Choose to Move - Next Steps: Can 'Booster Sessions' Sustain Health Benefits of an Effective, Scaled-up, Health Promotion Program?

Two items will assess change in a participants' ability to walk a quarter of a mile and up 10 steps (Simonsick et al., 2008). The output variable is self-reported presence of mobility-disability (no/any difficulty walking 400m or climbing one flight of stairs).

Change will be assessed using longitudinal modelling across 0, 3, 12 and 24 months.

Change in mobility will be assessed with the Physical Functioning Subscale of the 36-Item Short Form Survey (SF-36; Ware et al., 1989). The measure asks participants to rate if their health limits them in performing 10 different activities. The output variable is an average score from 0-100 of physical functioning, where a higher score indicates a more favourable health state.

Change will be assessed using longitudinal modelling across 0, 3, 12 and 24 months.

The Mobility Assessment Tool-Short Form (MAT-sf; Rejeski et al., 2015) will be used to assess change in mobility. The MAT-sf is a validated, short form video-animated tool to assess participant self-perception of mobility. Only participants with an internet connection are able to complete this measure. The output variable is a self-rated mobility score (30-80), with higher scores indicating greater self-perception of mobility.

Change will be assessed using longitudinal modelling across 0, 3, 12 and 24 months.

The single item physical activity questionnaire will be used to measure change in physical activity (Milton, Bull & Bauman, 2011). Output variable is self-reported number of days/week ≥30 min PA in the past week.

Change will be assessed using longitudinal modelling across 0, 3, 12 and 24 months.

The three-item loneliness scale (Hughes et al., 2004) will be used to assess change in loneliness. Participants rate three aspects of loneliness. The output variable is loneliness score (3-9); lower scores indicate lower levels of loneliness.

Change will be assessed using longitudinal modelling across 0, 3, 12 and 24 months.

Change in social isolation will be assessed using a 4-item questionnaire adapted from Vernoff, Kulka & Douvan (1981). The output variable is social isolation score (0-15). Lower scores indicate greater levels of social isolation and higher scores indicate lower levels of social isolation.

Change will be assessed using longitudinal modelling across 0, 3, 12 and 24 months.

A single item measure from the My Health My Community survey (2014) will be used to assess change in sense of belonging as an indicator of social connectedness. The output variable is sense of belonging score (1-4) with lower scores indicating a stronger sense of belonging.

Change will be assessed using longitudinal modelling across 0, 3, 12 and 24 months.

A five-item questionnaire (Marshall et al., 2010) will be used to assess change in sitting time (hours and minutes) each day in the following domains: (a) while travelling to and from places (e.g., work, shops); (b) while at work; (c) while watching television; (d) while using a computer at home; and (e) at leisure not including watching television (e.g., visiting friends, movies, eating out) on a weekday and a weekend day. The output variables are sitting hours per day across 5 domains.

Change will be assessed using longitudinal modelling across 0, 3, 12 and 24 months.

A single item from the My Health My Community survey (My Health My Community, 2013) will be used to assess change in screen time. The output variable is the range of hours of screen time per day.

Change will be assessed using longitudinal modelling across 0, 3, 12 and 24 months.

Change in participant social network will be assessed using the 6-item Lubben Social Network Questionnaire (Lubben et al., 2006). The output variable is a social network score (range 0 to 30) where higher scores indicate larger social networks.

Change will be assessed using longitudinal modelling across 0, 3, 12 and 24 months.

Change in health status (EQ-5D-5L Profile) will be assessed with the EQ-5D-5L (The EuroQol Group, 1990). Participants report on mobility, self-care, usual activities, pain/discomfort and anxiety/depression on a scale from 1-5 (level of perceived problems) for each item. Responses are used to create a 5-digit number which will be used descriptively.

Change will be assessed descriptively across 0, 3, 12 and 24 months.

Change in health status (EQ-5D-5L Level Sum Score) will be assessed with the EQ-5D-5L (The EuroQol Group, 1990). Participants report on mobility, self-care, usual activities, pain/discomfort and anxiety/depression on a scale from 1-5 (level of perceived problems) for each item. The Level Sum Score uses the 5-digit profile to create a numeric score, with scores ranging from 5-25 (lower levels indicate lower levels of perceived problems).

Change will be assessed using longitudinal modelling across 0, 3, 12 and 24 months.

