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      Scale-up of the Australian Fans in Training (Aussie-FIT) men’s health behaviour change program: a protocol for a randomised controlled hybrid effectiveness–implementation trial

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          Abstract

          Introduction

          Improving physical activity (PA) and healthy eating is critical for primary and secondary prevention of cardiovascular disease (CVD). Behaviour change programmes delivered in sporting clubs can engage men in health behaviour change, but are rarely sustained or scaled-up post trial. Following the success of pilot studies of the Australian Fans in Training (Aussie-FIT) programme, a hybrid effectiveness–implementation trial protocol was developed. This protocol outlines methods to: (1) establish if Aussie-FIT is effective at supporting men with or at risk of CVD to sustain improvements in moderate-to-vigorous PA (primary outcome), diet and physical and psychological health and (2) examine the feasibility and utility of implementation strategies to support programme adoption, implementation and sustainment.

          Methods and analysis

          A pragmatic multistate/territory hybrid type 2 effectiveness–implementation parallel group randomised controlled trial with a 6-month wait list control arm in Australia. 320 men aged 35–75 years with or at risk of CVD will be recruited. Aussie-FIT involves 12 weekly face-to-face sessions including coach-led interactive education workshops and PA delivered in Australian Football League (Western Australia, Northern Territory) and rugby (Queensland) sports club settings. Follow-up measures will be at 3 and 6 months (both groups) and at 12 months to assess maintenance (intervention group only). Implementation outcomes will be reported using the Reach, Effectiveness, Adoption, Implementation, Maintenance framework.

          Ethics and dissemination

          This multisite study has been approved by the lead ethics committees in the lead site’s jurisdiction, the South Metropolitan Health Service Human Research Ethics Committee (Reference RGS4254) and the West Australian Aboriginal Health Ethics Committee (HREC1221). Findings will be disseminated at academic conferences, peer-reviewed journals and via presentations and reports to stakeholders, including consumers. Findings will inform a blueprint to support the sustainment and scale-up of Aussie-FIT across diverse Australian settings and populations to benefit men’s health.

          Trial registration number

          This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12623000437662).

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          Most cited references43

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          Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)

          Purpose This article introduces the new 5-level EQ-5D (EQ-5D-5L) health status measure. Methods EQ-5D currently measures health using three levels of severity in five dimensions. A EuroQol Group task force was established to find ways of improving the instrument’s sensitivity and reducing ceiling effects by increasing the number of severity levels. The study was performed in the United Kingdom and Spain. Severity labels for 5 levels in each dimension were identified using response scaling. Focus groups were used to investigate the face and content validity of the new versions, including hypothetical health states generated from those versions. Results Selecting labels at approximately the 25th, 50th, and 75th centiles produced two alternative 5-level versions. Focus group work showed a slight preference for the wording ‘slight-moderate-severe’ problems, with anchors of ‘no problems’ and ‘unable to do’ in the EQ-5D functional dimensions. Similar wording was used in the Pain/Discomfort and Anxiety/Depression dimensions. Hypothetical health states were well understood though participants stressed the need for the internal coherence of health states. Conclusions A 5-level version of the EQ-5D has been developed by the EuroQol Group. Further testing is required to determine whether the new version improves sensitivity and reduces ceiling effects.
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            Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide

            Without a complete published description of interventions, clinicians and patients cannot reliably implement interventions that are shown to be useful, and other researchers cannot replicate or build on research findings. The quality of description of interventions in publications, however, is remarkably poor. To improve the completeness of reporting, and ultimately the replicability, of interventions, an international group of experts and stakeholders developed the Template for Intervention Description and Replication (TIDieR) checklist and guide. The process involved a literature review for relevant checklists and research, a Delphi survey of an international panel of experts to guide item selection, and a face to face panel meeting. The resultant 12 item TIDieR checklist (brief name, why, what (materials), what (procedure), who provided, how, where, when and how much, tailoring, modifications, how well (planned), how well (actual)) is an extension of the CONSORT 2010 statement (item 5) and the SPIRIT 2013 statement (item 11). While the emphasis of the checklist is on trials, the guidance is intended to apply across all evaluative study designs. This paper presents the TIDieR checklist and guide, with an explanation and elaboration for each item, and examples of good reporting. The TIDieR checklist and guide should improve the reporting of interventions and make it easier for authors to structure accounts of their interventions, reviewers and editors to assess the descriptions, and readers to use the information.
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              Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact.

