title: National Dissemination of StrongWomen-Healthy Hearts: A Community-Based Program to Reduce Risk of Cardiovascular Disease Among Midlife and Older Women.
abstract: OBJECTIVE
  We describe the national dissemination of an evidence-based community cardiovascular disease prevention program for midlife and older women using the RE-AIM (reach effectiveness adoption implementation maintenance) framework and share key lessons learned during translation.
  
  
  METHODS
  In a 2010 to 2014 collaboration between the StrongWomen program and the National Extension Association of Family and Consumer Sciences, we assessed reach, adoption, implementation, and maintenance using survey methods, and we assessed effectiveness using a pretest-posttest within-participants design, with weight change as the primary outcome.
  
  
  RESULTS
  Overall reach into the population was 15 per 10,000. Of 85 trained leaders, 41 (48%) adopted the program. During the 12-week intervention, weight decreased by 0.5 kilograms, fruit and vegetable intake increased by 2.1 servings per day, and physical activity increased by 1238 metabolic equivalent (MET)-minutes per week (all P < .001). Average fidelity score was 4.7 (out of possible 5). Eleven of 41 adopting leaders (27%) maintained the program.
  
  
  CONCLUSIONS
  The StrongWomen-Healthy Hearts program can be implemented with high fidelity in a variety of settings while remaining effective. These data provide direction for program modification to improve impact as dissemination continues.
authors.affiliation: At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Folta
authors.affiliation: At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Seguin
authors.affiliation: At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA.
authors.forename: Kenneth K H
authors.initials: KK
authors.lastname: Chui
authors.affiliation: At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA.
authors.forename: Valerie
authors.initials: V
authors.lastname: Clark
authors.affiliation: At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA.
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Corbin
authors.affiliation: At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA.
authors.forename: Jeanne P
authors.initials: JP
authors.lastname: Goldberg
authors.affiliation: At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Heidkamp-Young
authors.affiliation: At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA.
authors.forename: Alice H
authors.initials: AH
authors.lastname: Lichtenstein
authors.affiliation: At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Wiker
authors.affiliation: At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA.
authors.forename: Miriam E
authors.initials: ME
authors.lastname: Nelson
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D004059:Diffusion of Innovation; D005260:Female; D006801:Humans; D008875:Middle Aged; D015397:Program Evaluation; D040242:Risk Reduction Behavior