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Title: National dissemination of StrongWomen – Healthy Hearts: A community-based program to reduce risk of cardiovascular disease among midlife and older women

Author
item FOLTA, SARA - Tufts University
item SEGUIN, REBECCA - Cornell University
item CHUI, KENNETH - Tufts University
item CLARK, VALERIE - Tufts University
item CORBIN, MARILYN - Pennsylvania State University
item GOLDBERG, JEANNE - Tufts University
item HEIDKAMP-YOUNG, ELENOR - Tufts - New England Medical Center
item LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item WIKER, NANCY - Pennsylvania State University
item NELSON, MIRIAM - Tufts University

Submitted to: American Journal of Public Health
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/7/2015
Publication Date: 12/1/2015
Citation: Folta, S.C., Seguin, R.A., Chui, K., Clark, V., Corbin, M.A., Goldberg, J.P., Heidkamp-Young, E., Lichtenstein, A.H., Wiker, N., Nelson, M.E. 2015. National dissemination of StrongWomen – Healthy Hearts: A community-based program to reduce risk of cardiovascular disease among midlife and older women. American Journal of Public Health. 105(12):2578-2585.

Interpretive Summary: Implementing a community based program designed to improve cardiovascular disease risk factors can be challenging, particularly in rural settings. Summarized are lessons learned during a national dissemination and translation of an evidence-based community cardiovascular disease prevention program for midlife and older women using the RE-AIM – reach effectiveness adoption implementation maintenance, framework. Between 2010 and 2014 we collaborated with the National Extension Association of Family and Consumer Sciences to assess the reach, adoption, implementation and maintenance of the StrongWomen-Healthy Hearts program offered in rural setting using survey methods. Effectiveness was assessed using pre-test and post-test measures. Body weight change was the primary outcome. During the 12-week intervention period participants lost 0.5 kilograms (approximately 1 lb) body weight. Adherence to the program was high, averaging 4.7 out of a potential 5.0 points. Consistent with the objectives of the program, the women significantly increased their fruit and vegetable intake and level of physical activity. These data indicate the StrongWomen-Healthy Hearts program can be implemented with high fidelity in rural settings while remaining effective. These data provide direction for program modification to improve impact as dissemination continues.

Technical Abstract: Objective: We describe the national dissemination of an evidence-based community cardiovascular disease prevention program for midlife and older women using the RE-AIM (reach effectiveness adoption implementation maintenance) framework and share key lessons learned during translation. Methods: In a 2010 to 2014 collaboration between the StrongWomen program and the National Extension Association of Family and Consumer Sciences, we assessed reach, adoption, implementation, and maintenance using survey methods, and we assessed effectiveness using a pretest-posttest within-participants design, with weight change as the primary outcome. Results: Overall reach into the population was 15 per 10,000. Of 85 trained leaders, 41 (48%) adopted the program. During the 12-week intervention, weight decreased by 0.5 kg, fruit and vegetable intake increased by 2.1 servings per day and physical activity increased by 1238 metabolic equivalent (MET)-minutes per week (all p<0.001). Average fidelity score was 4.7 (out of possible 5). Eleven of 41 adopting leaders (27%) maintained the program. Conclusions: The StrongWomen – Healthy Hearts Program can be implemented with high fidelity in a variety of settings while remaining effective. These data provide direction for program modification to improve impact as dissemination continues.