BACKGROUND:Translating evidence-based interventions (EBIs) to advance health behaviors and well-being takes 15-17 years. This translational gap is lengthened for specific EBI and populations, such as yoga for people of color, with higher weight, or who live in rural areas. Yoga principles have positively impacted myriad populations and outcomes and align with scientific rigor, but misinformation persists. Applying a translational lens to input from under-represented yoga end-users may speed the gap. PURPOSE:To examine how underrepresented yoga end-users perceive yoga with consideration to yoga associations, facilitators, and barriers. METHODS:We utilized mixed methods in a cross-sectional survey with a large, diverse sample to explore yoga end-user input for communicating yoga-based health information and interventions. We used an inductive approach to qualitatively analyze responses to four prompts on perceptions of yoga. RESULTS:We surveyed 150 end-users (mean age 36 years; 50% female; 54% people of color; 29% with higher body weight) with 28 open-ended questions. Of more than 5000 meaning units, we present a subset of data (31% of total data) that includes associations of yoga (e.g. physical components) as well as present and future yoga facilitators (e.g. benefits) and barriers (e.g. lack of belonging in yoga spaces). CONCLUSIONS:Findings from end-users provided insights on how to comprehensively communicate behavioral medicine evidence using clear, inclusive language and representative imagery. Applying precursors of clarity and inclusivity is thus key to translation of yoga-based health information and interventions. Furthermore, these findings can be expanded and applied to bridge translation of other health evidence and interventions.
BACKGROUND:Type 2 diabetes (T2D) is a global public health challenge globally. Effective prevention programs must be tailored to cultural and logistical contexts. PURPOSE:This study evaluated the comparative efficacy of a culturally adapted diabetes prevention program (DPP) intervention versus usual care in reducing T2D risk factors in Ecuadorian institutional settings. METHODS:This quasi-experimental study included adults with high T2D risk (FINDRISC score ≥12). Participants voluntarily enrolled to an experimental group (EG, N = 192) receiving a 16-week, 10 session culturally adapted DPP, or a control group (CG, N = 91), receiving usual care. Primary comparative efficacy was assessed using analysis of covariance (ANCOVA), adjusting for key baseline imbalances. RESULTS:Intragroup analysis showed that EG achieved significant reductions in weight (average loss of 1.06%), BMI, and body fat mass (P < .05). However, the primary outcome reduction in FINDRISC score (P = .013) did not retain significance after Holm-Bonferroni correction. The comparative ANCOVA analysis revealed no significant difference between EG and CG for the primary outcomes of weight (P = .330) or FINDRISC score (P = .291). The intervention showed a reduction in systolic blood pressure (SBP) that was statistically significant in the per-protocol analysis (adjusted Δ = -3.338 mmHg; F = 5.160, P = .024), although this effect was attenuated to a trend (P = .079) in a multiply imputed intention-to-treat sensitivity analysis. CONCLUSION:The short-term, culturally adapted DPP intervention failed to demonstrate superior comparative efficacy in achieving the primary goals of T2D risk reduction or weight loss compared to usual care. Nevertheless, the per-protocol analysis identified a promising reduction in SBP, whose robustness was supported by inverse probability of treatment weighting but attenuated under intention-to-treat multiple imputation. These findings suggest partial efficacy of the short-term adaptation on cardiovascular health and underscore the critical need for longer program duration and strategies to reduce attrition in similar institutional settings.
