"My Body, My Rhythm, My Voice": a Community Dance Intervention Engaging Breast Cancer Survivors in Physical Activity in a Middle-income Country
Phase: NA
Conditions: Physical Inactivity, Breast Cancer
Sponsor: Olga Lucia Sarmiento

 
 
 
 
 
MY BODY, MY RHYTHM, MY VOICE  
PROMOTION OF PHYSICAL ACTIVITY IN BREAST CANCER SURVIVORS IN 
COLOMBIA 
 
 
 
 
STUDY PROTOCOL AND STATISTICAL ANALYSIS PLAN 
 
 
 
 
 
 
 
 
OCTOBER 2018 

A. Specific Aims (Overall Plan) 
The goal of this project is to build a state-of-the-science regional center of research excellence in Colombia 
known as the Stanford-Colombia Collaboratory on Chronic Disease (S-C3). The Collaboratory will focus on 
primary and secondary prevention of the major non-communicable diseases (NCDs) facing Colombia and the 
Latin American region, including cancer, cardiovascular disease, diabetes, and depression.1-4 Using a socio-
ecological framework,5-9 the S-C3 will emphasize a multi-sectoral and transdisciplinary approach to develop, 
test, and disseminate impactful NCD prevention programs in Colombia, as well as from Colombia to the Latin 
American region. In Latin America, 69% of deaths are due to NCDs and these rates are increasing.1,2 In 
Colombia, the third largest country in the region after Mexico and Brazil, 71% of deaths are due to NCDs.1,2 
Low- to middle-income countries (LMICs) like Colombia face significant challenges in effectively controlling this 
epidemic due, at least in part, to limited research to support innovative and effective interventions.  
Physical inactivity is one of the most important contributors to the global burden of NCDs, responsible for 
~6-10% of major NCDs worldwide.10 The prevalence of physical inactivity and sedentary behavior is increasing 
in LMICs and approaching levels of higher income countries such as the US.11 In Colombia, 47% of adults and 
74% of adolescents do not meet physical activity recommendations, comparable to levels in the US and higher 
than other Latin American countries such as Mexico, Ecuador, and Uruguay.11 Multi-level approaches that 
promote physical activity (PA) at the individual, family, community, and societal levels hold substantial promise 
for effectively preventing and controlling the major NCDs.8,9,12,13 We and others have demonstrated effective 
strategies for increasing PA among residents across the socioeconomic gradient, including leveraging widely 
available information technologies such as smartphone applications (apps), SMS text messaging, interactive 
voice response systems, and culturally tailored virtual advisors.14-21 However, substantial gaps remain in 
developing and testing such potentially far-reaching PA interventions in LMICs such as Colombia.22  
In Latin America, existing research efforts in the field have centered primarily on surveillance and other 
observational methods that lack potential to directly impact the increasing prevalence of NCDs locally and 
regionally. With support from US-based colleagues, Colombian researchers and stakeholders from multiple 
sectors can develop the necessary infrastructure and capacity to serve as a model and resource for cutting-
edge research aimed at developing effective PA interventions, rigorously testing these approaches in diverse 
communities, and effectively disseminating promising strategies. Developing the research capacity to support 
effective behavioral interventions to increase PA in Colombia will have far-reaching effects for the Latin 
American region given Colombia’s position as a regional leader in PA research and other relevant domains.  
This grant application builds upon an existing productive collaboration between scientists from the Stanford 
University School of Medicine, CA and the Universidad de los Andes (UniAndes) in Bogotá, Colombia. Building 
the S-C3 will allow scientists in the region to expand their expertise to include development and rigorous 
evaluation of behavioral interventions to promote PA that hold particular promise for impacting current NCD 
trajectories in the region. The S-C3 will emphasize, in particular, innovative applications of technology tools to 
increase intervention effectiveness and scalability. Additionally, the S-C3 partnership will include organizations 
from multiple sectors such as sports and recreation, education, and urban planning.  
The Specific Aims of the overall project are to: 
 
1. Establish the necessary infrastructure to support a regional center of research excellence for 
NCD prevention in Colombia. The S-C3 will represent a partnership between Stanford School of 
Medicine, Universidad de los Andes, and their academic, governmental and non-governmental partners 
from the sectors of Health, Sports and Recreation, Transport, and Urban Planning.  
2. Build sustainable mechanisms for increasing research capacity aimed at developing and 
rigorously testing theory-based interventions that leverage widely available technologies aimed 
at primary and secondary prevention of NCDs in Colombia. Capacity-building activities in Colombia 
will serve as a resource and a model for other Latin American countries. 
3. Demonstrate the partnership’s capability for engaging in cutting-edge behavioral intervention 
research to promote physical activity and prevent NCDs. We will conduct 2 pilot studies that target 
individual and community levels of impact to increase physical activity in underserved populations.  
4. Develop short-, mid-, and long-term transdisciplinary research plans that focus on optimizing 
regional capacity for impactful change in the prevalence of NCD’s in Colombia. The research 
plans will leverage the partnership’s expertise in utilizing technology for physical activity promotion in 
diverse Latino populations from the US and in the Latin American region.  
Successful completion of these aims will result in the needed infrastructure and mechanisms for building 
research capacity, experience conducting research, and comprehensive research planning to initiate a regional 
center of excellence focused on promotion of physical activity and reduction of NCDs in Colombia. The plans 
for the S-C3 will support a regional model and resource that will serve the Latin American region.  
Specific Aims                                                                                                 Page 52
Contact PD/PI: King, Abby C

B. Research Strategy – Overall Plan 
 
B.1. Overview of Proposed Plan  
The proposed regional center of research excellence is labeled a collaboratory, which refers to a 
borderless research environment in which scientists in the US, Colombia, and the Latin American region can 
work and interact with each other to develop, evaluate, and disseminate the most effective and scalable 
strategies for NCD prevention.23 Table 1 summarizes proposed aims and objectives. Successful completion of 
these aims will result in a multi-sectoral and transdisciplinary partnership, robust research enhancement 
activities, two pilot research projects that will demonstrate the team’s ability to collaborate and publish research 
together, and a well-conceived research plan for advancing the aims of the Collaboratory both currently and 
into the future. These aims and objectives will serve as a road map for other Latin American partners to 
support rigorous research aimed at NCD prevention and control in the region. 
 
 B.2. Structure, Leadership, and Experience  
The Collaboratory expands an existing partnership between scientists from the Stanford University School 
of Medicine and Universidad de los Andes (UniAndes). The partnership will include organizations from multiple 
Table 1.  Stanford-Colombia Collaboratory on Chronic Disease (S-C3) Aims and Objectives 
Aims  
Objectives 
1. Establish 
Collaboratory 
infrastructure 
1.1 Enhance multi-sectoral research partnerships and communication pathways for capacity 
building and intervention development; 
1.2 Finalize shared cores that will provide support for training and research activities. 
2. Build/expand 
mechanisms for 
capacity building 
in Colombia 
2.1 Scholar exchange between UniAndes and Stanford University; 
2.2 Professional certificate program focused on planning and evaluation of theory-based 
interventions for health promotion/disease prevention;  
2.3 Masters Program in Epidemiology with a track focused on behavioral interventions; 
2.4 1-day seminar courses for community members and key stakeholders. 
3. Conduct joint 
pilot projects 
3.1 Community-based intervention to promote physical activity among breast cancer survivors; 
3.2 Longitudinal evaluation of community-wide Ciclovía/Recreovía programs. 
4. Finalize center 
research plans 
4.1 Needs assessment with community members and key stakeholders using interviews and a 
network analysis of organizational and communication pathways and connections in Colombia;   
4.2 Finalize short-, mid-, and long-term goals and expected outcomes. 
Table 2. Current Multi-sectoral partnerships that will be leveraged in S-C3 
Partner 
Sector 
Description 
Role 
Stanford University 
Education 
One of the world´s leading research 
and teaching universities.  
Oversight of research and training, 
advising in implementation and 
evaluation of projects and courses 
Universidad de los Andes 
(UniAndes) 
Education 
One of Latin America’s top 
universities and the highest ranked 
university in Colombia.   
Lead research and training efforts 
with support from Stanford; 
Coordinate partnership with multi-
sectoral partners 
Universidad del Rosario 
Education 
Leading academic institution in 
Colombia for physical activity 
research, including measurement 
and interventions. 
Steering committee member and 
collaborator for pilot studies 
Fundación Simmon 
Health 
Non-governmental organization that 
advocates for cancer prevention 
and treatment. 
Steering committee member and 
collaborator for pilot studies 
National Institute of Cancer 
in Colombia 
Health 
National institute that advocates for 
primary and secondary cancer 
prevention. 
Steering committee member and 
collaborator for pilot studies 
Institutes of Sports and 
Recreation of Bogotá 
(IDRD) 
Sports and 
Recreation 
Government institution in charge of 
the implementation and 
coordination of the Ciclovía and 
Recreovia programs in Bogotá. 
Steering committee member and 
collaborator for pilot studies 
Ministry of Sports 
(COLDEPORTES) 
Sports and 
Recreation 
Government institution in charge of 
the Network of Ciclovías and 
Recreovias of Colombia.  
Steering committee member and 
collaborator for pilot studies 
Administrative Department 
for the Defense of the 
Public Space (DADEP) 
Transport 
& Urban 
Planning  
Government institution in charge of 
protecting Bogotá’s public space. 
Steering committee member and 
collaborator for pilot studies 
Research Strategy                                                                                             Page 53
Contact PD/PI: King, Abby C

