Dissemination and Dissemination and TranslationTranslation

Breakout SessionBreakout Session

2

Translation and Translation and DiffusionDiffusion

Translation: the process by which EB Translation: the process by which EB programs become adopted, adapted, programs become adopted, adapted, and sustained in public health practiceand sustained in public health practice

Diffusion: the process through which Diffusion: the process through which an idea perceived as new is an idea perceived as new is communicated through channels over communicated through channels over time among members of a social time among members of a social system (Dearing, Maibach, and Buller, system (Dearing, Maibach, and Buller, 2006)2006)

3

RE-AIM FrameworkRE-AIM Framework

R

E

A

I

M

Reach

Effectiveness

Adoption

Implementation

MaintenanceGlasgow, Klesges, Dzewaltowski, et al., Glasgow, Klesges, Dzewaltowski, et al., Ann Behav MedAnn Behav Med, 2004, 2004

Increase

Increase

Increase

Increase

Increase

4

RE-AIM Dimensions and RE-AIM Dimensions and DefinitionsDefinitions

DIMENSIONDIMENSION DEFINITIONDEFINITION

REACHREACH1. Participation rate among 1. Participation rate among

eligible individualseligible individuals

2. Representativeness of 2. Representativeness of participantsparticipants

EFFICACY / EFFICACY / EFFECTIVENESSEFFECTIVENESS

1. Effects on primary outcome of 1. Effects on primary outcome of interestinterest

2. Impact on quality of life and 2. Impact on quality of life and negative outcomes negative outcomes

Indiv

idual Le

vel

5

RE-AIM Dimensions and RE-AIM Dimensions and DefinitionsDefinitions

DIMENSIONDIMENSION DEFINITIIONDEFINITIION

ADOPTIONADOPTION1. Participation rate among possible 1. Participation rate among possible

settingssettings

2. Representativeness of settings 2. Representativeness of settings participatingparticipating

IMPLEMENTATIONIMPLEMENTATION1. Extent to which intervention 1. Extent to which intervention delivered delivered

as intendedas intended

2. Time and costs of intervention2. Time and costs of intervention

MAINTENANCEMAINTENANCE

1. (Individual) Long-term effects of 1. (Individual) Long-term effects of intervention ( intervention ( >> 6 months ) 6 months )

2. (Individual) Impact of attrition on 2. (Individual) Impact of attrition on outcomesoutcomes

3. (Setting) Extent of continuation or 3. (Setting) Extent of continuation or modification of treatmentmodification of treatment

Sett

ing L

evel

Both

6

Dissemination and Dissemination and Translation R18Translation R18

Partnering with 4 AAAs to Partnering with 4 AAAs to disseminate Fit and Strong!disseminate Fit and Strong! 2 AAAs in Illinois 2 AAAs in Illinois 2 AAAs in North Carolina2 AAAs in North Carolina

Working with AAAs and local Working with AAAs and local providers to learn about providers to learn about implementation, adoptionimplementation, adoption, and , and maintenancemaintenance..

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Specific R18 ActivitiesSpecific R18 Activities

Develop website, Fitandstrong.org, Develop website, Fitandstrong.org, ((reachreach))

Develop Implementation Checklist , Develop Implementation Checklist , test reliability (test reliability (implementationimplementation) )

Provider and Instructor focus groups Provider and Instructor focus groups ((adoption, implementation, adoption, implementation, maintenancemaintenance))

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R18 ActivitiesR18 Activities Participant pre and post-test outcome Participant pre and post-test outcome

assessments (assessments (effectivenesseffectiveness)) Assessments entered via secure login on Assessments entered via secure login on

Fitandstrong.org websiteFitandstrong.org website Reduced set of items-include LE pain, Reduced set of items-include LE pain,

stiffness, SE for exercise, energy/fatigue, stiffness, SE for exercise, energy/fatigue, exercise participationexercise participation

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R18 Activities R18 Activities cont’dcont’d

Capacity Survey (Capacity Survey (adoptionadoption)- examine )- examine uptakeuptake

Training (Training (implementationimplementation) – T-trainer, ) – T-trainer, master trainer- build critical infrastructuremaster trainer- build critical infrastructure 8 hour instructor training/curriculum8 hour instructor training/curriculum Currently offering training free of chargeCurrently offering training free of charge

Key informant interviews with adopters Key informant interviews with adopters and non-adopters (and non-adopters (adoption, maintenanceadoption, maintenance))

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New PartnershipNew Partnership Partnering with National Arthritis Partnering with National Arthritis

Foundation:Foundation: Implementing Fit and Strong! in 4 local Implementing Fit and Strong! in 4 local

chapters (4 additional states)chapters (4 additional states) Training conducted Fall 2008Training conducted Fall 2008 Implementation site visits in two statesImplementation site visits in two states Instructor Manual and Training curriculum Instructor Manual and Training curriculum

revised based on experiencesrevised based on experiences

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FindingsFindings

Substantial variability in fidelity possibleSubstantial variability in fidelity possible Aerobic video, ankle cuff weights Aerobic video, ankle cuff weights

backwards, ¼ of strength training backwards, ¼ of strength training delivereddelivered

Also have seen perfect programs in Also have seen perfect programs in remote places that move one to tearsremote places that move one to tears