BACKGROUND:Lung cancer screening (LCS) using low-dose computed tomography (LDCT) can reduce lung cancer mortality; however, screening uptake remains low. PURPOSE:This study aimed to identify factors influencing LDCT-LCS participation among high-risk individuals in Vietnam. METHODS:A cross-sectional study was conducted among 3288 high-risk individuals (aged 50-74) in Hanoi, Vietnam, in 2024. Potential participants were informed about the LCS project through mass media and local commune health stations. Eligible individuals were subsequently invited for fully subsidized LDCT. Demographic data, health status, behaviors, and LCS-related factors were collected through structured interviews. Logistic regression and classification tree models were used to assess the factors associated with LCS participation. RESULTS:Overall, the LCS participation rate was 63.87%. Women who did not drink alcohol had the highest participation (88.7%), while men with irregular health checkups, good health, and past smoking had the lowest (11.4%). Key predictors for higher LCS participation included higher education (adjusted odds ratio = 1.48; 95% CI: 1.25-1.74), high-risk occupations (1.51; 1.22-1.86), current smoking (4.37; 3.06-6.23), ≥30 pack-years of smoking (1.66; 1.41-1.95), family cancer history (3.11; 2.46-3.94), regular exercise (1.44; 1.19-1.75), and regular health checkups (2.42; 2.05-2.85). Lower participation was linked to high income (0.50; 0.42-0.59), drinking alcohol (0.43; 0.35-0.51), and normal/good self-perceived health (0.21; 0.15-0.29). CONCLUSIONS:This study highlights the complexity of participation in LCS, revealing the interplay of multiple interrelated factors influencing individuals' engagement in the screening process. These findings underscore the urgent need for community awareness campaigns and contextually tailored interventions to enhance LCS uptake in Vietnam.
BACKGROUND:Adaptations are changes to interventions or implementation strategies to improve fit in the real-world. Adaptations can promote research translation and intervention sustainment. PURPOSE:The study adaptations team refined their tracking methods and analyzed adaptations' perceived impact across three interventions executed in Veterans Health Administration (VHA). METHODS:From 2020 to 2025 the study team supported 15 VHA sites implementing one of three interventions intended to improve Veteran outcomes, clinician engagement, and care costs. Intervention and implementation strategy adaptations were tracked and analyzed in a web-based tool refined from previous projects, incorporating Framework for Reporting Modifications to Evidence-based Implementation Strategies and Practical, Robust, Implementation, and Sustainability Model components. Data were collected pragmatically via multi-methods. Proximal impact was analyzed close to real-time. The team used data validation, member checking, and data triangulation. RESULTS:Across interventions, 224 unique adaptations were recognized from audit trails (n = 119), interviews (n = 55), process maps (n = 51), and team meetings (n = 17). Intervention 1 made 119 adaptations, Intervention 2 made 44, Intervention 3 made 23, and the study team made 38 to enhance implementation support (implementation strategy adaptations). Most adaptations occurred during implementation (n = 161) and targeted adoption and implementation. The study adaptations team assessed adaptations' perceived impact on outcomes and found 130 adaptations impacted multiple outcomes. Adoption (n = 153) was impacted the most. CONCLUSIONS:The refined tool was effective for tracking and analyzing adaptations' impact. Future research should refine strategies for adaptation impact assessment.
BACKGROUND:Offering behavioral weight management interventions in college health centers may improve cardiometabolic health for hard-to-reach emerging adult populations. PURPOSE:This paper outlines the iterative process undertaken, guided by the Adaptome framework, to adapt an evidence-based small changes approach to weight gain prevention to target weight loss and to improve the fit for delivery to college students via health centers. METHODS:Initial intervention adaptations were completed following in-depth interviews with college students and health center staff. The program was iteratively tested in a series of single-arm pilot trials to reach pre-identified benchmarks for retention (≥70%), adherence (≥75%), and clinical effectiveness (≥3% weight loss). Focus groups were held following each iteration to inform intervention adaptations. RESULTS:Interview themes (n = 23) that highlighted environmental and developmental barriers to student weight management and strategies to promote engagement informed initial adaptations. Four cohorts (∼7 participants each) were run, with adaptations following each cohort made based on participant feedback and benchmark achievement. Major changes included transitioning to hybrid delivery, providing personalized feedback with autonomy supportive coaching, refining the self-monitoring approach, providing frequent text messages, and refining small change goals and instructional content to enhance feasibility and improve weight loss. The result was a final treatment package that exceeded pre-specified benchmarks with cohort 4 called HealthyU. CONCLUSION:Emerging adult college students benefit from facilitator and group interaction, community building, additional touchpoints via text message, and autonomy-supportive structured guidance. Future directions include testing the HealthyU intervention against a control using a more generalizable sample to determine preliminary effectiveness.