sectors representing sports and recreation, education, and urban planning (Table 2). The main center for S-C3 
and the majority of activities will occur at UniAndes, with Stanford playing a supporting role.  
Olga Sarmiento, MD PhD (UniAndes) and Abby King, PhD (Stanford) will serve as Multi-PIs. Carolyn Finck, 
PhD (UniAndes), Robert Haile, DrPH MPH (Stanford), and Lisa Goldman Rosas, PhD MPH (Stanford) will 
serve as co-investigators (Table 3). The investigative team brings complementary expertise representing 
multiple scientific disciplines, and has prior experience engaging in successful collaborations. 
UniAndes experience: Drs. Sarmiento and Finck bring extensive experience in evaluation and cultural 
adaptation of multi-sectoral programs to promote physical activity (PA) in Colombia such as the Ciclovía and 
Recreovía programs. They have experience in testing, developing, and validating instruments for the 
assessment of PA, physical and mental health, and quality of life. UniAndes also has experience in reaching 
and working effectively with policy makers through the Schools of Medicine, Government, and Law. 
Stanford experience: Drs. King, Haile, and Goldman Rosas bring broad experience in collaborating with LMIC 
institutions in Latin America on research related to chronic disease and cancer prevention and control. Dr. King 
was one of two US behavioral scientists participating in the 2011 CDC-sponsored International Think Tank 
aimed at Changing Physical Activity and Diet Behaviors in the Context of Latin America, held at UniAndes; she 
led, with Dr. Haile, a 2016 follow-up PA intervention Think Tank at Stanford; has led US-funded PA intervention 
research in Mexico in collaboration with the Mexican National Institute of Public Health (INSP); and sponsored 
an initial UniAndes graduate scholar traineeship at Stanford. Dr. Haile directs the Latin American Cancer 
Epidemiology (LACE) Consortium, established with NCI to facilitate and coordinate cancer epidemiology 
research in Latin America, with over 20 investigators in ten countries. Dr. Goldman Rosas has an ongoing 
collaboration with Mexico’s INSP focused on obesity prevention and treatment among children and adults.24-26 
Collaborative experience: The UniAndes and Stanford teams have successfully collaborated on several pilot 
projects using mobile technology,14 facilitated bi-directional training in both sites, and, as noted above, 
participated in regional think tanks focused on behavioral change and PA interventions, first held in Bogotá in 
2011 and again in 2016 at Stanford. During the latter, organized and hosted by Drs. King and Haile, this 
Collaboratory was identified as a critical priority for Colombia and the region. The successfully implemented 
pilot projects included: 1) using the Nuestra Voz (Our Voice) citizen scientist model in evaluating Ciclovías in 
Bogotá;14 and 2) initiating adaptations of three smartphone apps based on distinct motivational frameworks to 
promote PA among UniAndes employees. Both pilot projects were the result of training exchanges between 
Stanford and UniAndes; Dr. King conducted training in behavioral science at UniAndes in 2011 and Susana 
Barradas, predoctoral student with Dr. Finck, subsequently came to Stanford for 6 months.  
 
 
 
Table 3. Research team 
Investigator 
Expertise 
Role 
Olga Lucia 
Sarmiento  
MD PhD 
• Development of epidemiologic studies of behavioral lifestyle multi-sectoral 
community programs 
• Experience teaching biostatistics, epidemiology and PA measurement 
methods 
• Experience in multi-country studies 
PI: primary role 
Aims 1-4 
Carolyn Finck 
Barboza, 
PhD 
• Psychometric validation of instruments to assess health related quality of life 
and mental health 
• Assessment of mental health issues in breast cancer patients in Colombia 
and Germany 
• Experience in teaching personality and health psychology courses  
Co-I; primary role 
Aim 2 
Abby King, 
PhD 
• Applications of behavioral science theory and research in promoting NCD 
prevention interventions in US and globally 
• Development and evaluation of culturally adapted mobile health interventions 
in diverse communities 
• Tailoring of health promotion interventions, using a socio-ecological 
framework, for underserved populations 
PI; primary role 
Aims 1-4 
Robert Haile, 
DrPH 
• Extensive experience establishing and directing international research 
consortia 
• Experience in cancer epidemiology and prevention trials 
Co-I, primary role 
Aim 1, 4; supporting 
role Aims 2, 3 
Lisa 
Goldman 
Rosas, PhD 
MPH 
• Development and testing of behavioral lifestyle interventions 
• Effective community engagement 
• Significant experience developing educational programs focused on 
community health and preventive medicine 
Co-I, primary role 
Aim 2, 3; supporting 
role Aims 1, 4 
Research Strategy                                                                                             Page 54
Contact PD/PI: King, Abby C

B.3. Setting and Value added: Why Colombia?  
Colombia is an ideal setting for the proposed regional center of research excellence due to existing 
national multi-sectoral programs to promote PA with the potential for scalability in the Latin American region, 
recent shifts in policy to support NCD prevention, and a strong scientific foundation.  
B.3.1. Colombian context. Colombia is an international leader in developing innovative PA programs, 
some of which have been in place for more than 20 years. For example, programs like Ciclovía and Recreovía 
were implemented in Colombia years ago and are now being implemented in other LMICs as well as higher 
income nations (see B.6.2 and Montes et al., 2012 27). However, their effectiveness has never been evaluated 
in a rigorous manner. In terms of the policy context, Colombia’s priorities related to NCD have shifted from 
acute treatment to primary and secondary prevention, providing critical support for the research of the S-C3. 
PA promotion is a priority topic in Colombia for NCDs prevention in the public health agenda. The National 
Development Plan 2014-2018 establishes healthy lifestyles promotion, including PA, as one of the strategies to 
reduce the morbidity and mortality associated with cancer, cardiovascular disease, diabetes and other NCDs.28 
The Ten-Year Plan of Public Health establishes goals and strategies to improve PA levels among the 
Colombian population.29 Other policies that prioritize PA as one of the targets for NCD prevention are: the 
Obesity Law,30 the National Plan of Food and Nutrition Security, and the Ten-Year Plan of Cancer Control, 
which includes PA promotion as one of the strategic lines for primary prevention, establishing goals and 
specific action items at the levels of policy, community, and health services.31 Building on a strong political 
agenda, Colombia is at an ideal juncture to leverage scientific expertise in observational research 
methods and apply this experience to the development and rigorous evaluation of behavioral interventions. 
Researchers, led by Drs. Sarmiento and Finck, have made strong contributions to the understanding of PA 
patterns and determinants in Colombia and Latin America,22,32-37 and are now poised to utilize this body of 
research to support cutting-edge intervention research. Finally, Colombia is the third largest country in Latin 
America, with numerous demographic and social factors that make it characteristic of other countries in the 
region. For example, the sub-cultures found in the Andean region share elements with other Latin American 
countries with similar characteristics, while the Caribbean region resembles other Caribbean countries. Thus, 
strategies and approaches that are developed by S-C3 would likely be relevant to other countries in the region. 
Additionally, Drs. Sarmiento and Finck are members of academic networks with researchers in other Latin 
American countries (e.g., Network of Physical Activity of the Americas, Network of Ciclovías of the Americas, 
Active Healthy Kids Global Alliance) that will facilitate the translation of results to the region. 
B.3.2. Value added. A primary value added by S-C3 will be to facilitate the transition of behavioral sciences in 
Colombia (and the region) from observational studies to intervention studies in a manner that we believe will be 
scalable and sustainable. We will avoid duplication in two ways: 1) we will involve representatives of the 
multiple sectors that have a shared interest in this field to collaborate with us throughout this process (note that 
Drs. Sarmiento and Finck are already well connected with the relevant sectors); and 2) our focus will be on 
intervention-based research, of which there is currently virtually none of relevance in Colombia. 
 
