1. Translating What We Have Learned into Practice & Policy: Developing a Sustainable Peer-Led Physical Activity Program for Seniors Jacqueline Kerr, Associate Professor Michelle Takemoto, PhD Candidate Dept Family Medicine & Public Health, UCSD

2. RC & SC Setting

3. NHLBI R01s: Multi level cluster RCTs Pedometers, counseling Maps, community projects Peer leaders, group education

4. Retirement Community Walking Results Phone counseling Joint leadership Peer leadership Minutes of walking

5. Walking program lessons learned Counseling was effective, but focus on 3 month goal was detrimental Transitioning leadership was challenging Sites & staff who wanted to continue the program beyond 12 months did not value the components and did not have the capacity to continue the program

6. Walkability results Projects included improvements within the retirement community or the surrounding neighborhood Worked with the pedestrian advocacy organization, WalkSanDiego Successes included: –Cleaner pedestrian bridges –Safer crosswalks –Unobstructed sidewalks

7. Animations

8. Walkability lessons learned Older adults highly respected voters and great advocates Pedestrian advocacy organization and local planners helped frame the scope of projects UCSD had to oversee walkability implementation Photos of successes are powerful Animated GPS points are motivating for planners and policy makers

9. Differences in Retirement Community vs Senior Center approach Retirement facilitySenior Center No staff involvementTrained staff on site UCSD co-leadingPeer & site staff leading UCSD phone counselorsIn person peer counselors

10. Senior Center RCT design Hybrid type II effectiveness-implementation trial –Physical activity & functioning –Implementation measures 18 month sustainability randomization –Followed to 24 months Cost effectiveness compared to no treatment control

11. Conceptual Model of Implementation Research Proctor, E.K., et al., Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health, 2009. 36(1): p. 24-34.

12. Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors Aarons, G.A., M. Hurlburt, and S.M. Horwitz, Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health, 2011. 38(1): p. 4-23.

13. Implementation mixed methods Inner/outer context: Appropriateness –Perceived fit Acceptability –Satisfaction Adoption/Reach Feasibility −Actual fit Program setting Program content Program deliverers Program users Training Directors Staff Coaches Participants

14. Fidelity monitoring Web database available via tablets Track activities –Coaches –Staff –UCSD Prompt activities Feedback –Coaches –Participants

15. Walking program lessons learned In person counseling by peers –Improved interaction –Peers working on same PA goals Feasible intervention dose for counseling –Color coding to identify goal setting –Working with those most in need Rolling recruitment helps with motivation –Analysis challenge

16. Capacity building lessons learned Community Advisory Board broadens context More structured & on-going training –Training others –Peer networking events Empowerment –Ownership, valuable volunteer activity, community responsibility Beyond single community projects

17. Community partnerships Mayor attending group walk Sponsorships by businesses Attending and joining local committees Attending other organizations’ training –America Walks walking college Safe routes to school Charity walks

18. Sustainment lessons learned Continuous quality improvement -From tablet data, interviews Sustainability from beginning with director, staff & peer involvement –Obtaining funding

19. Policy applications

20. These amazing leaders, using their own words, do the best job motivating each other & others!