Maximizing limited staff resources to increase programming, reach and community engagement in evidence-based programs for older adults

The [blinded] Extension service adopted an evidence-based walking program for older adults in 2012 for state-wide implementation. Due to budget cuts and insufficient resources for program delivery in Year 1, administrative policies were adapted in 2013 allowing for existing staff funded via an established nutrition program to combine delivery of the programs to target audiences. This study examines the impacts of blending delivery of the two programs on dissemination, implementation and fidelity of the walking program.

Nineteen extension staff responsible for implementation participated in qualitative interviews on barriers and facilitators to implementation and fidelity. Implementation outcomes were assessed via administrative reports; fidelity assessed via program observations.

After combining delivery and compared to Year 1, there was a 59% increase in new walking programs implemented by Extension employees and a 53% increase in participants enrolled. Staff drew on existing community partnerships to expand and augmented the walking program by substituting nutrition content for some physical activity lessons. We found participant recruitment and retention were improved in the combined program; however, fidelity to the walking program was reduced. Participants reported significant change in self-reported fatigue and pain (p<.05, p<.01; respectively), and 93% indicated they were confident they will continue walking on their own.

Blending complementing programs can expand reach of public health efforts to new settings and target populations while maximizing on limited human and fiscal resources. Planned adaptations and technical assistance is needed to maximize fidelity when combining programs. We discuss implications for maximizing implementation quality and program reach.