How to Leverage Your State's Land Grant Extension System: Partnering to Promote Physical Activity
The U.S. Department of Agriculture's Cooperative Extension System (Extension) is available in every state and territory, with trained health professionals assigned to each county within the system. Themission of Extension is to translate research to practice in community settings. In 2014, the term "physical activity" current physical activity behaviors of Americans, objectives for improved outcomes, was added to the Farm Bill, encouraging Extension professionals to affect physical activity participation for a large proportion of Americans. The purpose of this manuscript is to describe Extension and provide case studies on physical activity promotion within this setting. Three case studies are presented that reflected both direct and indirect physical activity promotion across different target audiences. Direct physical activity promotion through Extension was operationalized as interventions that included an in person physical activity component or specific physical activity outcome. Indirect physical activity promotion included interventions that aimed to facilitate physical activity (e.g. policy, environmental changes, connecting community members with programs sponsored by different entities) One case study is based on an integrated research practice partnership approach to improve the compatibility of an evidence based intervention within the Extension system. A second case study indicates long standing physical activity promotion efforts through direct education for older adults, a toolkit for integrating physical activity into elementary school settings, and an environmental assessment for physical activity within schools. The third case study reports on an overarching initiative to promote physical activity participation in early childhood through direct education, policy funding and support, and community campaigns. There are several ways to partner with the land grant system of Extension to promote programs, policies, and practice that support physical activity participation. INTRODUCTION To have a public health effect on physical activity behaviors, multilevel intervention work is necessary (1) Moreover, this Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA; College of Public Health and Human Sciences, Oregon State University, Corvallis, OR; and College of Agriculture, Biotechnology and Natural Resources, University of Nevada Reno, Cooperative Extension, Las Vegas, NV Address for correspondence: Samantha M. Harden, Ph.D. 1981 Kraft Drive, Blacksburg, VA 24060 (E mail: harden.samantha@vt.edu) 2379 2868/0315/0113 0118 Translational Journal of the ACSM Copyright (c) 2018 by the American College of Sports Medicine http:/www.acsm tj.org Copyright (c) 2018 by the American College of Sports Medicine. Unauthorized repro intervention work needs to be scaled and sustained at the setting level to continuously reach thosemost in need of intervention (2) Robust examples of physical activity promotion interventions exist that have been evaluated in a variety of settings, including primary health care clinics (3) worksites (4) and schools (5) However, recent work related to successful implementation of evidence based interventions considers both penetration and sustainability. Penetration relates to the integration of a practice within a service setting (6,7) Sustainability consists of three stages moving from a single event or application of an intervention, to repetitive use, and ultimately to the intervention being continuously delivered over time (7) Taken together, the degree to which an intervention penetrates a setting may also be related to the degree towhich it is sustained (8) Because this level of adoption is rarely the case, billions of dollars are lost along the spectrum from efficacy testing to dissemination trials annually (9) That is, funds are spent identifying evidence based interventions, but these interventions are not taken to scale. One major gestalt to the scalability of evidence based physical activity interventions is the lack of intervention fit with themission, values, and resources of the intended delivery system (2,10 12) For example, a plethora of data support classroom based physical activity as an effective strategy to increase children's physical activity levels at school, but if the school culture prioritizes academic achievement and physical activity is perceived as diminishing that priority, theremay be a perceived lack of fit and subsequent resistance to, or lack of suitable support for, sustaining a classroom based physical activity intervention. No doubt the reader can summon several ideas about how to bring these disparate priorities into alignment. Unfortunately, too few interventionists consider the gap between effectiveness through fidelity and the readiness and/or capacity necessary to achieve fidelity. Dissemination and implementation Translational Journal of the ACSM 113 duction of this article is prohibited. science in this context focuses on bridging the gap between research (i.e. evidence based physical activity recommendations) and practice (i.e. delivering evidence based physical activity programs or implementing evidence based physical activity policies) Dissemination research systematically examines the processes and factors that lead to widespread adoption of evidencebased programs or interventions, and implementation research is focused on processes and factors associated with successful implementation in specific settings (7) Several prolific implementation and dissemination models (13) address factors related to organizational readiness and capacity (14) or specify ways to build general or specific capacity for an intervention (15) By way of specific example, the University of New Mexico Prevention Research Center studied the translation of evidencebased physical activity recommendations published by the Community Preventive Services Task Force (16) in a single rural community (17) Research questions were focused on elements of implementation success such as establishing an evaluation system, community engagement, tailoring to the local context, using evidence based strategies, and more as proposed by Milat et al. (18) Unfortunately, few organizations and/or interventionists collect this kind of process data, or if they do collect it, they fail to publish the results (19 21) Reasons for this may be related to scholarly expectations (e.g. an emphasis on did the intervention work or not versus what are the factors influencing fidelity and translation) The continued low participation in physical activity among all Americans and the lower participation rates exhibited among vulnerable populations (e.g. low income, rural, etc. will lead to greater health disparities if recommended, evidence based physical activity strategies are not scaled up effectively in communities that need them the most. Cooperative Extension System Poised as a Partner for Physical Activity Promotion One system poised to scale up physical activity promotion activities and evaluate the planning, delivery, and outcomes associated with these efforts is the Cooperative Extension System (herein Extension) Extension is a critical component of land grant universities across the nation. Federally funded through the U.S. Department of Agriculture, Extension is available in every state and territory in the United States. Since its inception over 100 years ago, Extension programming has emphasized nutrition, food safety, agriculture, and youth development. More recently, in response to the growing obesity epidemic, Extension has increasingly included physical activity content in programming, predominately in the context of nutrition education. More specifically, the term "physical activity"was added to the Farm Bill (22) in 2014 enabling "state agencies to [sic] implement a nutrition education and obesity prevention program for eligible individuals that promotes healthy food choices and physical activity consistent with themost recent Dietary Guidelines for Americans." This change resulted in a transformative effort by Extension to integrate physical activity (i.e. activity time and knowledge based learning) with existing nutrition programming and develop relevant evaluations of physical activity program efforts. To assure that content is evidence based and supported by relevant expertise, states increasingly began hiring Extension faculty with exercise science expertise. This is an evolving trend, with opportunities for exercise science faculty in academic units to contribute their expertise in states that may not have Extension faculty with these skills. That 114 Volume 3 Number 15 August 1 2018 Copyright (c) 2018 by the American College of Sports Medicin said, there is much work to be done to leverage the potential of Extension as a partner in physical activity promotion efforts. The purpose of this article was to provide background and context as to the organization of the Extension system as well as examples of direct and indirect physical activity promotion efforts across three state systems. Related to the former, although the Extension system has similarities across state systems, each state system operates uniquely. Therefore, examples across three states as case studies were presented to show different approaches to physical activity promotion. Direct physical activity promotion through Extension was operationalized as interventions that included an in person physical activity component or specific physical activity outcome. Indirect physical activity promotion included interventions that aimed to facilitate physical activity (e.g. policy, environmental changes, connecting community members with programs sponsored by different entities) Extension Organizational Climate and Culture For other researchers and practitioners to determine whether partnership with Extension and its staff and volunteers is feasible, it is important to u