BACKGROUND:Produce prescription programs (PRx) have the potential to improve participants' fruit and vegetable intake (FVI), and food security (FS), but further information is needed to understand which program characteristics contribute to these participant outcomes. PURPOSE:To explore the associations between PRx design characteristics, incentive redemption, and program-level participant outcomes including FVI, FS, and perceived health. METHODS:An ecological, exploratory study with a quasi-experimental design (one group pre-test post-test) following the exploration, preparation, implementation, sustainment (EPIS) framework was used among Gus Schumacher Nutrition Incentive Program (GusNIP)-funded PRxs in the United States. Data were sourced from a GusNIP program operator survey (84% response rate; n = 80), PRx redemption data (n = 77), and an outcomes sample including redemption and participant outcomes data (n = 39 programs). Redemption data included program-level incentive distribution and redemption rates, measured as the dollar amount of incentives redeemed per participant per month. Participant data included changes in FVI (dietary screener questionnaire), FS (USDA household FS survey module), and perceived health (healthy days). Nonparametric and parametric comparisons were examined between program characteristics with program level-redemption rates and changes in aggregated participant-level outcomes. RESULTS:Program-level characteristics, design, and implementation features were associated both positively and negatively with redemption data and changes in participant outcomes including FVI, FS, and perceived health. Programs that provide more funds but serve fewer participants, offer transportation assistance, and offer staff training were positively associated with improved aggregated participant outcomes. CONCLUSIONS:This exploratory research identified factors to be considered for promoting favorable program and participant outcomes in GusNIP PRx and similar initiatives.
BACKGROUND:Little is known about the content of routine smoking cessation support in primary care and how it relates to abstinence. While 121 behavior change techniques (BCTs) have been identified for cessation treatment, English treatment guidelines recommend 30 across cessation consultations. PURPOSE:We sought to identify: (1) BCTs delivered during routine cessation support in primary care in England; (2) associations between abstinence and (a) the total number of BCTs used, (b) delivery of the 30 recommended BCTs, (c) delivery of individual BCTs. METHOD(S):In an evaluation trial across 32 English General Practices, 149 pre-quit consultations (across 29 practitioners trained in cessation support) from a multisession cessation program were audio-recorded, transcribed, and analyzed for BCT delivery using a modified BCT taxonomy v1 and smoking-specific taxonomy. Abstinence was collected at 4-weeks (biochemically verified), 8-weeks (primary outcome, self-reported), and 6-months (self-reported) post quit date. Multilevel modelling assessed associations. RESULTS:Of 121 BCTs, 85 were delivered in at least one consultation. A mean of 13.4 (SD = 2.76) of recommended BCTs were delivered, with 33% (10/30) delivered in at least half of the consultations. Total BCTs delivered were not associated with abstinence. Delivery of more guideline-recommended BCTs was only associated with abstinence at 4 weeks (OR = 1.03, 95% CI 1.00-1.06; P = .03). One BCT was positively associated, and one negatively associated with abstinence. CONCLUSIONS:One-third of recommended BCTs were delivered in at least 50% of initial consultations, with delivery associated with short-term abstinence. Limited practitioner time may constrain BCT delivery and is a consideration for future guidelines. CLINICAL TRIALS INFORMATION:The Clinical Trials Registration #ISRCTN 56702353.
