Purpose: To describe the scope of NIH-funded extramural research grants using implementation science (IS) methods in nutrition research and offer insights into future research opportunities relevant to the Strategic Plan for NIH Nutrition Research 2020-2030.

Methods: A portfolio analysis of funded grants using an NIH internal reporting system, Query View Report, was conducted to identify nutrition research and IS awarded between fiscal years 2011 and 2022. The authors screened the titles and abstracts for inclusion criteria: research and career development awards involved a nutrition and/or dietary intervention and measured a stated implementation outcome or used an IS theory, model, or framework.

Results: The analysis identified 33 NIH-funded awards. Investigator-initiated research projects accounted for about half of the awards (48.5%) compared to research career awards (27.3%) and cooperative agreements (9.1%). Only five studies were conducted in Africa, Latin America, and Asia (15.2%) none of which were long-term research projects. Identified studies frequently examined obesity and nutrition in tandem developing novel approaches, evaluating the implementation of nutrition/dietary guidelines, and adapting culturally-tailored interventions in collaboration with community partners from schools, hospitals, and religious settings. Feasibility, costs, adoption, and acceptability were the most cited implementation outcomes. Only 16 awards (48.5%) used an IS theory, model, or framework to guide their work. Studies that addressed health disparities and health equity (54.5%) most often included a culturally-tailored nutrition or dietary intervention. A few limitations: the analysis was restricted to publicly-available abstracts and IS outcomes had to be specifically named.

Conclusions: While the identified studies account for a small portion of the NIH portfolio, there is a large breadth of NIH-funded nutrition and implementation research. The findings support the opportunities to stimulate IS in nutrition research in alignment with the NIH strategic plan for nutrition research outlined in a recent commentary. This called for including implementation and dissemination early in the intervention design, developing and testing strategies for equitable implementation of nutrition and diet evidence-based, and building and strengthening capacity and expertise needed to increase the use of IS in nutrition research.

1 Note, this abstract is based on data previously published in Oct. 2023.

Purpose: Local Wellness Policies (LWPs) establish healthy eating and physical activity practices in U.S. schools. When well-implemented, LWPs improve child health; however, LWPs implementation is complex and requires many individuals within a school. This study explores the role of Relational Connections, a Consolidated Framework for Implementation Research (CFIR) construct defined as “formal and informal relationships, networks and teams within schools”, during planning and execution of a school-level LWP implementation strategy.

Methods: Data were drawn from a cluster randomized trial in low/middle-income elementary and middle schools. The trial tested implementation and effectiveness of Wellness Champions for Change (WCC), a school-level implementation strategy whereby a teacher Wellness Champion was recruited to build a wellness team and carry out LWP initiatives. The Wellness Champion received support from a trained health educator over one schoolyear. We conducted CFIR-guided semi-structured interviews with Wellness Champions from 14 of 21 schools receiving WCC and all 4 health educators after study completion to understand factors that influenced WCC implementation. We conducted axial coding with “Roles and Characteristics” codes and Inner Setting codes of “Relational Connections” and “High Level Leaders.” We utilized data visualization techniques to describe dynamic relationships between school-level implementation personnel.

Results: Personnel holding key roles in WCC included administrators, Wellness Champion, and school staff-at-large. In all schools, WCC success was influenced by both characteristics of and relationships between these personnel. Using data visualization, we described how relationships varied across schools and influenced WCC success. As examples: when a Wellness Champion was new to the school, a more “hands-on” administrator was needed to build staff buy-in; however, when a Wellness Champion was more “seasoned” with existing staff ties, administrator involvement was less necessary and could even slow progress. When Wellness Champion had to “shoulder the load” without support from staff-at-large, initiatives were limited in scope and impact. “Fractured” relationships negatively influenced implementation, and often required modification of implementation goals.

Conclusions: Characteristics of and relationships between administrators, Wellness Champions, and staff-at large influenced WCC success across all schools, yet the mechanism of influence varied. Findings underscore the importance of understanding school-specific Relational Connections when tailoring LWP implementation strategies.

Purpose:
This study investigates components of the Children's Healthy Living program (CHL) that have been sustained and retained, 9 years post-intervention. CHL was established In 2011 to build networks across Alaska, Hawai‘i, and the US Affiliated Pacific Islands, to develop a multi-level intervention to reduce childhood overweight and obesity, and to test it in intervention sites in 9 jurisdictions. Data collected 2 years and 5 years post-intervention suggest that CHL reduced the prevalence of overweight and obesity in intervention communities. Subsequent funding has allowed CHL to continue its networking and measuring programs, but no research had explored the activities and community factors that contributed to the long-term existence and success of CHL. This research addresses this gap.
Methods:
We retrospectively examined surveys, interviews and program documentations to capture CHL-site activities and community factors between 2015 and 2020 using the Process Tracing method. To validate and further explore the initial findings, we developed a chronological timeline of events; identified key events; established causal links; and explored the broader context to ascertain which activities were associated with maintenance 9-years post intervention.
Results/findings:
Key components identified in sustaining CHL included: 1) activities dedicated to maintaining a strong network, e.g., monthly calls and annual meetings; 2) embedding of CHL site activities within Land-Grant institutions; 3) training of the next generation through financial support of college courses and degrees; 4) use of Pacific-tailored behavior analysis tools to measure CHL target behaviors; 5) mandated co-authorship of all partner sites on publications and presentations; 6) incorporation of intervention activities in community programs, 7) provision of leadership advancement opportunities, and 8) secured funding to support these activities. Collaboration and trust among partners; established network and vision, strategy and work plan; sustained training programs; and attainment of additional funding and grants was the identified causal pathway for the sustainment of CHL.
Conclusions:
By understanding the components and causal pathway that contributed to the sustained change in the CHL program, this study informs multi-site interventions by highlighting enduring components and causal pathway of a successful intervention, ultimately contributing to the promotion of healthier lifestyles among children and communities.

