Built environment approaches are recommended to improve population physical activity levels. Implementation strategies are needed to improve uptake, but little is known about effective strategies to translate research to practice in community settings.
Purpose
Inform implementation strategies through understanding delivery agents’ perceptions of (1) built environment approaches, (2) a toolkit developed to support implementation, and (3) other required implementation strategies.
Method
A toolkit was developed to detail the process of partnering to change the built environment and provide examples of built environment approaches (e.g., walking paths, traffic calming). Data were collected through focus groups (N = 3) with Extension Agents (n = 46) in 2020. The semi-structured focus group script was based on the Consolidated Framework for Implementation Research and the Technology Acceptance model. Rapid content analysis techniques and a deductive, grounded theory approach were used to interpret the data. Results. Focus groups generated meaning units coded into themes of perceptions of the intervention (subthemes: barriers, resources needed, and facilitators) and perceptions of the toolkit (subthemes: components to add, positive perceptions, and helpful components). The most common resources needed were coalition guidance and funding.
Conclusion
Agents experience barriers and facilitators to implementing built environment approaches and have specific needs for support. Based on the results, we created implementation strategies: (1) Places for Physical Activity toolkit, (2) Coalition Coaching, and (3) Mini-Grants. Future work is needed to investigate the effectiveness of these implementation strategies.
AbildsoC. G.DyerA.DailyS. M.BiasT. K. (2019). Evaluability assessment of “growing healthy communities,” a mini-grant program to improve access to healthy foods and places for physical activity. BMC Public Health, 19(1), Article 779. https://doi.org/10.1186/s12889-019-7156-8
2.
AyalaG.ElderJ. (2013). Qualitative methods to ensure acceptability of behavioral and social interventions to the target population. Journal of Public Health Dentistry, 71(1), S69–S79. https://doi.org/10.1111/j.1752-7325.2011.00241.x
3.
BalisL. E.KennedyL.HoughtalingB.HardenS. M. (2021). Red, yellow, and green light changes: Adaptations to Extension health promotion programs. Prevention Science, 22, 903–912. https://doi.org/10.1007/s11121-021-01222-x
4.
BalisL. E.StrayerT.III. (2019). Evaluating “Take the Stairs, Wyoming!” through the RE-AIM framework: Challenges and opportunities. Frontiers of Public Health, 7(368). https://doi.org/10.3389/fpubh.2019.00368
5.
BalisL. E.StrayerT.IIIHardenS. M. (2021). First things first: Assessing needs, comfort, and role clarity for physical activity promotion. Journal of Human Sciences and Extension, 9(1), 123–138.
6.
BalisL. E.StrayerT. E.IIIRamalingamN.HardenS. M. (2018). Beginning with the end in mind: Contextual considerations for scaling-out a community-based intervention. Frontiers in Public Health, 6, 1–14. https://doi.org/10.3389/fpubh.2018.00357
7.
BauerM.DamschroderL.HagedornH.SmithJ.KilbourneA. (2015). An introduction to implementation science for the non-specialist. BMC Psychology, 3, Article 32. https://doi.org/10.1186/s40359-015-0089-9
8.
BennieJ. A.De CockerK.TeychenneM. J.BrownW. J.BiddleS. J. H. (2019). The epidemiology of aerobic physical activity and muscle-strengthening activity guideline adherence among 383,928 U.S. adults. International Journal of Behavioral Nutrition and Physical Activity, 16(1), Article 34. https://doi.org/10.1186/s12966-019-0797-2
9.
BennieJ. A.LeeD.-C.KhanA.BaumanA. E.StamatakisE.BiddleS. J. H. (2018). Muscle-strengthening exercise among 397,423 U.S. adults: Prevalence, correlates, and associations with health conditions. American Journal of Preventive Medicine, 55(6), 864–874. https://doi.org/10.1016/j.amepre.2018.07.022
10.
ButterfossF. D. (2007). Coalitions and partnerships in community health. Jossey-Bass.
11.
CaperchioneC.MummeryW. K.JoynerK. (2010). WALK community grants scheme: Lessons learned in developing and administering a health promotion microgrants program. Health Promotion Practice, 11(5), 637–644. https://doi.org/10.1177/1524839908328996
CurranG. M. (2020). Implementation science made too simple: A teaching tool. Implementation Science Communications, 1(1), Article 27. https://doi.org/10.1186/s43058-020-00001-z
17.
CutcliffeJ.McKennaH. (2004). Expert qualitative researchers and the use of audit trails. Methodological Issues in Nursing Research, 45(2), 126–135. https://doi.org/ 10.1046/j.1365-2648.2003.02874.x
18.