BACKGROUND:Exercise is an evidence-based treatment for depression, yet it is rarely integrated into mental health care in the United States. PURPOSE:The purpose of this study was to examine patient experiences with and preferences for integrating exercise into mental health care. METHODS:Participants were 457 US adults with depression who reported current or past receipt of mental health care and completed an online survey assessing experienced and preferred levels of exercise integration using parallel three-level ordinal scales. Related samples Wilcoxon signed-rank tests compared experienced versus preferred levels of exercise integration. Multivariable ordinal logistic regression examined predictors of preferred exercise integration. RESULTS:22.5% preferred no discussion of exercise in the context of mental health care, 56.5% preferred general education and encouragement around exercise in mental health care, and 21.0% preferred structured exercise goal setting in mental health care. Participants preferred significantly greater exercise integration than they had experienced (Z = 6.8, P < .001). In multivariable analyses, prior experience with exercise being integrated into mental health care and greater belief in exercise's antidepressant effects were associated with higher preferred integration, whereas current antidepressant use and physical health conditions limiting exercise were associated with lower preferred integration. Preference for integration of exercise into mental health care was unrelated to depression severity or physical activity level. CONCLUSION:US adults with depression prefer greater integration of exercise into mental health care than they currently receive, but most prefer limited integration. These findings highlight the importance of flexible, patient-centered approaches to exercise integration into mental health care.
BACKGROUND:"Food is Medicine (FIM)" programs can improve diet-related health outcomes. Produce prescription programs (PRxs), a type of FIM program, entail healthcare providers "prescribing" free or reduced-cost vegetables. Previous studies have identified multilevel barriers to implementing FIM programs. However, there is scant research examining how implementation strategies can influence FIM implementation outcomes. PURPOSE:Assess changes in implementation outcomes following the introduction of tailored implementation strategies to support the delivery and uptake of a PRx in four participating clinics. METHODS:VeggieRx is a 6-month PRx in Rhode Island. This single-arm pilot study measured implementation outcomes according to the Consolidated Framework for Implementation Research Outcomes Addendum before and after tailored implementation strategies were applied for the 2023 VeggieRx season. Adoption was measured as the number of VeggieRx referrals. Implementation was measured by the number of individuals and households receiving produce. Patient acceptability was measured via text message after each delivery. Patient food security status and vegetable intake were assessed before and after VeggieRx participation. RESULTS:From 2022 to 2023, following the introduction of the implementation strategies, VeggieRx referrals increased by 57.9% and the number of households receiving vegetables increased by 86.2%. Study participants (n = 44) used Most to all vegetables in each delivery (median = 88.6% of weekly responses, interquartile range = 78.4%, 95.5%). The proportion of participants classified as High or marginal food security increased from 18.2% at baseline to 36.6% at follow-up (Cohen's h = 0.42). CONCLUSION:This study demonstrates the value of tailored implementation strategies and their potential to expand the delivery of future PRx programs. CLINICAL TRIAL INFORMATION:The Clinical Trials Registration #NCT05941403.
BACKGROUND AND PURPOSE:We investigated the capabilities, opportunities and motivations associated with decision making related to at-home COVID-19 testing in populations most affected by the pandemic. METHODS:We conducted semi-structured interviews to explore the capability, opportunity and motivation for COVID-19 testing by the pandemic populations most affected by the pandemic. Interviews were carried out according to the Critical Incident Technique, and analysis and interpretation were guided by the COM-B model for behavior change. RESULTS:We conducted 19 (13 in English, 6 in Spanish) semi-structured interviews with participants from both urban and rural areas in Utah. The following 6 key themes emerged: (i) Participants sought clear information about COVID-19 from trustworthy, credible sources, (ii) Economic concerns relating to job security and income loss as well as costs associated with COVID-19 testing were concerns, conversely access to free COVID-19 tests facilitated testing, (iii) Rapid testing with fast results at convenient locations including at-home were key facilitators to COVID-19 testing, (iv) Wide variation of trust levels related to at-home COVID-19 test accuracy, (v) Perception of risk to self and others, including misconceptions surrounding risk, and (vi) Intense emotions ranging from fear associated with loss to peace of mind associated with confirmation of a negative COVID-19 test. CONCLUSION:The six themes identified surfaced as facilitators, barriers, and key considerations depending upon the context when participants were engaging in decision-making about COVID-19 testing. Providing validated easy to understand information, from trustworthy sources, while addressing and minimizing concerns about economic implications associated with testing are critical to increase patient engagement.
