Dissemination and Translation Breakout Session

2 Translation and Diffusion Translation: the process by which EB programs become adopted, adapted, and sustained in public health practice Translation: the process by which EB programs become adopted, adapted, and sustained in public health practice Diffusion: the process through which an idea perceived as new is communicated through channels over time among members of a social system (Dearing, Maibach, and Buller, 2006) Diffusion: the process through which an idea perceived as new is communicated through channels over time among members of a social system (Dearing, Maibach, and Buller, 2006)

3 RE-AIM Framework REAIMREAIM Reach Effectiveness Adoption Implementation Maintenance Glasgow, Klesges, Dzewaltowski, et al., Ann Behav Med, 2004 Increase

4 RE-AIM Dimensions and Definitions DIMENSIONDEFINITIONREACH 1. Participation rate among eligible individuals 2. Representativeness of participants EFFICACY / EFFECTIVENESS 1. Effects on primary outcome of interest 2. Impact on quality of life and negative outcomes Individual Level

5 RE-AIM Dimensions and Definitions DIMENSIONDEFINITIION ADOPTION 1. Participation rate among possible settings 2. Representativeness of settings participating IMPLEMENTATION 1. Extent to which intervention delivered as intended 2. Time and costs of intervention MAINTENANCE 1. (Individual) Long-term effects of intervention ( > 6 months ) 2. (Individual) Impact of attrition on outcomes 3. (Setting) Extent of continuation or modification of treatment Setting Level Both

6 Dissemination and Translation R18 Partnering with 4 AAAs to disseminate Fit and Strong! Partnering with 4 AAAs to disseminate Fit and Strong! 2 AAAs in Illinois 2 AAAs in Illinois 2 AAAs in North Carolina 2 AAAs in North Carolina Working with AAAs and local providers to learn about implementation, adoption, and maintenance. Working with AAAs and local providers to learn about implementation, adoption, and maintenance.

7 Specific R18 Activities Develop website, Fitandstrong.org, (reach) Develop website, Fitandstrong.org, (reach) Develop Implementation Checklist, test reliability (implementation) Develop Implementation Checklist, test reliability (implementation) Provider and Instructor focus groups (adoption, implementation, maintenance) Provider and Instructor focus groups (adoption, implementation, maintenance)

8 R18 Activities Participant pre and post-test outcome assessments (effectiveness) Participant pre and post-test outcome assessments (effectiveness) Assessments entered via secure login on Fitandstrong.org website Assessments entered via secure login on Fitandstrong.org website Reduced set of items-include LE pain, stiffness, SE for exercise, energy/fatigue, exercise participation Reduced set of items-include LE pain, stiffness, SE for exercise, energy/fatigue, exercise participation

9 R18 Activities cont’d Capacity Survey (adoption)- examine uptake Capacity Survey (adoption)- examine uptake Training (implementation) – T-trainer, master trainer- build critical infrastructure Training (implementation) – T-trainer, master trainer- build critical infrastructure 8 hour instructor training/curriculum 8 hour instructor training/curriculum Currently offering training free of charge Currently offering training free of charge Key informant interviews with adopters and non-adopters (adoption, maintenance) Key informant interviews with adopters and non-adopters (adoption, maintenance)

10 New Partnership Partnering with National Arthritis Foundation: Partnering with National Arthritis Foundation: Implementing Fit and Strong! in 4 local chapters (4 additional states) Implementing Fit and Strong! in 4 local chapters (4 additional states) Training conducted Fall 2008 Training conducted Fall 2008 Implementation site visits in two states Implementation site visits in two states Instructor Manual and Training curriculum revised based on experiences Instructor Manual and Training curriculum revised based on experiences

11 Findings Substantial variability in fidelity possible Substantial variability in fidelity possible Aerobic video, ankle cuff weights backwards, ¼ of strength training delivered Aerobic video, ankle cuff weights backwards, ¼ of strength training delivered Also have seen perfect programs in remote places that move one to tears Also have seen perfect programs in remote places that move one to tears Trick, need to make the rules for program implementation as explicit as possible Trick, need to make the rules for program implementation as explicit as possible Need ongoing monitoring capacity

12 Current challenges Licensure- only way to assure fidelity, maintain program quality Licensure- only way to assure fidelity, maintain program quality Sustainable business plan Sustainable business plan Current economic climate- how to provide secure underpinnings; at same time have program be affordable for providers Current economic climate- how to provide secure underpinnings; at same time have program be affordable for providers

13 Lessons Learned Fidelity checks crucial Fidelity checks crucial Feedback essential Feedback essential Important to revise materials based on real world implementation challenges Important to revise materials based on real world implementation challenges Ongoing process but worth it; everyone wins in the end! Ongoing process but worth it; everyone wins in the end!

