Supporting Evidence-based Practice : Center of Excellence for Training and Research Translation

SIP 10-04 Cooperative Agreement Number U48-DP000059Centers for Disease Control and Prevention

Division for Heart Disease and Stroke PreventionDivision of Nutrition, Physical Activity and Obesity

Center TRT – Promoting Evidence-based Practice

Brief Overview and HistoryTraining practitioners

◦Obesity Prevention Course◦Web-based Training

Translation and Dissemination ProductsTranslation and Dissemination MethodsQuestions and Discussion

Center TRT LeadershipPrincipal Investigator:

◦Alice Ammerman, RD DrPH

Co-Investigators:◦Jennifer Leeman, DrPH, MDIV◦Tom Keyserling, MD, MPH

Project Director:◦Janice Sommers, MPH

CDC Technical Advisors from DNPAO◦Claire Heiser, MS, RD◦Diane Thompson, MPH, RD

Center TRT Staff

Nancy AycockAvia MainorKelly NorbySusanne SchmalJanice SommersMay May Leung (not pictured)

National Advisory Board

Their Advice…..Use a broad definition of evidence and

include evidence from practice in the translation model

The potential public health impact of an intervention is a result of more than effectiveness

Include a feedback loop that provides an opportunity for practice to inform research

Invest time and energy in obtaining input from primary audience (intended users)

2005-06 Website: designed, tested, launched

2004 Infrastructure takes root: Staff, Coordinating Committee,National Board

2005 Formative work: surveys and focused discussion with state staff, literature reviews, web searches, lots of meetings

2005-09 Training Courses: Nutrition and Public Health, Obesity Prevention, WW Short Courses

2005-06 Methods Developed: criteria, review tools, processes for review, methods for literature reviews

2008-09 Disseminate Evidence: web-based training, contributing factors, strategies, interventions

Growing the Center-TRT

2007-09 Interventions reviewed and templates developed

Center TRT TRAINING

Primary Audience is State-level Program staff

Develop training competencies Conduct training needs assessments Develop a training plan Provide training for state-level

WISEWOMAN and Obesity Prevention Program staff

Evaluate impact of trainings on practice

Training

Training

Obesity Prevention in Public Health2005: Program Coordinators (29)2006: Nutrition Coordinators (44)2007: Physical Activity Coordinators (35)2008: Open to new state staff (31)

Obesity Prevention in Public Health Course: 2009

DATES: August 23 – 28 at the Rizzo Center in Chapel Hill, NC

NEW Curriculum focused on leadership development for NPAO State Coordinators

APPLICATIONS are being accepted; we have a number of scholarships available for unfunded states

www.center-trt.org

Cover the basics to allow more advanced material during in-person trainings

Extends the reach of Center TRT Easily accessed at any time (great staff

orientation) Interactive and self-paced Low cost to participant (time only; no

travel, no registration fee)

Nutrition, Physical Activity, and Chronic Disease Series

Nutrition and Health Physical Activity and Health Nutrition, Physical Activity and Cardiovascular Health (April 2009) Obesity Prevention in Children (Summer 2009)

Physical Activity Module

Required ReadingsLesson 1: Terms and Definitions Lesson 2: Recommendations & RationaleLesson 3: Barriers Lesson 4: Science to PracticeSupplemental Materials

RE-AIM Online! Reach, Effectiveness, Adoption,

Implementation and Maintenance

Required Readings

Lesson 1: Introduction to RE-AIM

Lesson 2: RE-AIM for Behavior Change

Lesson 3: RE-AIM for Policy/Environmental Change

Lesson 4: Putting it All Together

Available Summer 2009

Nutrition and Health Demonstration

Intervention-Specific Implementation Trainings

NAPSACC

Online LifestyleAssessments

www.center-trt.org

Web-based TrainingThe 2008 Numbers

• 595 users registered for the modules

• 305 completed the post tests▫ 82 – NAPSACC (4/08) ▫ 97 – Physical Activity and Health

(6/08)▫ 126 – Nutrition and Health (6/08)

Phase 1: Evidence Identification and

Review

Phase 2: Intervention Abstraction

Phase 3: Dissemination

Phase 4: Research – Practice Integration

Center TRT Translation and Dissemination Framework

Phase 3: DisseminationIntervention Resources

• Evidence to support development of interventions• Contributing Factors (target areas)• Intervention Strategies (approaches)

• Interventions that can be adapted• Research-tested • Practice-based • Emerging

www.center-trt.orgwww.center-trt.org

www.center-trt.org

Center-TRT.org UsersThe 2008 Numbers

• Users in every state and the District of Columbia. Visitors from North Carolina were among the most frequent users.

• People from 79 different countries with users in the US, Canada, United Kingdom and Australia, the most frequent visitors

• 5,725 NEW users, defined as first-time-ever visitors and an additional 6,000 unique but not new visitors

Center-TRT.org Center-TRT.org DownloadsDownloadsThe 2008 NumbersThe 2008 Numbers

7,926 documents were downloaded from the website.

New Leaf, Choices for Healthy Living and the Nutrition and Physical Activity Self-Assessment for Childcare (NAPSACC) are UNC developed and tested interventions and were the most frequently downloaded interventions from the site!

Center TRT Translation Methods

A Model for Balancing Evidence of Effectiveness with Other Practice-

relevant Evidence

Phase 1: Evidence Identification and Review

Evidence

Contributing Factors

Intervention Strategies

Research-Tested Interventions

Practice-Based Interventions

Source

Systematic Reviews

Systematic Reviews and Other Consensus Documents

Research Studies

Evaluation in real-life conditions

Criteria for Review of Interventions

Potential public health impactDissemination readinessEvidence in support of its

effectiveness

Review Criteria: Potential Public Health ImpactREACH and representation

EFFECTIVENESS, especially in groups disproportionately affected

Evidence of and Potential for ADOPTION, IMPLEMENTATION, and MAINTENANCE in public health practice.

Glasgow et al., 2003

Review Criteria: Dissemination ReadinessIntervention/policy described sufficiently

to allow replication

Materials/supporting documents are available for download and of useable quality

A knowledgeable contact person is available

Review Criteria: Evidence for its Effectiveness

Research-Tested Interventions

Assess strength of reported methods for

Sampling

Design

Measurement

Analysis

Interpretation of Results

Review Criteria: Evidence for its EffectivenessPractice-Based Interventions

Use of an evidence-based intervention strategy

Formative work with stakeholder groups & intended audience

Logic and theory

Methods for evaluating processes and outcomes

Review Criteria: Evidence for its Effectiveness

Practice-Based Interventions illustrate how practitioners working within the constraints of a real world setting implemented an evidence-based strategy in practice.

Review ProcessApplication from Developer

Stop

NO

Review ProcessReview ProcessExpert PanelExpert Panel

NO

Stop

In the pipeline…In the pipeline…

Food Access

Food Pricing Policy

Play Space

Afterschool policy

Worksite Wellness Incentives

Questions, Counterpoints, Discussion….