BACKGROUND:Prostate cancer is the most common noncutaneous malignancy among men and disproportionately affects those with low socioeconomic status, particularly men from racial and ethnic minority populations. PURPOSE:This study describes the development of a culturally tailored Mediterranean diet intervention for medically underserved Black and Hispanic men with prostate cancer, using the Intervention Mapping Adaptation (IM ADAPT) framework. METHODS:Conducted at a county safety-net hospital in a large urban area, which serves a population with high medical needs and low socioeconomic status, the project aimed to ensure the intervention was culturally relevant and evidence-based. A collaborative process was used, involving community scientists and patient stakeholders to identify dietary barriers and preferences, while existing interventions were reviewed for cultural fit. Guided by the six steps of the IM ADAPT framework, stakeholder feedback was incorporated throughout the adaptation process. The result was a culturally adapted intervention that included tailored dietary modifications, food provision strategies, and educational materials specifically designed for Black and Hispanic men. RESULTS:Completion of the IM ADAPT steps yielded a culturally adapted Mediterranean diet intervention incorporating tailored dietary recommendations, provision of food, and distribution of educational materials designed to meet the specific needs of Black and Hispanic men. CONCLUSIONS:The IM ADAPT framework enabled the development of a culturally tailored, evidence-based dietary intervention ready for pilot testing among medically underserved men with prostate cancer. This approach may serve as a replicable model for designing interventions for other racial and ethnic minority populations affected by cancer.
BACKGROUND:Diabetic foot ulcers (DFUs) affect approximately 25% of people with diabetes and are associated with decreased quality of life, high healthcare costs, recurrent wounds, and amputation risk. Standard DFU care emphasizes offloading to promote healing; however, adherence is often poor due to behavioral, psychosocial, and everyday life challenges. These gaps highlight the need for person-centered interventions that support DFU self-management within daily routines. PURPOSE:To systematically adapt a Lifestyle Redesign® occupational therapy intervention (LR-OT) for DFU self-management using the ADAPT-ITT framework. METHODS:An iterative, stakeholder-engaged adaptation process was conducted across the first seven ADAPT-ITT phases: Assessment, Decision, Administration, Production, Topical Experts, Integration, and Training. Activities included targeted literature synthesis, theater testing with individuals with DFUs and DFU care providers, iterative material development, and expert consultation. Adaptation efforts focused on refining intervention content, delivery, and training supports to DFU-specific care demands while retaining alignment with LR-OT core elements. RESULTS:The ADAPT-ITT process yielded an interventionist-ready, DFU-specific LR-OT package, including patient-facing materials, an interventionist resource guide, and a conceptual mapping linking LR-OT theoretical elements to DFU-targeted management activities. Stakeholder input informed coordinated refinements to content, session structure, and delivery to support feasibility within DFU care contexts. CONCLUSION:Application of the ADAPT-ITT framework supported a transparent, stakeholder-informed, and reproducible process for adapting an evidence-based occupational therapy intervention for a high-risk and medically complex population. This work illustrates how lifestyle-focused interventions can be systematically adapted for specialty care contexts, with subsequent testing needed to evaluate fidelity and effectiveness. CLINICAL TRIAL INFORMATION:#NCT06278935.
BACKGROUND:Psychedelics such as 3,4-methylenedioxymethamphetamine (MDMA) and psilocybin are showing promising results in clinical trials for the treatment of mental health disorders, including post-traumatic stress disorder, addiction, and treatment-resistant depression. US Food and Drug Administration approval may be on the horizon. Yet, little is known about how these treatments will move from tightly controlled clinical trials to routine clinical care. PURPOSE:This study examines how psychedelic clinical investigators anticipate this transition and what challenges they expect. METHODS:We conducted semi-structured interviews with 21 clinical investigators based at major academic psychedelic research centers across the United States. We transcribed and analyzed these conversations using inductive and deductive coding to identify major themes. RESULTS:Investigators generally viewed psychedelic medicine as distinct from existing treatments, particularly in terms of drug effects, treatment models, and broader goals. They highlighted three major translational challenges: (i) uncertainty surrounding the role of psychotherapy, (ii) the cost of treatment and its scalability, and (iii) the effects of both hype and stigma on clinical uptake. CONCLUSION:Despite these challenges, most investigators anticipated that psychedelic medicine could eventually fit into routine clinical care and may even improve it.
