Background: The Healthy Lifestyle Program for women (HeLP-her Rural) is a large cluster randomized controlled trial, targeting weight gain prevention in rural dwelling women. We describe the evaluation results, focusing on program implementation and informing future prevention program scale-up.
Methods: An embedded mixed-method evaluation guided by the RE-AIM framework (addressing the Reach, Efficacy, Adoption, Implementation and Maintenance) was undertaken. Data collection tools included anthropometric data, program checklists, questionnaires and semi-structured interviews with participants and local stakeholders. To establish evaluation rigour an evaluation self-audit was conducted, applying the RE-AIM assessment tool.
Results: We engaged 649 women from relatively socio-economic disadvantaged communities, mean age 39.6 years (+/-SD 6.7) and body-mass index of 28.8kg/m2 (+/-SD 6.9) into this program. At 1-year the mean change in the control group was +0·44kg (95%CI -0.09 to 0.97) and the intervention group -0.48kg (95%CI -0.99 to 0.03) a between group difference of -0·92kg (95% CI -1.67 to -0.16) or -0.87kg (95% CI -1.62 to -0.13) adjusted for baseline values and clustering. Broad program reach was achieved, as 62% of participants reported influencing the health behaviours of their families and social networks. Implementation was supported by the development of 300 multi-level partnerships (local government, education, health and community sectors) with partners valuing the underlying program theory and low intensity program design. Stakeholders reported capacity to implement a low intensity weight gain prevention program, highlighting promising program sustainability. Strong implementation fidelity, dose delivered and program satisfaction were achieved.
Conclusion: Obesity prevention programs have potential for population level scale-up, due to their broad program reach, demonstrated program effectiveness and high program acceptability at the community and stakeholder level. In taking implementation research to scale-up, program success needs to incorporate program reach to the wider community, implementation rigour and the potential for program sustainability across diverse real world settings.