Implementation-effectiveness trial of an ecological intervention for physical activity in ethnically diverse low income senior centers

Porchia Rich, Gregory A Aarons, Michelle Takemoto, Veronica Cardenas, Katie Crist, Khalisa Bolling, Brittany Lewars, Cynthia Castro Sweet, Loki Natarajan, Yuyan Shi, Kelsie M Full, Eileen Johnson, Dori E Rosenberg, Melicia Whitt-Glover, Bess Marcus, Jacqueline Kerr, Porchia Rich, Gregory A Aarons, Michelle Takemoto, Veronica Cardenas, Katie Crist, Khalisa Bolling, Brittany Lewars, Cynthia Castro Sweet, Loki Natarajan, Yuyan Shi, Kelsie M Full, Eileen Johnson, Dori E Rosenberg, Melicia Whitt-Glover, Bess Marcus, Jacqueline Kerr

Abstract

Background: As the US population ages, there is an increasing need for evidence based, peer-led physical activity programs, particularly in ethnically diverse, low income senior centers where access is limited.

Methods/design: The Peer Empowerment Program 4 Physical Activity' (PEP4PA) is a hybrid Type II implementation-effectiveness trial that is a peer-led physical activity (PA) intervention based on the ecological model of behavior change. The initial phase is a cluster randomized control trial randomized to either a peer-led PA intervention or usual center programming. After 18 months, the intervention sites are further randomized to continued support or no support for another 6 months. This study will be conducted at twelve senior centers in San Diego County in low income, diverse communities. In the intervention sites, 24 peer health coaches and 408 adults, aged 50 years and older, are invited to participate. Peer health coaches receive training and support and utilize a tablet computer for delivery and tracking. There are several levels of intervention. Individual components include pedometers, step goals, counseling, and feedback charts. Interpersonal components include group walks, group sharing and health tips, and monthly celebrations. Community components include review of PA resources, walkability audit, sustainability plan, and streetscape improvements. The primary outcome of interest is intensity and location of PA minutes per day, measured every 6 months by wrist and hip accelerometers and GPS devices. Secondary outcomes include blood pressure, physical, cognitive, and emotional functioning. Implementation measures include appropriateness & acceptability (perceived and actual fit), adoption & penetration (reach), fidelity (quantity & quality of intervention delivered), acceptability (satisfaction), costs, and sustainability.

Discussion: Using a peer led implementation strategy to deliver a multi-level community based PA program can enhance program adoption, implementation, and sustainment.

Trial registration: ClinicalTrials.gov, USA ( NCT02405325 ). Date of registration, March 20, 2015. This website also contains all items from the World Health Organization Trial Registration Data Set.

Keywords: Cost-effectiveness; Low-income; Older adults; Peer led; Randomized control trial; Walking.

Conflict of interest statement

Ethics approval and consent to participate

Ethics approval was granted by the Human Research Protections Program of the University of California, San Diego (Protocol #150336). Participants provided written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study design and procedural flow
Fig. 2
Fig. 2
Conceptual model of intervention delivery, mediators and moderators

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