Table 2 Aussie-FIT program content and implementation strategy adaptations for rural Australian contexts guided by FRAME-IS and FRAME reporting frameworks
From: ‘A Different Ball Game’: Adaptation of a men’s health program for implementation in rural Australia
Adaptation: Implementation Strategy, Type, Nature, and Level | Pilot/Metropolitan Aussie-FIT | Rural Aussie-FIT | Rationale for Adaptation or Rural Specific Considerations | Exemplar Quotes and Linked Qualitative Themes Informing Adaptations | Generalisability, Fidelity, and Potential Outcome of Adaptation |
Substitution of recruitment strategy content (organisational level) | Professional Australian Football League clubs affiliated with the Aussie-FIT programs shared promotional articles and recruitment information on their social media pages and websites to their large fan bases | Multi-faceted approach to recruitment including Facebook promotion, via local Australian Football clubs, local media coverage (radio and newspapers), word of mouth (e.g., via community champions, local organisations and other men interested in participating) | No affiliation with AFL clubs. The rural recruitment strategies were informed by stakeholder focus groups. The goal of this adaptation is to increase the reach and health equity relevance of the program | Most Relevant Qualitative Themes and Sub-Themes: - A Smaller Fishpond - Trust, Recognition and Credibility: The Importance of Local Champions - A Double-Edged Sword Exemplar Stakeholder Quotations: ‘Hit the socials’[…]‘Site 1 community board goes off on Facebook’ (Site 1, FG2, Female) ‘…leveraging the (local) clubs is definitely one way to do it’ (Site 1, FG1, Female) ‘…bring a friend or two is probably going to have to be a realistic approach’ (Site 3, FG2, Male) ‘It's probably the medium (newspapers) that works regionally, that doesn't work metro’ (Site 3, FG2, Female) ‘…if you're talking about, how do we speak to the community, I guess I mean I, for our programs I use local radio. (FG1, Site 1, Female) | This adaptation does not impact intervention delivery or likely effectiveness and is classified as fidelity consistent How effective the adapted recruitment strategy for rural areas is unknown and requires evaluation Given the smaller rural population sizes and the that well supported professional AFL clubs with large social media followings are not promoting the program, the rate of recruitment may be reduced in comparison to the metropolitan pilot Potential Generalisability: These recruitment approaches are potentially generalisable across rural Australian towns, for both the Aussie-FIT program and/or other health initiatives or target groups |
Tailoring and adding/removing marketing strategy (implementer level) | Marketing of the program highlighted a ‘behind the scenes’ experience at the professional AFL club men support. This included alluding to the potential for bumping into players and access to professional footy settings for the program sessions. The program was marketed as an AFL club-specific program | Rural program marketing refers to the program as being ‘footy themed’ in the text and images used, with no mention of specific club affiliation. The phrases ‘no footy experience required’, ‘meeting likeminded men’, ‘having a laugh’, ‘limited places available’ and the potential for ‘mental health benefits’ is highlighted in flyers and social media posts. The fact the program is free of charge was also highlighted | Rural marketing strategies were informed by stakeholder focus groups. Adaptation reasons include to: • make clear there is no affiliation with specific football clubs • make clear that all eligible men are welcome, regardless of their football experience • highlight potential mental health benefits and the opportunity to form connections with other likeminded men • use language that may give a sense that men may be one of the lucky few to participate • clearly highlight that the program is free of charge The goal of this adaptation is to increase the appropriateness of the marketing for rural contexts without club affiliations, and to increase the potential reach and health equity relevance of the program | Most Relevant Qualitative Themes and Sub-Themes: - Engaging Rural Men and Diversity - Program Marketing and Cost - A Common Language - Local Club Rivalries Exemplar Stakeholder Quotations: ‘…pushing the point that they probably don't need to have been a footy or played footy to participate…[…]…If that can be pushed out that you know, they may not have ever had to do a hand ball to be able to participate. (Site 1, FG1) ‘So we kind of need to develop that kind of feeling here where people feel lucky to be one of the 60’ (Site 2, FG1) ‘…they formed those social groups at the end and people that maybe had been feeling a bit lonely. Particularly after this lovely year we've just had, I think that could be a real drawcard as well, around coming in, meeting new people. As opposed to perhaps going just purely for the fitness or the health angle.’ (FG2, Site 2, Female) | This adaptation does not impact intervention delivery or likely effectiveness and is classified as fidelity consistent How effective the adapted marketing strategies for rural areas are unknown and requires evaluation alongside the rural recruitment strategy Potential Generalisability: The rural marketing strategy could be generalisable for the marketing of Aussie-FIT across rural areas. Although the marketing is specific to the Aussie-FIT program (e.g., ‘footy themed’), aspects of the approach could be generalisable to other initiatives taking a gender-tailored approach to engaging men or for programs looking to appeal to individuals from diverse backgrounds |
