). PRECIS-2 results indicated that most study designs (14/22, 63%) were equally explanatory and pragmatic, with an overall PRECIS-2 score across all interventions of 2.93/5 (SD 0.54). The most pragmatic dimension was flexibility (adherence), with an average score of 3.73 (SD 0.92), whereas follow-up, organization, and flexibility (delivery) appeared more explanatory with means of 2.18 (SD 0.75), 2.36 (SD 1.07), and 2.41 (SD 0.72), respectively. An overall positive treatment effect was observed (Cohen d=0.29, 95% CI 0.13-0.46). Meta-regression analyses revealed that more pragmatic studies (−0.81, 95% CI −1.36 to −0.25) were associated with smaller increases in physical activity. Treatment effect sizes were homogenous across study duration, participants’ age and gender, and RE-AIM scores

Physical activity self-management interventions for adults with spinal cord injury: Part 2 – Exploring the generalizability of findings from research to practice

Despite the benefits associated with regular participation in physical activity, individuals with spinal cord injury (SCI) remain insufficiently active. The ability to self-manage participation may increase physical activity levels, but only if self-management interventions can be implemented in the ‘real world’. The purpose of this review was to examine the degree to which authors of published studies of LTPA self-management interventions for individuals with SCI have reported on factors that could increase the likelihood of translating this research into practice. A systematic search of five databases was conducted, yielding 33 eligible studies representing 31 interventions. Each intervention was assessed using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) Framework and the PRECIS-2 (PRagmatic-Explanatory Continuum Indicator Summary) tool. The most commonly reported RE-AIM dimensions were Effectiveness (51.0% of interventions) and Reach (18.5%), followed by Implementation (14.2%), Maintenance (13.8%), and Adoption (4.0%). Overall, interventions were scored as primarily explanatory in five of the nine PRECIS-2 domains (recruitment, primary analysis, organization, flexibility [delivery], follow-up) and primarily pragmatic in one domain (setting). These findings suggest that while some LTPA self-management interventions for individuals with SCI are intended to be translated to real world settings, limited information is available to understand the degree to which this has been accomplished. Enhanced reporting of factors that could increase the likelihood of translating these interventions into practice is recommended

Understanding for whom, under what conditions, and how group-based physical activity interventions are successful: a realist review Health behavior, health promotion and society

Background: Participation in group-based physical activity (GBPA) interventions has been found to result in higher levels of exercise adherence and program compliance. However, previous reviews of GBPA programs have provided limited insight regarding \u27for whom\u27, \u27under what conditions\u27, and \u27how\u27 these interventions increase physical activity behavior. Methods: A realist review was conducted by following the seven recommended iterative and overlapping steps (J Health Serv Res Policy 10S1:21-34, 2005). The review was limited to group dynamics-based interventions for adults (\u3e17 years of age). The search was conducted in PubMed, PsychInfo, and Web of Science search engines associated with the Science Citation Index Expanded, Social Sciences Citation Index, Arts & Humanities Citation Index, and MEDLINE. Results: Using a realist review approach, data from 52 studies were synthesized. Of those, 92 % (n∈=∈48) reported significant increases in participant physical activity. The synthesis resulted in three main observations and recommendations. Discussion: GBPA interventions have worked for a variety of populations, including those who are hard to reach; however, more research is needed on moderating factors to determine for whom different GBPA programs may be effective. Second, previous interventions have varied in the duration, frequency, and number of group-based strategies used, and comparative effectiveness research may be necessary to isolate the mechanisms of effect. Third, these interventions have been conducted in a diverse range of settings, using a variety of research designs and analytical approaches. Less information is known about the costs or sustainability of these programs in their intended settings. Conclusion: The results of this realist review have important implications for practice, refining trial designs, and replication across diverse populations and settings