Predictors of implementation in the Faith, Activity, and Nutrition dissemination and implementation study: application of the Consolidated Framework for Implementation Research (CFIR) in a statewide initiative

Sara Wilcox; Danielle E Jake-Schoffman; Ruth P Saunders; Deborah Kinnard; Andrew T Kaczynski; Brent Hutto; Katherine L James

doi:10.1093/tbm/ibaa025

Predictors of implementation in the Faith, Activity, and Nutrition dissemination and implementation study: application of the Consolidated Framework for Implementation Research (CFIR) in a statewide initiative

Transl Behav Med. 2021 Mar 16;11(2):419-429. doi: 10.1093/tbm/ibaa025.

Authors

Sara Wilcox^{1

2}, Danielle E Jake-Schoffman³, Ruth P Saunders^{1

4}, Deborah Kinnard¹, Andrew T Kaczynski^{1

4}, Brent Hutto¹, Katherine L James⁵

Affiliations

¹ Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC.
² Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC.
³ Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL.
⁴ Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC.
⁵ South Carolina Conference of the United Methodist Church, Columbia, SC.

Abstract

Faith-based organizations, with broad reach and trust, are well-positioned to promote health. The purpose of the study was to examine 12-month implementation and its predictors in the statewide Faith, Activity, and Nutrition (FAN) dissemination and implementation (D&I) study. Churches (n = 93; 42% predominantly African American) in the [South Carolina] Conference of the United Methodist Church trained by Community Health Advisors participated in the study. Church FAN coordinators (n = 92) completed implementation surveys regarding opportunities, policies, messages, and pastor support for physical activity (PA) and healthy eating (HE) at baseline and 12 months. FAN coordinators and pastors (n = 93) completed CFIR-based measures at baseline, immediate post-training, and 12 months. Repeated measures ANOVAs tested change in PA and HE implementation composite scores; Cohen's d indicated magnitude of change. Mixed model linear regression tested whether CFIR items predicted 12-month implementation, controlling for baseline implementation. PA (d = 1.42) and HE (d = 2.05) implementation increased significantly over time. PA and HE implementation were significantly greater in predominantly African American (versus White) congregations, and HE implementation was greater in churches with <500 members. FAN coordinators' ratings of the inner setting (networks/communication, culture, tension for change, organizational rewards, readiness, and congregant needs) and implementation process (engaging opinion leaders and champions) domains were most predictive of implementation outcomes. Few pastor ratings related to implementation outcomes. This study identified constructs, guided by CFIR, that may be important for understanding PA and HE implementation in churches. Future studies will need to test them for replication. Greater changes in implementation outcomes among African American churches underscores the potential of promoting health equity through this setting.

Keywords: Churches; Dissemination; Faith-based; Implementation; Nutrition; Physical activity.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Black or African American
Diet, Healthy
Exercise
Faith-Based Organizations*
Health Promotion*
Humans

Abstract

Publication types

MeSH terms

Grants and funding