BACKGROUND:Racism is a driver of community health disparities, and there is a dearth of evidence-based multilevel antiracism interventions developed in partnership with community constituents. Community-engaged systems science defines intervention points within complex systems and was utilized for early-phase multilevel intervention development within the ORBIT translational model to improve type 2 diabetes (T2DM) management among Black patients in the South. METHODS:Group model-building sessions were conducted with five primary care physicians, thirteen nurses, six support staff, and nine Black patients with T2DM in North Florida and analyzed with qualitative systems science methods. Facilitation scripts were developed with a core modeling team consisting of investigators and community partners. RESULTS:Resulting systems maps suggested leverage points for interventions, including strategies to increase trust and support, such as increasing appointment length and quality and deepening the health care system's understanding of race and culture as strengths instead of barriers. CONCLUSION:Formal care coordination pathways to reduce structural racism and address social determinants of health without stigma are needed, with multilevel interventions to address provider support and improve trust. This study demonstrates how to use community-engaged systems science within a translational behavioral medicine framework to define multilevel interventions to reduce health disparities in other systems.
BACKGROUND:While biopsychosocial interventions are effective for low back pain (LBP), implementing them in workplace settings remains challenging due to resource constraints. We adapted a comprehensive biopsychosocial approach into a single, brief, individualized advice session to enhance real-world feasibility. This study aimed to evaluate the reach, adoption, implementation, and preliminary effectiveness of this program using the RE-AIM (Reach, Adoption, Implementation, Effectiveness, and Maintenance) framework. METHODS:A prospective pre-post quasi-experimental study was conducted in a Japanese insurance company. Employees with LBP were invited to a single 30-min occupational physiotherapy advice session. Outcomes were assessed at baseline and 3 months. Effectiveness was evaluated using mean changes in pain (numerical rating scale) and disability (Roland-Morris Disability Questionnaire), supplemented by a responder analysis based on minimal important change (MIC). RESULTS:Of 1201 eligible employees, 154 (12.8%) attended the session (Reach), and 68 (44.2%) provided completed the 3-month follow-up (Implementation). Regarding effectiveness, mean pain intensity showed no significant change (+0.12). However, the responder analysis revealed that 17.6% of participants achieved MIC in pain (≥2 points), and 35.3% were classified as meeting MIC in disability (≥2 points). Additionally, the proportion of participants perceiving LBP as the primary cause of productivity loss decreased from 58.8% to 16.2%. Between-group analyses showed no statistically significant differences. CONCLUSIONS:This quasi-experimental evaluation suggests that a single 30-min workplace physiotherapy advice session is feasible to implement. Effectiveness findings were exploratory: mean pain intensity changed little and between-group differences were not statistically significant, while some attendees who completed follow-up met the MIC threshold for disability.
