Implementation costs and relationships between costs and outcomes in the Faith, Activity, and Nutrition program: a...

Program administration and implementation costs are critical for scale-up and dissemination of effective public health interventions. Costing methods within dissemination and implementation studies examining organizational-level implementation outcomes are limited, especially in community settings. Therefore, this study focuses on costs as an implementation outcome in the 2020-2023 national implementation study of Faith, Activity, and Nutrition (FAN). FAN is an evidence-based intervention that targets church policy, systems, and environments to support church members' physical activity and dietary behaviors.

We examined costs in two ways using micro-costing approaches. The first is costs to an organization (n = 1) hosting and administering web-based training and support for churches, using time tracking and programmatic data. The second is costs to churches (n = 90) trained to implement FAN, using surveys. We accounted for the potential voluntary nature of FAN church implementation by costing labor in three ways: assume FAN is run by volunteers and time is donated (time costed at zero), assume FAN is run by volunteers and they could be undertaking other activities in society (time costed at minimum wage), assume FAN is run by church employees (time costed as church employees). We also analyzed church implementation costs by church size, region, and existence of a health ministry. Finally, we analyzed the relationship between church implementation costs and implementation outcomes (i.e., fidelity).

On average, 3.97 h/week were spent by an organization hosting and administering FAN. The average cost/year to host and administer FAN was $7,844.29, including program administration, recruitment, and IT support. Churches implementing FAN spent 15.2 ± 6.28 h/year training, 23.4 ± 19.6 h/year planning, and 28.3 ± 37.3 h/year implementing FAN-related activities. For church implementation of FAN, the average annual cost was between $327.30 ($0.00-$2,099.98) and $2,858.11 ($330.94-$10,490.01), depending on labor cost assumptions. Church implementation costs were positively and significantly correlated with healthy eating (r = 0.344, P = 0.017), but not physical activity (r = 0.106, P = 0.372) outcomes.

Administration and implementation of FAN may be feasible from a resource perspective. This analysis provides an exemplar for public health program costing methods for organizational-level implementations.