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Purpose. The purpose of this study was to evaluate an ongoing statewide weekend backpack program through the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Design. Mixed-methods inquiry was used to explore the reach, effectiveness, adoption, implementation, and maintenance of backpack programs within Montana. Setting. Study participants completed audio-recorded one-on-one phone interviews. Participants. Key informants (e.g., managers at food banks, staff at participating schools, policy makers) were purposively sampled (N = 20). Method. Semistructured interviews were conducted to gather data to describe each RE-AIM dimension. Interviews were transcribed verbatim and deductively (i.e., using RE-AIM as themes) coded for meaning units, placed into higher-order categories, and summarized in narrative. Supporting quantitative data (e.g., the proportion of eligible students that joined the program, rate of school-level adoption) were calculated using descriptive statistics. Results. Backpack programs with a broad reach and evidenced effect may be appealing to adopt. Weekend food bags cost an average $3.87 (SD ± .94) and there were some positive (i.e., ease, protecting participants' privacy) and very few negative (logistical) components of implementation. Collaborators and community partners are necessary for long-term sustainability. Conclusion. Backpack programs are widespread and have potential to relieve weekend hunger; however, more efforts need to be made to end childhood hunger.

Cooperative Extension Service (Extension) Agents are
tasked with incorporating physical activity promotion in their work. Physical activity
training interventions rarely report specific structures (dose, content) and measures
(fidelity, resource cost). The study's purpose was to evaluate the feasibility and
resource costs of Physical Activity in Cooperative Extension (PACE), a training to
increase physical activity in public health competency. PACE is a virtual, 9-week,
18-hour general capacity-building training based on the Interactive Systems Framework.
Fidelity was calculated as the proportion of objectives delivered as intended and total
time to deliver core components. Resource cost was calculated as the time spent on each
implementation strategy and responsibility and total time spent delivering PACE.
Fidelity was 93% (39/42 planned objectives delivered as intended). PACE required 183
hours to implement, with session delivery (45 hours) and participant communication (40
hours) requiring the most time. Overall, time spent included 37 hours per delivery team
member and 18 hours per PACE participant. The personnel time spent was within the
standard time spent on other Extension training protocols and perceived as feasible.
Fidelity to session components was high and easy to track. Future work should determine
the scalability and sustainability of PACE within Extension nationally.

Extension has recently begun delivering physical activity programs, but delivering evidence-based interventions is a challenge. To increase adoption of evidence-based interventions, a better understanding of agents' perceptions and needs is necessary. The purpose of this research was to conduct a readiness assessment to identify organizational factors and agent perceptions that speed or impede uptake of evidence-based physical activity programs. Data were gathered from agents through a sequential mixed-methods design informed by the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. A survey assessed current work status, demographic variables, physical activity levels, and time spent on programming tasks. Semi-structured focus group questions included current physical activity programs, integration of physical activity into current programs, and barriers and facilitators of physical activity programming. Agents were willing to adopt physical activity programs into their schedule but experienced barriers. Notably, agents perceived a lack of training and evaluation tools for measuring impact. As for organizational factors, "physical activity" was not in their job descriptions, and integrating physical activity with nutrition programs was perceived as a better fit within the USDA-funded system. Understanding the factors that impede adoption is critical for ensuring physical activity program uptake to influence public health behaviors.

A dimensão Implementação do RE-AIM avalia a fidelidade ao protocolo de tratamento e seus custos relacionados. Neste estudo, um programa comunitário de atividade física e consumo de frutas e vegetais baseado em evidências foi implementado por educadores em saúde no âmbito do Sistema de Extensão Cooperativa. O objetivo deste estudo foi determinar: 1) a medida em que os educadores em saúde aderiram aos princípios subjacentes e 2) o tempo necessário para planejar, recrutar e executar a intervenção. Dezesseis educadores em saúde (100,0%) que aplicaram o programa completaram um questionário que incluiu itens sobre os requisitos de tempo e protocolo de tratamento. Verificou-se que os educadores em saúde aderiam aos três princípios subjacentes do programa, como observado através da criação de grupos (100,0%), coleta do alcance de metas dos grupos (80,1%, SD+0,08%), e fornecimento de feedback (72,5%, SD+0,16%) ao longo de 8 semanas do estudo. No entanto, quando o programa se aproximou do final (semanas 6-8), houve uma redução significativa (p<0,05) no fornecimento de feedback para as equipes. Os educadores em saúde passaram mais tempo na coleta de quilômetros percorridos por cada equipe (12,4 SD+18,8 horas), na coleta de informações dos participantes (9,47 SD+19,8 horas), se comunicando com os participantes (9,32 SD+13,7 horas) e no desenvolvimento de materiais locais para boletins informativos (5,7 SD+3,79 horas). Os componentes do programa que os educadores em saúde passaram a menor quantidade de tempo foram na preparação dos pacotes para os lideres de cada equipe (0,909 SD+2,7 horas), na condução de atividades (2,54 SD+7,17 horas) e no acompanhamento dos lideres (3,09 SD+2,81 horas). Este estudo indica que o tempo necessário para o programa Fit Extension se adequou às expectativas dos educadores em saúde. Pesquisas futuras são necessárias para comparar a fidelidade da implementação e estruturas que possam promover a sustentabilidade do programa.

