Implementation Strategies and Outcomes of Physical Activity and Nutrition: Baseline Values of Missouri SPAN, HOP, and REACH Programs

Missourians are not meeting recommendations for physical activity or nutrition. To address this challenge, the CDC has provided Missouri with state (SPAN), regional (HOP), and community-level (REACH) funding to implement large-scale programs. This study describes the implementation strategies and outcomes of SPAN, HOP, and REACH programs in Missouri. A cross-sectional, online survey was conducted in 2024 of practitioners from SPAN, HOP, and REACH program collaborating organizations, who implemented policy, systems, and environmental change to improve physical activity and nutrition. Implementation strategies were assessed using a comprehensive list of 73 implementation strategies. Implementation, service, and client outcomes were assessed using an 11-item questionnaire. Descriptive statistics were calculated for all study variables. Across programs, most practitioners (n = 44) were female (50.0%-61.5%), White (61.5%-92.3%), and had graduate degrees (62.5%-100%). Overall, the most common strategies used were providing interactive assistance (89.5%-81.0%), adapting and tailoring to context (89.5%-81.0%), and developing stakeholder interrelationships (84.2%-81.0%). Programs were reported to be safe (M = 4.80-4.69), effective (M = 4.47-4.18), timely (M = 4.60-4.35), and likely to improve physical activity and nutrition (M = 4.33-4.06). Missouri's programs employ strategies that reportedly reached priority populations. These programs seem to work upstream of policy, systems, and environment on capacity building. Future longitudinal studies should examine the impact of implementation strategies on built environment changes to ensure lasting health improvements for Missourians.