The Land-Grant University Cooperative Extension (herein: Extension) system has been an underutilized resource for physical activity programming. With the recent addition of physical activity as a focus of Extension work, efforts are needed improve dissemination and implementation of evidence-based physical activity interventions. Improving implementation requires overcoming limitations including institutional support and perceptions of Extension health educators who could develop, deliver, and evaluate these programs. A participatory approach that includes input at all delivery levels (program participants, delivery agents, and administrators) can aid implementation through considering program acceptability, appropriateness, and feasibility from the beginning. This dissertation includes three manuscripts that explore the Extension's role in promoting physical activity in older adults, both in the United States and abroad. Manuscript 1 detailed a systematic review of community-based older adult physical activity programs that was conducted in order to determine the characteristics of effective older adult physical activity programs and the extent to which programs implemented in Extension systems nationwide employ these characteristics. The results indicated notable differences between peer-reviewed literature and Extension programs as well as presented an opportunity for Extension programs to more effectively use evidence-based program characteristics, including behavioral theories and group dynamics. The results also suggested that Extension programs could more effectively report their findings through peer-reviewed sources so that effective programs can be disseminated to reach a broader population. Manuscript 2 was an exploratory study conducted as a first step in bringing older adult physical activity programming to Ghana through Extension. Results of the mixed-methods study suggested that older adults in Ghana have mostly positive perceptions of physical activity and would be receptive to an in-person physical activity program. In particular, without specific prompting on principles of group dynamics, across all focus groups, participants mentioned aspects of groupness ranging from the need for accountability to the enjoyment of exercising with others. The results also indicated a need for education on Ministry of Health physical activity recommendations and how to meet them. These findings can be used as the first step to adapting and delivering an evidence-based intervention in Ghana through an integrated research-practice partnership. This approach includes community-level decision making to ensure the resultant program is a good fit in the intended delivery system. Manuscript 3 detailed the translation of an evidence-based older adult physical activity program to an Extension system in a rural state (population 585,501). Results suggested that Extension health educators have overall positive perceptions of physical activity programming, but they experience barriers in delivering these programs. While the program has the potential to reach a representative sample of the population, the adoption rate among Extension health educators was low, and system-wide changes may be needed to improve physical activity program adoption rates among educators. Overall, results of the three manuscripts provided evidence and recommendations for Extension professionals to improve physical activity program implementation through using evidence-based interventions and characteristics, considering perceptions of end users prior to program implementation, and considering system-level changes that promote physical activity program adoption. / Ph. D. / The United States Department of Agriculture funds a national Cooperative Extension system. This system brings Land-Grand University evidence to the people. Physical activity was recently added as a focus of Extension programming, but work is needed improve the dissemination and implementation of evidence-based physical activity interventions. To improve implementation, barriers such as institutional support and perceptions of Extension professionals need to be addressed. A shared decision-making approach that includes input from multiple groups (those who participate in programs, teach or organize programs, and make decisions about programs) can help with implementation. This approach considers program acceptability, appropriateness, and feasibility from the beginning. This dissertation includes three manuscripts about promoting physical activity in older adults through Extension. This work takes place both in the United States and abroad. Manuscript 1 was a review of older adult physical activity programs that are based in communities. It identifies traits of programs that are shown to be effective. This is compared to similar programs done through Extension throughout the U.S. Results demonstrated differences between effective programs with published results and programs done through Extension. Extension could be more effective by using program characteristics that are backed up by evidence. This included using theories that explain how people change their behavior and using group strategies. Results also suggested that Extension programs could do better publishing their results so others can learn about them. Manuscript 2 was a study about perceptions of physical activity among older adults in Ghana. Results of the surveys and group interviews suggested that older adults in Ghana have mostly positive perceptions of physical activity and that they would like an in-person physical activity program. Participants were especially interested in a group-based program. In each focus group, participants shared the need for accountability and that they enjoyed being active with friends and family. The results also showed a need for education on government physical activity guidelines and how to meet them. These findings can be used as the first step to adapting and delivering a physical activity program in Ghana through a partnership between researchers and those who will teach or organize the program. This approach includes community-level decision making to make sure the program is a good fit in the intended delivery system. Manuscript 3 was a study about bringing an effective older adult physical activity program to Extension in a rural state (population 585,501). Results suggested that Extension health educators have positive views of physical activity programs, but they perceive barriers in delivering these programs. The program that was studied reached older adults who needed it, but most Extension health educators did not want to deliver the program. Changes to the Extension system may be needed to help more educators deliver physical activity programs. Overall, results of the three manuscripts provided evidence and suggestions for Extension staff to improve physical activity program implementation through using evidence-based programs and characteristics, thinking about the perceptions of end users prior to starting a program, and making system-level changes that promote physical activity program adoption.
| Identifer | oai:union.ndltd.org:VTETD/oai:vtechworks.lib.vt.edu:10919/82843 |
| Date | 17 April 2018 |
| Creators | Balis, Laura Elizabeth |
| Contributors | Human Nutrition, Foods and Exercise, Harden, Samantha M., Davy, Kevin P., Serrano, Elena L., Wardlaw, Mary Kay |
| Publisher | Virginia Tech |
| Source Sets | Virginia Tech Theses and Dissertation |
| Detected Language | English |
| Type | Dissertation |
| Format | ETD, application/pdf |
| Rights | In Copyright, http://rightsstatements.org/vocab/InC/1.0/ |
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