Evidence-based program repositories (EBPR) report intervention characteristics and how to implement the intervention. These EBPR are a dissemination strategy to address questions such as, "I have cancer, what programs can I join?" or "What evidence-based programs for weight loss are a good fit for my community?" However, these EBPR fall short of realizing their potential and are not seen as particularly interactive, robust, or relevant to stakeholders who may benefit from their content. We propose 2 solutions for existing EBPR to enhance dissemination of evidence-based information. Addressing this critical dissemination need is one strategy for health promotion.

Extension enhances the lives of Americans by translating research-based information related to existing needs into programming that is practical and accessible to the general public. Evidence clearly indicates that physical activity is correlated to positive health outcomes, but despite this conclusion, the majority of Americans do not meet the recommendations for physical activity. The 2nd Edition of the Physical Activity Guidelines for Americans provides guidance for Extension professionals to implement physical activity interventions. We recommend training and technical assistance strategies based on the Interactive Systems Framework to integrate physical activity promotion into all Extension areas.

Improving the nation's health will require collaboration among many stakeholders and systems, including representatives from Cooperative Extension Services (CES). This paper describes the process of establishing a multistate collaboration and discusses initial outcomes of a third-party facilitated participatory planning meeting. State-level specialists with expertise and responsibilities in "health" promotion participated. Satisfaction with meeting format; feasibility, acceptability, and appropriateness of the proposed approach to public health impact; and general meeting feedback were collected through a survey and cultural artifacts (e.g., notes, worksheets). Preparation and attendance costs were captured. Seventeen of the 20 attendees (85%) responded to the survey and reported the process was satisfactory and the proposed plan for moving forward was feasible, acceptable, and appropriate. The meeting cost was $1,011 per attendee. The process mobilized a multistate Extension collaborative to promote health but revealed potential cost-benefit challenges. Leveraging resources is necessary to plan, implement, and measure collaborative public health efforts. Future data on outcomes will show if the process leads to intended objectives. If successful, this approach can be replicated across CES for stronger impacts.

Purpose: The Cooperative Extension System (Extension) has implemented concerted efforts toward health promotion in communities across the nation by acting as an intermediary between communities and universities. Little is known about how these intermediaries communicate and learn about existing evidence-based programming. This study serves to explore this gap by learning about information sources and channels used within Extension. Design: Sequential explanatory mixed methods approach. Setting: National Cooperative Extension System. Participants: Extension community-based health educators. Methods: A nationally distributed survey with follow-up semistructured interviews. Survey results were analyzed using a Kruskal-Wallis 1-way analysis of variance test paired with Bonferroni post hoc. Transcripts were analyzed by conventional content analysis. Results: One hundred twenty-one Extension educators from 33 states responded to the survey, and 18 of 20 invited participants completed the interviews. Educators' information seeking existed in 2 forms: (1) information sources for learning about programming and (2) channels by which this information is communicated. Extension educators reported contacting health specialists and other educators. Extension educators also reported using technological means of communication such as e-mail and Internet to reach information sources such as peers, specialists, academic journals, and so on. Conclusion: Extension state specialists were preferred as primary sources for intervention information, and technology was acknowledged as an easy contact channel. This study identifies county-based health educators' information structures and justifies the need for future research on the role of specialists in communication efforts for educators.

The need for physical activity promotion is ubiquitous, and offering physical activity interventions in community settings may reach people where they live, work, and play. Reaching people and providing evidence-based programming is exactly what the Cooperative Extension System has accomplished over the last century. In 2014, federal policy brought physical activity promotion into the mission of Extension. Although this policy marks the beginning of concerted efforts for physical activity promotion, several states have had strong success in this area. Borrowing from these efforts, this paper reports strengths, challenges, and opportunities for physical activity promotion in Extension.

Purpose: To examine if employee health literacy (HL) status moderated reach, retention, and weight outcomes in a worksite weight loss program. Design: The study was a two-group cluster randomized controlled weight loss trial. Setting: The study was conducted in 28 worksites. Subjects: Subjects comprised 1460 employees with a body mass index >25 kg/m2. Interventions: Two 12-month weight loss interventions targeted diet and physical activity behaviors: incentaHEALTH (INCENT; incentivized individually targeted Internet-based intervention) and Livin' My Weigh (LMW; less-intense quarterly newsletters). Measures: A validated three-item HL screening measure was self-completed at baseline. Weight was objectively assessed with the Health Spot scale at baseline and 12-month follow-up. Analysis: The impact of HL on program effectiveness was assessed through fixed-effect parametric models that controlled for individual (i.e., age, gender, race, ethnicity, income, education) and worksite random effects. Results: Enrolled employees had significantly higher HL status [13.54 (1.68)] as compared to unenrolled [13.04 (2.17)] ( p < .001). This finding was consistent in both interventions. Also, HL moderated weight loss effects ( beta = .66; SE = 027; p = .014) and losing >5% weight ( beta = −1.53; SE = .77; p < .047). For those with lower baseline HL, the INCENT intervention produced greater weight loss outcomes compared to LMW. The HL level of employees retained was not significantly different from those lost to follow-up. Conclusion: HL influences reach and moderates weight effects. These findings underscore the need to integrate recruitment strategies and further evaluate programmatic approaches that attend to the needs of low-HL audiences.