1. Supporting Evidence-based Practice : Center of Excellence for Training and Research Translation SIP 10-04 Cooperative Agreement Number U48-DP000059 Centers for Disease Control and Prevention Division for Heart Disease and Stroke Prevention Division of Nutrition, Physical Activity and Obesity

2. Center TRT – Promoting Evidence-based Practice Brief Overview and History Training practitioners ◦Obesity Prevention Course ◦Web-based Training Translation and Dissemination Products Translation and Dissemination Methods Questions and Discussion

3. Center TRT Leadership Principal Investigator: ◦Alice Ammerman, RD DrPH Co-Investigators: ◦Jennifer Leeman, DrPH, MDIV ◦Tom Keyserling, MD, MPH Project Director: ◦Janice Sommers, MPH CDC Technical Advisors from DNPAO ◦Claire Heiser, MS, RD ◦Diane Thompson, MPH, RD

4. Center TRT Staff Nancy Aycock Avia Mainor Kelly Norby Susanne Schmal Janice Sommers May May Leung (not pictured)

5. National Advisory Board

6. Their Advice….. Use a broad definition of evidence and include evidence from practice in the translation model The potential public health impact of an intervention is a result of more than effectiveness Include a feedback loop that provides an opportunity for practice to inform research Invest time and energy in obtaining input from primary audience (intended users)

7. 2005-06 Website: designed, tested, launched 2004 Infrastructure takes root: Staff, Coordinating Committee, National Board 2005 Formative work: surveys and focused discussion with state staff, literature reviews, web searches, lots of meetings 2005-09 Training Courses: Nutrition and Public Health, Obesity Prevention, WW Short Courses 2005-06 Methods Developed: criteria, review tools, processes for review, methods for literature reviews 2008-09 Disseminate Evidence: web-based training, contributing factors, strategies, interventions Growing the Center-TRT 2007-09 Interventions reviewed and templates developed

8. Center TRT TRAINING Primary Audience is State-level Program staff

9. Develop training competencies Conduct training needs assessments Develop a training plan Provide training for state-level WISEWOMAN and Obesity Prevention Program staff Evaluate impact of trainings on practice Training

10. Obesity Prevention in Public Health 2005: Program Coordinators (29) 2006: Nutrition Coordinators (44) 2007: Physical Activity Coordinators (35) 2008: Open to new state staff (31)

11. Obesity Prevention in Public Health Course: 2009 DATES: August 23 – 28 at the Rizzo Center in Chapel Hill, NC NEW Curriculum focused on leadership development for NPAO State Coordinators APPLICATIONS are being accepted; we have a number of scholarships available for unfunded states www.center-trt.org

12. Cover the basics to allow more advanced material during in-person trainings Extends the reach of Center TRT Easily accessed at any time (great staff orientation) Interactive and self-paced Low cost to participant (time only; no travel, no registration fee)

13. Nutrition, Physical Activity, and Chronic Disease Series Nutrition and Health Physical Activity and Health Nutrition, Physical Activity and Cardiovascular Health (April 2009) Obesity Prevention in Children (Summer 2009)

14. Physical Activity Module Required Readings Lesson 1: Terms and Definitions Lesson 2: Recommendations & Rationale Lesson 3: Barriers Lesson 4: Science to Practice Supplemental Materials

15. RE-AIM Online! Reach, Effectiveness, Adoption, Implementation and Maintenance Required Readings Lesson 1: Introduction to RE-AIM Lesson 2: RE-AIM for Behavior Change Lesson 3: RE-AIM for Policy/Environmental Change Lesson 4: Putting it All Together Available Summer 2009

17. Nutrition and Health Demonstration

18. Intervention-Specific Implementation Trainings NAPSACC

19. Online Lifestyle Assessments www.center-trt.org

20. Web-based Training The 2008 Numbers 595 users registered for the modules 305 completed the post tests ▫82 – NAPSACC (4/08) ▫97 – Physical Activity and Health (6/08) ▫126 – Nutrition and Health (6/08)

21. Phase 1: Evidence Identification and Review Phase 2: Intervention Abstraction Phase 3: Dissemination Phase 4: Research – Practice Integration Center TRT Translation and Dissemination Framework

22. Phase 3: Dissemination Intervention Resources Evidence to support development of interventions Contributing Factors (target areas) Intervention Strategies (approaches) Interventions that can be adapted Research-tested Practice-based Emerging

23. www.center-trt.org www.center-trt.org

24. Center-TRT.org Users The 2008 Numbers Users in every state and the District of Columbia. Visitors from North Carolina were among the most frequent users. People from 79 different countries with users in the US, Canada, United Kingdom and Australia, the most frequent visitors 5,725 NEW users, defined as first-time-ever visitors and an additional 6,000 unique but not new visitors

25. Center-TRT.org Downloads The 2008 Numbers 7,926 documents were downloaded from the website. New Leaf, Choices for Healthy Living and the Nutrition and Physical Activity Self-Assessment for Childcare (NAPSACC) are UNC developed and tested interventions and were the most frequently downloaded interventions from the site!

26. Center TRT Translation Methods A Model for Balancing Evidence of Effectiveness with Other Practice- relevant Evidence

27. Phase 1: Evidence Identification and Review Evidence Contributing Factors Intervention Strategies Research-Tested Interventions Practice-Based Interventions Source Systematic Reviews Systematic Reviews and Other Consensus Documents Research Studies Evaluation in real-life conditions

28. Criteria for Review of Interventions Potential public health impact Dissemination readiness Evidence in support of its effectiveness

29. Review Criteria: Potential Public Health Impact REACH and representation EFFECTIVENESS, especially in groups disproportionately affected Evidence of and Potential for ADOPTION, IMPLEMENTATION, and MAINTENANCE in public health practice. Glasgow et al., 2003

30. Review Criteria: Dissemination Readiness Intervention/policy described sufficiently to allow replication Materials/supporting documents are available for download and of useable quality A knowledgeable contact person is available

31. Review Criteria: Evidence for its Effectiveness Research-Tested Interventions Assess strength of reported methods for Sampling Design Measurement Analysis Interpretation of Results

32. Review Criteria: Evidence for its Effectiveness Practice-Based Interventions Use of an evidence-based intervention strategy Formative work with stakeholder groups & intended audience Logic and theory Methods for evaluating processes and outcomes

33. Review Criteria: Evidence for its Effectiveness Practice-Based Interventions illustrate how practitioners working within the constraints of a real world setting implemented an evidence-based strategy in practice.

34. Review Process Application from Developer Yes Intervention or Policy targets outcome of interest Yes Application complete with both process and outcome evaluation data available Yes Intervention materials available for dissemination Stop NO

35. Review Process Expert Panel Yes The methodology to develop AND evaluate the intervention is of reasonable quality Yes The intervention/policy positive outcomes outweigh potential adverse outcomes Yes The intervention has potential for public health impact NO Stop

36. In the pipeline… Food Access Food Pricing Policy Play Space Afterschool policy Worksite Wellness Incentives

37. Questions, Counterpoints, Discussion….