Background: Interventions undergo adaptations when moving from efficacy to effectiveness trials. What happens beyond these initial steps—that is, when the “research” is over—is often unknown. The degree to which implementation quality remains high and impacts remain robust is underreported as these data are often less valued by community entities. Comprehensive and iterative evaluation is recommended to ensure robust outcomes over time. Methods: The reach, effectiveness, adoption, implementation, and maintenance framework was used within an assess, plan, do, evaluate, report process to determine the degree to which a statewide physical activity promotion program aligned with evidence-based core components, assess who was reached and impacts on physical activity behaviors, and make decisions for future iterations. Results: Walk Across Arkansas was adopted by a majority of delivery agents and was effective at increasing physical activity levels postprogram, but those effects were not maintained after 6 months. Future decisions included recruitment strategies to reach a more diverse population and a blueprint document to reduce program drift. Conclusions: This article details the process of “replanning” a community-based physical activity intervention to understand public health impact and make decisions for future iterations. Pragmatic reach, effectiveness, adoption, implementation, and maintenance questions were useful throughout the assess, plan, do, evaluate, report process.
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“Replanning” a Statewide Walking Program Through the Iterative Use of the Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework
Laura E. Balis and Samantha M. Harden
Factors Associated With Leisure-Time Bicycling Among Adults in the United States: An Urban–Rural Comparison
Eugene C. Fitzhugh, Carissa Smock, Laura E. Balis, Jeanette Gustat, Debra Kellstedt, James N. Roemmich, Zachary Townsend, and Christiaan Abildso
Background: Bicycling is a healthy form of physical activity that can be performed by most adults as part of leisure-time (LT) activity. However, little is known about LT bicycling behaviors, especially in the rural areas of the United States. This study sought to contrast the prevalence and factors associated with LT bicycling in populations living in urban settings with those living in rural settings. Methods: The 2019 Behavior Risk Factor Survey, which contains information regarding LT physical activity behaviors among adults (N = 396,261) in the United States, was used to determine the prevalence, demographic profile, and likelihood of meeting the physical activity guidelines of LT bicyclists. The 2013 National Center for Health Statistics Urban/Rural Classification Scheme was used to classify respondents living in rural and urban settings. Results: Among US adults, 3.8% (95% CI, 3.7–3.9) reported LT bicycling activity, the sixth most common physical activity. Adults living in urban counties compared with rural counties had a greater prevalence of LT bicycling (3.9% vs 2.3%, respectively), with adults living in rural counties having a 34% lower probability of LT bicycling. Rural bicycling prevalence rates were lower across all demographics. Urban bicyclists, compared with rural bicyclists, cycled more months of the year. Overall, 85.5% of all bicyclists met the aerobic physical guidelines, with no differences between urban and rural bicyclists. Conclusions: Bicycling remains an important LT physical activity among adults in the United States. However, a rural–urban difference in the prevalence does exist for LT bicycling. The reasons for this disparity warrant further investigation.