Purpose: Translation into practice of effective physical activity interventions in primary care is difficult, due to a complex interaction of implementation determinants. This study sought to identify implementation determinants (barriers and facilitators) of four primary care interventions: physical activity assessment, counselling, prescription, and referral.

Methods: A systematic review of qualitative, quantitative and mixed-methods studies published since 2016 was conducted. The “Tailored Implementation for Chronic Diseases” (TICD) framework was adapted to extract and synthesize barriers and facilitators.

Results/findings: Sixty-two studies met the inclusion criteria. Barriers (n = 56) and facilitators (n = 55) were identified across seven domains, related to characteristics of the intervention, individual factors of the implementers and receivers, organizational factors, and political and social determinants. The top five determinants (most frequently reported) were: professionals’ knowledge and skills; intervention feasibility/compatibility with primary health care routine; interventions’ cost and financial incentives; tools and materials; and professionals’ cognitions and attitudes. “Social, political and legal factors” domain was the least reported. Physical activity counselling, prescription, and referral were influenced by determinants belonging to all the seven domains.

Conclusions: The implementation of physical activity interventions in primary care is influenced by a broader range of determinants. The triad of health professionals, intervention characteristics, and available resources is particularly relevant, as it encompasses the most frequently reported barriers and facilitators. A deep understanding of the local context, with particularly emphasis on these determinants, should be considered when preparing interventions’ implementation, to contribute for designing tailored implementation strategies and optimize the interventions’ effectiveness.

Purpose: The Stanford Lightning Report (SLR) protocol provides a methodology for rapid qualitative data collection and feedback that can be used to support goal setting related to evidence-based intervention delivery. The purpose of this presentation is to describe the application of the SLR within the context of a learning collaborative implementation strategy to support the delivery of Building Healthy Families (BHF), a family healthy weight EBI, in rural areas and small towns. Specifically, we will present barriers and facilitators during the pre-implementation or implementation phase of BHF, using the iPARIHS framework.
Methods: Seven rural community implementation teams in a pilot type 3 hybrid effectiveness implementation study received a BHF Online Training Resource and Program Package with (n=4) or without (n=3) participation in a learning collaborative (LC). The LC strategy included quarterly meetings (N=8) followed by an action period (AP) to follow up on implementation goals. Between meetings, community implementation teams participated in a one hour, video conference SLR to discuss progress on implementation goals, barriers encountered, facilitators, and planning to overcome barriers and leverage facilitators.
Results: During the pre-implementation phase, communities cited barriers regarding context at the local, organizational, and external health system levels (n=12), recipients (n=8), facilitation (n=4), and implementation outcomes (n=2). Sixteen of the 26 pre-implementation barriers were related to the COVID-19 pandemic—with community implementation team time as a consistent pre-implementation barrier. Pre-implementation facilitators (n=44) were primarily related to the recipient (n=16), context (n=13), and innovation (n=12). During the implementation phase, reported barriers were related to context (n=4), the innovation (n=2), implementation outcomes (n=3), and recipients (n=6; only 3 COVID-19 related) and facilitators were similar to those identified during pre-implementation. Community implementation team motivation, collaboration and teamwork, and existing networks were recorded as both barriers and facilitators. The BHF Online Training Resource and Program Package usability and content was a consistent pre-implementation and implementation facilitator. Finally, barriers decreased from the pre-implementation to the implementation phase, suggesting the use of a learning collaborative and the SLR is beneficial to BHF implementation.
Conclusion: The use of a SLR protocol was feasible and reduced implementation barriers over time.

Purpose: Despite the presence of evidence-based weight loss programs, achieving broad participation and sustaining engagement remains a challenge during implementation. This study aims to pinpoint the hindering continued involvement in a 12-month, technology-supported weight loss program among participants who discontinued within six months within the community context.
Methods: Applying a qualitative study design, we conducted semi-structured interviews to identify contextual factors influencing program participation and retention. Our framework drew upon the Practical Robust Implementation and Sustainability Model (PRISM), encompassing program characteristics (complexity, trialability, observability, relative advantage, compatibility, and cost), recipient characteristic, implementation and sustainability infrastructure, and external environment. Eligible individuals, who dropped out of the weight loss program within a six-month period in 2021 were recruited. Interviews were conducted between May and August, 2022, deliberately oversampling racial/ethnic minority participants (42% under-represented minorities out of n=12). Each interview lasted approximately 20-30 minutes, and participants received a $30 gift card as compensation. Deductive content analysis was utilized to code the transcripts and identify themes aligned with PRISM constructs.
Results/findings: A total of 12 disenrolled participants engaged in the interview. The most prominent factors affecting retention were program compatibility, followed by program complexity, accounting for 50% and 36% of negative retention-associated meaning units, respectively. Commonly identified themes included time constraints, psychological capability, inadequate social support, and absence of personalized features (such as tailored email message, meal plans, and exercise programs), and technical glitches (such as app malfunction or difficulties connecting scales to the app). The majority (8 out of 12) of participants enrolled in the program through their health insurance (pertaining to external environment and cost). Having a coach or community support emerged as incentives for sustained participation, while monetary incentives played a modest role. Recommendations for program enhancement included human coach check-in (as opposed to AI/robot-powered interactions), diverse/cultural meal planning options, meal tracking, and customizable calorie counting tools.
Conclusions: These findings are pivotal in developing and implementing viable and effective strategies aimed at bolstering sustained participant engagement and retention.