PROMOTING PHYSICAL ACTIVITY AMONG LATINAS IN FAITH BASED SETTINGS: - PowerPoint PPT Presentation

PROMOTING PHYSICAL ACTIVITY AMONG LATINAS IN FAITH BASED SETTINGS: ENHANCING THE ORGANIZATION Elva M. Arredondo, Ph.D. Jessica Haughton, MPH, MA

Faith in Action • Faith in Action ( Fe en Acción ) was a two-group randomized controlled trial that intervened at multiple levels to increase physical activity among churchgoing Latinas. • Church members ( promotoras ) were hired and trained to implement a physical activity intervention in their churches and nearby communities. • Based on Social Cognitive Theory and Social Ecological Framework. NCI: R01CA138894

Sociodemographic and anthropometric characteristics M (SD) / % Characteristics (n=436) Mean age (SD) 44.4 (9.6) Married or coupled (%) 77.4 % Employed (%) 65.7 % Household income (< 2,000) (%) 63.3 % Education (< HS) (%) 54.9 % Country of Birth (Mexico) (%) 90.8 % Mean years in the US (SD) 21.0 (10.3) Mean BMI (SD) 30.3 (6.22) Mean waist circumference (SD) 94.9 (14.7)

12 month follow up Table 1: Mixed effects models evaluating intervention for primary and secondary outcomes Condition Diff (inter-control) Intervention Control Adj Mean SE Adj Mean SE Diff in adj p-value MVPA (accelerometer) 4.93 0.05 4.78 0.03 0.15 .03 Leisure time MVPA self report 4.86 0.05 4.47 0.09 0.39 .003 BMI 30.2 0.14 30.6 0.14 -.40 .03 Waist circumference 95.2 0.5 96.5 0.5 -1.3 .08 Behavioral strategies for PA 4.84 0.21 3.77 0.16 1.07 <.0001 Calories from fat 29.5 0.2 29.5 0.2 0 .97 1Mixed effects or generalized linear mixed models were used to adjust for the clustering effects of churches and to account for repeated measures over M2 and M3. If the time by condition interaction term was not significant, the term was dropped and the condition main effect was tested. All analyses were adjusted for the baseline measure of the outcome, age, marital status, employment and education. 2 Negative binomial error distribution. Results are shown in logged units. 3 Binomial error distribution (Logistic model)

Next steps? • Consider factors that influence sustainability • Consider organizational level factors that will lead to greater impact (reach) • Consider dissemination and scale-up ---Enhancing the organization will impact all three

Implementation substudy Aim: To identify church-specific factors affecting implementation of Fe en Acción . Beard M, Chuang E, Haughton J, Arredondo, EM. Determinants of Implementation Effectiveness in a Physical Activity Program for Church Going Latina Women. Fam Community Health. 2016,39(4):225-33.

Results

Applying the Consolidated Framework for Implementation Research (CFIR) and Schell et al. Intervention level Data collection Framework Method instrument Promotoras Surveys Schell et al/CFIR In person (self-administered) Focus groups CFIR In person Participants Surveys Schell et al Mailed (self-administered) Interviews Schell et al/CFIR Phone Church leaders Interviews CFIR In person Church staff (former Fe churches and new Catholic and Evangelical churches) Schell, S. F., Luke, D. A., Schooley, M. W., Elliott, M. B., Herbers, S. H., Mueller, N. B., & Bunger, A. C. (2013). Public health program capacity for sustainability: a new framework. Implementation Science, 8 (15). Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: a consolidates framework for advancing implementation science. Implementation Science, 4 (50). d oi:10.1186/1748-5908-4-50

Applying the Consolidated Framework for Implementation Research (CFIR) and Schell et al. www.cfirguide.org

Applying the Consolidated Framework for Implementation Research (CFIR) and Schell et al. Example from Church Leader interview guide:

