Prevention Science

, Volume 16, Issue 1, pp 11–20 | Cite as

Understanding “Agency” in the Translation of a Health Promotion Program

  • Janet Page-Reeves
  • Sally Davis
  • Camilla Romero
  • Eric Chrisp


Health promotion interventions conducted under “ideal conditions” to prove their efficacy are often difficult to translate and disseminate for utilization in “real-world” settings. This article retrospectively integrates and analyzes the experience of three related projects. We investigate how the development and dissemination of a school-based nutrition and physical activity curriculum for American Indian elementary school children inspired the implementation of an across-the-lifespan train-the-trainer program that has trained more than 600 trainers in American Indian communities nationwide. This process provides an opportunity to explore how individuals in the community and the context in which the research was conducted affected project outcomes in ways which were not anticipated. Results challenge the use of “internal validity” as the primary measure of success in translation–dissemination–utilization research.


Agency Validity Integration 



Research referenced in this article was funded by grants #UO1 HL-50867, #UO1 HL50869, #UO1 HL-50905, #UO1 HL-50885, and #UO1 HL-50907 from the National Heart, Lung and Blood Institute, National Institutes of Health, and R06/CCR621570 from the Centers for Disease Control (CDC). This publication was also supported in part by cooperative agreements from CDC's Prevention Research Centers Program (PRC) at the University of New Mexico (U48/CCU610818-08 Special Interest Project #17-00). Its content is solely the responsibility of the authors and does not necessarily represent the official views of the CDC.