DamschroderL.AronD.KeithR.KirshS.AlexanderJ.LoweryJ. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4, Article 50. https://doi.org/10.1186/1748-5908-4-50
19.
DowneyS.WagesJ.JacksonS. F.EstabrooksP. A. (2012). Adoption decisions and implementation of a community-based physical activity program: A mixed methods study. Health Promotion Practice, 13(2), 175–182. https://doi.org/10.1177/1524839910380155
20.
DurstineL.GordonB.WangZ.LuoX. (2013). Chronic disease and the link to physical activity. Journal of Sport and Health Science, 2(1), 3–11. https://doi.org/10.1016/j.jshs.2012.07.009
21.
EstabrooksP.BradshawM.FoxE.BergJ.DzewaltowskiD. (2004). The relationships between delivery agents’ physical activity level and the likelihood of implementing a physical activity program. American Journal of Health Promotion, 18(5), 350–353. https://doi.org/10.4278/0890-1171-18.5.350
22.
EstabrooksP.HardenS. M.AlmeidaF.HillJ.JohnsonS.PorterG. C.GreenawaldM. (2019). Using Integrated Research-Practice Partnerships to move evidence-based principles into practice. Exercise and Sport Sciences Review, 47(3), 176–187. https://doi.org/10.1249/JES.0000000000000194
23.
EvensonK. R.PorterA. K.DayK. L.McPhillips-TangumC.HarrisK. E.KochtitzkyC. S.BorsP. (2020). Developing the active communities tool to implement the Community Guide’s built environment recommendation for increasing physical activity. Preventing Chronic Disease, 17, 200118. https://doi.org/10.5888/pcd17.200118
24.
EveretteA.BrooksA.RamalingamN.PowellT.EatonR.SerranoE.HardenS. M. (2017). An Integrated Research–Practice Partnership for physical activity promotion in a statewide program. Translational Journal of the American College of Sports Medicine, 2(11), 57–67. http://doi.org/10.1249/TJX.0000000000000035
25.
FaganA. A.BumbargerB. K.BarthR. P.BradshawC. P.CooperB. R.SuppleeL. H.WalkerD. K. (2019). Scaling up evidence-based interventions in US public systems to prevent behavioral health problems: Challenges and opportunities. Prevention Science, 20(8), 1147–1168. https://doi.org/10.1007/s11121-019-01048-8
26.
FriedenT. R. (2010). A framework for public health action: The health impact pyramid. American Journal of Public Health, 100(4), 590–595. https://doi.org/10.2105/AJPH.2009.185652
27.
GaleR.WuJ.ErhardtT.BounthavongM.ReardonC.DamschroderL.MidboeA. (2019). Comparison of rapid vs in-depth qualitative analytic methods from a process evaluation of academic detailing in the Veterans Health Administration. Implementation Science, 14, Article 11. https://doi.org/10.1186/s13012-019-0853-y
28.
GraneheimU.LundmanB. (2004). Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24, 105–112. https://doi.org/10.1016/j.nedt.2003.10.001
HardenS.JohnsonS. B.AlmeidaF.EstabrooksP. (2017). Improving physical activity program adoption using integrated research-practice partnerships: An effectiveness-implementation trial. Translational Behavioral Medicine, 7, 28–38. https://doi.org/10.1007/s13142-015-0380-6
31.
HolstonD.StroopeJ.CaterM.KendallM.BroylesS. (2020). Implementing policy, systems, and environmental change through community coalitions and Extension partnerships to address obesity in rural Louisiana. Preventing Chronic Disease, 17(190284). https://doi.org/10.5888/pcd17.190284
32.
Jacob ArriolaK. R.HermstadA.St Clair FlemmingS.HoneycuttS.CarvalhoM. L.CherryS. T.DavisT.FrazierS.LiangL.EscofferyC.KeglerM. C. (2016). Promoting policy and environmental change in faith-based organizations: Outcome evaluation of a mini-grants program. Health Promotion Practice, 17(1), 146–155. https://doi.org/10.1177/1524839915613027
33.
KoortsH.EakinE.EstabrooksP.TimperioA.SalmonJ.BaumanA. (2018). Implementation and scale up of population physical activity interventions for clinical and community settings: The PRACTIS guide. International Journal of Behavioral Nutrition and Physical Activity, 15(1), Article 51. https://doi.org/10.1186/s12966-018-0678-0
34.
