ORIGINAL RESEARCH article

Front. Public Health

Sec. Public Health and Nutrition

Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1564567

Scaling up the Med-South Lifestyle Program in Public Health Settings to Reduce Chronic Disease Risk: A Hybrid Implementation-Effectiveness Study

Provisionally accepted
Carmen Samuel-HodgeCarmen Samuel-Hodge1,2*Lisa PhamLisa Pham2Kiira LyonsKiira Lyons2Lindy B. DraegerLindy B. Draeger2Li JiangLi Jiang3Feng-Chang LinFeng-Chang Lin3Rachel RamRachel Ram2Jennifer LeemanJennifer Leeman4
  • 1Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • 2Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, United States
  • 3Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • 4School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

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Introduction: Major disparities persist in heart disease, diabetes, and obesity, with rates highest among those living in the southeastern and central parts of the US. Intervening to improve lifestyle behaviors represents an opportunity to address health inequities. Although the scientific rationale for lifestyle interventions is robust, evidence is limited on how to implement these interventions at scale. Methods: Using a type 3 hybrid implementation-effectiveness design, we evaluated a statewide scale-up trial implementing the Med-South Lifestyle Program in mostly rural community health centers and health departments across North Carolina, in the southeastern US. Implementation outcomes were measured at the site level and program effectiveness outcomes were assessed by physiologic and behavioral changes at the participant level. Descriptive statistics and paired t-tests comprised our statistical analyses. Results: We invited 200 public health sites to participate in the study and 28 (14%) expressed interest. Among those expressing interest, 21 (75%) signed a Memorandum of Agreement. The statewide scale-up resulted in the enrollment of 95% (19/20) of the proposed sites -13 health departments (68%) and six community health centers. The majority of the 235 study participants who started the program were adults self-identifying as non-Hispanic White (45%) or non-Hispanic Black (37%); 11% identified as Hispanic and 5% as American Indian. Most participants were female (88%), with a mean age of 51 years, and educational attainment of a 2-or 4year college degree (57%). Implementation outcomes included 17 sites (89%) retained throughout the

Keywords: lifestyle intervention, implementation, prevention and control, COVID-19, Federally qualified health centers

Received: 21 Jan 2025; Accepted: 19 May 2025.

Copyright: © 2025 Samuel-Hodge, Pham, Lyons, Draeger, Jiang, Lin, Ram and Leeman. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Carmen Samuel-Hodge, Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, 27599‑7400, North Carolina, United States

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Supplementary Material