Trick, need to make the rules for program Trick, need to make the rules for program implementation as explicit as possibleimplementation as explicit as possible

Need ongoing monitoring capacityNeed ongoing monitoring capacity

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Current challengesCurrent challenges

Licensure- only way to assure Licensure- only way to assure fidelity, maintain program qualityfidelity, maintain program quality

Sustainable business planSustainable business plan Current economic climate- how to Current economic climate- how to

provide secure underpinnings; at provide secure underpinnings; at same time have program be same time have program be affordable for providersaffordable for providers

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Lessons LearnedLessons Learned

Fidelity checks crucialFidelity checks crucial Feedback essentialFeedback essential Important to revise materials Important to revise materials

based on real world based on real world implementation challengesimplementation challenges

Ongoing process but worth it; Ongoing process but worth it; everyone wins in the end!everyone wins in the end!

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Dissemination and Dissemination and Translation SummaryTranslation Summary

CDC R18CDC R18 Trained 1 T Trainer, 2 Master Trainers in IL Trained 1 T Trainer, 2 Master Trainers in IL

and NCand NC Implementing Fit and Strong! in 4 AAAs, 2 Implementing Fit and Strong! in 4 AAAs, 2

per stateper state Implementing Fit and Strong! in 30 sites Implementing Fit and Strong! in 30 sites

across the two statesacross the two states Training 30 instructors to offer Fit and Training 30 instructors to offer Fit and

Strong! Strong! Enrolling a minimum of 1,200 new Enrolling a minimum of 1,200 new

participantsparticipants

15

Dissemination and Dissemination and Translation SummaryTranslation Summary

National Arthritis Foundation National Arthritis Foundation PartnershipPartnership Partnering with 4 A F Chapters to Partnering with 4 A F Chapters to

offer Fit and Strong!: MI, N. CA, W. offer Fit and Strong!: MI, N. CA, W. MO/ KS, and N. and S. New EnglandMO/ KS, and N. and S. New England

Trained 20 certified exercise Trained 20 certified exercise instructorsinstructors

Implement in 4 sites in MI, 3 sites in Implement in 4 sites in MI, 3 sites in N. CA, 6 sites in W. MO/ KS, and 4 N. CA, 6 sites in W. MO/ KS, and 4 sites in N. and S. New Englandsites in N. and S. New England

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Training, Support, and Training, Support, and Resources for Fit and Resources for Fit and Strong!Strong!

8 hour instructor training8 hour instructor training Monitoring program fidelity by Fit and Monitoring program fidelity by Fit and

Strong! team Strong! team Data entry of attendance, pre- and post-Data entry of attendance, pre- and post-

test assessments and program evaluation test assessments and program evaluation via Fitandstrong.org secure websitevia Fitandstrong.org secure website

Opportunity for master trainer trainingOpportunity for master trainer training Support for instructors and providers via Support for instructors and providers via

telephone hotline, email, and websitetelephone hotline, email, and website Registration, cost, and implementation Registration, cost, and implementation

information available on Fitandstrong.orginformation available on Fitandstrong.org

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Fitandstrong.orgFitandstrong.org

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AwardsAwards Award for Excellence in Program Award for Excellence in Program

Innovation, 2007Innovation, 2007 Archstone Foundation and American Public Archstone Foundation and American Public

Health Association, Gerontological Health Health Association, Gerontological Health SectionSection

Healthcare and Aging Award, 2008 Healthcare and Aging Award, 2008 American Society on Aging in Collaboration American Society on Aging in Collaboration

with Pfizer Medical Humanities Initiativewith Pfizer Medical Humanities Initiative CVS and NCOA’s Prescription for Better CVS and NCOA’s Prescription for Better

Health Award, 2009Health Award, 2009 National Honorable MentionNational Honorable Mention Winner North Carolina State AwardWinner North Carolina State Award

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Awards help but…..Awards help but…..

No substitute for No substitute for

local championslocal champions

participant word of mouth re value participant word of mouth re value of programof program

provider testimonials at national provider testimonials at national meetings meetings like ASAlike ASA

Important: seek providers with capacity; Important: seek providers with capacity; not everyone ready and able do EB not everyone ready and able do EB programsprograms

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Capacity measured Capacity measured multiple waysmultiple ways

Physical spacePhysical space Prior PA experiencePrior PA experience Ability to hire, maintain certified Ability to hire, maintain certified

exercise instructorsexercise instructors Fit with current programmingFit with current programming Available time slot/spaceAvailable time slot/space Consistent with mission/enthusiasm!Consistent with mission/enthusiasm!

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Reach to DateReach 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

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Contact InformationContact Information Susan Hughes – Principal InvestigatorSusan Hughes – Principal Investigator

shughes@uic.edushughes@uic.edu (312) 996-1473(312) 996-1473

Rachel Seymour – Co-InvestigatorRachel Seymour – Co-Investigator rseymo1@uic.edurseymo1@uic.edu (828) 478-2213(828) 478-2213

Pankaja Desai – Project ManagerPankaja Desai – Project Manager pdesai5@uic.edupdesai5@uic.edu (312) 355-3174(312) 355-3174

www.fitandstrong.orgwww.fitandstrong.org

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Thanks!