B.4. Aim 1: Establish S-C3 Infrastructure  
S-C3 leaders will cultivate strong multi-sectoral partnerships and 
develop cores that will provide the infrastructure needed to support 
the Collaboratory’s training and research endeavors. The S-C3 is 
guided by the socio-ecological framework that describes how health 
behaviors, such as PA, are influenced by multiple factors at the 
individual, family, organizational, neighborhood, and policy levels 
(Figure 1).5-9 The partnerships and shared core resources will 
support program development, evaluation, and dissemination across 
these multiple levels of influence. Partnership development activities 
will be guided by Community-Based Participatory Research (CBPR) 
principles emphasizing the importance of equitable and genuine 
participation in all phases of research.38-40 
B.4.1. Enhance multi-sectoral partnerships. The rationale for the 
partnerships that will form part of S-C3 is twofold. First, the 
institutions and organizations selected represent sectors that are 
well positioned in Latin America to address the multiple levels of 
influence on PA for adults and children as described by the socio-ecological model. We recognize that NCD 
risk factors such as physical inactivity can rarely be modified through policies and interventions within the 
health sector alone. Rather, prevention measures that address physical inactivity embrace a range of different 
Research Strategy                                                                                             Page 55
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sectors, including education, sports and recreation, and urban design and transport, along with civil society and 
the private sector. Second, the specific types of partnerships formed through S-C3 will have high potential for 
replication in other Latin American countries.  
Enhancement activities: The partners that form an integral part of S-C3 (Table 2) have already been 
engaged in developing this proposal, with local meetings with stakeholders in Colombia conducted by Drs. 
Sarmiento and Finck, two international meetings (Bogotá and Stanford), and weekly teleconferences for the 
past two months. These relationships will be fortified further during the project period with support from the 
Community Engagement Core (see B.4.2). Using principles of CBPR,38-40 representatives from each partner 
will form a Steering Committee that will be a central governing body for the Collaboratory (see letters of 
support). The Steering Committee will meet monthly in the first six months, quarterly thereafter, with additional 
as-needed meetings for specific projects. These meetings will provide opportunities for research enhancement 
activities (see B.5), and will be used for strategic coordination of all Collaboratory activities. Drs. Sarmiento and 
Finck will facilitate these meetings with support from the Community Engagement Core (see below). The part-
ners also will be engaged in the training and research activities of the Collaboratory. The Steering Committee 
will proactively identify and agree by consensus if additional partners are needed to complete its objectives.  
B.4.2. Cores. Drs. Sarmiento and Finck engaged scientific leaders and key stakeholders to identify the primary 
gaps in advancing behavioral intervention research in Colombia and the region, which included: 1) Data 
management and analysis of observational and experimental behavioral intervention studies; 2) Development 
of theory-based behavioral interventions and evaluation design; and 3) Community engagement and 
translation. Based on these gaps, the S-C3 will provide three Cores described below. Each Core will be led by 
members of the investigative team and will include a knowledge bank and training opportunities. A 
transdisciplinary advisory panel of researchers from Stanford, UniAndes, and partner organizations will be 
available to consult on Collaboratory activities (e.g., Drs. Michele Barry [global health], Mike Baiocchi 
[biostatistics in global contexts] Sanjay Basu [cross-country data modeling and comparisons]). The Cores will 
provide a foundation for research enhancement activities (B.5). 
     1. Data management and statistical analysis core. This core will focus on data management and 
analysis from observational and experimental research. It will be centered at UniAndes and led by Dr. 
Sarmiento with support from Andrés Medaglia, director of Industrial Engineering and the Analytics program at 
UniAndes, and Dr. Haile. We will develop a knowledge bank of resources for effective data management and 
other online data collection tools (e.g., REDCap, data visualization tools), as well as data analysis resources 
with help from Dr. Haile. The core will establish an online repository where scientists can share analysis code 
(e.g., R code for analyzing accelerometry data, procedures for analyzing PA diary data) and other analysis 
resources (e.g., instructions for scoring international PA questionnaires, and forms for systematic observation 
of spaces for PA, GIS data analysis, and network analysis).  
2. Development and evaluation of theory-based behavioral interventions core. This core will support 
the development of innovative behavioral interventions for increasing PA and decreasing sedentary behavior 
as well as the design of rigorous evaluations of these programs. Dr. King will provide overall leadership for this 
core with support from Dr. Finck and Diana Agudelo PhD, director of the psychology department at UniAndes. 
We will develop a knowledge bank with the following content: 1) information on existing evidence-based PA 
interventions; 2) strategies for successful adaptation of evidence-based interventions to the Latin American 
context; 3) validated measures for intervention evaluation; and 4) strategies for validation of other measures.  
3. Community engagement and translation core: This core will provide knowledge and resources for 
effectively engaging community members and key stakeholders to support the development, evaluation, and 
dissemination of PA interventions. Dr. Goldman Rosas will lead this core with support from Catalina Gonzalez 
MA, MSc, PhD, director of the Epidemiology program at UniAndes. The knowledge bank will include 
information on best practices for engaging community members and key stakeholders in intervention research, 
as well as key resources such as partnership agreement templates and data sharing plans, training materials 
for community members engaging in research, and information on training in the ethical conduct of research.  
 
B.5. Aim 2: Building Sustainable Mechanisms for Capacity Building  
We propose bi-directional training methods between Stanford and UniAndes that build on existing 
multidisciplinary programs. The UniAndes programs are relatively new and will greatly benefit from the 
experience at Stanford. We will also engage trainees through providing hands-on research experience as part 
of the two innovative pilot projects. 
B.5.1. Scholar exchange. An aim of the S-C3 is to build a scholar exchange program, initially focused on 
postdoctoral and graduate-level scholars, that will emphasize mutual learning opportunities. For example, 
Stanford postdocs would spend an average of two weeks in Colombia helping to present information and 
participate in relevant research projects under the guidance of Drs. Sarmiento and Finck. Similarly, fellows 
from Colombia would spend an average of two weeks at Stanford, participating in selected lectures and 
Research Strategy                                                                                             Page 56
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discussion groups along with relevant research and training activities under the guidance of Drs. King, Haile, 
and Goldman Rosas. During the first two years, we plan on one Stanford fellow spending time in Colombia and 
one from Colombia spending time at Stanford to gain relevant experience in how to optimize training 
experiences in both locales. Additional trainees can participate with support from outside sources.  
B.5.2. Professional certificate program. We will develop a Professional Certificate Course in behavioral 
science for health in Colombia that will be accessible to trainees, partnership organizations, key stakeholders 
and others. Professional certificate courses are commonly used in Latin America and are an effective strategy 
for enhancing research capacity; the course can also serve as an elective for masters students. Based on a 
successful professional certificate program at Stanford (Stanford Health 4 All, Dr. Goldman Rosas is a core 
faculty member) the professional certificate course will use case studies based on relevant behavioral science 
research.15,21,41 Participants will learn about health behavior theories and behavior change constructs, relevant 
measurement approaches, and program design and implementation. The certificate program will also serve as 
an elective course in currently offered master programs at UniAndes (MPH, psychology, engineering).  
B.5.3. Masters program. We will lay the groundwork to develop a Masters of Epidemiology program at 
UniAndes in 2017. The specific objectives of the Masters of Epidemiology are: 1) understanding of the 
contributions of epidemiology and biostatistics to health research in interdisciplinary contexts; 2) design, 
conduct, and analysis of clinical and social epidemiologic investigations; 3) critical appraisal of epidemiologic 
studies, including synthesis and integration of epidemiologic research and causal inference; and d) 
interpretation and communication of epidemiological research for interdisciplinary audiences. 
The S-C3 team will draw on the extensive experience that Stanford has in developing and maintaining an MS in 
Epidemiology and Clinical Research and an MS in Community Health and Prevention Research.  
B.5.4. Sources of trainees in Colombia. Sources of potential trainees include the following: 
Doctoral students from the Ceiba Foundation: “Ceiba” is the Spanish acronym for Center of 
Interdisciplinary Studies in Basic and Applied Complexity. Ceiba includes four top universities in Colombia 
(UniAndes, Universidad Nacional de Colombia, Universidad Javeriana, la Universidad del Rosario). Ceiba 
started 7 years ago in response to a call from the National Department of Science, Technology and Innovation 
to create Excellence Centers in Colombia, and has had more than 40 affiliated doctoral students.  
MPH students: The MPH program at UniAndes is a unique joint program between the Schools of Medicine 
and Government, begun in 2012. Specific objectives of the MPH program are to: (1) provide a basic foundation 
of knowledge in public health and health policy; and (2) teach concepts and scientific skills in epidemiology, 
biostatistics and health policy. We propose to add training in behavioral sciences as an elective course.  
MS and Doctoral students and postdocs in Psychology: The Masters of Science in Research in 
Psychology is a two-year program with mandatory courses in advanced qualitative and quantitative methods 
as well as in program evaluation and design. There is also a 4-year doctorate program in Psychology and 
postdoctoral programs there through which additional synergies can be explored.  
B.5.5. Sources of trainees in US. Trainees at Stanford will primarily come from 3 programs: 
Stanford Prevention Research Center (SPRC) Postdoctoral Fellowship (Dr. King is Co-Director): There 
is funding for 6-8 postdoctoral fellowships each year to focus on chronic disease prevention research.  
Masters of Science programs: Masters-level students in Community Health and Prevention Research (Dr. 
Goldman Rosas is a core faculty member) and Epidemiology (Dr. King is Chair of the program admissions 
committee and a core faculty member) may participate in bi-directional training opportunities as part of S-C3. 
 
