Train the Trainer Course book - Cochrane Public Health Group

Exercise: Allow participants 20 minutes for the exercise and then 10-20 minutes reporting back – put
all ideas onto a whiteboard and determine if they match all the factors listed in the table provided
in the handbook.
Additional information:
Reach – require information on the representativeness of the study sample. This is defined as the
similarity or differences between those who participate and those who are eligible but do not. The
intervention may have a differential impact based on the variables that differ between participants
and non-participants. Less differences, better generalisability.
Adoption - Comparisons should be made on basic information such as resource availability, setting
size and location, and interventionist expertise.
Examples from www.re-aim.org
Reach:
Eakin and her associates (1998) illustrate how Reach issues can be incorporated in a smoking
cessation study offered to participants in a planned-parenthood program. They begin by explicitly
reporting their inclusion criteria --female smokers between 15 and 35 years of age who are patients
at a planned-parenthood clinic. During a routine visit to the clinic the patient services staff
described the study and solicited participants. Those women who declined (n=185) were asked to
complete a short questionnaire that included questions to assess demographics, smoking rate, and
reasons for non-participation. Participants (n=518) also completed baseline demographic and
smoking rate assessments. They tracked recruitment efforts and reported that 74% percent of the
women approached agreed to participate in the study. To determine the representativeness of the
sample two procedures were completed. First, based on information from patient medical charts,
those who were contacted were compared on personal demographics to those who were not
contacted. Second, participants were compared to non-participants on personal demographics and
smoking rate. The study found that those contacted did not differ from those not contacted on any
of the test variables. Also, the results suggested that participants were slightly younger than nonparticipants,
but there were no other differences between these groups. This suggests that Eakin
and her associates were fairly successful in contacting and recruiting a fairly representative sample
of their target population.
The Language for Health (Elder et al., 2000) nutrition education intervention provides a good
example of determining the representativeness of study participants to a given target population.
The behaviour change intervention was developed to target Latino participants in English as a
second language (ESL) classes at seven schools. To examine representativeness, the 710 participants
in the study were compared to the overall Latino ESL student population in the city. This
comparison revealed that the intervention participants did not differ from the general ESL student
population on gender, age, or education level. As such, the authors concluded that the study had
strong generalisability to the greater target population (Elder et al., 2000).
Efficacy:
Project GRAD (Graduate Ready for Activity Daily; Zabinski, Calfas, Gehrman, Wilfley, & Sallis,
2001). Project GRAD was an efficacy trial of a physical activity promotion course offered to
university students. The results of the trial revealed that the intervention was successful in
increasing total energy expenditure, strength exercises, and flexibility exercises of female students.
Unfortunately, there were also some unintended negative consequences for women who
participated. Female participants who participated in the intervention showed a significant increase
in drive for thinness as measured by the Eating Disorder Inventory. This increase was not observed
in females in the control condition. These findings suggest that there is a need to assess both
130