BACKGROUND:Due to the excessive burden and health costs of noncommunicable diseases, public health and clinical practice guidelines emphasize the importance of targeting population changes in risk factors of physical activity and sedentary behavior. Primary healthcare presents a pragmatic setting for embedding interventions targeting sitting less and moving more. However, to design effective implementation strategies for such interventions, it is necessary to understand the determinants that drive implementation in this setting. PURPOSE:To determine the barriers and facilitators influencing the implementation of sit-less and move-more interventions within Australian primary healthcare, as perceived by general practitioners and general practice nurses. METHODS:Ten general practitioners and 10 general practice nurses completed online semi-structured individual interviews. Interviews were digitally transcribed and analyzed deductively; both the interview guide and analysis were guided by the Theoretical Domains Framework. RESULTS:All domains within the Theoretical Domains Framework were represented. Notable barrier domains were: Environmental Context and Resources, related to reported time constraints; Skills, relating to limited formal training; Social Influences, relating to patient engagement challenges. Notable facilitator domains were: Beliefs about Consequences, reflecting perceived health benefits for patients with healthier movement behaviors, Environmental Context and Resources, including use of educational resources and integration of sit-less and move-more assessments within clinic workflows; and Social/Professional Role and Identity, highlighting how both general practitioners and general practice nurses have a role in implementation. CONCLUSIONS:These findings provide a foundation for future research focusing on the co-design of strategies supporting the implementation of such interventions within primary healthcare.
BACKGROUND:Applying established frameworks for cultural adaptation of evidence-based programs (EBPs) is essential to ensure cost-effectiveness, adoption, and sustainability while advancing health equity. However, adaptation processes often lack systematic approaches, particularly outside academic contexts. PURPOSE:This study explores how cultural adaptation processes of prevention programs are delivered to address adolescent substance use and common mental health issues, from the perspective of the main stakeholders involved in these processes. In parallel, it aims to empirically refine and specify the 11 stages synthesized in prior work that integrated insights from multiple cultural adaptation processes and frameworks. METHODS:A qualitative analysis was conducted using content analysis of 22 semi-structured interviews with stakeholders from the quadruple helix model: 6 from Academia, 6 from Non-governmental organizations (NGOs), and 10 from Public administration, selected globally. Stakeholders were identified via brainstorming and purposive-convenience sampling, based on their roles in adapting, implementing, evaluating, or funding prevention programs addressing adolescent substance use and mental health issues. Despite extensive recruitment efforts, no representation from the Business helix was achieved, as only one business contact agreed to be interviewed, which was not considered sufficient for inclusion. RESULTS:The qualitative analysis refined and expanded the stages of a cultural adaptation sequence that reflects how cultural adaptation processes are conducted in practice: building synergies, local needs assessment, program selection, initial cultural adaptation, advisory group consultation, staff training, piloting, program refinement and readiness for implementation, implementation, monitoring and evaluation, and dissemination and sustainability. Notably, not all stakeholders followed or applied the steps uniformly. Furthermore, academics were the only group to report using formal cultural adaptation models, while NGOs and the Public administration relied on experiential and contextual knowledge. CONCLUSIONS:Findings underscore the importance of translating scientific knowledge into practice contexts while ensuring continuous evaluation, dissemination, and sustainability of adapted EBPs targeting adolescent substance use and mental health issues. Collaborative efforts and co-creative strategies are crucial to maintaining cultural relevance. This study contributes by offering empirical refinement and operational specification of an 11-step cultural adaptation sequence identified in a prior scoping review. Linking evidence from prior literature with practice provides greater clarity and applicability for implementers seeking to culturally adapt prevention programs across diverse contexts.
BACKGROUND:Stakeholder engagement improves the quality, clinical relevance, and contextual fit of healthcare interventions. However, there is limited work characterizing how researchers approach stakeholder engagement in practice, and which organizational supports they most value. PURPOSE:The objective of this study is to describe how experienced researchers engaged multilevel stakeholders in implementation studies, and the benefits, challenges, and needs they encountered. METHODS:We identified Veterans Affairs (VA) healthcare system researchers with histories of stakeholder-engaged implementation research through a combination of literature review and snowball sampling. We conducted semi-structured telephone interviews with 28 participants in 2016. Two research team members analyzed interview data using a hybrid inductive-deductive approach. RESULTS:Participants described how multilevel stakeholder input substantively improved their research. Common engagement approaches varied in intensity and included interviews and focus groups, advisory committees, and stakeholder membership on research teams. Although participants expressed a desire-even a moral imperative-to increase stakeholder engagement, their efforts were limited by organizational constraints. Participants suggested that VA can support stakeholder engagement in research by reconceptualizing funding mechanisms, providing resources, and fostering an organizational culture that aligns with engagement principles. CONCLUSIONS:Experienced researchers perceived multilevel stakeholder engagement as both critical for implementation research and difficult to achieve. Findings highlight that stakeholder engagement is shaped not only by researcher commitment and skill but also by organizational constraints, incentives, and power structures. Results offer actionable suggestions for improving alignment between engagement activities, professional incentives, and organizational infrastructure that may strengthen stakeholder-engaged implementation research in VA and other healthcare settings.