B.6. Aim 3: Conduct Joint Pilot Projects  
We will complete two joint pilot projects that will demonstrate the Center’s ability to collaborate effectively, 
engage partners from multiple sectors, and develop and conduct preliminary evaluations of interventions at 
multiple levels of impact (e.g., individual, social, environmental, community).  
B.6.1. Pilot Study # 1: Promoting physical activity (PA) among breast cancer survivors in Colombia 
Rationale: Breast cancer is the most common cancer in women worldwide.42,43 In Colombia, nearly 5,000 new 
cases are diagnosed annually.44 PA is associated with decreased cancer risk.10 A growing body of evidence 
supports the idea that increasing PA provides important benefits to psychological and physical wellbeing in 
breast cancer patients.45 We will design a theory-based intervention to integrate PA promotion into clinical care 
for breast cancer survivors, with the ultimate goal of secondary prevention and enhanced survival.  
Methods: We will conduct a small, randomized controlled study of a PA intervention among 60 breast cancer 
patients (18-65 years). Eligible women will be randomized to the PA intervention or a control group that will 
receive an education program not related to PA. The intervention will include supervised exercise through 
dancing and a culturally relevant and piloted smartphone app aimed at promoting PA and decreasing 
sedentary behavior. The primary outcomes for this pilot will be weekly minutes of PA, quality of life, and mental 
health – specifically, anxiety and depression. This project will involve partnerships between researchers at 
Stanford School of Medicine, the Institute of Sports and Recreation in Bogotá, the Universidad del Rosario, the 
Foundation Simmon, the National Cancer Institute of Colombia, and UniAndes. 
Research Strategy                                                                                             Page 57
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Analysis: We will use a mixed methods approach to access acceptability, feasibility, and preliminary 
effectiveness of the intervention. Acceptability/feasibility: Qualitative methods will include focus group 
discussions with participants at the conclusion of the study to explore acceptability and feasibility. Non-
participants will be included in focus groups to examine factors influencing participation. Quantitative methods 
will include ratings of intervention components to capture acceptability, practicality, and motivational 
capabilities on a Likert-type 7-point scale (with a goal of obtaining acceptability mean ratings >6 out of 7). 
Preliminary effectiveness: To assess preliminary effectiveness, we will use repeated measures ANOVA, 
Kruskal–Wallis and McNemar tests to establish the change in outcomes before and after treatment. Outcomes 
will include physical activity/sedentary behavior,46 health-related quality of life,47 and anxiety and 
depression.37,48 (All measures have been tested in and shown to be appropriate for Latino populations.) 
B.6.2. Evaluation of community Ciclovía/Recreovía programs to promote PA in public spaces 
Rationale: The Ciclovía is a multi-sector program in which streets are closed to motorized vehicles and open 
exclusively for individuals to enjoy safe, free spaces for leisure activities.32,35,49 Ciclovías at least twice/year are 
implemented in at least 496 cities in 27 countries, and 93% of programs are in Latin America. The model for 
many of them worldwide is the Bogotá Ciclovía. The Recreovía is a community-based PA program that com-
prises free PA classes in public spaces (parks, plazas, streets, malls, community centers) led by trained 
instructors.50 In 2015, Recreovía offered PA classes in 41 hubs in 95% of Bogotá’s districts, with 75% of those 
hubs in low- to middle-income neighborhoods. We will design the prospective evaluation of the Ciclovía/ 
Recreovía programs to promote PA and cancer prevention among women (ultimate goal=primary prevention).  
Methods: We will: 1) design and develop the logic model/ theory-based instruments for these existing 
programs that promote PA in public spaces; 2) assemble, based on previous cross-sectional studies, an 
appropriate cohort study including 100 adults ≥ 30 years old who are regular users of the programs (i.e., 
participate every week) and irregular users of the program (i.e., once a month or less) with a follow-up after 6 
months; 3) measure initial uptake of the program and demonstrate the feasibility of follow-up over time. This 
project will involve partnerships between Stanford researchers, the Institute of Sports and Recreation in 
Bogotá, the Health Department of the city of Bogotá, DADEP, and UniAndes. 
Analysis: We will use mixed methods to assess the longitudinal impact of the Ciclovía/Recreovía on physical 
activity levels among adults and children. For qualitative methods, we will use the citizen scientist Nuestra Voz 
(Our Voice) model that employs a tablet-based application to empower residents to document features of their 
neighborhoods that promote and hinder physical activity.14,41 Drs. King, Goldman Rosas, and Sarmiento have 
successfully used this approach in diverse communities including with Latinos in the US and in Latin America. 
For quantitative methods, we will assess the median differences in moderate to vigorous PA (pre-post) and 
interquartile range (IQR) of the self-reported46 and objectively measured (via accelerometers) PA outcomes, 
which will be compared using the Wilcoxon Signed Rank Test.  
 
B.7. Aim 4: Develop Center Research Plans 
B.7.1. Needs assessment. We will conduct a needs assessment in the first 3 months of the project period with 
the goal of identifying the needs and assets related to NCD prevention and PA promotion among the 
Collaboratory partnership and the communities that they serve. The methods for the needs assessment are 
described in the Coordinating Unit description in section B.5. These results will help to assess research 
plans, priorities and opportunities for the Center and its expansion in the Latin American region.  
B.7.2. Finalize plans. To finalize short-, mid-, and long-term goals, the S-C3 will utilize principles of CBPR (see 
Planning Unit description-Table 1 for proposed goals).38-40 We will engage two stakeholder groups to gather 
input on research and education priorities for the partnership. Stakeholder groups will include participants in 
pilot studies, multi-sectoral colleagues from the Steering Committee, and other groups as needed. The 
investigative team will meet with stakeholders to strategize and finalize short-, mid-, and long-term goals.  
 
B.8. Sustainability and Future Directions 
The ultimate goal of the activities planned during this 2-year period are to create, enhance, and support the 
infrastructure and capacities that are needed to maintain a sustained effort focused on NCD prevention in 
Colombia and the Latin American region. This project is built on an existing partnership that has already 
successfully maintained collaborations and will expand to engage additional partners from diverse sectors, 
thus promoting sustainability. The partnership development activities will promote sustained engagement in 
research activities. Research enhancement activities, including scholar exchanges and various training 
programs, are designed not only to sustain research activities, but also to expand and grow these activities 
over time and throughout the Latin American region. Finally, the pilot projects are aimed at producing the 
necessary preliminary experience and evidence to support future larger scale projects. As described in Table 1 
of the Planning Unit description, short- and mid-term goals include submitting proposals for larger-scale 
studies that build on findings from the pilot studies. 
Research Strategy                                                                                             Page 58
Contact PD/PI: King, Abby C

A. Specific Aims (Coordinating Unit) 
The Stanford-Colombia Collaboratory on Chronic Disease (S-C3) will focus on prevention of major non-
communicable diseases (NCDs) facing Colombia and the Latin American region, including cancer, 
cardiovascular disease, diabetes, and depression. NCDs are responsible the largest proportion of deaths in 
Latin America (69%) and in Colombia specifically (71%).1,2 Prevention will focus on promotion of physical 
activity given that inactivity is one of the most important contributors to the global burden of NCDs, responsible 
for ~6-10% of major NCDs worldwide.10 In Colombia, 47% of adults and 74% of adolescents do not meet 
physical activity recommendations.11 Essential to effectively controlling the NCD epidemic in low- and middle-
income countries (LMICs) in Latin America, such as Colombia, is to increase research capacity in the areas of 
theory-based behavioral intervention research, statistical methods to assess impact and potential for 
dissemination, and strategies for effectively engaging community members and key stakeholders. The S-C3 
includes a systematic and coordinated plan to support such research capacity building activities.  
S-C3 is built upon an existing strong partnership between Stanford University School of Medicine and the 
Universidad de los Andes (UniAndes) in Bogotá, Colombia and is the result of regional think tanks focused on 
behavioral change and PA interventions, first held in Bogotá in 2011 and again in 2016 at Stanford. The 
research plans are informed be a socio-ecological model for health promotion and guided by principles of 
Community-Based Participatory Research (CBPR). These frameworks will also guide the Coordinating Unit. 
The S-C3 Coordinating Unit’s function will be to provide seamless administrative support to facilitate day-
to-day operations of the S-C3, including the two proposed pilot studies, all three cores, all communications 
internal to the study and external to the study (e.g., with granting agencies, outside collaborators, and outside 
investigators who express interest in using the cores), oversight of the database and data management 
system, financial and grants management, and regulatory requirements, such as IRB approvals and annual 
progress reports.  
 
The Specific Aims of the Coordinating Unit are to: 
 
1. Provide administrative support to facilitate the conduct of the two proposed pilot studies, 
including the clinic-based intervention to integrate physical activity prescription and practice into the 
clinical care of breast cancer survivors and the community-based intervention focused on initial 
evaluations of Ciclovias and Recreovias in Bogotá. 
2. Provide administrative support for the proposed training and research enhancement activities, 
including a scholar exchange program between Stanford and the Universidad de los Andes (UniAndes), 
a professional certification program in behavioral sciences for health, development of the Master’s 
Program in in Epidemiology, and the specialized seminars. 
3. Provide administrative support for the three proposed cores: 1) Data Management and Statistical 
Analysis, 2) Development and Evaluation of Theory-Based Behavioral Interventions, and 3) Community 
Engagement and Translation.  
 
The partnership between Stanford University and UniAndes is uniquely positioned to provide seamless and 
unified coordination given their existing successful collaborations that include scholar exchanges, regional 
think tank workshops, and joint research projects. The investigative teams at both Stanford and UniAndes have 
extensive experience conducting large-scale and complex research projects, including international 
collaborations. Detailed plans and milestones, developed and executed as part of the proposed S-C3, will 
provide a foundation to monitor and track progress, identify barriers and solutions, and strategically plan for the 
future.  
 