Tailoring and loosening the structure of the coach recruitment strategy and coach training mode. This modification is to the context (setting/format and personal) and the training of the implementors (implementer level) | The intention was for coaches to be recruited directly from AFL clubs, but ultimately, three coaches were recruited via the clubs and an additional three coaches were identified by the research team. The coaches attended four-half day program training workshops | Coach role information will be circulated amongst local stakeholders for dissemination via email and/or social media. Stakeholders will be encouraged to share the role information to local football and other sporting clubs, and other community or health organisations. Key characteristics of coaches (e.g., interest in Australian Football; coaching experience, communication skills) to deliver the program are unchanged. Coaches with or without specific club affiliations are eligible. Flexibility of coach training delivery mode will be considered (e.g., partially online) if coordinating face-to-face training is challenging. The content of the training is unchanged | The flexibility with the coach training mode is informed by pragmatism. The coach recruitment strategy is informed by the stakeholder focus groups and the fact that the rural program is not affiliated with AFL clubs. Stakeholders reported that rural football club volunteers were overburdened and, in many cases, unlikely to be able to have any active involvement in Aussie-FIT. Hence, coach recruitment efforts were not targeted solely at local football clubs. The goal of this adaptation is to increase the adoption of the program | Most Relevant Qualitative Themes and Sub-Themes: - A Smaller Fishpond - Trust, Recognition and Credibility: the importance of local champions - Rural Partnerships and Sustainability Exemplar Stakeholder Quotations: ‘So it would restrict yourself, if you're looking for coaches I wouldn't restrict yourself to the two [site 1] teams by a long shot.’ (FG1, Site1, Male) ‘…people are over worked in footy clubs now. Like there's a small amount of volunteers doing a lot of the pulling power. So it's yeah. It's, to ask them to do more is probably unrealistic at this point I reckon.’ (FG1, Site1, Male) ‘So I think one of your key things will be finding absolutely right person on the ground to be your go to person’ (FG3, Site3, Female) | All coaches bring their own style of delivery, and some may deliver core program components with a higher degree of fidelity than others, which could in turn influence participant health and health behaviour outcomes. However, the adaptation to the coach recruitment strategy and flexibility with training mode itself is unlikely to impact intervention delivery or program effectiveness and is classified as ‘fidelity-consistent’ How effective the coach recruitment strategy for rural areas is unknown and requires evaluation Potential Generalisability: The adapted coach recruitment strategy and coach training mode could be generalisable to the recruitment of Aussie-FIT coaches across other rural areas and could be applicable to other rural health initiatives |
Program partnership organisation modifications for context (organisational level) | Professional AFL clubs were partners in the pilot Metropolitan Aussie-FIT program. Their primary role was to help promote the program to potential participants and to provide a program delivery venue | Partnerships with the West Australian Football Commission, local government authorities, and other community or health organisations will be sought in the rural Aussie-FIT program. Their role will include helping to promote the program, support the identification and recruitment of coaches, and to help identify and liaise with organisations around venue bookings. Stakeholders will be consulted with on an ongoing basis, during and post-program implementation, in an advisory capacity | The rural program partnerships were informed by the stakeholder focus groups and the fact that the rural program is not affiliated with AFL clubs. The goal of this adaptation is to increase the potential sustainability of the program, as well as the program reach, adoption and the acceptability and appropriateness of the implementation effort in rural contexts | Most Relevant Qualitative Themes and Sub-Themes: - Trust, Recognition and Credibility: the importance of local champions - Rural Partnerships and Sustainability Exemplar Stakeholder Quotations: ‘They roll out all AFL down here to the kids and everything. Yeah. So I would probably say they're the best ones to get involved in rolling this program out. (FG1, Site3, Male) That's the big word, relationship. For it to be sustainable, you've got to build on it (Male)…. And while we've got budget, we may as well start doing that and work with them.’ (FG2, Site3, Female) | This adaptation does not impact intervention delivery or likely effectiveness and is classified as fidelity consistent. The role that program partnership organisations have undertaken during rural implementation will be reviewed and discussed with stakeholders following initial implementation efforts, with a view to working towards a sustainable program delivery model Potential Generalisability: Program partnership organisations either have equivalent organisations across rural areas, or their organisation and employee structure spans across rural Western Australia. Thus, partnerships adopted for rural implementation could be generalisable for Aussie-FIT implementation across rural areas and could be applicable to other rural health initiatives |
Program Adaptation | Pilot/Metropolitan Aussie-FIT | Rural Aussie-FIT | Rationale for Adaptation or Rural Specific Considerations | Exemplar Quotes and Linked Qualitative Themes Informing Adaptations | Core Program Components, Fidelity, and Potential Generalisability |
