Browsing by Author "Johnson, Sarah Elizabeth"

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    Improving the functional fitness of older adults through Lifelong Improvements through Fitness Together (LIFT): Use of an integrated research-practice partnership approach in community and clinical settings
    Wilson, Meghan Loving (Virginia Tech, 2018-04-23)
    Older adults represent one of the fastest growing populations as well as one of the most inactive. The effects of inactivity (e.g., fall risk, reduced quality of life, inability to age in place) may be mitigated through health promotion programs that include strength-training components. In addition to targeted exercises, it is recommended that programs for older adults incorporate principles of group dynamics (e.g., group goal setting, group distinctiveness) as these types of interventions have previously increased adherence and compliance of physical activity beyond the life of the program and are more effective than individually delivered interventions (e.g., at home DVD, one-on-one). However, these programs are not readily adopted and sustained in practice, which could reflect a lack of programmatic fit within the intended delivery setting. Forming a partnership with key stakeholders within the intended practice setting (e.g., communities and clinics) to identify or develop an evidence-based program that satisfies the mission, values, and resources of the deliver setting, may influence program uptake and sustainability. It is essential to assess setting- and staff-level perceptions of program fit prior to successful implementation. Once interventions are embedded within the standards of care or practice, the intervention has the potential to reach a greater number of older adults and improve their functional fitness outcomes. These intervention attributes are outlined in the prominent RE-AIM Framework: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Taken together, practice- and research- adaptations may increase the adoption of an intervention, and it is necessary to also measure the degree to which an adapted program impacts Reach, Effect, Implementation, and Maintenance. Practice- and evidence-based adaptations are often necessary and inevitable to improve intervention fit within an intended delivery setting. The overall objective of this dissertation was to use an integrated research-practice partnership approach to select, adapt, and evaluate effects of a multi-faceted strength-training program for older adults in community and clinical settings. The aim of Manuscript 1 was to describe the process by which an evidence-based intervention was adapted to meet the needs of a community entity as well as the initial Adoption, Implementation, and Maintenance dimensions of the RE-AIM framework. Manuscript 2 aims to evaluate the initial Reach of older adults and Effect on functional fitness of the adapted program, LIFT, to generate evidence in support of the adapted intervention through an integrated research-practice partnership with a community entity. Manuscript 3 outlines the development, processes, and temporal outcomes of an integrated research-practice partnership approach aimed at linking stakeholders across the academic-clinical-community continuum to assess feasibility, acceptability, and appropriateness outcomes associated with Implementation of a LIFT referral scheme. Based on the research presented in this dissertation, it is concluded that an integrated research-practice partnership, although time intensive, may be an effective approach to report real-world adaptations based on the needs of the delivery setting without compromising effects of an evidence-based strength-training intervention for older adults.
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    Pragmatic Implementation Trials: Understanding the Integrated Research-Practice Partnership Approach to Lifestyle Obesity Management Across a Transforming Health System
    Johnson, Sarah Elizabeth (Virginia Tech, 2017-01-10)
    Obesity, a condition of excess body fat, is one of the most complex problems facing health systems. Lifestyle management programs that combine diet, physical activity, and intensive behavioral therapy have been shown by research to support a degree of weight loss that produces health benefits (i.e., at least a 3-5% initial body weight). However, it has been difficult for research-developed programs to be delivered in typical practice to have a meaningful impact. Integrated research-practice partnerships that involve the coming together of academic researchers, health system administrators, and program delivery staff may help overcome this gap, especially during this transformational time in the healthcare sector. This dissertation aimed to develop an understanding of how using the integrated research-practice approach would facilitate and sustain evidence-based lifestyle management strategies across a health system to treat obesity among patients and employees. An integrated research-practice partnership with Carilion Clinic, a health system in western Virginia, served as an example for the study. From 2013-2016, the Carilion Clinic integrated research-practice partnership conducted a series of trials testing different strategies for delivering weight loss and weight loss maintenance support. An evaluation guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was conducted to describe implementation processes and outcomes for each strategy. Lessons learned from the evaluation support the value of the integrated-research practice partnership approach as a solution for overcoming gaps in obesity care. A shared priority perspective between research and practice was identified as the powerful process for supporting facilitation and sustainability of strategies. In addition, findings from the evaluation produced evidence to inform the future development of a system for Carilion Clinic to help patients and employees lose weight and keep it off through lifestyle management.