BACKGROUND:Nutrition incentive programs (NIPs) that integrate fruit and vegetable (FV) incentives into Supplemental Nutrition Assistance Program (SNAP) Electronic Benefit Transfer (EBT) systems have strong potential for scaling in the United States, yet little is known about implementation from brick-and-mortar food retailers' perspectives. PURPOSE:To examine brick-and-mortar food retailers' perceptions and experiences with an NIP using SNAP EBT integration for FV incentives at the point of sale. METHODS:Guided by the Inner Context of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, an implementation science evaluation was conducted among 79 independent chain grocers implementing the NIP in Southern California. Leadership and staff were invited to complete an online survey (89% response rate) using validated tools (e.g. Implementation Leadership Scale), expert-developed items, and open-ended questions. The analysis included descriptive statistics and inferential tests that assessed response differences between leadership and staff. RESULTS:Of 538 respondents, most were female (76%) and Latino/a (94%). Perceptions and experiences with the NIP were favorable across EPIS Inner Context constructs, with some differences noted. Leadership support for implementation was rated highly overall, though staff scored items on supportive and knowledgeable leadership lower compared to leadership. While highly satisfied with NIP implementation overall, open-ended responses highlighted opportunities to optimize implementation across stores. CONCLUSIONS:Nutrition incentive programs integrating FV incentives into SNAP EBT systems appear well-suited to the brick-and-mortar food retail context. Findings can inform the design and testing of implementation strategies to support sustainment and scaling for population-level impact locally and nationally.
BACKGROUND:There is a need to scale up effective physical activity interventions among the general population, particularly those incorporating resistance training. Ecofit is a community-based, multicomponent intervention promoting resistance and aerobic physical activity through smartphone technology, the outdoor built environment, and social support. This study aimed to scale up ecofit by comparing Low versus Moderate implementation support on the reach (outdoor gym use) of ecofit within two large regional municipalities. METHODS:A hybrid type 3 implementation-effectiveness trial was conducted across two large municipalities in eastern Australia. Outdoor gyms (n = 18) were randomized to Low (ecofit app only) or Moderate [ecofit app, QR (quick response) codes on equipment, face-to-face workout sessions] implementation support. The primary outcome of "reach" was defined as the baseline-adjusted difference in the number of outdoor gym users (i.e. adults using outdoor gym equipment for resistance training) between groups. Reach was measured at baseline and 3-month follow-up using a modified System for Observing Play and Recreation in Communities tool, with blinded assessors observing community members perceived to be ≥18 years [categorized as Adults (aged 18-59) or Seniors (aged ≥60)]. Secondary outcomes included app uptake, dose received, implementation fidelity, and acceptability, feasibility, and dose-satisfaction regarding the app and guided sessions. RESULTS:There was no significant difference in people using outdoor gym equipment for resistance training between Low and Moderate support groups at 3-month follow-up [incidence rate ratio (IRR) = 1.68, 95% CI: 0.96-2.94]. Among adults (aged 18-59), the Moderate support group showed significantly higher outdoor gym use at follow-up (IRR = 1.83, 95% CI: 1.01-3.31) compared to the Low support group. Over 6 months, 1273 users registered for the app, completing 503 workouts, 62% of which occurred indoors. CONCLUSIONS:Ecofit shows promise for promoting resistance training, particularly among adults. Broader marketing and enhanced engagement strategies may be required to increase outdoor gym use and sustain participation over time.
