Beginning With the End in Mind: Contextual Considerations for Scaling-Out a Community-Based Intervention

Area of Science:

• Gerontology
• Public Health
• Health Promotion

Background:

• Effective physical activity programs for older adults are not widely implemented in community settings like the Cooperative Extension System.
• Translating evidence-based interventions (EBIs) to new state systems requires careful evaluation.

Purpose of the Study:

• To assess the feasibility of scaling out an evidence-based physical activity intervention from one state's Extension system to another.
• To identify barriers and facilitators to program adoption and implementation within a new state Extension system.

Main Methods:

• The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework guided an iterative evaluation across three translational stages.
• Surveys and interviews were used with Extension health educators, training attendees, program participants, and administrators.
• Data collection focused on perceptions, adoption decisions, program delivery, and stakeholder feedback.

Main Results:

• A scalable virtual training protocol was identified as necessary, needing hands-on components for less confident educators.
• Training did not significantly alter educators' perceptions, intent, or confidence in delivering the program.
• While the program showed potential to reach a large, representative audience, especially in rural areas, adoption and implementation rates were low, and data collection proved challenging.

Conclusions:

• Initial attempts to translate and evaluate the physical activity EBI in a large, rural state encountered significant struggles.
• System-level changes are recommended to boost adoption rates among Extension health educators and enhance data collection/evaluation processes.
• Additional research is required to determine the necessary infrastructure support and capacity for successfully scaling out EBIs in community settings.