Contextually responsive implementation of place-activation interventions for promoting physical activity in low-income urban communities - ABSTRACT Background: Mexico is an upper-middle income country which, like the U.S., is highly urbanized (79%) and has a high noncommunicable disease (NCD) level (77% of all deaths), including a major diabetes and obesity crisis. Given this public health emergency, multiple bold, large-scale evidence-based interventions (EBIs) to improve healthy eating have been implemented. However, commensurate action for physical activity promotion, another critical determinant of obesity, diabetes, and multiple other NCDs, remains lacking. Residents of low-income urban communities comprise a high-need population with multiple challenges, including limited access to spaces and programs for leisure-time physical activity. Place-activation interventions are research-proven strategies (EBIs) for increasing physical activity in urban settings, optimizing use of new or rehabilitated public open places through community-engaged, multisectoral approaches. Goal: This proposal seeks to reduce the burden of physical inactivity by accelerating the uptake of place-activation EBIs in low-income urban communities in Mexico and informing action for high need groups in the U.S., including U.S.-based Latin Americans. Methods: We will harness an existing policy in Mexico that is supporting the renovation of multiple public spaces across the country to conduct a mixed-methods study in up to 10 cities where our team has existing partnerships. Our study will test multisectoral engagement methods to advance active dissemination and implementation for increasing the uptake of place-activation EBIs in low-income urban communities. We will pursue three specific aims: (1) use a mixed methods approach to adapt place-activation EBIs for use in our study settings (surveys, interviews, and focus groups); (2) conduct a hybrid III group-randomized controlled trial testing the effectiveness of active dissemination and implementation methods for improving the reach, adoption and implementation of place-based EBIs (15 intervention neighborhoods with recent public open space improvements will receive the intervention, and 15 comparison neighborhoods with recent public open space improvements will serve as controls); and, (3) use a community-engaged, participatory approach to examine the potential for longer-term maintenance and scalability of place-activation EBIs (GIS interviews, co-creation workshops, concept mapping). Our work will be guided by the “necessity- vs. choice-based physical activity models” framework for contextually responsive physical activity promotion; and the adapted version of the RE-AIM framework for scaling up physical activity interventions. Innovations and Impact: This study is innovative and impactful as it will be the first to test state-of-the-art implementation science methods for improving the uptake of effective, place-based physical activity EBIs in low-income urban Latin American communities. As such, it will provide critical evidence for addressing the growing levels of NCDs for similar high-need populations, including U.S.-based Latin Americans.
