Scaling Out a 4-H Healthy Meeting Initiative: Challenges in Implementation and Comprehensive Evaluation.

The national Cooperative Extension System delivers a number of nutrition and physical activity interventions, but it is unknown how an intervention may translate from 1 state within the system to another. Using the reach, effectiveness, adoption, implementation, maintenance framework for program evaluation can improve intervention scale-out. Adoption is a key dimension of reach, effectiveness, adoption, implementation, maintenance: if delivery personnel do not deliver an intervention, it can have no impacts on health. Here, differences are discussed regarding adoption rates between state Extension systems when scaling out a 4-H healthy meeting intervention. This experience provides suggestions for improved scale-out of Extension programs, including state-specific adaptation and pragmatic data collection.