Purpose: Community-based exercise interventions may help pregnant women reach exercise recommendations. The purpose of this systematic review is to identify implementation and effectiveness outcomes of studies conducting community-based prenatal exercise interventions.
Methods: CINAHL, CENTRAL, and PubMed were searched in May 2021 for structured exercise interventions with pregnant women in freely accessible locations (e.g., parks). PRISMA 2020 guidelines were followed (PROSPERO registration CRD42020171035). Study selection and data extraction occurred in a duplicate and independent manner. Extracted data included study design, population characteristics, intervention type, measurement methods, and results. The Cochrane Risk of Bias 2 (ROB 2) tool was utilized for Randomized Controlled Trials. Data was analyzed using descriptive statistics.
Results/Findings: Fifteen studies were included representing 3,857 participants. Most studies used randomized controlled trial designs (n = 12) and 8 of those had a high risk of bias. The most common intervention was moderate-intensity exercise classes led by a healthcare professional. Recruitment relative to targeted, retention, and adherence rates averaged 49%, 82%, and 73%, respectively. Women found interventions acceptable and appropriate, but reported barriers like pregnancy symptoms, time conflicts, and childcare. No data were collected on fidelity of implementation delivery, penetration, or sustainment. Effectiveness outcomes showed 58% of studies significantly increased exercise quantity, and 80% significantly improved aerobic capacity.
Conclusions: More implementation-focused research is needed on community-based exercise interventions for pregnant women with a high risk of inactivity. A lack of implementation data undermines promising observed impacts because the field has limited information to guide future real-word implementation efforts.

Pilot Testing a College Student Service-Learning Implementation Strategy in a Low-Socioeconomic Rural Middle School
Megan M. Kwaiser (presenting), Janette M. Watkins, Julia E. Brunnemer, Jacob Otile, Janelle M. Goss, James M. Hobson, Vanessa M. Martinez Kercher, Kyle A. Kercher (corresponding)
PURPOSE: Although the benefits of physical activity are well-documented, children's activity levels remain low, and interventions often struggle to extend to community settings or scale up effectively. Our approach involves training college student mentors to implement interventions, leveraging their influential role in modeling behavior for children. This study aimed to assess the feasibility of this strategy in promoting physical activity and a healthy lifestyle among low-socioeconomic rural middle school children. The main goal was to determine if this approach met specific feasibility indicators: recruitment, retention, attendance, cost, acceptability, and treatment fidelity.
METHODS: During an 8-week intervention at a rural middle school, we implemented a comprehensive strategy involving 16 team members, including students, faculty, and a school administrator. Our approach encompassed a pre-intervention workshop, staff presentations, equipment provision, pedometer-based monitoring, a college student mentoring program, reflective activities, and consortium meetings. Following Phase 1 of the Obesity-Related Behavioral Intervention Trials (ORBIT) model, this community-engaged approach actively engaged local stakeholders. We gathered both qualitative and quantitative data before, during, and after the intervention.
RESULTS: The study involved 10 college student mentors and 2 faculty specializing in various health-related fields. Findings revealed that most participants strongly supported community volunteering (n = 11), intended to continue such work after the study (n = 10), believed in their ability to create a positive impact (n = 11), and disagreed that the current public health curriculum encourages lifelong healthy behaviors (n = 10). Additionally, the majority strongly agreed that the course enhanced their understanding of how they could contribute to their community through involvement (n = 11). Post-intervention data collection will conclude in December 2023.
CONCLUSIONS: The pilot implementation strategy could serve as a blueprint for future initiatives aimed at promoting physical activity and healthy lifestyles in similar communities. The intervention effectively enhanced community engagement and empowered members to take proactive steps toward better health and well-being.

PURPOSE
To explore how community sport clubs (clubs) in Victoria, Australia used small grants to implement health promotion initiatives and deliver physical activity outcomes.
METHODS
A realist approach was used to explore what works, for whom, under what conditions. A qualitative survey with ten open-ended questions was sent to 150 clubs funded (up to AU$3,000) by the Victorian Health Promotion Foundation (VicHealth) Fifty-seven (57) responses were received. Participants were asked to explain: how they generated and implemented initiatives; challenges experienced; what they learned; and health outcomes delivered. Interviews (N=20) were conducted with representatives and participants from six clubs. Data were analysed against the Six VicHealth Doing Sport Differently Principles.
FINDINGS
The club experience aligned to the VicHealth Doing Sport Differently Principles. These have been modified based on results to provide a guide for funded clubs to best ideate and implement health promotion initiatives to realise physical activity outcomes.
Principle 1: Gather evidence on the club’s target market to understand their barriers and motivations. Where possible, talk to them directly.
Principle 2: Consider the total participant experience. Consider how the initiative can promote social connection between participants and a sense of belonging to the club.
Principle 3: Club initiatives should be inclusive and cater to different levels of skill, ability, and fitness.
Principle 4: The deliverer is critical to the participants’ experience and retention. Make sure everyone in the club understands what is trying to be achieved (e.g. health outcomes rather than winning at sport).
Principle 5: Participants need a clear pathway for retention or transition as their skill, fitness, or interest changes.
Principle 6: Engage in best-practice project management. Have a plan with clear outcomes. Be flexible, patient, and persistent during delivery and ask for help when needed.

