Adopting an evidence-based lifestyle physical activity program: dissemination study design and methods

There is a scarcity of research studies that have examined academic–commercial partnerships to disseminate evidence-based
physical activity programs. Understanding this approach to dissemination is essential because academic–commercial partnerships
are increasingly common. Private companies have used dissemination channels and strategies to a degree that academicians have
not, and declining resources require academicians to explore these partnerships. This paper describes a retrospective case–control
study design including the methods, demographics, organizational decision making, implementation rates, and marketing strategy
for Active Living Every Day (ALED), an evidence-based lifestyle physical activity program that has been commercially available
since 2001. Evidence-based public health promotion programs rely on organizations and targeted sectors to disseminate these
programs although relatively little is known about organizational-level and sector-level influences that lead to their adoption
and implementation. Cases (n = 154) were eligible if they had signed an ALED license agreement with Human Kinetics (HK), publisher of the program’s textbooks
and facilitator manuals, between 2001 and 2008. Two types of controls were matched (2:2:1) and stratified by sector and region.
Active controls (control 1; n = 319) were organizations that contacted HK to consider adopting ALED. Passive controls (control 2; n = 328) were organizations that received unsolicited marketing materials and did not initiate contact with HK. We used Diffusion
of Innovations Theory constructs as the basis for developing the survey of cases and controls. Using the multi-method strategy
recommended by Dillman, a total of n = 801 cases and controls were surveyed. Most organizations were from the fitness sector followed by medical, non-governmental,
governmental, educational, worksite, and other sectors with significantly higher response rates from government, educational,
and medical sectors compared with fitness and other sectors, (p = 0.02). More cases reported being involved in the decision to adopt ALED (p < 0.0001). Data indicate that a low percentage of controls had ever heard of ALED despite repeated marketing and offering
other types of physical activity programs and services. Finally, slightly over half of the adopters reported they had actually
implemented the ALED program. Dissemination research requires new perspectives and designs to produce valid insights about
the results of dissemination efforts. This study design, survey methods and theoretically based questions can serve as a useful
model for other evidence-based public health interventions that are marketed by commercial publishers to better understand
key issues related to adoption and implementation of evidence-based programs.