The slow translation of health-related research findings into practice is well documented and this extends to health literacy interventions. Our R21 application is driven by the desire to reduce the excessive lag times along the research pipeline by speeding the translation of emergent findings from SIPsmartER, a health literacy intervention to reduce sugar-sweetened beverage (SSB) consumption. SSB consumption is a high priority public health behavior and contributes ~7% of total energy intake for US adults. Unfortunately, the targeted Appalachian region of Southwest Virginia for this application exceeds the national average consumption of SSB by more than three times. SIPsmartER is a theory-based, 6-month, multi- component health literacy intervention designed to reduce SSB intake and is currently being tested in a type 1 effectiveness-implementation hybrid RCT. Emerging findings from this rigorously designed trial illustrate that SIPsmartER is an efficacious intervention to decrease SSB intake: intervention participants have significantly decreased SSB intake by 236 SSB kcals/day (SD=46) from 0 to 6 months compared to a decrease of 54 SSB kcals/day (SD=19) in the control group (p<0.001). Furthermore, SSB outcomes and SIPsmartER completion rates do not vary by health literacy status and preliminary data indicate that SSB reductions are being sustained one year post intervention. To translate these promising effects into population-level SSB reductions, a concerted effort is needed to understand the feasibility of organizational-level adoption and implementation of SIPsmartER within existing systems and to develop an implementation support system to aid in delivery. Additionally, since a system-delivered SIPsmartER intervention would be conducted under less-controlled conditions, ascertaining individual-level effects on SSB consumption is necessary. Thus, our approach is guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Framework and integrates the Interactive Systems Framework and cutting-edge strategies for advancing organizational-level health literacy. We target four medically-underserved Southwest Virginia Department of Health districts and their client population, and propose a mixed-methods design that includes formative, process, and outcome evaluations. Our primary aim is to develop, establish feasibility, and determine the potential utility of an implementation strategy for SIPsmartER, which will reflect system-level needs, barriers, and resources specific to SIPsmartER, as well as build general capacity related to organizational health literacy. Secondary aims are to determine the adoption and implementation process at the organization-level and determine individual-level reach and effectiveness of SIPsmartER within an existing system. The goal is to have an implementation support system for SIPsmartER that can be tested in a subsequent full-scale R01 type 3 effectiveness-implementation hybrid randomized-controlled trial, with a long-term goal of broad scale dissemination of SIPsmartER within public health care systems to achieve population-level reductions in SSB.
The goal of this research is to partner with Virginia Department of Health (VDH) districts in Southwest Virginia to develop and establish feasibility of an implementation support system for SIPsmartER; a health literacy intervention to reduce sugar-sweetened beverage (SSB) consumption. Our approach allows us to address participant's health literacy skills and reduce SSB consumption; while simultaneously strengthening the organizational health literacy capacity of the partnering districts. By building organizational heath literacy capacity through the implementation support system; our approach allows for the transfer of health literacy skills among VDH staff that can extend beyond SIPsmartER and SSB reduction efforts to also support other public health initiatives of the partnering districts.