CONCLUSION
Small grants can be successful at supporting community sport clubs to implement interventions to improve physical activity, sport participation, social connection and mental health outcomes. The research findings could guide funding bodies on how to best support community organisations to use small grant funding to ideate, implement, and manage challenges associated with health promotion initiatives.

Purpose: Design a version of the evidence-based online healthful eating program, About Eating, to be culturally and linguistically acceptable for Spanish-speaking audiences in upstate New York.
Methods: The English version of About Eating was translated using a modified Beaton process. The iterative translation, back-translation, language review, re-translation and re-back-translation scheme was followed for each of the six program modules by native Spanish speaking and English-speaking personnel. Images and integral components, e.g., recipes and websites, were reviewed by a bilingual native Spanish speaker for cultural congruence. Cognitive interviews about the translated and culture-informed program were held with native Spanish speakers recruited with flyers, social media posts, and email blasts. A “think aloud” process was used as each module screen was reviewed for comprehension of the translation, appearance, and cultural appropriateness.
Results/Findings:
Each of the six modules was translated independently by native Spanish speakers from Puerto Rico. The time from initial translation to final approved version ranged from 76 days (Enjoying Eating) to 114 days (Time to Eat). Each module required eight iterations with four for translation and four for back-translation. Barriers to timely translation activities included coordinating with the schedules of Spanish translators and project Spanish speaking staff, locating culturally appropriate Spanish recipes and weblinks, finding photos more congruent with the target audience, and number of details that required attention in each back-translation iteration.
Online cognitive interviews were conducted with four Spanish speakers. Interviewees were mainly from Columbia with one informed in multiple dialects because of work experience. Each reviewed two modules of About Eating, now called Acerca de Comer. These individuals went through each module page by page, sharing their perspective on translation quality, content, photos and images used, and overall perception of the module. Findings from the interviews highlighted the importance of including Spanish translators from more than one country.
Conclusions:
Translation of evidence-based healthy eating programs, a vital dissemination activity to reach low-income, health-challenged audiences, is a labor and time-intensive undertaking. Adhering to a modified Beaton process facilitated translation activities. Language dialects and native speaker countries of origin must be considered to develop a translated program with wide dissemination potential.

Purpose:
We present the overall design and lessons learned from implementation of a comprehensive Produce Prescription Program (PPRx) in improving pregnancy and birth-related outcomes among low-income, ethnically diverse, high risk pregnant women in Harris County, Texas. Using a phased approach over three years (2023-2026), a total of 620 women, <20 weeks of gestation are targeted for recruitment with measures encompassing diet quality, food and nutrition security, pregnancy-related health data, participant satisfaction, and program utilization.

Methods:
Phase 1 pilot testing includes partnership building for PPRx, workflow design, training and recruitment of 20 women who are then randomly assigned to either the Prescription Dose group (twice monthly home delivery) or the Maintenance Dose group (once monthly home delivery). Utilization and satisfaction are evaluated through phone calls facilitated by Community Health Workers. Phase 2 expands to 200 women randomly allocated to a 6-month intervention group provided with an AI-based Chatbot smartphone app for interactive nutrition education plus bi-weekly home delivery of produce, while the comparison group receives produce delivery only. Our outcome in Phase 2 is to assess implementation and utilization outcomes of the chatbot and produce delivery. Phase 3 integrates insights from the prior phases, randomly assigning 400 women to differing doses of produce delivery (bi-weekly vs. monthly) plus incorporating the AI Chatbot starting in pregnancy through 2 months post-partum. Data collection includes pregnancy outcomes (gestational weight gain as the primary outcome, blood pressure, HbA1c), and birth outcomes (pre-term birth, gestational week of delivery), mental health outcomes, food security, nutrition security and diet quality at enrollment, 3 and 6 months post-enrollment, and a post-partum survey at 2 months.

Results:
Data analysis involves summary statistics, graphical analyses, logistic regression for Excess Gestational Weight Gain (EGWG), and growth curve models for weight trajectories. Mixed effects models estimate changes in selected health, social and behavioral outcomes over time, while considering potential confounders such as age, parity, and socioeconomic status.

Conclusions:
The results contribute valuable insights into the design of produce prescription programs for high risk pregnant women, potential benefits and challenges associated with integrating PPRx initiatives into broader healthcare frameworks.