KwanB.FernaldD.FerraroneP.LoskutovaN.Summers HoltropJ.StantonE.WestfallJ. (2019). Implementation and evaluation of a laboratory safety process improvement toolkit. Journal of the American Board of Family Medicine, 32, 136–145. https://doi.org/10.3122/jabfm.2019.02.180109
35.
LeeY.KozarK.LarsenK. (2003). The Technology Acceptance Model: Past, present, and future. Communications of the Association for Information Systems, 12. https://doi.org/10.17705/1CAIS.01250
36.
LeemanJ.BirkenS. A.PowellB. J.RohwederC.SheaC. M. (2017). Beyond “implementation strategies”: Classifying the full range of strategies used in implementation science and practice. Implementation Science, 12(1), Article 125. https://doi.org/10.1186/s13012-017-0657-x
37.
LeemanJ.CalancieL.HartmanM. A.EscofferyC. T.HerrmannA. K.TagueL. E.MooreA. A.WilsonK. M.SchreinerM.Samuel-HodgeC. (2015). What strategies are used to build practitioners’ capacity to implement community-based interventions and are they effective? A systematic review. Implementation Science, 10(1), 1–15. https://doi.org/10.1186/s13012-015-0272-7
38.
LiamputtongP. (2011). Focus group methodology: Principle and practice. SAGE.
39.
MazzuccaS.ArredondoE. M.HoelscherD. M.Haire-JoshuD.TabakR. G.KumanyikaS. K.BrownsonR. C. (2021). Expanding implementation research to prevent chronic diseases in community settings. Annual Review of Public Health, 42(1), 135–158. https://doi.org/10.1146/annurev-publhealth-090419-102547
40.
OmuraJ. D.CarlsonS. A.BrownD. R.HopkinsD. P.KrausW. E.StaffilenoB. A.ThomasR. J.LobeloF.FultonJ. E., American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic Health, Council on Cardiovascular and Stroke Nursing, & Council on Clinical Cardiology. (2020). Built environment approaches to increase physical activity: A science advisory from the American Heart Association. Circulation, 142(11), e160–e166. https://doi.org/10.1161/CIR.0000000000000884
PickensC.PierannunziC.GarvinW.TownM. (2018). Surveillance for certain health behaviors and conditions among states and selected local areas—Behavioral Risk Factor Surveillance System, United States, 2015. Morbidity and Mortality Weekly Reports Surveillance Summaries, 67(9), 1–90. https://doi.org/10.15585/mmwr.ss6709a1
43.
PiercyK. L.TroianoR. P.BallardR. M.CarlsonS. A.FultonJ. E.GaluskaD. A.GeorgeS. M.OlsonR. D. (2018). The physical activity guidelines for Americans. Journal of the American Medical Association, 320(19), 2020–2028. https://doi.org10.1001/jama.2018.14854
44.
PowellB. J.BeidasR. S.LewisC. C.AaronsG. A.McMillenJ. C.ProctorE. K.MandellD. S. (2017). Methods to improve the selection and tailoring of implementation strategies. The Journal of Behavioral Health Services & Research, 44(2), 177–194. https://doi.org/10.1007/s11414-015-9475-6
45.
PowellB. J.WaltzT. J.ChinmanM. J.DamschroderL. J.SmithJ. L.MatthieuM. M.ProctorE. K.KirchnerJ. E. (2015). A refined compilation of implementation strategies: Results from the Expert Recommendations for Implementing Change (ERIC) project. Implementation Science, 10. https://doi.org/10.1186/s13012-015-0209-1
46.
ProctorE.PowellB.McMillenJ. C. (2013). Implementation strategies: Recommendations for specifying and reporting. Implementation Science, 8(139), 1–11. https://doi.org/10.1186/1748-5908-8-139
47.
RabinB. A.GlasgowR. E.KernerJ. F.KlumpM. P.BrownsonR. C. (2010). Dissemination and implementation research on community-based cancer prevention: A systematic review. American Journal of Preventive Medicine, 38(4), 443–456. https://doi.org/10.1016/j.amepre.2009.12.035
48.
RayM. L.WilsonM. M.WandersmanA.MeyersD. C.KatzJ. (2012). Using a training-of-trainers approach and proactive technical assistance to bring evidence based programs to scale: An operationalization of the Interactive Systems Framework’s support system. American Journal of Community Psychology, 50(3), 415–427. https://doi.org/10.1007/s10464-012-9526-6
49.
RhodesT.StimsonG.FitchC.BallA.RentonA. (1999). Rapid assessment, injecting drug use, and public health. Lancet, 354, 65–68.
