Abstract
To optimize public health impact, health interventions must be delivered widely to reach the population in need. Yet, few interventions are ever implemented at broad scale (scaled-up). Thus it is necessary to devise implementation strategies that support scale-up of effective interventions. Adapting an intervention and implementation strategies to the local context to improve “fit” at scale-up is critical to success. Therefore, our study responds to a call to build a database of systematic adaptations of evidence-based interventions across populations and contexts, including scaled-up designs. To do so, we focus on the process of adapting an effective physical activity program for older adults, called Choose to Move (CTM), for scale-up. Our objectives were to describe the systematic process of adapting CTM for scale-up across British Columbia (BC) and to report the actual changes made to CTM. We adopted a 6-step process: (1) identify stakeholders; (2) conduct needs assessment; (3) develop prototype of adaptations; (4) validate prototype with stakeholders; (5) create adapted program; and (6) pilot test adaptations. For the adaptation process, we described each step and organized data within an adaptation coding system. Results showed that adaptations to CTM span program content, program context, and the training modules. For example, to address the request by CTM participants for more opportunities to socially connect with others, we added more group meetings, reduced phone check-ins, and integrated aspects of training related to social cohesion. Our study extends the current literature by providing researchers a clear pathway toward adapting health promotion interventions for scale-up.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aarons, G. A., Green, A. E., Palinkas, L. A., Self-Brown, S., Whitaker, D. J., Lutzker, J. R., et al. (2012). Dynamic adaptation process to implement an evidence-based child maltreatment intervention. Implementation Science, 7, 32.
Bauman, A., Merom, D., Bull, F. C., Buchner, D. M., & Fiatarone Singh, M. A. (2016). Updating the evidence for physical activity: summative reviews of the epidemiological evidence, prevalence, and interventions to promote "active aging". Gerontologist, 56, 268–280. https://doi.org/10.1093/geront/gnw031.
Bopp, M., Saunders, R. P., & Lattimore, D. (2013). The tug-of-war: Fidelity versus adaptation throughout the health promotion program life cycle. The Journal of Primary Prevention, 34, 193–207.
Bronfenbrenner, U. (1994). Ecological models of human development(2nd ed., Vol. 3, International Encyclopedia of Education). Oxford: Elsevier.
Carvalho, M. L., Honeycutt, S., Escoffery, C., Glanz, K., Sabbs, D., & Kegler, M. C. (2013). Balancing fidelity and adaptation: Implementing evidence-based chronic disease prevention programs. Journal of Public Health Management and Practice, 19, 348–356.
Castro, F. G., Barrera Jr., M., & Martinez Jr., C. R. (2004). The cultural adaptation of prevention interventions: Resolving tensions between fidelity and fit. Prevention Science, 5, 41–45.
Chambers, D. A., & Norton, W. E. (2016). The adaptome. American Journal of Preventive Medicine, 51, S124–S131.
Chambers, D. A., Glasgow, R. E., & Stange, K. C. (2013). The dynamic sustainability framework: Addressing the paradox of sustainment amid ongoing change. Implementation Science, 8, 117.
Chase, J. D. (2015). Interventions to increase physical activity among older adults: A meta-analysis. Gerontologist, 55, 706–718.
Colvin, R. M., Witt, G. B., & Lacey, J. (2016). Approaches to identifying stakeholders in environmental management: Insights from practitioners to go beyond the ‘usual suspects’. Land Use Policy, 52, 266–276.
Colley, R. C., Garriguet, D., Janssen, I., Craig, C. L., Clarke, J., & Tremblay, M. S. (2011). Physical activity of Canadian adults: Accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Reports, 22, 1–8.
Curran, G. M., Bauer, M., Mittman, B., Pyne, J. M., & Stetler, C. (2012). Effectiveness-implementation hybrid designs: Combining elements of clinical effectiveness and implementation research to enhance public health impact. Medical Care, 50, 217–226.
Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41, 327–350.
Dusenbury, L., Brannigan, R., Falco, M., & Hansen, W. B. (2003). A review of research on fidelity of implementation: Implications for drug abuse prevention in school settings. Health Education Research, 18, 237–256. https://doi.org/10.1093/her/18.2.237.
Escoffery, C., Lebow-Skelley, E., Haardoerfer, R., Boing, E., Udelson, H., Wood, R., et al. (2018). A systematic review of adaptations of evidence-based public health interventions globally. Implementation Science, 13, 125.
Family & Youth Services Bureau (n.d). Making adaptations tip sheet. Designing an evaluation: resources.
Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89, 1322–1327.
Glasgow, R. E., Klesges, L. M., Dzewaltowski, D. A., Bull, S. S., & Estabrooks, P. (2004). The future of health behavior change research: What is needed to improve translation of research into health promotion practice? Annals of Behavioral Medicine, 27, 3–12.
Graham, I. D., Logan, J., Harrison, M. B., Straus, S. E., Tetroe, J., Caswell, W., et al. (2006). Lost in knowledge translation: Time for a map? The Journal of Continuing Education in the Health Professions, 26, 13–24.
Harden, S. M., Johnson, S. B., Almeida, F. A., & Estabrooks, P. A. (2017). Improving physical activity program adoption using integrated research-practice partnerships: An effectiveness-implementation trial. TBM, 7, 28–38.
Hildebrand, M., & Neufeld, P. (2009). Recruiting older adults into a physical activity promotion program: Active living every day offered in a naturally occurring retirement community. Gerontologist, 49, 702–710.
Indig, D., Lee, K., Grunseit, A., Milat, A., & Bauman, A. (2018). Pathways for scaling up public health interventions. BMC Public Health, 18, 68.