  1. Barr-Anderson, D. J., AuYoung, M., Whitt-Glover, M. C., Glenn, B. A., & Yancey, A. K. (2011). Integration of short bouts of physical activity into organizational routine: A systematic review of the literature. American Journal of Preventive Medicine, 40, 76–93.CrossRefPubMedGoogle Scholar
  2. Cunningham-Sabo, L.D. (2000). Nutrition education for Navajo elders: Use of diffusion of innovation attributes. Unpublished Doctoral Dissertation, University of New Mexico, Albuquerque, New Mexico.Google Scholar
  3. Davis, S. M., & Reid, R. (1999). Practicing participatory research in American Indian communities. American Journal of Clinical Nutrition, 69, 755S–759S.PubMedGoogle Scholar
  4. Davis, S. M., Clay, T., Smyth, M., Gittelsohn, J., Arviso, V., & Flint-Wagner, H. (2003). Pathways curriculum and family interventions to promote healthful eating and physical activity in American Indian schoolchildren. Preventive Medicine, 37, S24–S34.CrossRefPubMedGoogle Scholar
  5. Dilworth, K., Tao, M., Shapiro, S., & Timmings, C. (2013). Making health promotion evidenced-informed an organizational priority. Health Promotion Practice, 14, 139–145.CrossRefPubMedGoogle Scholar
  6. Elliot, D. L., Kuehl, K. S., Goldberg, L., DeFrancesco, C. A., & Moe, E. L. (2011). Worksite health promotion in six varied US sites: Beta testing as a needed translational step. Journal of Environmental and Public Health. doi: 10.1155/2011/797646.PubMedCentralPubMedGoogle Scholar
  7. Frolich, K., & Potvin, L. (2010). Commentary: Structure or agency? The importance of both for addressing social inequities in health. International Journal of Epidemiology, 39, 378–379.CrossRefGoogle Scholar
  8. Giddens, A. (1984). The Constitution of Society. Berkeley: University of California Press.Google Scholar
  9. Gittelsohn, J., Evans, M., Helitzer, D., Anliker, J., Story, M., & Metcalfe, L. (1998). Formative research in a school-based obesity prevention program for Native American school children (Pathways). Health Education Research, 13, 251–265.CrossRefPubMedGoogle Scholar
  10. Gittelsohn, J., Davis, S. M., Steckler, A., Ethelbah, B., Clay, T., & Metcalfe, L. (2003). Pathways: Lessons learned and future directions for school-based interventions among American Indians. Preventive Medicine, 37, S107–S112.CrossRefPubMedGoogle Scholar
  11. Glasgow, R. E., & Emmons, K. M. (2007). How can we increase translation of research into practice? Types of evidence needed. Annual Review of Public Health, 28, 413–433. doi: 10.1146/annurev.publhealth.28.021406.144145.CrossRefPubMedGoogle Scholar
  12. Green, L. W. (2001). From research to “best practices” in other settings and populations. American Journal of Health Behavior, 25, 165–178.CrossRefPubMedGoogle Scholar
  13. Green, L. W., & Glasgow, R. E. (2006). Evaluating the relevance, generalization, and applicability of research: Issues in external validation and translation methodology. Evaluation and the Health Professions, 29, 126–153. doi: 10.1177/0163278705284445.CrossRefPubMedGoogle Scholar
  14. Green, L. W., Ottoson, J. M., Garcia, C., & Hiatt, R. A. (2009). Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annual Review of Public Health, 30, 151–174. doi: 10.1146/annurev.publhealth.031308.100049.CrossRefPubMedGoogle Scholar
  15. Hicks, S., Duran, B., Wallerstein, N., Avila, M., Belone, L., & Lucero, J. (2012). Evaluating community-based participatory research to improve community-partnered science and community health. Progress in Community Health Partnerships, 6, 289–299. doi: 10.1353/cpr.2012.0049.PubMedCentralCrossRefPubMedGoogle Scholar
  16. Hoffman, A., Montgomery, R., Aubry, W., & Tunis, S. R. (2010). How best to engage patients, doctors, and other stakeholders in designing comparative effectiveness studies. Health Affairs, 29, 1834–1841.CrossRefPubMedGoogle Scholar
  17. Krumeich, A., Weijts, W., Reddy, P., & Meijer-Weitz, A. (2001). The benefits of anthropological approaches for health promotion research and practice. Health Education Research, 16, 121–130.CrossRefPubMedGoogle Scholar
  18. Lambert, H., & McKevitt, C. (2002). Anthropology in health research: From qualitative methods to multidisciplinarity. British Medical Journal, 325, 210–213.PubMedCentralCrossRefPubMedGoogle Scholar
  19. Malina, R. M. (1996). Tracking of physical activity and physical fitness across the lifespan. Research Quarterly for Exercise and Sport, 67, S40–S48.CrossRefGoogle Scholar
  20. Mantoura, P., & Potvin, L. (2012). A realist-constructionist perspective on participatory research in health promotion. Health Promotion International. doi: 10.1093/heapro/das037.PubMedGoogle Scholar
  21. Marcus, B. H., Dubbert, P. M., Forsyth, L. H., McKenzie, T. L., Stone, E. J., Dunn, A. L., & Blair, S. N. (2001). Physical activity behavior change: Issues in adoption and maintenance. Health Psychology, 19, 32–41.CrossRefGoogle Scholar
  22. Meyer, A. L., & Gullotta, T. P. (Eds.). (2012). Physical activity across the lifespan (Vol. 12). New York: Springer.Google Scholar
  23. O'Loughlin, J., Renaud, L., Richard, L., Gomez, L. S., & Paradis, G. (1998). Correlates of the sustainability of community-based heart health promotion interventions. Preventive Medicine, 27, 702–712.CrossRefPubMedGoogle Scholar
  24. Paez, D., Parra, D., Sarmiento, O., Hallal, P., Reis, R., Simoes, E., et al. (2012). Physical activity classes in community settings: Interventions to promote healthy lifestyles. Journal of Science and Medicine in Sport, 15, S315–S316.CrossRefGoogle Scholar
  25. Ponic, P., & Frisby, W. (2010). Unpacking assumptions about inclusion in community-based health promotion: Perspectives of women living in poverty. Qualitative Health Research, 20, 1519–1531. doi: 10.1177/1049732310374303.CrossRefPubMedGoogle Scholar
  26. Rychetnik, L., Bauman, A., Laws, R., King, L., Rissel, C., & Nutbeam, D. (2012). Translating research for evidence-based public health: Key concepts and future directions. Journal of Epidemiological Community Health, 66, 1187–1192. doi: 10.1136/jech-2011-200038.CrossRefGoogle Scholar
  27. Steckler, A., Ethelbah, B., Martin, C. J., Stewart, D., Pardilla, M., & Gittelsohn, J. (2003). Pathways process evaluation results: A school-based prevention trial to promote healthful diet and physical activity in American Indian third, fourth, and fifth grade students. Preventive Medicine, 37, S80–S90.CrossRefPubMedGoogle Scholar
  28. Stone, E. J., Norman, J. E., Davis, S. M., Stewart, D., Clay, T. E., & Caballero, B. (2003). Design, implementation, and quality control in the Pathways American-Indian multicenter trial. Preventive Medicine, 37, S13–S23.CrossRefPubMedGoogle Scholar
  29. Trickett, E. J., Beehler, S., Deutsch, C., Green, L. W., Hawe, P., & McLeroy, K. (2011). Advancing the science of community-level interventions. American Journal of Public Health, 101, 1410–1419. doi: 10.2105/AJPH.2010.300113.PubMedCentralCrossRefPubMedGoogle Scholar
  30. Unger, J. B., & Schwartz, S. J. (2012). Conceptual considerations in studies of cultural influences on health behaviors. Preventive Medicine, 55, 353–355. doi: 10.1016/j.ypmed.2012.09.024.PubMedCentralCrossRefPubMedGoogle Scholar
  31. Wallerstein, N. (1992). Powerlessness, empowerment, and health: Implications for health promotion programs. American Journal of Health Promotion, 6, 197–205.CrossRefPubMedGoogle Scholar
  32. Wallerstein, N., & Duran, B. (2010). Community-based participatory research contributions to intervention research: The intersection of science and practice to improve health equity. American Journal of Public Health, 100, S40–S46. doi: 10.2105/AJPH.2009.184036.PubMedCentralCrossRefPubMedGoogle Scholar
  33. Woolf, S. H. (2008). The meaning of translational research and why it matters. Journal of the American Medical Association, 299, 211–213. doi: 10.1001/jama.2007.26.PubMedGoogle Scholar

Copyright information

© Society for Prevention Research 2013

Authors and Affiliations

  • Janet Page-Reeves
    • 1
    • 3
  • Sally Davis
    • 1
  • Camilla Romero
    • 2
  • Eric Chrisp
    • 1
  1. 1.University of New MexicoAlbuquerqueUSA
  2. 2.Casa de SaludAlbuquerqueUSA
  3. 3.Office for Community HealthUniversity of New MexicoAlbuquerqueUSA

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