Implementation outcomes and associated constructs from the Consolidated Framework for Implementation Research among churches trained online to implement Faith, Activity, and Nutrition in a national implementation study

Churches hold promise for reaching populations with high rates of chronic disease, yet few faith-based large-scale implementation studies exist. The study purpose was to examine 12-month implementation outcomes and associated Consolidated Framework for Implementation Research (CFIR) constructs after converting in-person training to online for an evidence-based intervention designed to improve church organizational practices related to physical activity (PA) and healthy eating (HE). US churches recruited from 2020 to 2022 participated in eight online lessons prior to implementation. Each church's coordinator completed an online baseline and 12-month survey assessing church practices for PA/HE components targeted in the Faith, Activity, and Nutrition (FAN) intervention (opportunities, messages, policies, and pastor support) and constructs from four CFIR domains. Mixed-effects regression models examined changes in practices over time and the impact of in-person versus online church operation at baseline. Linear regression tested associations between CFIR constructs and PA/HE implementation, adjusting for baseline practices. Churches (N = 107, 75% predominantly African American) from 23 states enrolled. At 12 months, 84% completed the survey. Implementation of all PA/HE practices increased, with larger effects for churches operating in-person for PA composite, messages, and policies and HE messages and policies. Constructs from all four CFIR domains were associated with implementation outcomes. In conclusion, online training was associated with significantly improved PA/HE church practices at 12 months. For churches operating in-person at baseline, effect sizes and CFIR associations with implementation outcomes were comparable to results of three prior studies using in-person training. Training for FAN is scalable with the potential to advance racial health equity.