The Virginia Advancing Cancer Control Engaged Research through Transformative Solutions Center

The project will implement a multi-level lifestyle intervention targeting diet quality and physical activity, grounded in evidence and previous work, spanning individual, community, and organizational levels, with collective efficacy as a mechanism of action. Using a cluster randomized, hybrid type 2 trial design, the intervention will be implemented over 6 months, followed by a 6-month maintenance phase. Twelve income-based housing communities will be randomized to intervention or delayed intervention control, enrolling 480 participants (approximately 40 per community, ≥18 years) assessed at 0, 6, and 12 months. Primary dual effectiveness outcomes are diet quality (ASA-24) and moderate-to-vigorous physical activity (accelerometry). Co-primary implementation effectiveness will be evaluated using the RE-AIM Framework and PRISM. Investigators will also examine mechanisms of action associated with greater clinical benefit and maintenance of behavior change. Specific aims include: 1) Testing clinical effectiveness of the intervention to promote changes in diet quality and physical activity; 2a) Evaluating implementation effectiveness; 2b) Systematically evaluating facilitators and barriers to sustainability via process data, surveys, and interviews with residents and Public Housing Authority staff; and 3) Examining putative intervention mechanisms.