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B. Research Strategy – Coordinating Unit 
The Coordinating Unit will be located at UniAndes. This Unit will provide all administrative services and 
support to facilitate the completion of the research and capacity building goals. This unit will be directed by Dr. 
Olga Lucía Sarmiento, a renowned researcher in the field of physical activity (PA) in Colombia, with local 
participation of Dr. Carolyn Finck, a well-respected behavioral scientist/psychologist with expertise in the 
behavioral theories and interventions related to behavior change in promoting physical activity and experience 
in the assessment of mental health issues. UniAndes has the capability of serving as the home institution for 
the planned collaboration. Established in 1948, UniAndes is a private non-profit organization with 
approximately 18,000 students and more than 640 full-time faculty in 12 Schools. UniAndes offers 39 
undergraduate programs, 15 doctoral, and 55 master level programs. UniAndes has been ranked consistently 
among Latin America’s Top 10 Universities according to QS World University Rankings. In 2016, it was ranked 
eighth in the region. Furthermore, UniAndes has extensive experience in international collaborations and the 
administration of grants with international funding. For example, it has received funding by the World Bank, 
USAID, and the European Commission. At Stanford, Drs. Abby King, Lisa Goldman Rosas, and Robert Haile 
will play collaborating/consulting roles in this Unit. Their relevant expertise is summarized in the Overall Plan 
and Bio Sketches sections of the current application. 
 
B.1. Organizational Chart 
The Coordinating Unit for this Collaboratory will be situated physically and organizationally at the School of 
Medicine in UniAndes. The leader of this School is the Dean, Andrés Sarmiento, who is very supportive of this 
application. Dr. Sarmiento is the Research Director of the School. The Coordinating Unit will lead operations in 
Colombia and will be assisted by a full time research assistant and the consulting experts from Stanford. The 
Steering Committee will guide the Coordinating Unit in decision-making and problem solving. The Steering 
Committee will be co-chaired by Drs. Sarmiento and King (as Dual PIs), and will include the other co-
investigators (Drs. Finck, Goldman Rosas, and Haile) and a representative each from Universidad del Rosario, 
Fundacion Simmon, Institutes of Sports and Recreation of Bogotá, Ministry of Sports, National Institute of 
Cancer in Colombia, and the Colombian Obesity Foundation. The Organization Chart below (Figure 1) 
summarizes the infrastructure and key partnerships for the proposed S-C3 projects and activities. 
 
B.2. Modes of Operation 
The Coordinating Unit will maximize efficiency of the research through its recruiting and other activities, 
which include providing assistance with identification of potential research subjects, coordinating meetings 
among research staff, facilitating subject retention throughout the studies, providing oversight of human 
subjects and data safety and monitoring, overseeing budgets and expenditures, and coordinating the 
management of staff, writing of papers, submission of ancillary studies, presentations at scientific meetings, 
and addressing problems in all of these areas as they occur. The Coordinating Unit also will avoid duplication 
of effort while assuring efficiency and coordination of all scientific activities through some of the following 
processes described below: 
• 
In-person meetings in Colombia: the Coordinating Unit will plan and oversee the in-person meetings 
in Colombia. 
• 
Teleconferences: The Coordinating Unit will plan and arrange at least two teleconferences per month 
with the research team at Stanford to update the team and solicit feedback and ideas related to 
research progress and findings, any problems, and results as well as on the establishment and 
maintenance of the multi-sectoral research network. 
• 
Annual meetings of Stanford and Colombia team in Bogotá: the Coordinating Unit will also plan 
and arrange the logistics related to travel, lodging, and other issues related to the team of Stanford 
researchers coming annually to Bogotá. 
• 
Communication strategy: finally, the Coordinating Unit will develop and assess the needs and 
efficiency of different communication strategies (social media, webpage, etc.) to make the research 
projects and their results available to study participants and lay public as well as experts and 
researchers in the field.  
 
B.3. Measures to Ensure Transparent, Efficient Administration to Serve All Institutions 
The Coordinating Unit will take the lead on all activities to ensure a transparent and interdisciplinary 
collaboration between Stanford, UniAndes and the other involved institutions (IDRD, Coldeportes, etc.). As 
stated above, a multi-sectoral Steering Committee will be established, which will meet monthly to discuss 
progress, new developments, any emerging issues with standard operating procedures, and any 
setbacks/issues that need to be resolved. This committee will also oversee issues regarding data sharing, and 
Research Strategy                                                                                             Page 119
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IRB related issues. Our plan is to invite all major stakeholders to designate a representative to serve on the 
Steering Committee, which will help facilitate efficient, transparent administration. We also believe that the in-
person meetings, teleconferences, and annual meeting will enable the Coordinating Unit to ensure transparent, 
efficient administration. For each meeting, whether in person or by teleconference, minutes will be taken and 
reviewed/revised/approved at each subsequent meeting, and then posted on a study web site or portal. 
 
 
B.4. General Areas to be Coordinated  
The Coordinating Unit will coordinate activities in the following areas. Progress in each area will be 
discussed at the monthly Steering Committee meetings. 
• 
Coordination of two pilot studies: The Coordinating Unit will coordinate administrative activities 
regarding all research activities of the two pilot studies, including IRB approvals, budget administration, 
hiring and salary payment for personnel, monitoring progress, providing the SC with updates, and 
preparing progress reports. Through experience providing coordination for the pilot studies, the 
partnership will develop skills to support future larger-scale clinical trials and longitudinal studies.  
• 
Coordination of training activities: The Coordinating Unit will administer all training activities both for 
the development of the proposed masters program in Epidemiology and for the professional certificate 
training in behavior change theories and interventions. This will include students as well as 
professionals in several health related professions (medical doctors, psychologists, etc.). Specifically, 
the Coordinating Unit will be in charge of student recruitment strategies, course evaluation, and 
certificates. It will maintain relations and communicate with other areas of UniAndes that are involved in 
the training processes (School of Medicine, School of Social Sciences, Continuing Education).  
• 
Coordination of the cores: The Coordinating Unit will oversee and assist in reaching the specific aims 
of the cores, including budget management of core budgets, scheduling of meetings, monitoring and 
ordering of supplies for the cores, monitoring of core usage, management of communications within 
and between cores and between cores and the Planning Unit, handling communications with 
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investigators outside of this program who express interest in using the cores, and scheduling 
presentations for core leaders to present at Steering Committee meetings. 
• 
Oversight of database and data management: The Coordinating Unit will develop and review 
relevant data sharing and data management protocols, ensuring confidentiality and care of all 
participant and study information. It will also assume primary responsibility for the sharing of data 
internally and externally in accordance with an agreed upon data sharing policy. This Unit will also 
oversee the informed consent process and the legal permissions needed in Colombia for storage of 
medical and personal information (i.e., ley habeas data).  
• 
Financial and grants management practices: To facilitate the research mission, the Coordinating 
Unit will monitor progress and oversee expenditures on the grant, including all consultant costs, 
salaries, supplies, travel, etc. Project staff will assist the PIs (Sarmiento and King) in preparing progress 
reports for the proposed project and will meet with PIs on a regular (monthly or more frequently if 
appropriate) basis. The project budget analyst will provide budget projections on a quarterly basis. 
• 
Regulatory requirements, such as IRB approvals: The Coordinating Unit will develop the human 
subjects protocol and consent forms for each of the intervention projects and work with Stanford 
Human Subjects Administrative Panel as well as the Committee for Ethics in Research from UniAndes 
to maintain approval of all activities and monitor training and certification of staff. Forms will be 
developed, based on our extensive number of prior studies, to ensure full informed consent. IRB 
progress and issues will be included at each meeting of the Steering Committee. 
 