Kohl, H. W., Craig, C. L., Lambert, E. V., Inoue, S., Alkandari, J. R., Leetongin, G., et al. (2012). The pandemic of physical inactivity: Global action for public health. The Lancet, 380, 294–305.
Leask, C. F., Sandlund, M., Skelton, D. A., & Chastin, S. F. M. (2017). Co-creating a tailored public health intervention to reduce older adults’ sedentary behaviour. Health Education Journal, 76, 595–608.
Lee, S. J., Altschul, I., & Mowbray, C. T. (2008). Using planned adaptation to implement evidence-based programs with new populations. American Journal of Community Psychology, 41, 290–303.
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Beverly Hills: Sage.
Mackey, D. C., Perkins, A. D., Hong Tai, K., Sims-Gould, J., & McKay, H. A. (2018). Men on the move: A randomized controlled feasibility trial of a scalable, choice-based physical activity and active transportation intervention for older men. JAPA, 27, 489–502.
McKay, H. A., Sims-Gould, J., Nettlefold, L., Hoy, C. L., & Bauman, A. E. (2017). Implementing and evaluating an older adult physical activity model at scale: Framework for action. TJACSM, 2, 10–19.
McKay, H., Nettlefold, L., Bauman, A., Hoy, C., Gray, S. M., Lau, E., et al. (2018). Implementation of a co-designed physical activity program for older adults: Positive impact when delivered at scale. BMC Public Health, 18, 1289.
McKay, H. A., Mackey, D. C., Gray, S. M., Hoy, C. L., Ahn, R., Perkins, A. D., et al. (2019). Translational formative evaluation before scale-up of a physical activity intervention for older men. TJACSM, 4, 106–113.
Meyers, D. C., Durlak, J. A., & Wandersman, A. (2012). The quality implementation framework: A synthesis of critical steps in the implementation process. American Journal of Community Psychology, 50, 462–480.
Milat, A. J., Bauman, A., & Redman, S. (2015). Narrative review of models and success factors for scaling up public health interventions. Implementation Science, 10, 113.
Moreno, R., & Mayer, R. (2007). Interactive multimodal learning environments. Educational Psychology Review, 19, 309–326.
National Cancer Institute (n.d). Guidelines for choosing and adapting programs. Research-Tested Intervention Programs (RTIPs).
Poscia, A., Stojanovic, J., La Milia, D. I., Duplaga, M., Grysztar, M., Moscato, U., et al. (2018). Interventions targeting loneliness and social isolation among the older people: An update systematic review. Experimental Gerontology, 102, 133–144. https://doi.org/10.1016/j.exger.2017.11.017.
Proctor, E. K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B. (2009). Implementation research in mental health services: An emerging science with conceptual, methodological, and training challenges. Administration and Policy in Mental Health, 36, 24–34.
QSR International Pty Ltd. 10 (2014). NVivo qualitative data analysis software
Rabiee, F. (2004). Focus-group interview and data analysis. Proceedings of the Nutrition Society, 63, 655–660.
Saldana, L., Chamberlain, P., Wang, W., & Hendricks Brown, C. (2012). Predicting program start-up using the stages of implementation measure. Administration and Policy in Mental Health, 39, 419–425.
Stewart, A. L., Gillis, D., Grossman, M., Castrillo, M., Pruitt, L., McLellan, B., et al. (2006). Diffusing a research-based physical activity promotion program for seniors into diverse communities: CHAMPS III. Preventing Chronic Disease, 3, A51.
Stirman, S. W., Miller, C. J., Toder, K., & Calloway, A. (2013). Development of a framework and coding system for modifications and adaptations of evidence-based interventions. Implementation Science, 8, 65.
van Dongen, E. J., Leerlooijer, J. N., Steijns, J. M., Tieland, M., de Groot, L. C., & Haveman-Nies, A. (2017). Translation of a tailored nutrition and resistance exercise intervention for elderly people to a real-life setting. BMC Geriatrics, 17, 25.
Wandersman, A., Duffy, J., Flaspohler, P., Noonan, R., Lubell, K., Stillman, L., et al. (2008). Bridging the gap between prevention research and practice: The interactive systems framework for dissemination and implementation. American Journal of Community Psychology, 41, 171–181.
Watkins, D. C. (2017). Rapid and rigorous qualitative data analysis: The “RADaR” technique for applied research. International Journal of Qualitative Methods, 16. https://doi.org/10.1177/1609406917712131.
WHO (2018). Fact Sheets: Ageing and Health. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed December 1, 2019.
WHO & ExpandNet (2011). Beginning with the end in mind: Planning pilot projects and other programmatic research for successful scaling up.
Wilson, M., Strayer, T., Davis, R., & Harden, S. (2018). Informed adaptations of a strength-training program through a research-practice partnership. Frontiers in Public Health, 6, 58.
Yamey, G. (2011). Scaling up global health interventions: A proposed framework for success. PLoS Medicine, 8, e1001049.
Zubala, A., MacGillivray, S., Frost, H., Kroll, T., Skelton, D. A., Gavine, A., et al. (2017). Promotion of physical activity interventions for community dwelling older adults: A systematic review of reviews. PLoS One, 12, e0180902.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Research Involving Human Participants and Informed Consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (University of British Columbia [H15–02522] and Simon Fraser University Research Ethics Boards [22,015 s0614]) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Samantha M. Gray and Heather A. McKay shared primary authorship
Rights and permissions
About this article
Cite this article
Gray, S.M., McKay, H.A., Hoy, C.L. et al. Getting Ready for Scale-Up of an Effective Older Adult Physical Activity Program: Characterizing the Adaptation Process. Prev Sci 21, 355–365 (2020). https://doi.org/10.1007/s11121-019-01085-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11121-019-01085-3