14 Dissemination and Translation Summary CDC R18 CDC R18 Trained 1 T Trainer, 2 Master Trainers in IL and NC Trained 1 T Trainer, 2 Master Trainers in IL and NC Implementing Fit and Strong! in 4 AAAs, 2 per state Implementing Fit and Strong! in 4 AAAs, 2 per state Implementing Fit and Strong! in 30 sites across the two states Implementing Fit and Strong! in 30 sites across the two states Training 30 instructors to offer Fit and Strong! Training 30 instructors to offer Fit and Strong! Enrolling a minimum of 1,200 new participants Enrolling a minimum of 1,200 new participants

15 Dissemination and Translation Summary National Arthritis Foundation Partnership National Arthritis Foundation Partnership Partnering with 4 A F Chapters to offer Fit and Strong!: MI, N. CA, W. MO/ KS, and N. and S. New England Partnering with 4 A F Chapters to offer Fit and Strong!: MI, N. CA, W. MO/ KS, and N. and S. New England Trained 20 certified exercise instructors Trained 20 certified exercise instructors Implement in 4 sites in MI, 3 sites in N. CA, 6 sites in W. MO/ KS, and 4 sites in N. and S. New England Implement in 4 sites in MI, 3 sites in N. CA, 6 sites in W. MO/ KS, and 4 sites in N. and S. New England

16 Training, Support, and Resources for Fit and Strong! 8 hour instructor training 8 hour instructor training Monitoring program fidelity by Fit and Strong! team Monitoring program fidelity by Fit and Strong! team Data entry of attendance, pre- and post- test assessments and program evaluation via Fitandstrong.org secure website Data entry of attendance, pre- and post- test assessments and program evaluation via Fitandstrong.org secure website Opportunity for master trainer training Opportunity for master trainer training Support for instructors and providers via telephone hotline, , and website Support for instructors and providers via telephone hotline, , and website Registration, cost, and implementation information available on Fitandstrong.org Registration, cost, and implementation information available on Fitandstrong.org

17 Fitandstrong.org

18 Awards Award for Excellence in Program Innovation, 2007 Award for Excellence in Program Innovation, 2007 Archstone Foundation and American Public Health Association, Gerontological Health Section Archstone Foundation and American Public Health Association, Gerontological Health Section Healthcare and Aging Award, 2008 Healthcare and Aging Award, 2008 American Society on Aging in Collaboration with Pfizer Medical Humanities Initiative American Society on Aging in Collaboration with Pfizer Medical Humanities Initiative CVS and NCOA’s Prescription for Better Health Award, 2009 CVS and NCOA’s Prescription for Better Health Award, 2009 National Honorable Mention National Honorable Mention Winner North Carolina State Award Winner North Carolina State Award

19 Awards help but….. No substitute for No substitute for local champions participant word of mouth re value of program provider testimonials at national meetings like ASA Important: seek providers with capacity; not everyone ready and able do EB programs

20 Capacity measured multiple ways Physical space Physical space Prior PA experience Prior PA experience Ability to hire, maintain certified exercise instructors Ability to hire, maintain certified exercise instructors Fit with current programming Fit with current programming Available time slot/space Available time slot/space Consistent with mission/enthusiasm! Consistent with mission/enthusiasm!

21 Reach to Date Efficacy Trial, N=115 Effectiveness Trial R01, N=536 CDC Dissemination and Translation Study, planned N=1,200 National Arthritis Foundation, planned N=600+ in first iteration Summary: roughly 2,500 enrolled in program, 7 states

22 Contact Information Susan Hughes – Principal Investigator Susan Hughes – Principal Investigator (312) (312) Rachel Seymour – Co-Investigator Rachel Seymour – Co-Investigator (828) (828) Pankaja Desai – Project Manager Pankaja Desai – Project Manager (312) (312) www.fitandstrong.org

23 Thanks!