B.5. Needs Assessment and Community Engagement 
The needs assessment will employ mixed methods and genuine community engagement to identify needs 
and assets as they related to PA promotion for NCD prevention. Mixed methods will include focus groups, in-
depth interviews, and a social network analysis. This process will guide decision-making and strategic planning 
of the different actions and help identify primary gaps in advancing behavioral intervention research in 
Colombia and the region through a multidisciplinary approach. According to CBPR principles, community 
members and key stakeholders will be engaged in all phases of the research project.40 Using a CBPR 
orientation to research, the needs assessment activities in the first 3 months of the project will include 
significant community and stakeholder engagement that will set the stage for ongoing engagement throughout 
the project period and for the long-term.  
B.5.1. Qualitative methods. We will use focus groups and in-depth interviews with community members and 
key stakeholders. We anticipate conducting 4 focus groups with participants and their family members from the 
target populations involved in the pilot studies (i.e., breast cancer patients and Ciclovías/ Recreovías 
participants). Additionally, we will conduct up to 3 focus groups with stakeholders from the partner 
organizations. Key informant interviews will be used to examine needs and assets among community members 
and key stakeholders that were not able to participate in the focus groups. For qualitative data, all interviews 
with stakeholders will be recorded and transcribed.51,52 Led by Co-Investigator Dr. Goldman Rosas (see letter 
of support), we will use ATLAS.ti, a multifunctional software system, to code the focus group and interview 
transcripts. We will initially use the interview guide to organize and provide a starting list of codes related to 
needs and assets, which we will supplement with emergent codes to capture new factors that stem from the 
interview process. Two project team members will independently code the transcripts. Discrepancies in initial 
coding will be solved by discussion between project team members. Based on these discussions, the raters 
will conduct a final code of the transcripts. Intercoder agreement will be quantified for each coding domain 
using Cohen’s Kappa: (Observed agreement – Chance) / (1 – Chance). If substantial intercoder disagreements 
exist, a third project team member will review the text in question to determine appropriate coding before 
finalizing the coding scheme.53 
B.5.2. Quantitative methods. Through network analysis, we will assess our multi-sectoral partnerships using 
methodology that Dr. Sarmiento (Dual PI) has employed previously.54 This analysis is essential for a deeper 
understanding of the interconnections between groups and for revealing opportunities for partnership 
development. An example of such a network is provided in Figure 2 below. 
B.5.3. Community engagement. Investigators at both UniAndes and Stanford have extensive experience in 
partnering with diverse groups of community stakeholders to enhance the contextual relevance and impact of 
our community-based research activities. We will engage stakeholder groups to gather input on research and 
education priorities for the partnership. Stakeholder groups will include participants in pilot studies, multi-
sectoral colleagues from the Steering Committee, and other groups as needed. The investigative team will 
meet with stakeholders to strategize and finalize short-, mid-, and long-term goals described in the Planning 
Unit description. Through applications of the Citizen Science model that Drs. King, Goldman Rosas, and 
Research Strategy                                                                                             Page 121
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Sarmiento together have been employing in Colombia as well as with Latino populations in Mexico, Chile, and 
the U.S., we will collect and analyze information from residents as well as stakeholders pertaining to the 
programs being developed and evaluated.14 The Nuestra Voz (Our Voice) citizen science engagement model 
provides an evidence-based step-by-step approach for directly engaging residents from underserved 
communities in direct forms of neighborhood and community data collection around health issues of relevance 
to their community. Using a simple mobile health application, they are readily able to capture elements of their 
local environments that either promote or hinder PA as well as other types of health behaviors. Residents then 
learn how to prioritize relevant issues and communicate their findings to stakeholders in ways that promote 
relevant, low-cost solutions. In this model the information is evaluated by community members and 
subsequently presented in accessible and compelling ways to policy makers. Finally, in the last year of the 
project, we will hold a seminar with presentations of our Collaboratory and research projects. This seminar will 
have a panel including representatives of the multiple sectors (government and nongovernment) and 
community members representing our Collaboratory.  
Figure 2. 
 
 
 
B.6. Evaluation, with an Emphasis on Metrics 
We have identified short- and long-term outcomes for the overall aims of the S-C3 (Tables 1A-D). The aims 
and outcomes support long-term sustainability and promote policies that support PA in Colombia.  
 
Table 1 A. Performance metrics for overall aims of S-C
3 for Aim 1: Establish Collaboratory infrastructure 
Aims 
Expected Outcomes/ Milestones 
Steps to support 
sustainability 
How activities will inform local 
public policy 
1.1 Enhance multi-sectoral 
research partnerships and 
communication pathways for 
capacity building and 
intervention development 
 
Short-term: 
• Multi-sector partnerships are 
established  
• Partnerships meet at least 4 times 
per year 
• At least 2 partners are engaged in 
each of the pilot projects 
Mid- & long-term: 
• Partners initiate their own research 
projects 
• Partners will be invited to 1-
day courses on NCD 
prevention and research (see 
Aim 2) to increase capacity 
and promote sustinability 
• We will employ a CBPR 
approach to promote long-term 
engagement 
•  
• Engaging diverse partners will 
inform policies for NCD prevention 
in various sectors 
• Training provided to partners will 
increase potential to infuse NCD 
prevention policy in all policies.  
1.2 Finalize shared cores 
that will provide support 
for training and research 
activities 
Short-term: 
• Supportive cores are established 
and used by researchers in 
Colombia 
Mid- & long-term: 
• All cores reside at UniAndes 
• The cores will employ 
capacity building strategies 
(e.g., co-learning) in their 
support to increase research 
capacity in all encounters 
• Cores will strengthen research 
capacity among Colombian 
colleagues for conducting research 
to inform policies to address NCD 
prevention strategies  
 
 
Research Strategy                                                                                             Page 122
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Table 1 B. Performance metrics for overall aims of S-C
3 for Aim 2: Build/expand mechanisms for capacity building in Colombia 
Performance metrics for 
overall aims 
Expected Outcomes/ Milestones 
Steps to support 
sustainability 
How activities will inform local 
public policy 
2.1 Scholar exchange between 
UniAndes and Stanford 
University 
2.2 Professional certificate 
program focused on planning 
and evaluation of theory-based 
interventions for health 
promotion/disease prevention 
2.3 Masters Program in 
Epidemiology with a track 
focused on behavioral 
interventions 
2.4 1-day seminar courses for 
community members and key 
stakeholders 
 
 
Short-term: 
• At least 2 scholar exchanges have 
been successfully completed 
between Stanford and UniAndes 
• Professional certificate program is 
developed and delivered at least 
once at UniAndes 
• A behavioral science track within 
the epidemiology masters program 
is developed at UniAndes 
• At least three 1-day courses are 
provided to partner organizations 
in Colombia 
Mid- & long-term: 
• Targeted groups (e.g., scholars, 
professionals, masters students) 
significantly increase knowledge 
and practices of NCD prevention 
research 
• Professional training activities 
are aimed at increasing 
research capacity in Colombia 
and the Latin American region 
to support long-term 
engagement in NCD 
prevention research 
• Training will focus on research 
aimed at sustainable policy change 
 
Table 1 C. Performance metrics for overall aims of S-C
3 for Aim 3: Conduct joint pilot projects 
Performance metrics for 
overall aims 
Expected Outcomes/ Milestones 
Steps to support 
sustainability 
How activities will inform local 
public policy 
3.1 Community-based 
intervention to promote PA 
among breast cancer 
survivors; 
3.2 Longitudinal 
evaluation of community-
wide Ciclovía/Recreovía 
programs. 
Short-term: 
• Pilot studies successfully 
completed 
• Manuscript describing findings 
submitted 
• Grant for larger scale study 
submitted.  
Mid- & long-term: 
• Larger scale studies implemented 
• Behavior change (e.g., objective 
PA, self-report PA) documented 
among target populations 
• Pilot studies will be 
conducted by Colombian 
researchers with support 
from Stanford peers to 
increase research capacity 
• Dissemination of findings through 
multi-sectoral stakeholder 
partnerships will promote changes 
in policies to support NCD 
prevention practices and policies 
 
Table 1 D. Performance metrics for overall aims of S-C
3 for Aim 4: Finalize center research plans 
Performance metrics for 
overall aims 
Expected Outcomes/ Milestones Steps to support 
sustainability 
How activities will inform local 
public policy 
4.1 Needs assessment with 
community members and key 
stakeholders using focus 
groups, interviews and a 
network analysis of 
organizational and 
communication pathways and 
connections in Colombia  
 
Short-term: 
• 3-5 focus groups and 5-8 
interviews completed and 
analyzed  
• Network analysis completed 
• Findings summarized in scientific 
manuscript and in policy briefs for 
key stakeholders 
Mid- & long-term: 
• Research activities aligned with 
needs and leverage assets 
• Methods documented to 
enable periodic assessment 
of needs and assets to 
account for changes in 
epidemiology and policy 
environments 
• Dissemination of findings through 
multi-sectoral stakeholder 
partnerships will promote changes 
in policies to support NCD 
prevention practices and policies 
4.2 Finalize short-, mid-, 
and long-term goals and 
expected outcomes. 
Short-term: 
• Multi-sectoral partners engaged to 
finalize goals and outcomes 
• Goals and outcomes 
disseminated through policy briefs 
for key stakeholders  
Mid- & long-term: 
• Goals and outcomes 
continuously 
communicated back to 
partners 
• CBPR approach will ensure 
that multiple stakeholders 
from various sectors are 
invested in the goals and 
outcomes to promote 
sustainability 
• Goals and outcomes will be focused 
on policy changes to sustain NCD 
prevention policies and outcomes 
 
B.6.1. Steps to enhance longevity of activities. By employing a socio-ecological model and utilizing a CBPR 
orientation to research, all S-C3 priorities are designed to promote long-term sustainability of research plans, 
enhancement activities, and shared core facilities. The strategies for promoting long-term sustainability are 
provided in Tables 1A-D. To summarize, key strategies to promote long-term sustainability of S-C3 plans 
Research Strategy                                                                                             Page 123
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include: 1) The training program we propose will help ensure longevity by training a cadre of scientists in 
behavioral intervention research and leaving in place courses and a Masters Program in Epidemiology; 2) We 
will engage the major stakeholders in this project as voting members of the Steering Committee since they 
represent sectors that will facilitate longevity of the program; and 3) We intend to use the pilot studies to 
generate preliminary results to seek major NIH grants in addition to other sources of funding to enable us to 
continue and enhance continuing research activities.  
 
B.6.2.  How activities will inform local public health policy. The strategies for informing local public health 
policy are provided in Tables 1A-D. Our primary means of informing public health policy is by engaging 
relevant policy making sectors to become part of our team by membership on our Steering Committee. We 
also plan a seminar at the end of the two years to present summary results to those groups that have the 
power to influence policy. Additionally, the steps to inform local public health policy in Latin America that are 
employed for this project will provide a road map for how this can be accomplished in other Latin American 
context.  
 
