Jacqueline Kerr, Associate Professor Michelle Takemoto, PhD Candidate

1. Translating What We Have Learned into Practice & Policy:Developing a Sustainable Peer-Led Physical Activity Program for Seniors Jacqueline Kerr, Associate Professor Michelle Takemoto, PhD Candidate Dept Family Medicine & Public Health, UCSD

2. RC & SCSetting

3. NHLBI R01s: Multi level cluster RCTs Maps, community projects Peer leaders, group education Pedometers, counseling

4. Retirement CommunityWalking Results Phone counseling Joint leadership Peer leadership Minutes of walking

5. Walking programlessons learned • Counseling was effective, but focus on 3 month goal was detrimental • Transitioning leadership was challenging • Sites & staff who wanted to continue the program beyond 12 months did not value the components and did not have the capacity to continue the program

6. Walkability results • Projects included improvements within the retirement community or the surrounding neighborhood • Worked with the pedestrian advocacy organization, WalkSanDiego • Successes included: • Cleaner pedestrian bridges • Safer crosswalks • Unobstructed sidewalks

7. Animations

8. Walkability lessons learned • Older adults highly respected voters and great advocates • Pedestrian advocacy organization and local planners helped frame the scope of projects • UCSD had to oversee walkability implementation • Photos of successes are powerful • Animated GPS points are motivating for planners and policy makers

9. Differences in Retirement Community vs Senior Center approach

10. Senior Center RCT design • Hybrid type II effectiveness-implementation trial • Physical activity & functioning • Implementation measures • 18 month sustainability randomization • Followed to 24 months • Cost effectiveness compared to no treatment control

11. Conceptual Model of Implementation Research • Proctor, E.K., et al., Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health, 2009. 36(1): p. 24-34.

12. Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors • Aarons, G.A., M. Hurlburt, and S.M. Horwitz, Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health, 2011. 38(1): p. 4-23.

13. Implementation mixed methods Program setting Program content Program deliverers Program users Training Inner/outer context: • Appropriateness • Perceived fit • Acceptability • Satisfaction • Adoption/Reach • Feasibility • Actual fit Directors Staff Coaches Participants

14. Fidelity monitoring • Web database available via tablets • Track activities • Coaches • Staff • UCSD • Prompt activities • Feedback • Coaches • Participants

15. Walking program lessons learned • In person counseling by peers • Improved interaction • Peers working on same PA goals • Feasible intervention dose for counseling • Color coding to identify goal setting • Working with those most in need • Rolling recruitment helps with motivation • Analysis challenge

16. Capacity building lessons learned • Community Advisory Board broadens context • More structured & on-going training • Training others • Peer networking events • Empowerment • Ownership, valuable volunteer activity, community responsibility • Beyond single community projects

17. Community partnerships • Mayor attending group walk • Sponsorships by businesses • Attending and joining local committees • Attending other organizations’ training • America Walks walking college • Safe routes to school • Charity walks

18. Sustainment lessons learned • Continuous quality improvement • From tablet data, interviews • Sustainability from beginning with director, staff & peer involvement • Obtaining funding

19. Policy applications

20. These amazing leaders, using their own words, do the best job motivating each other & others!