Background Implementation of evidence-based interventions often involves strategies to engage diverse populations while also attempting to maintain external validity. When using health IT tools to deliver patient-centered health messages, systems-level requirements are often at odds with ‘on-the ground’ tailoring approaches for patient-centered care or ensuring equity among linguistically diverse populations. Methods We conducted a fidelity and acceptability-focused evaluation of the STAR MAMA Program, a 5-month bilingual (English and Spanish) intervention for reducing diabetes risk factors among 181 post-partum women with recent gestational diabetes. The study’s purpose was to explore fidelity to pre-determined ‘core’ (e.g. systems integration) and ‘modifiable’ equity components (e.g. health coaching responsiveness, and variation by language) using an adapted implementation fidelity framework. Participant-level surveys, systems-level databases of message delivery, call completion, and coaching notes were included. Results 96.6% of participants are Latina and 80.9% were born outside the US. Among those receiving the STAR MAMA intervention; 55 received the calls in Spanish (61%) and 35 English (39%). 90% (n = 81) completed ≥ one week. Initially, systems errors were common, and increased triggers for health coach call-backs. Although Spanish speakers had more triggers over the intervention period, the difference was not statistically significant. Of the calls triggering a health coach follow-up, attempts were made for 85.4% (n = 152) of the English call triggers and for 80.0% (n = 279) of the Spanish call triggers (NS). Of attempted calls, health coaching calls were complete for 55.6% (n = 85) of English-language call triggers and for 56.6% of Spanish-language call triggers (NS). Some differences in acceptability were noted by language, with Spanish-speakers reporting higher satisfaction with prevention content (p = < 0.01) and English-speakers reporting health coaches were less considerate of their time (p = 0.03). Conclusions By exploring fidelity by language-specific factors, we identified important differences in some but not all equity indicators, with early systems errors quicky remedied and high overall engagement and acceptability. Practice implications include: (1) establishing criteria for languge-equity in interventions, (2) planning for systems level errors so as to reduce their impact between language groups and over time; and (3) examining the impact of engagement with language-concordant interventions on outcomes, including acceptability. Trial Registration National Clinical Trials registration number: CT02240420 Registered September 15, 2014. ClinicalTrials.gov.

From international and national agreements, considering the legislation in Chile, Inclusive Education requires having an in-depth understanding of theoretical, normative and legislative constructs so that the teacher can transform and innovate in the school Physical Education class. For this reason, the research question of this review is: How should the appropriation of Educational Inclusion take form for students with Special Educational Needs and living with disabilities when realized by Physical Education teachers? The keywords "Inclusion", "Educational inclusion", "Special educational needs", and "People with disabilities" were used in the Library of National Congress and the Ministry of Education (Chile). Furthermore, decrees and laws were found regulating the teaching profession in school contexts. Finally, school Physical Education teachers must work collaboratively with education professionals if they do not know how to interpret the current regulations that guide their duties. Vital points were evidenced considering the Physical Education initial training, ministerial documents and laws that would allow educational inclusion in the Physical Education and Health class. However, an appropriation of the agreements, regulations and legislation by the Physical Education teacher is even more required.

Background: Evidence-based interventions often develop strategies to engage diverse populations while also attempting to maintain external validity. When using health IT tools to deliver patient-centered health messages, systems-level requirements are often at odds with ‘on-the ground’ tailoring approaches employed in patient-centered care, particularly regarding ensuring equity is achieved linguistically diverse populations. Methods: STAR MAMA, is a 5-month bilingual (English and Spanish) intervention adapted from the Diabetes Prevention Program, examined in a pilot RCT conducted among 181 post-partum women with recent gestational diabetes. Fidelity to pre-determined ‘core’ intervention components (e.g. systems integration) as well as important ‘modifiable’ components focused on population equity (e.g. health coaching responsiveness, and variation in outcomes by language), were assessed, using an adapted implementation fidelity framework. Evaluation data included participant-level surveys, systems-level databases of message delivery, call completion, and health coaching notes.Results: Participant mean age was 31.5 years, 96.6% of participants are Latina and 80.9% were born outside the US. Among those receiving the STAR MAMA calls 55 received the calls in Spanish (61%) and 35 English (39%). Of those in the call arm, 81 women (90%) completed all 20 weeks of the program. There were many more systems errors in the beginning of the program, than over time. Health coaching triggers were also more widespread in the first several weeks of the STAR MAMA intervention, notably among Spanish-speakers. Although Spanish speakers had more triggers than English-speakers, the difference was not statistically significant. Of the calls that triggered a health coach follow-up, a call-back attempt was made for 85.4% (n=152) of the English call triggers and for 80.0% (n=279) of the Spanish call triggers (NS). Of those with attempted calls, health coaching calls were complete for 55.6% (n=85) of English-language call triggers and for 56.6% of Spanish-language call triggers (NS). Some differences in acceptability were noted by language, with Spanish-speakers reporting higher satisfaction with prevention content (p=<0.01) and English-speakers reporting health coaches were less considerate of their time (p=0.03). Conclusions: Implementation fidelity for health IT interventions involving health coaching should address moderating factors, such as language, as well as systems level factors.Trial Registration: National Clinical Trials registration number: CT02240420 Registered September 15, 2014 . ClinicalTrials.gov