B.7. Resource Sharing Plan 
In keeping with current requirements, once the data collected through the Collaboratory have undergone 
final data cleaning and analysis, we will make the final data collected as part of the proposed research 
available in electronic form to researchers who request them. We will request that researchers submit a data 
request in writing to the project principal investigators so that the requested data can be made available while 
protecting the confidentiality of study participants. By setting up a centralized data request process, we will be 
able to provide requestors with information that will help to inform external research groups about duplicate 
data analysis activities on the part of other research groups related to the data set in question. 
 
B.8. Study Timeline 
The project period will span two years (Table 2). 
 
Table 2. Study timeline 
  
Year 1 
Year 2 
Study (Bimonthly) 
2 
4 
6 
8 
10 
12 
2 
4 
6 
8 
10 
12 
Project set up (e.g., IRB approval, 
Subcontracting, hiring) 
  
  
  
  
  
  
  
  
  
  
  
  
Specific Aim 1 
  
  
  
  
  
  
  
  
  
  
  
  
Multi-sectoral partnership meetings 
  
  
  
  
  
  
  
  
  
  
  
  
Establish cores 
  
  
  
  
  
  
  
  
  
  
  
  
Specific Aim 2 
  
  
  
  
  
  
  
  
  
  
  
  
Scholar exchange 
  
  
  
  
  
  
  
  
  
  
  
  
Behavioral science track in Epidem. MS 
  
  
  
  
  
  
  
  
  
  
  
  
Professional certificate course 
  
  
  
  
  
  
  
  
  
  
  
  
1-day mini courses 
  
  
  
  
  
  
  
  
  
  
  
  
Specific Aim 3 
  
  
  
  
  
  
  
  
  
  
  
  
Pilot study 1: PA among breast cancer pts. 
  
  
  
  
  
  
  
  
  
  
  
  
Pilot study 2: Ciclovía/Recreovía 
  
  
  
  
  
  
  
  
  
  
  
  
Specific Aim 4 
  
  
  
  
  
  
  
  
  
  
  
  
Needs assessment 
  
  
  
  
  
  
  
  
  
  
  
  
Finalize Collaboratory goals 
  
  
  
  
  
  
  
  
  
  
  
  
Publications and grant submissions 
  
  
  
  
  
  
  
  
  
  
  
  
 
B.9. Potential pitfalls and solutions 
One challenge is that the proposed planning process supports a robust set of activities, and without careful 
coordination the project could miss key milestones. Careful monitoring of study milestones and timelines will be 
critical for ensuring successful completion of project aims. This will be accomplished by frequent 
communication, both in-person and via web conferencing, as we have done for planning the Think Tank 
workshops and preparing this proposal.  A second challenge will relate to sustainability and potential to inform 
public policy, which are challenges in research aimed at promoting PA for NCD prevention. Employing a CBPR 
orientation to research will be critical for promoting sustainability and success in informing policy, as key 
stakeholders will be genuinely engaged in the process and capacity building is a focus. As other challenges 
arise, the Steering Committee will develop plans for rapidly identifying and implementing solutions. 
Research Strategy                                                                                             Page 124
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A. Specific Aims (Planning Unit) 
The goal of the Planning Unit for the Stanford-Colombia Collaboratory on Chronic Disease (S-C3) is to 
provide a structured roadmap for a set of coordinated activities aimed at increasing research capacity in the 
Latin American region for reducing the prevalence of non-communicable diseases (NCDs) through promotion 
of physical activity. Colombia is uniquely positioned to serve as a regional leader given the country’s academic 
resources (e.g., Universidad de los Andes), emerging governmental support of NCD prevention, and numerous 
partnerships throughout the region. Stanford researchers, who have an existing strong collaboration with 
researchers at Universidad de los Andes (UniAndes), will act as a catalyst by providing strategic scientific and 
academic support to increase research capacity in the areas of behavioral science, technology, measurement 
and data analysis, and community engagement and translation methods.  
The high burden of (NCDs) in low- to middle-income countries (LMIC) in Latin America, such as Colombia, 
calls for a highly coordinated, effective, and innovative research strategy to develop, test, and disseminate 
prevention and management strategies with high potential to improve population health. Close to 7 in 10 
deaths in Latin America are due to NCDs, including cancer, cardiovascular disease (CVD), and type 2 
diabetes.1,2 Fortunately, NCDs are largely preventable through low-cost, non-invasive, and culturally centered 
strategies such as promotion of guideline-concordant physical activity.8,9,12,13 Moderate- to vigorous-intensity 
physical activity (PA) of 150 minutes per week among adults and 60 minutes per day among children is 
associated with substantially lower lifetime risk of NCD. There is enormous opportunity to prevent NCDs in the 
Latin American region through promotion of physical activity given increasingly low levels of PA and high levels 
of sedentary behavior.11 In Colombia, 47% of adults and 74% of adolescents do not meet physical activity 
recommendations, comparable to levels in the US and higher than other Latin American countries such as 
Mexico, Ecuador, and Uruguay.11 If left unaddressed, physical activity levels in Latin America will continue to 
decline, with corresponding increases in NCD prevalence.  
Evidence-based strategies to promote physical activity encompass approaches that target individuals, their 
families, the neighborhoods in which they live, work, and play, and the policies that shape their opportunities 
for leading active lives. Additionally, physical activity interventions are easily culturally targeted and tailored, 
especially when community-based participatory research approaches are employed, making them an ideal 
approach for reducing NCD risk in regions such as Latin America with rich and heterogeneous cultural 
backgrounds. To support such potentially effective approaches, significant investment in the research capacity 
in the region is needed. Currently, in Colombia and the Latin American region, research has focused largely on 
observational methods for physical activity surveillance and examination of multi-level determinants of physical 
activity levels (e.g., individual, family, and neighborhood).22 With this critically important information on activity 
levels and determinants, the region now has an opportunity to build upon this foundation to create a body of 
research focused on behavior change through multiple levels of influence. The plans for research studies, 
research enhancement, and shared core facilities will be informed by the mixed methods needs assessment as 
described in the Coordinating Unit.  
 
The Specific Aims of the Planning Unit are the following: 
1. Complete two pilot studies of physical activity interventions that focus on distinct levels of 
influence in diverse populations. One pilot study will use a randomized controlled trial design to examine the 
preliminary effectiveness of a physical activity intervention for breast cancer patients. A second pilot study will 
use a longitudinal cohort design of Ciclovías and Recreovías in Colombia.  
2. Take advantage of Stanford’s expertise in core research areas to train world leaders in 
behavioral science research at Universidad de los Andes to support regional expertise in physical 
activity intervention research. A multi-pronged educational approach is planned for increasing research 
capacity among research partners, students, and community members. Activities will include developing a 
masters of science degree, a professional certificate program, and mini-courses for key stakeholders. 
3. Establish and sustain core research resources that will support development and 
implementation of cutting-edge behavioral science research focused on physical activity promotion. 
The supportive cores, described in section B.3, which were developed through a participatory process, will 
focus on behavioral science, measurement and data analysis, and community outreach and translation.  
This coordinated set of planning activities will provide a strong foundation to support an impactful research 
strategy with high potential to create and disseminate evidence-based physical activity interventions to prevent 
NCDs in Colombia and the Latin American region. 
Specific Aims                                                                                                 Page 160
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B. Research Strategy – Planning Unit 
The Stanford-Colombia Collaboratory on Chronic Disease (S-C3) will support transformative research 
aimed at significantly decreasing the prevalence of NCDs, including cancer, cardiovascular disease, diabetes, 
and depression through effective promotion of physical activity. Two fundamental frameworks guide the plans 
for this Collaboratory. First, the socio-ecological model, which posits that health outcomes are shaped by 
factors at the individual, family, community/neighborhood, and policy/societal levels (see Figure 1 in Overall 
Plan),5-9 guides the design and evaluation of physical activity interventions in this project. Second, Community-
Based Participatory Research (CBPR) approaches are utilized in partner development, research 
enhancement, needs assessment, and pilot studies. Utilizing CBPR approaches is essential for ensuring that 
the Collaboratory is relevant for Colombia and the Latin American region and sustainable over the long-term.40 
Among the CBPR strategies, we leverage the Nuestra Voz (Our Voice) model, originally developed by PI Dr. 
King and colleagues and extensively tested across the globe, including in Latin America by dual PI Dr. 
Sarmiento and Co-I Dr. Goldman Rosas, among others.14 The Nuestra Voz model empowers neighborhood 
residents to be “citizen scientists” through systematically collecting information about aspects of their 
neighborhoods that promote or hinder healthy living. Residents then learn how to effectively communicate their 
results to policy makers to promote realistic changes that will support healthier lifestyles. Thus, the Stanford-
Colombia Collaboratory not only engages stakeholders from multiple sectors but also community residents 
themselves in the planning process. Using these frameworks, the S-C3 includes specific and coordinated plans 
to support research, research enhancement, and shared core facilities to develop a highly productive Center of 
Research Excellence focused on prevention of NCDs in Latin America. 
 