Specific Aims for Implementation Study (draft) Aim 1 Aim 1 . Examine pre-implementation strategies of an organizational-enhanced EBI promoting PA among Catholic and non-Catholic (Evangelical) churches. We will use the consolidated framework for Implementation Research (CFIR) to inform the development of the organizational enhanced PA intervention and conduct semi- structured interviews and surveys with church leadership to adapt the current EBI to non-Catholic denominations (e.g., Evangelical). Also, we will identify program champions, develop the technical support manual, and church leadership training. Furthermore, we will identify factors associated with organizational readiness and program sustainability. And, we will explore partnering with community organizations (e.g., health departments, kinesiology departments, YMCA) that may support program activities. Primary Implementation Aim Aim 2 Aim 2 . Facilitate implementation of an organizational enhanced-EBI promoting PA among Catholic and non-Catholic (e.g., Evangelical) churches. We will engage church leadership and promotoras to facilitate its implementation, adoption, and delivery with strong fidelity, and sustain its use for 10 months following the active implementation phase. We will use mixed methods approach to examine barriers and facilitators to adoption, fidelity and sustainability. Hypothesis: We hypothesize that churches that have greater church leadership engagement will have lower barriers to adoption, greater fidelity and sustainability compared to the churches that have lower church leadership engagement. Primary Intervention Effectiveness Aim Aim 3 Aim 3 . Test the effectiveness of an organizational-enhanced EBI on the individual (e.g., PA levels), social (e.g., social cohesion), organizational (e.g., leadership support, presence of a health ministry), and community (e.g., perceived safety) levels in the implementation of the intervention . Hypothesis: We hypothesize that churches that have greater church leadership engagement will have greater physical activity changes, greater social cohesion, leadership engagement, and community engagement.

Intervention strategies and outcomes Level Intervention strategy Intervention outcome Program satisfaction/ number of Individual Motivational interviewing calls calls completed Knowledge/ number of handouts Health handouts distributed PA classes MVPA (accelerometer, self-report) Social Motivational Interviewing calls Increased motivation Noche familiar gatherings Attendance and participation Organizational Signed MOU Readiness/ commitment Health ministry Does one exist? Promotoras’ standing meeting with Number of meetings leaders Role modeling/ program support Involvement of church leader(s) Promote program from pulpit Number of promotions Bulletin advertising (branding) Number of times in bulletin Promotora network events Number of events and attendance Challenges across church sites Number of events Intervention effectiveness outcome = increased PA

Implementation strategies and outcomes Implementation Actor Action targeted Temporality Dose Outcome strategy Training stakeholders Promotoras Motivational interviewing Beginning Initial training Certification Leading PA classes Beginning Initial training Certification Meeting with church staff Continuously Once a week Adoption Developing a business or Beginning Initial training Sustainment fundraising model Leadership skills Continuously Throughout Sustainment Church leader(s) Knowledge about program Beginning 1 day Adoption and PA Using mass media Promotoras and church Information in bulletin about Monthly Blurb in bulletin: testimonials, star Penetration staff program participant, most improved, photos from events Obtain formal Church leader(s) Signed MOU Beginning One time Adoption commitment Promotoras Application to be a health Beginning Full participation in training Adoption coach; completion of training Model and stimulate Church leader(s) Role model behaviors Continuously Announcements during sermons; Penetration change participation in program activities Create a learning Promotoras Networking meetings and Quarterly Every three months and location rotates Fidelity collaborative booster trainings Powell, B. J., Garcia, K. G., & Fernandez, M.E. (In Press). Implementation Strategies. In D. Chambers, C Vinson, and W Norton (Eds.), Optimizing the cancer control continuum: Advancing implementation research. New York: Oxford University Press. Proctor, E., Silmere, H., Raghaven, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38 (2), 65-76.

Innovation Organizational supported interventions • Fe did not engage the church leadership; we will learn ways of effectively engage the church leadership Examine the sustainability • Evaluate the extent to which the organizational level factors facilitate sustainability; this will inform a follow up implementation trial which will lead to a dissemination trial. Examine the adoption of the organizational enhanced EBI among non Catholic denominations • In Fe, we focused on Catholic churches so adapting the programs to other organizations will increase its impact.

Next step: Implementation study Formative phase: interview church leaders, promotoras and participants Implementation study Hybrid Type II Implementation study (Hybrid Type III) Dissemination study