Running Head: EVIDENCE-BASED PROGRAMS

Evidence-Based Programs for Health Enhancement:

From the Laboratory to the Community
Cheryl M. Hubert
Pima Medical Institute
January 10, 2016

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A recent article in Gerinotes, a journal of the Academy of Geriatric Physical
Therapy, offers this definition of evidence-based programs. Evidence-based programs
are research-supported programs to promote health and prevent disease and include
components for behavior change and self-management (Betz, 2015, p. 30). This
review will explore the complexities of bringing research from the laboratory to the
public sector.
Widespread public health initiatives must provide conservative recommendations
to be safe for the general public. One size, as the saying goes, does not fit all. Health
officials recognize that special initiatives have to be instituted for major health risk
categories, such a heart disease, diabetes, or arthritis; or for special populations, such
as older adults, children, or low-income. These special initiatives require programs that
are supported by research to promote health and prevent disease in target populations.
Evidence-based programs are programs that are created for a target population
and have been proven safe and effective in randomized controlled trials. Many are
supported by federal funding as more and more emphasis is placed on providing
programs that are based on solid evidence. Communities seek out programs that are:
proven to make an impact, easy to replicate, consistently implemented, and maintain
ongoing data collection.
This research focuses on the development of such community interventions,
beginning from clinical evidence and expanding into well-tested packaged programs.
The information from these sources will be an integral part of a video presentation to
promote the creation and use of evidence-based programs for health enhancement to
rehabilitation professionals and community organizations.

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Betz (2015) offers several descriptions of existing programs, listed in the
categories of chronic disease, physical activity, falls prevention, and behavioral health.
Her article, What are evidence-based exercise programs and why are they important? is
a resource to government agencies providing guidance on development and
implementation, as well as requirements for specific agency approval.
Translating research from the lab to the community requires creation of a
research design that considers treatment fidelity, outcomes that are meaningful to the
consumer, and program reach. Prohaska & Etkin (2010) stress that research must not
only meet the needs of the consumer, but also the needs of the organizations
implementing the program. Programs must be designed to be applied consistently, with
training and tools for process evaluation. Cost effectiveness and the availability of
resources, settings, and access to target populations must be considered. A useful
framework for evaluating the impact of research interventions throughout the translation
from clinic to community is the RE-AIM framework (Belza & PRC-HAN, 2007; Prohaska
& Etkin, 2010). RE-AIM is a tool to help program planners and policy makers implement
interventions to promote healthy behavior in the public sector. RE-AIM is an acronym
for the 5 critical elements of program development: Reach, Effectiveness, Adoption,
Implementation, and Maintenance. (see figure 1 on page 7)
Reach refers determining the needs of the demographic of the area and
providing access to people who would benefit by being users of the program.
Effectiveness of the desired outcomes is verified by continued research to ensure that
the gains received in the experimental setting carry over consistently when the
intervention is presented in community programs. Adoption, Implementation, and

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Maintenance depend greatly upon the ultimate providers of the program in each
community. Providers must have the resources, staff, and space to implement the
program as designed for Adoption, Implementation, and Maintenance to take place.
Training and tools for data collection and participant recruitment are vital to maintaining
consistency in delivery. Maintenance is measured in long-term gains achieved by
participants, as well as the ability of the providers to offer the program repeatedly and
consistently (Belza & PRC-HAN, 2007).
Translation of research to the community requires partnerships among
government agencies, community coalitions, community-based organizations, and
institutions to secure funding, provide venues and equipment, recruit participants,
promote programs, and provide staffing to operate the programs. Cheadle, Egger,
Logerfo, Schwartz & Harris (2010) present a case study of the organizing strategy used
by the Southeast Seattle Senior Physical Activity Network (SESPAN) to disseminate
evidence-based programs to increase the physical activity of older adults, especially in
the low-income, multicultural and underserved communities.
Even after an evidence-based program is introduced into the community, further
research is carried out to determine if the program can be beneficial to other groups or if
further refinement of the program is necessary to reach a certain demographic. For
example, Greenwood-Hickman, Rosenberg, Phelan, & Fitzpatrick (2015) investigated
whether two community fitness programs, designed to improve physical functioning in
older adults, could also be effective in reducing falls resulting in medical care. Using a
retrospective cohort design, health insurance cooperative members over age 65 were
categorized into groups of consistent users, intermittent users and non-users of Silver

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Sneakers (SS) or EnhanceFitness (EF), two evidence-based fitness programs that are
widely available. Since physical activity has been known to decrease fall risks, it was
expected that both physical activity programs would prove effective in limiting
healthcare related falls. The study found that both consistent and intermittent users of
EnhanceFitness showed a significant reduction of falls over the non-user group.
Randomized controlled trials that are done during the experimental phase are
often from a less diverse population and exclude people with multiple co-morbidities.
Efficacy studies during the translation to community phase can ensure that the
programs have external validity. Wilcox, et al. (2006) describe the testing done during
the first year after introducing two evidence-based fitness programs, designed to help
senior citizens become more active. A pretest-posttest design was used to measure the
programs effect on the participants self-reported physical activity, satisfaction with body
appearance and function, depressive symptoms, perceived stress, and body mass
index. The testing included participants recruited from 12 geographic sites and will
continue for 3 more years.
These six articles describe the process for development and implementation of
evidence-based community health programs. They all provide practical examples of
existing programs and how they fill particular needs of special population groups. This
information provides a broad view of the importance of such programs and the type of
research conducted though the various stages of development and implementation. My
capstone project will be a presentation of this material using a whiteboard animation
film. I hope that the film will inspire rehabilitation professionals to perform research to
be applied for public programs and inspire community organizations to apply their

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research to the communitys needs by sponsoring evidence-based programs in their
communities.

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References
Belza, B. & PRC-HAN Physical Activity Conference Planning Workgroup (2007). Moving
ahead: Strategies and tools to plan, conduct, and maintain effective communitybased physical activity programs for older adults. Centers for Disease Control and
Prevention: Atlanta, Georgia. Obtained from:
http://www.cdc.gov/aging/pdf/CommunityBased_Physical_Activity_Programs_For_Older_Adults.pdf.
Betz, S. (2015). What are evidence-based exercise programs and why are they
important? Gerinotes, 22(6), p 30-33.
Cheadle, A., Egger, R., Logerfo, J., Schwartz, S., & Harris, J. (2010). Promoting
sustainable community change in support of older adult physical activity: Evaluation
findings from the Southeast Seattle Senior Physical Activity Network (SESPAN).
Journal of Urban Health, 87(1), 67-75. doi:http://dx.doi.org/10.1007/s11524-0099414-z.
Greenwood-Hickman, M., Rosenberg, D., Phelan, E. & Fitzpatrick, A. (2015).
Participation in older adult physical activity programs and risk for falls requiring
medical care, Washington State, 2005-2011. Preventing Chronic Disease, 12,
140574. doi:http://dx.doi.org/10.5888/pcd12.140574.
Prohaska, T., & Etkin, C. (2010). External validity and translation from research to
implementation. Generations, 34(1), 59-65.

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Wilcox, S., Dowda, M., Griffin, S. F., Rheaume, C., et al. (2006). Results of the first year
of active for life: Translation of 2 evidence-based physical activity programs for
older adults into community settings. American Journal of Public Health, 96(7),
1201-9. http://www.ncbi.nlm.nih.gov/pubmed/16735619.

CORE: Cummings Online Resources 2015

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