              This study proposes methods for blending design components of clinical effectiveness and implementation research. Such blending can provide benefits over pursuing these lines of research independently; for example, more rapid translational gains, more effective implementation strategies, and more useful information for decision makers. This study proposes a "hybrid effectiveness-implementation" typology, describes a rationale for their use, outlines the design decisions that must be faced, and provides several real-world examples. An effectiveness-implementation hybrid design is one that takes a dual focus a priori in assessing clinical effectiveness and implementation. We propose 3 hybrid types: (1) testing effects of a clinical intervention on relevant outcomes while observing and gathering information on implementation; (2) dual testing of clinical and implementation interventions/strategies; and (3) testing of an implementation strategy while observing and gathering information on the clinical intervention's impact on relevant outcomes. The hybrid typology proposed herein must be considered a construct still in evolution. Although traditional clinical effectiveness and implementation trials are likely to remain the most common approach to moving a clinical intervention through from efficacy research to public health impact, judicious use of the proposed hybrid designs could speed the translation of research findings into routine practice.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2023
                25 October 2023
                : 13
                : 10
                : e078302
                Affiliations
                [1 ]departmentPhysical Activity and Well-being Research Group , Ringgold_1649Enable Institute, Curtin University , Perth, Western Australia, Australia
                [2 ]departmentCurtin School of Population Health , Ringgold_1649Curtin University , Perth, Western Australia, Australia
                [3 ]Ringgold_1065College of Medicine and Public Health, Rural and Remote Health, Flinders University , Darwin, Northern Territory, Australia
                [4 ]departmentExercise and Nutrition Sciences , Ringgold_1969Queensland University of Technology , Brisbane, Queensland, Australia
                [5 ]departmentCurtin School of Allied Health , Ringgold_1649Curtin University , Perth, Western Australia, Australia
                [6 ]departmentExercise Physiology Department , Fiona Stanley Hospital , Perth, Western Australia, Australia
                [7 ]departmentDepartment of Nutrition, Dietetics and Food , Monash University , Melbourne, Victoria, Australia
                [8 ]departmentDepartment of Cardiology , Ringgold_6508Royal Perth Hospital , Perth, Western Australia, Australia
                [9 ]departmentSchool of Medicine and Pharmacology , Ringgold_2720The University of Western Australia , Perth, Western Australia, Australia
                [10 ]Institute for Social Marketing, University of Stirling , Stirling, UK
                [11 ]departmentNHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health , Ringgold_2281The University of Melbourne , Melbourne, Victoria, Australia
                [12 ]departmentFaculty of Psychology , Ringgold_86927SWPS University of Social Sciences and Humanities , Warsaw, Poland
                Author notes
                [Correspondence to ] Associate Professor Eleanor Quested; eleanor.quested@ 123456curtin.edu.au
                Author information
                http://orcid.org/0000-0003-2417-4673
                http://orcid.org/0000-0001-9294-0996
                http://orcid.org/0000-0002-5873-3632
                http://orcid.org/0000-0002-2005-2970
                http://orcid.org/0000-0002-6211-9045
                Article
                bmjopen-2023-078302
                10.1136/bmjopen-2023-078302
                10603488
                37879681
                191e23a1-4197-4ffb-a41d-686e8b8349a8
                © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 29 July 2023
                : 23 September 2023
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001030, National Heart Foundation of Australia;
                Award ID: 106534
                Categories
                Public Health
                1506
                1724
                Protocol
                Custom metadata
                unlocked

                Medicine
                obesity,primary prevention,public health,randomized controlled trial,cardiology
                Medicine
                obesity, primary prevention, public health, randomized controlled trial, cardiology

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