title: Adoption, reach, and implementation of a cancer education intervention in African American churches.
abstract: Use of technology is increasing in health promotion and has continued growth potential in intervention research. Guided by the Reach, Effectiveness, Adoption, Implementation, ﻿and Maintenance (RE-AIM) framework, this paper reports on the adoption, reach, and implementation of Project HEAL (Health through Early Awareness and Learning)-a community-based implementation trial of a cancer educational intervention in 14 African American churches. We compare adoption, reach, and implementation at the organizational and participant level for churches in which lay peer community health advisors (CHAs) were trained using traditional classroom didactic methods compared with a new online system.
  
  
  
  Fifteen churches were randomized to one of two study groups in which two CHAs per church were trained through either classroom ("Traditional"; n = 16 CHAs in 8 churches) or web-based ("Technology"; n = 14 CHAs in 7 churches) training methods. Once trained and certified, all CHAs conducted a series of three group educational workshops in their churches on cancer early detection (breast, prostate, and colorectal). Adoption, reach, and implementation were assessed using multiple data sources including church-level data, participant engagement in the workshops, and study staff observations of CHA performance.
  
  
  
  The project had a 41% overall adoption rate at the church level. In terms of reach, a total of 375 participants enrolled in Project HEAL-226 participants in the Traditional group (43% reach) and 149 in the Technology group (21% reach; p < .10). Implementation was evaluated in terms of adherence, dosage, and quality. All churches fully completed the three workshops; however, the Traditional churches took somewhat longer (M = 84 days) to complete the workshop series than churches in the Technology group (M = 64 days). Other implementation outcomes were comparable between both the Traditional and Technology groups (p > .05).
  
  
  
  Overall, the Project HEAL intervention had reasonable adoption, though reach could have been better. Implementation was strong across both study groups, suggesting the promise of using web-based methods to disseminate and implement evidence-based interventions in faith-based settings and other areas where community health educators work to eliminate health disparities.
authors.affiliation: Department of Behavioral and Community Health, University of Maryland, School of Public Health, 4200 Valley Dr., 1101 E SPH Building 255, College Park, MD, 20742, USA. ssantos1@umd.edu.
authors.forename: Sherie Lou Zara
authors.initials: SL
authors.lastname: Santos
authors.affiliation: Department of Behavioral and Community Health, University of Maryland, School of Public Health, 4200 Valley Dr., 1101 E SPH Building 255, College Park, MD, 20742, USA.
authors.forename: Erin K
authors.initials: EK
authors.lastname: Tagai
authors.affiliation: Scheirer Consulting, Princeton, NJ, USA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Scheirer
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Janice
authors.initials: J
authors.lastname: Bowie
authors.affiliation: Institute for Applied Environmental Health, University of Maryland, School of Public Health, College Park, MD, USA.
authors.forename: Muhiuddin
authors.initials: M
authors.lastname: Haider
authors.affiliation: Community Ministry of Prince George's County, Upper Marlboro, MD, USA.
authors.forename: Jimmie
authors.initials: J
authors.lastname: Slade
authors.affiliation: Department of Behavioral and Community Health, University of Maryland, School of Public Health, 4200 Valley Dr., 1101 E SPH Building 255, College Park, MD, 20742, USA.
authors.forename: Min Qi
authors.initials: MQ
authors.lastname: Wang
authors.affiliation: Department of Behavioral and Community Health, University of Maryland, School of Public Health, 4200 Valley Dr., 1101 E SPH Building 255, College Park, MD, 20742, USA.
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Holt
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D016000:Cluster Analysis; D005260:Female; D006266:Health Education / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy*; D012068:Religion and Medicine