Partnership With University Cooperative Extension in the Implementation of Happy Healthy Homes Interventions for Rural Child Care Providers: Application of RE-AIM Framework.

Abstract

University Cooperative Extension, which may be the original rural Implementation Science model, holds great promise for translating research into practice and addressing rural health disparities. As this model not only requires successful collaboration between academic researchers and Extension Educators but also possible implementation adaptation to the context of Cooperative Extension and the environments in which they work, implementation research is critical to effective translation into practice and impact. This study was informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework describes Cooperative Extension Educators' implementation of the virtual Happy Healthy Homes interventions, a nutrition intervention and a children's environmental health intervention, for rural Family Child Care Home providers. Educators provided feedback on curricula, were trained and conducted the two virtual interventions with providers. Implementation of intervention activities and dose were recorded using REDCap. Virtual, structured interviews were conducted to assess Educators' intervention adoption, implementation, and maintenance. Transcribed interviews were analyzed for themes by two investigators and confirmed by a third. Results indicated that the majority the intervention curricula and activities were delivered as planned. Adoption themes included topical relevance to the community; toolkit provision and financial resource need; and need for additional marketing materials. Implementation themes included Educator's content expertise; learning environment distractions; and virtual delivery. Maintenance themes included transferability of content to multiple audiences; mission alignment; and Educator awareness. Overall, the implementation partnership with Extension Educators was successful. Virtual implementation was novel for Educators but considered to be positive and an opportunity for expanding future reach.