Change in health status (EQ-5D-5L Visual Analogue Scale) will be assessed with the EQ-5D-5L (The EuroQol Group, 1990). Participants report on their health on a visual analogue scale from 0 (worst health) to 100 (best health).

Change will be assessed using longitudinal modelling across 0, 3, 12 and 24 months.

Reach is defined as the proportion of the intended priority audience who participate in the intervention (Saunders et al., 2005).

Reach of CTM-NS will be captured across 3, 12 and 24 months at the level of the participant. This is operationalized as the number of older adult participants (and proportion of eligible population).

Data will be provided by Provincial Coordinators (program records).

Reach is defined as the proportion of the intended priority audience who participate in the intervention (Saunders et al., 2005).

Reach of CTM-NS will be captured across 3, 12 and 24 months at the level of organizations. This is operationalized as the number of Activity Coaches and sites that deliver CTM-NS.

Data will be provided by Provincial Coordinators (program records).

Dose delivered is defined as the amount of each intervention component delivered or provided to participants (Saunders et al 2005). This will be captured at 3, 12, and 24 months.

Dose delivered (by Activity Coaches) will be assessed via survey. Items have been designed in-house. For example, "I provided opportunities for group check-in with Choose to Move participants during virtual group meetings", with response options on a scale from 0-4 (no/a few/most/all group meetings).

Dose delivered is defined as the amount of each implementation strategy delivered or provided to participants (Saunders et al 2005). This will be captured at 3, 12, and 24 months.

Data will be collected from internal program records.

Dose received is defined as the amount of each intervention component received by participants (attendance). This will be captured at 3, 12, and 24 months time points.

Activity Coaches will provide dose received (by older adults) data via survey. Items have been designed in-house. For example, Activity Coaches will be asked "How many group meetings did this participant attend?". Attendance will be expressed as a percentage out of 24 (for participants in the high dose arm) and 8 (for participants in the low dose arm).

Defined as how well different program components were conducted (e.g., are the main program elements delivered clearly and correctly?) (Durlak and Dupre 2008) and the extent to which the intervention was implemented as planned (Saunders et al., 2005).

The extent to which Activity Coaches deliver CTM-NS with quality will be captured at 3, 12, and 24 months. Older adults will provide data via survey. Items have been designed in-house and response options will be on an agreement scale or yes/no (e.g., "I feel comfortable at the Choose to Move group meetings.").

Defined as the degree to which CTM-NS stimulates the interest or holds the attention of participants (Durlak and Dupre 2008).

Older adult participant satisfaction, engagement and enjoyment with each component of CTM-NS will be captured at 3, 12, and 24 months. Data will be collected from Activity Coaches and older adults via survey. Items have been designed in-house (e.g., "Participants were enthusiastic, interested, and engaged with the CTM content and each other during virtual group meetings."), and response options will include agreement scales and yes/no.

Defined as changes made to the original program during implementation (Durlak and Dupre, 2008).

Adaptation of CTM-NS during delivery will be described and characterized using an adaptation framework (Stirman et al 2019). Activity Coaches will provide data via survey across 3, 12, and 24 months. Items have been designed in-house and include open-ended responses. For example, "When you delivered Choose to Move to this group of participants, did you make any adaptations or modifications? These could be additions, deletions, substitutions, repetitions, etc. If so, please describe the modification(s), explain why you made them, and explain when and/or the frequency with which you made them."

Open-ended responses will be explored using framework analysis.

Defined as changes made to the original program during implementation (Durlak and Dupre, 2008).

Data to be provided by Provincial coordinators (interview) and Activity Coaches (focus groups). Interview and focus group guides were designed in-house (e.g., "We described and outlined the structure of the Choose to Move program in your training supplement, but we acknowledge that it is not always feasible or realistic to deliver it as planned. Can you tell me about any changes you made to the program, if any?").

Interview and focus group data will be explored using framework analysis.

Defined as aspects of the larger social, political, and economic environment that may influence intervention implementation (Linnan & Steckler, 2002).

The context (policy, health, community) in which CTM-NS is delivered that may support and/or hinder program implementation will be captured at 3, 12, and 24 months. Data will be provided by Activity Coaches via survey.

Items have been designed in-house (e.g., "What factors helped you to deliver Choose to Move?", with a list of response options).

Defined as aspects of the larger social, political, and economic environment that may influence intervention implementation (Linnan & Steckler, 2002).