50.
RogersL.De BrúnA.McAuliffeE. (2020). Development of an integrative coding framework for evaluating context within implementation science. BMC Medical Research Methodology, 20, Article 158. https://doi.org/10.1186/s12874-020-01044-5
51.
SallisJ. F.FloydM. F.RodríguezD. A.SaelensB. E. (2012). Role of built environments in physical activity, obesity, and cardiovascular disease. Circulation, 125, 729–737. https://doi.org/10.1161/CIRCULATIONAHA.110.969022
52.
SalvoD.BandaJ.A.SheatsJ.L.WinterS.J.Lopes Dos SantosD.KingA.C. (2017). Impacts of a temporary urban pop-up park on physical activity and other individual- and community-level outcomes. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 94(4), 470–481. https://doi.org/10.1007/s11524-017-0167-9
53.
SmithJ. D.LiD. H.RaffertyM. R. (2020). The Implementation Research Logic Model: A method for planning, executing, reporting, and synthesizing implementation projects. Implementation Science, 15(1), Article 84. https://doi.org/10.1186/s13012-020-01041-8
54.
SpearM.RowlandB.VincentJ.BrownT.McElfishP.LongC.PresleyJ.WilsonA.PalenskeC.BalisL. (2022). A feasibility demonstration for built environment changes to increase physical activity in a rural community: Results of a community-based traffic calming event. Journal of Extension: In Press.
55.
StewartD.ShamdasaniP. (2015). Focus groups: Theory and practice (3rd ed.). SAGE.
56.
StraussA.CorbinJ. (1994). Grounded theory methodology—An overview. In DenzinN.LincolnY. (Eds.), Handbook of qualitative research (pp. 273–285). SAGE.
57.
StrayerT.IIIBalisL.HardenS. (2020). Partnering for successful dissemination: How to improve public health with the National Cooperative Extension System. Journal of Public Health Management & Practice, 26(2), 184–186. https://doi.org/10.1097/PHH.0000000000001025
58.
StrayerT.IIIKennedyL.BalisL.RamalingamN.WilsonM.HardenS. (2020). Cooperative extension gets moving, but how? Exploration of extension health educators’ sources and channels for information-seeking practices. American Journal of Health Promotion, 34, 198–205. https://doi.org/10.1177/0890117119879606
59.
TomasoneJ. R.KauffeldtK. D.MorganT. L.MagorK. W.Latimer-CheungA. E.FaulknerG.Ross-WhiteA.PoitrasV.KhoM. E.RossR. (2020). Dissemination and implementation of national physical activity, sedentary behaviour, and/or sleep guidelines among community-dwelling adults aged 18 years and older: A systematic scoping review and suggestions for future reporting and research. Applied Physiology, Nutrition, and Metabolism, 45(10Suppl. 2), S258–S283. https://doi.org/10.1139/apnm-2020-0251
60.
TuckerJ. M.WelkG. J.BeylerN. K. (2011). Physical activity in U.S.: Adults compliance with the Physical Activity Guidelines for Americans. American Journal of Preventive Medicine, 40(4), 454–461. https://doi.org/10.1016/j.amepre.2010.12.016
WandersmanA.ChienV. H.KatzJ. (2012). Toward an evidence-based system for innovation support for implementing innovations with quality: Tools, training, technical assistance, and quality assurance/quality improvement. American Journal of Community Psychology, 50(3), 445–459. https://doi.org/10.1007/s10464-012-9509-7
63.
WarburtonD.NicolC.BredinS. (2006). Health benefits of physical activity: The evidence. Canadian Medical Association Journal, 174(6), 801–809. https://doi.org/10.1503/cmaj.051351
64.
WilcoxS.SaundersR. P.KaczynskiA. T.ForthoferM.SharpeP. A.GoodwinC.CondraskyM.KennedyV. L.Sr.Jake-SchoffmanD. E.KinnardD.HuttoB. (2018). Faith, Activity, and Nutrition randomized dissemination and implementation study: Countywide adoption, reach, and effectiveness. American Journal of Preventive Medicine, 54(6), 776–785. https://doi.org/10.1016/j.amepre.2018.02.018
65.
WinterS.J.SheatsJ.L.SalvoD.BandaJ.A.QuinnJ.RiveraB.R.KingA.C. (2020). A mixed method study to inform the implementation and expansion of pop-up parks for economic, behavioral, and social benefits. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 97(4), 529–542. https://doi.org/10.1007/s11524-020-00434-w
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