PURPOSE: The National Diabetes Prevention Program (NDPP) has not had the population health impact intended, especially in rural counties where the availability of DPP sites is significantly lower compared to urban counties. The U.S. Cooperative Extension (CE) offers a potentially viable and under-examined option for the delivery of the NDPP to rural areas. This study assessed the views and experiences of rural adults with prediabetes participating in the NDPP using the PreventT2 curriculum (0–6 mos.) delivered by CE personnel using Zoom® (CE-Zoom®) or by research staff using Facebook® (FB).

METHODS: Two focus groups were conducted with 15 participants (N=5 for FB, N=10 for CE-Zoom®) after participating in the NDPP for 6-months. Participants were asked questions about recruitment, enrollment, dietary information, physical activity (PA), and technology usage in the study. Data analysis included a reflexive thematic analysis in search of themes from focus group responses.

RESULTS/FINDINGS: Participants stated that engaging rural health clinics for recruitment and providing physician education on the NDPP components would be helpful for enrollment into the NDPP in rural communities. Health motives were the primary reason for NDPP participation. Regarding dietary information, participants desired a more structured eating plan and material on how to eat healthier. PA changes were more difficult than dietary changes, with walking or housework as the primary mode of PA. Confusion over PA intensity and which intensity to focus on was a reported barrier to achieving the prescribed PA goal. Technology usage, specifically the Fitbit smartwatch and scale provided were helpful for accountability, but participants noted using the diet tracking component within the Fitbit app may have provided additional benefits. The FB group noted that they felt uncomfortable posting content to the group page and lacked social connectedness. CE-Zoom® found Zoom® easily accessible, especially after COVID, and felt they could connect better with participants who had their cameras on during the meetings.

CONCLUSIONS: Qualitative findings highlight opportunities for the implementation of the NDPP through CE in rural communities emphasizing recruitment through rural health clinics, additional resources for eating healthy and increasing physical activity, using technology for delivery, and group social support.

Purpose: This case study evaluates 'La Salud es Sabrosa,' a nutrition education program, emphasizing its sustainable strategies and impact on Hispanic immigrant caregivers and children. The study aims to illustrate how the program was strategically developed and implemented to ensure long-term efficacy and cultural relevance.
Methods: 'La Salud es Sabrosa' represents a collaboration between Nutrition & Dietetics and Spanish students at a US Midwest university. Funded by the university’s community engagement program and in partnership with an immigrant-serving nonprofit agency, this 10-week intervention uses cooking as the primary educational tool. The curriculum, crafted under Dr. Romo-Palafox's guidance, involves bilingual lesson development and culturally sensitive content delivery. Sustainability is integrated into the program design through ongoing community feedback, iterative curriculum development, and the training of student facilitators for future scalability.
Results: Over three years, the program has demonstrated resilience and adaptability, showing positive outcomes in enhancing nutritional knowledge and practices among participants. Preliminary findings, pending IRB approval, suggest a significant improvement in health awareness and cooking skills. Unique to this program is its approach to filling service gaps by providing detailed nutritional information tailored to the community's needs. The evaluation of students' cultural competency and perceptions, scheduled for April 2024, will further inform the program's sustainable and strategic implementation.
Conclusion: 'La Salud es Sabrosa' serves as an exemplary model in sustainable nutritional education, showcasing how strategic planning, community involvement, and educational partnerships can coalesce to foster lasting impact. The program's success underscores the importance of sustainability in educational interventions and its potential for replication in diverse community settings. Future research will focus on long-term program viability and the transferability of its strategies.

Purpose: An impediment to the large-scale adoption of evidence-based school nutrition interventions is the lack of evidence on effective strategies to implement them. This study describes a “Collaborative Network Trial” to support the simultaneous testing of strategies undertaken by New South Wales Local Health Districts to facilitate the adoption of a school-based nutrition program (‘SWAP IT’). The primary aim of this study is to assess the effectiveness of different implementation strategies employed by 10 NSW LHDs to increase school adoption of SWAP IT.

Methods: Within a Master Protocol framework, a collaborative network trial was conducted consisting of independent randomised controlled trials in 10 different NSW LHDs. Schools within each LHD were randomly allocated to either intervention or control. Schools allocated to the intervention group received a combination of implementation strategies. Across the LHDs, six strategies were developed and combinations of these strategies were executed over a 9-month period. The primary outcome of the trial was adoption of SWAP IT. Between-group differences at 9-month follow-up was assessed using logistic regression analyses. Individual participant data component network meta-analysis, under a Bayesian framework, was used to explore strategy-covariate interactions; to model additive main effects; two-way and full interactions.

Results: Findings of the analysis will be presented.

Conclusions: The study will provide rigorous evidence of the effects of a variety of implementation strategies, employed in different contexts on the adoption of a school-based nutrition program at scale. It will provide evidence as to whether collaborative research models can rapidly generate new knowledge and yield health service improvements.