Fit and Strong! Efficacy Study

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Dissemination and Translation
Breakout Session
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Translation and Diffusion

• Translation the process by which EB programs
  become adopted, adapted, and sustained in public
  health practice
• Diffusion the process through which an idea
  perceived as new is communicated through channels
  over time among members of a social system
  (Dearing, Maibach, and Buller, 2006)

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RE-AIM Framework
R E A I M
Reach Effectiveness Adoption Implementation Ma
intenance
Increase Increase Increase Increase Increase
Glasgow, Klesges, Dzewaltowski, et al., Ann Behav
Med, 2004
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RE-AIM Dimensions and Definitions
www.re-aim.org
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RE-AIM Dimensions and Definitions
www.re-aim.org
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Dissemination and Translation R18

• Partnering with 4 AAAs to disseminate Fit and
  Strong!
• 2 AAAs in Illinois
• 2 AAAs in North Carolina
• Working with AAAs and local providers to learn
  about implementation, adoption, and maintenance.

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Specific R18 Activities

• Develop website, Fitandstrong.org, (reach)
• Develop Implementation Checklist , test
  reliability (implementation)
• Provider and Instructor focus groups (adoption,
  implementation, maintenance)

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R18 Activities

• Participant pre and post-test outcome assessments
  (effectiveness)
• Assessments entered via secure login on
  Fitandstrong.org website
• Reduced set of items-include LE pain, stiffness,
  SE for exercise, energy/fatigue, exercise
  participation

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R18 Activities contd

• Capacity Survey (adoption)- examine uptake
• Training (implementation) T-trainer, master
  trainer- build critical infrastructure
• 8 hour instructor training/curriculum
• Currently offering training free of charge
• Key informant interviews with adopters and
  non-adopters (adoption, maintenance)

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New Partnership

• Partnering with National Arthritis Foundation
• Implementing Fit and Strong! in 4 local chapters
  (4 additional states)
• Training conducted Fall 2008
• Implementation site visits in two states
• Instructor Manual and Training curriculum revised
  based on experiences

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Findings

• Substantial variability in fidelity possible
• Aerobic video, ankle cuff weights backwards, ¼ of
  strength training delivered
• Also have seen perfect programs in remote places
  that move one to tears
• Trick, need to make the rules for program
  implementation as explicit as possible
• Need ongoing monitoring capacity

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Current challenges

• Licensure- only way to assure fidelity, maintain
  program quality
• Sustainable business plan
• Current economic climate- how to provide secure
  underpinnings at same time have program be
  affordable for providers

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Lessons Learned

• Fidelity checks crucial
• Feedback essential
• Important to revise materials based on real world
  implementation challenges
• Ongoing process but worth it everyone wins in
  the end!

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Dissemination and Translation Summary

• CDC R18
• Trained 1 T Trainer, 2 Master Trainers in IL and
  NC
• Implementing Fit and Strong! in 4 AAAs, 2 per
  state
• Implementing Fit and Strong! in 30 sites across
  the two states
• Training 30 instructors to offer Fit and Strong!
• Enrolling a minimum of 1,200 new participants

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Dissemination and Translation Summary

• National Arthritis Foundation Partnership
• Partnering with 4 A F Chapters to offer Fit and
  Strong! MI, N. CA, W. MO/ KS, and N. and S. New
  England
• Trained 20 certified exercise instructors
• Implement in 4 sites in MI, 3 sites in N. CA, 6
  sites in W. MO/ KS, and 4 sites in N. and S. New
  England

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Training, Support, and Resources for Fit and
Strong!

• 8 hour instructor training
• Monitoring program fidelity by Fit and Strong!
  team
• Data entry of attendance, pre- and post-test
  assessments and program evaluation via
  Fitandstrong.org secure website
• Opportunity for master trainer training
• Support for instructors and providers via
  telephone hotline, email, and website
• Registration, cost, and implementation
  information available on Fitandstrong.org

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Fitandstrong.org
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Awards

• Award for Excellence in Program Innovation, 2007
• Archstone Foundation and American Public Health
  Association, Gerontological Health Section
• Healthcare and Aging Award, 2008
• American Society on Aging in Collaboration with
  Pfizer Medical Humanities Initiative
• CVS and NCOAs Prescription for Better Health
  Award, 2009
• National Honorable Mention
• Winner North Carolina State Award

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Awards help but..

• No substitute for
• local champions
• participant word of mouth re value of program
• provider testimonials at national meetings
  like ASA
• Important seek providers with capacity not
  everyone ready and able do EB programs

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Capacity measured multiple ways

• Physical space
• Prior PA experience
• Ability to hire, maintain certified exercise
  instructors
• Fit with current programming
• Available time slot/space
• Consistent with mission/enthusiasm!

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Reach to Date

• Efficacy Trial, N115
• Effectiveness Trial R01, N536
• CDC Dissemination and Translation Study, planned
  N1,200
• National Arthritis Foundation, planned N600 in
  first iteration
• Summary roughly 2,500 enrolled in program, 7
  states

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Contact Information

• Susan Hughes Principal Investigator
• shughes_at_uic.edu
• [phone]
• Rachel Seymour Co-Investigator
• rseymo1_at_uic.edu
• [phone]
• Pankaja Desai Project Manager
• pdesai5_at_uic.edu
• [phone]
• www.fitandstrong.org

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Thanks!