Data will be provided by Provincial partners, Provincial coordinators (interviews) and Activity Coaches (focus groups). Interview guides have been designed in-house (e.g., "How does offering CTM fit with the strategic direction of your organization moving forward?").

Interview and focus group data will be explored using framework analysis.

Defined as aspects of the provider that may influence intervention implementation (e.g., organizational functioning).

CTM-NS provider characteristics that support and/or hinder program implementation (perceived need, readiness, self-efficacy) will be captured at 3, 12, and 24 months. Data will be provided by Activity Coaches (focus groups) and Provincial coordinators (interviews). Interview scripts have been designed in-house (e.g. "Are there any major challenges your organization needs to overcome to continue to deliver CTM?").

Interview and focus group data will be explored using framework analysis.

Innovation characteristics are defined as aspects of the intervention that may influence implementation. Acceptability is the perception among implementation stakeholders that a given treatment, service, practice, or innovation is agreeable, palatable, or satisfactory (Proctor et al., 2011).

Four items, each rated 1-5, will be used to assess acceptability of CTM-NS as perceived by Provincial Partners and Activity Coaches (Weiner et al., 2017) across at time points 3, 12, and 24 months via survey. The output variable is a mean score from 1-5, with higher scores indicating more acceptable.

Innovation characteristics are defined as aspects of the intervention that may influence implementation. Feasibility is defined as the extent to which a new treatment, or an innovation, can be successfully used or carried out within a given agency or setting (Proctor et al., 2011)

Four items, each rated 1-5, will be used to assess feasibility of CTM-NS as perceived by Provincial Partners and Activity Coaches (Weiner et al., 2017) across at time points 3, 12, and 24 months via survey. The output variable is a mean score from 1-5, with higher scores indicating more feasible.

Innovation characteristics are defined as aspects of the intervention that may influence implementation. Appropriateness is the perceived fit, relevance, or compatibility of the innovation or evidence-based practice for a given practice setting, provider, or consumer; and/ or perceived fit of the innovation to address a particular issue or problem (Proctor et al 2011)

Four items, each rated 1-5, will be used to assess appropriateness of CTM-NS as perceived by Provincial Partners and Activity Coaches (Weiner et al., 2017) across at time points 3, 12, and 24 months via survey. The output variable is a mean score from 1-5, with higher scores indicating more appropriate.

Innovation characteristics are defined as aspects of the intervention that may influence implementation.

Feasibility, acceptability and appropriateness of CTM-NS as perceived by older adults (Weiner et al., 2017) will be captured across at time points 3, 12, and 24 months via survey. Items have been designed in-house. For example, older adults will be asked, "Overall how easy is it for you to attend virtual group meetings?".

Defined as aspects of the intervention that may influence implementation.

Data provided by Provincial Partners/Coordinators (interviews) and Activity Coaches (focus groups). Interview guides have been designed in-house. For example, Activity Coaches will be asked "What factors do you think helped with the delivery of the model? What worked well during program delivery?".

Interview and focus group data will be explored using framework analysis.

Defined as aspects of the support system that may influence implementation (e.g., training and technical assistance).

Characteristics of the prevention support system that support and/or hinder program implementation (satisfaction with training and support) will be assessed. Activity Coaches will provide data via survey. Questions have been designed in-house (e.g., "The Choose to Move training provided me with the resources I needed to deliver CTM-NS."), and response options will include agreement scales and yes/no.

Defined as aspects of the support system that may influence implementation (e.g., training and technical assistance).

Characteristics of the prevention support system that support and/or hinder program implementation (satisfaction with training and support) will be assessed. Data provided by Provincial Coordinators and Activity Coaches via interview/focus groups. Interview questions have been designed in-house (e.g., "What was the support like from the Active Aging Research Team throughout the planning and delivery phases of Choose to Move?").

Interview and focus group data will be explored using framework analysis.

Direct intervention delivery costs (overall, per program and per participant) will be assessed at the end of CTM-NS.

Data will be provided by Provincial Coordinators via project management records, including expenditures across all aspects of program development and implementation (e.g., program costs, personnel and non-personnel costs, recruitment, and organizational/equipment costs).

Value will be assessed by comparing the incremental cost per participant with benefit achieved at the participant level across each study arm. It will be calculated at the end of the CTM-NS.

Financial data proved by Provincial Coordinators via project management records.