Tailoring/ tweaking, changes in packaging and materials, and substituting aspects of the existing program to reflect the modified Australian football theme/framing and related program content. These modifications cut across community coach, target group, and organisational levels | Delivered in association with specific professional AFL clubs to specifically engage men that support those teams. ‘Behind the scenes’ program feel, with coaches wearing club shirts and men participating getting a free club/team shirt to wear during the program. Session 1: ‘Behind the scenes’ tour of club facilities, walk around the oval with club insider stories. Session 6: A club player, former player, coach, or other’celebrity’ is invited to the session to talk to the men about the football club and reflect on setbacks they have overcome in their career, and how men might relate to setbacks they may experience | An Australian Football themed program, not delivered in association with any specific local or non-local clubs, to appeal to men that may have an interest in Australian Football. Local community program, run by local coaches, with coaches wearing Aussie-FIT shirts, and participants wearing an Aussie-FIT team t-shirt. Session 1: Will likely differ across rural programs depending on the context, but often a walk around the oval, and sharing stories about the history of football in the area or local clubs. Session 6: If a local football guest is not available to come and speak to the men, the coach and participants will share stories of when they have experienced a setback (football related or other) | The goal of these adaptations was to improve intervention fit for the context. The reason for these adaptations was the location/accessibility. Rural contexts with no access to professional AFL club facilities. Program is not affiliated with professional AFL clubs. The program framing and theme were informed by stakeholder focus groups. Stakeholders did not discuss specific program content, with these adaptations made by the research team. Session 1: Rural context with no access to professional AFL club facilities. Session 6: Access to a ‘celebrity guest’ likely more difficult in rural contexts, without AFL club affiliation. Where relevant, program materials (e.g., participant booklets) were tweaked to correspond with these adaptations (e.g., removing or replacing mentions of ‘your club’) | Most Relevant Qualitative Themes and Sub-Themes: - A Common Language - Popularity of Australian Football - Local Club Rivalries Exemplar Stakeholder Quotations: ‘…you're on a winner with the access to you know, something that is common language which is AFL. Everyone, every dad, and their kids… male has had exposure to it. May have loved it or hated it, but at least they're aware of it. And it's in your face every day, in the paper.’ (FG1, Site 2, Male) ‘…it probably wouldn't be best affiliated to clubs down here. Because yeah, you'll get ones that are just affiliated to that club that will go and then you might not get the others coming…’ (FG1, Site3, Female) | Core elements or functions of the program are preserved, and this modification is deemed fidelity consistent. The theoretical basis, behaviour change techniques utilised, and the program content designed to support men to make positive changes to their health behaviours have not been adapted. No tour around professional football settings and potential lack of a ‘celebrity’ appearance links to the rural program not being associated to professional clubs. This removes an aspect of the original program ‘hook’, which could influence how attractive or engaging the program is for some men Potential Generalisability: These adaptations are likely generalisable to many Western Australian and other rural contexts. For generalisability to parts of Australia where Australian Football is less popular, modifying the sport of choice for the program theme may be a consideration. Using sport as a program ‘hook’ could be applicable to other rural health initiatives to engage participants |
Contextual modifications made to the program delivery setting and time of year the program is delivered. These modifications were made for the target group | Professional AFL club settings often with access to a gym onsite. The time of year that programs were delivered varied, with recruitment during the early months of the football season a deliberate consideration. If men were not available for the scheduled program, then they were not enrolled in the program | Local accessible rural amateur Australian Football settings. Program timings are likely to vary across the three rural sites. The peak winter months should be avoided in sites 2 and 3, and the farming season avoided in site 1 | The goal of these adaptations is to improve intervention fit for the context. The reason for these adaptations was the location, accessibility, and social context (local climate and employment). Rural context with no access to professional football club facilities. The program venue choices and delivery timings were informed by pragmatism and considerations raised in stakeholder focus groups. In site 1, there was only one possible football oval in town. In sites 2 and 3 where there was more than one potential option, the venue was selected based on availability, accessibility, and potential to reach men from diverse backgrounds. In site 1, the program was not scheduled during farming season in site 1, and not scheduled during winter months in sites 2 and 3 | Most Relevant Qualitative Themes and Sub-Themes: - Engaging Rural Men and Diversity - Accessibility and Rural Football Settings - Seasonality, Work and Weather Exemplar Stakeholder Quotations: ‘Public transport, there is no public transport….[…..]… So central, wherever the programs being run.’ (FG1, Site 2, Male) ‘…location-wise and that's where [venue name] would be a good one, because that's the area where there is, a lower socioeconomic area, state housing, some Aboriginal involvement there.’ (FG3, Site 3, Male) ‘…weather is a bit of an issue down here. So if you're having an outdoor program and you're doing it in July, you're not going to get many participants…’ (FG1, Site2, Female) ‘…every eligible bloke disappears over harvest time.’ (FG2, Site 1, Female) | These modifications do not impact core elements or functions of the program and are deemed fidelity consistent Potential Generalisability: Local contextual factors (e.g., weather, employment) will vary across rural sites in Australia which will influence the most appropriate program delivery settings and time of year to deliver Aussie-FIT or other health initiatives to engage the target population |