# Accessibility, acceptability, and usage during COVID-19 of the evidence-based intervention Healthy Eating and Active Living Taught at Home (HEALTH): implications for implementation strategies

## TL;DR

The study evaluates how well a home-based health program was used during the pandemic and suggests ways to improve its reach and effectiveness.

## Contribution

The study integrates dissemination and implementation frameworks to assess coverage of an evidence-based health intervention during the pandemic.

## Key findings

- 67% of home visitors referred to the HEALTH program, but 33% made no referrals.
- Only 26% of mothers received all eight core HEALTH lessons, indicating gaps in usage.
- 80% of mothers reported satisfaction with the program, showing strong acceptability.

## Abstract

Healthy Eating and Active Living Taught at Home (HEALTH) is an evidence-based intervention (EBI) embedded in Parents as Teachers (PAT) home visiting to improve weight outcomes among mothers. Public health impact of HEALTH relies on EBI coverage (accessibility, acceptability, usage). Therefore, the purpose of this study is to identify coverage strengths/gaps which can inform dissemination and implementation (D&I) strategies to increase HEALTH coverage.

We conducted descriptive analyses using baseline data and home visitor documentation of PAT visits from the HEALTH D&I study, which took place during COVID-19. Coverage was measured by expanding on RE-AIM with the adapted Shengelia et al. Access, utilization, quality, and effective coverage framework and included: accessibility (home visitor referrals to HEALTH), acceptability (mother self-report satisfaction), usage (number of visits mothers received from the home visitor, proportion of HEALTH content delivered, proportion of HEALTH lessons delivered).

In the HEALTH D&I study, 67% of home visitors made at least one referral to HEALTH; however, 33% made no HEALTH referrals. The average number of referrals was 2.05 (SD = 2.38). Most mothers (80%) were satisfied with HEALTH. The average number of visits mothers received was 13.91 (SD = 10.62). On average 39% of all 24 HEALTH lessons, 66% of the eight core HEALTH lessons, and 33% of the HEALTH handouts were delivered. Only 26% of mothers received all 8 core HEALTH lessons. These lessons focus on goals and basic information on healthy eating and physical activity (e.g., Your Health Goals, Let’s Get Moving!, Making Healthy Beverage Habits) and make up the core section of the HEALTH curriculum.

This study demonstrates integration of D&I frameworks to evaluate D&I outcomes and offers insights into strategies for EBIs in community settings and insights into service delivery during COVID-19. Findings show strong EBI coverage (acceptability) and gaps (accessibility; usage) supporting the need for implementation strategies to increase adoption (e.g., building partner relationships, choosing strategic partners, ) and support implementation (e.g., facilitate peer learning, create program guide).

NCT03758638 (https//clinicaltrials.gov/study/NCT03758638), registered Nov 29, 2018.