B1. Planning for research activities 
The rationale for the focus of the S-C3 builds directly from the Latin America Cancer Epidemiology Think 
Tank hosted at the Stanford Cancer Center in April 15-16, 2016. Ten researchers from Latin American 
academic institutions, four researchers from the US, and three scientists from the National Cancer Institute 
participated in a 2-day workshop focused on identifying strategic opportunities to impact the growing burden of 
cancer and other NCDs in Latin America. Physical activity (PA) promotion clearly emerged as a high priority 
given the potential effectiveness for prevention of cancer and other chronic diseases, existing expertise in 
physical activity epidemiology in Colombia and other parts of the region,22,34,55,56 and the flexibility offered to 
culturally target and tailor interventions to the heterogeneous cultural backgrounds in Latin America.  
B.1.1. Rationale for targeting physical inactivity in ameliorating NCD burden in Latin America. As 
described in the Overall Plan, Colombia and other LMICs in Latin America share a high degree of burden from 
a constellation of NCDs, including cancer, cardiovascular disease and type 2 diabetes, in addition to mental 
health conditions such as anxiety and depression.1-4 A key behavioral pathway is physical inactivity—one of 
three behavioral risk factors leading to the four major NCDs responsible for 50% of global mortality.57 The 
development of evidence-based PA interventions at multiple levels of impact thus provides a potentially cost- 
and resource-efficient way to address multiple NCDs. However, while the prevalence of physical inactivity is 
increasing in LMICs in Latin America and elsewhere,58 the development of effective, culturally relevant PA 
interventions aimed at NCD prevention and control in the Latin American region generally has lagged behind 
scientific efforts in other behavioral risk factor areas (e.g., diet).  
B.1.2. Rationale for Stanford-Universidad de los Andes partnership. Scientists at the Universidad de los 
Andes (UniAndes) and their partner institutions in Bogotá, Colombia have a proven track record of scientific 
excellence and prominence in the Latin American region in relevant health areas, including PA epidemiology, 
assessment, and theory-building. They also have begun developing successful collaborations with PA 
intervention researchers at Stanford University. A major goal of the proposed Planning Unit is to take 
advantage of the research and training expertise and synergies across both academic institutions (UniAndes, 
Stanford) to create a coherent and collaborative set of research and training mechanisms and structures in 
Colombia that will lay the groundwork for developing an impactful and sustainable regional Center of 
Excellence (i.e., “Collaboratory”) that can have a potentially transformative effect on NCD burden in Colombia 
and the Latin American region.  
B.1.3. Research environment at UniAndes. Universidad de los Andes was founded in 1948. It has nine 
schools: Medicine, Business Administration, Architecture and Design, Arts and Humanities, Science, Social 
Sciences, Law, Economics, and Engineering. In addition, the University includes the first private school for 
public affairs--the Alberto Lleras Camargo Government School. There are 644 full-time professors in UniAndes 
in 2016. This number has increased by 60% between 2002 and 2014. Seventy percent of the faculty holds 
doctoral degrees. This percentage is the biggest in the country and has increased significantly in the past few 
years (it was only 39% in 2002) and it is above the national average (14% in 2014). There are approximately 
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18,000 students: 26% are enrolled in graduate and professional degree programs, 30% of the students come 
from outside Bogotá, and 87% of the undergraduate students come from the top 5% of high school students in 
the country. UniAndes is the only Colombian university within the top 450 universities of the world, according to 
the QS 2015 (World University Ranking). According to the 2016 QS Ranking for Latin America, Universidad de 
los Andes is the eighth best university of this region. Located on a total area of 163,961 square meters, Uni-
Andes has excellent laboratory facilities, 428,490 books in the library system, which has been classified as one 
of the best libraries in Latin America, 2,507 computers for student use on campus, and a modern sports center. 
B.1.4. Implementation of pilot studies. The pilot studies, described in Section B.6 of the Overall Plan, were 
specifically chosen to provide opportunities to develop and understand distinct behavioral intervention 
strategies, utilize different research methods, and engage diverse research partners. Additionally, the pilot 
studies will serve multiple functions. First, the pilot research will inform future larger-scale proposals with high 
potential for success. Second, the pilot studies will provide training opportunities for the various constituent 
groups engaged in the research enhancement activities. Third, the shared core facilities will support the pilot 
projects and through this process the Steering Committee will identify additional resources needed. Finally, the 
pilot projects will provide key opportunities to engage partners in research activities.  
B.1.5. Short-, mid-, and long-term goals. The S-C3 is aimed at short-, mid-, and long-term goals as described 
below. In the short-term, the S-C3 aims to create infrastructure to support research, increase research 
capacity, demonstrate the acceptability and feasibility of NCD prevention research approaches, and 
disseminate plans for NCD prevention research to multiple stakeholder groups from multiple sectors. In the 
mid-term, the S-C3 goals will include supporting ongoing partnerships, further building research capacity, 
utilizing pilot research to build larger scale research projects, and disseminating successes related to research 
infrastructure and capacity building. The long-term goals of the S-C3 are focused on expansion of the above S-
C3 activities in the Latin American region and meaningful change in health and policy outcomes. The 
aspirational goals for each period are described below.  
 
Table 1. S-C3 Goals 
 
Short-term (2 years) 
Mid-term (2-5 years) 
Long-term (5-10 years) 
Research 
infrastructure 
and 
community 
engagement 
• Supportive cores are 
established and used by 
researchers in Colombia 
• Multi-sector partnerships are 
established and engaged in 
research 
• Increase utilization of 
consulting from cores in 
Colombia with expanded 
services for the Latin 
American region 
• Infrastructure to support 
clinical trials and other large-
scale studies is in place and 
utilized 
• Colombian NCD prev. partner-
ship is annually evaluated, 
sustained, and expanded 
• Continued utilization of 
supportive cores in Colombia 
with additional satellite cores 
established in the Latin 
American region 
• Lessons learned from the 
partnership development 
process in Colombia are 
replicated in at least 3 
additional countries in the 
Latin American region 
Research 
enhancement 
• At least 2 scholar exchanges 
have been successfully 
completed between Stanford 
and UniAndes 
• Professional certificate 
program is developed and 
delivered at least once at 
UniAndes 
• A behavioral science track 
within the epidemiology 
masters program is developed 
at UniAndes 
• At least 3 1-day courses are 
provided to partner 
organizations in Colombia 
• At least 2 scholar exchanges 
occur annually between 
Stanford and UniAndes 
• Professional certificate 
program is provided annually 
with increasing participation at 
UniAndes 
• At least 5 students are 
enrolled in the behavioral 
science track annually at 
UniAndes 
• At least 5 1-day courses are 
provided each year in 
Colombia 
• The scholar exchange 
program is expanded to 
include additional universities 
in Colombia and the Latin 
American region 
• Additional universities in 
Colombia and the Latin 
American region offer the 
professional certificate 
program 
• A behavioral science track is 
offered at additional 
universities in Colombia and 
the Latin American region 
• The 1-day courses continue to 
be offered in Colombia (5 
annually) and at least 3 
additional courses are offered 
annually in Latin Am. region 
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NCD 
prevention 
research  
• Two pilot studies are 
successfully completed 
• At least 2 grant proposals are 
submitted for larger scale 
studies in Colombia 
 
• At least 2 larger scale studies 
are underway in Colombia 
• At least 3 grant proposals are 
submitted for additional larger 
scale studies in Colombia and 
the Latin American region 
• At least 3 to 5 larger scale 
studies are underway in 
Colombia and the Latin 
American region 
• At least 3 to 5 grant proposals 
submitted for additional larger 
scale studies in Colombia and 
the Latin American region 
Health and 
policy 
outcomes 
Health outcomes: 
• Changes in health outcomes 
are not expected in the short-
term 
Policy outcomes: 
• Policy changes are not 
expected in the short term 
Health outcomes: 
• Preliminary evidence of 
increases in physical activity 
among certain subgroups 
targeted in research studies is 
documented in Colombia 
Policy outcomes: 
• Initial changes in policies 
related to NCD prevention 
research are documented in 
Colombia and the Latin 
American region 
• Changes in Colombian 
policies to support active living 
are documented  
Health outcomes: 
• Increasing evidence of 
increases in physical activity 
is documented in Colombia 
and the Latin American region 
Policy outcomes: 
• Sustained political support for 
NCD prevention research is 
documented in Colombia and 
the Latin American region 
• Changes in policies to support 
active living are documented 
in Colombia and the Latin 
American region 
Dissemination  Scientific:  
• At least 3 publications on 
research enhancement & pilot 
studies submitted 
• Seminar of the results of pilot 
studies with policy makers, 
researchers and community 
members. 
Non-scientific:  
• Policy briefs on the importance 
of NCD prevention research 
are created and disseminated 
through partner organizations 
• Web portal is created to 
facilitate communication 
among partners 
Scientific:  
• At least 3 publications are 
submitted annually focused on 
NCD prevention research in 
Colombia and the Latin 
American region 
Non-scientific:  
• Evidence from pilot studies is 
effectively disseminated 
through partner organizations 
to promote policy changes in 
Colombia 
Scientific:  
• At least 5 publications are 
submitted annually focused on 
NCD prevention research in 
Colombia and the Latin 
American region 
Non-scientific: 
• Evidence from research 
studies is effectively 
disseminated through partner 
organizations to promote 
policy changes in Colombia 
and the Latin American region 
 
B.1.6. How S-C3 activities complement existing research endeavors at UniAndes. The planned activities 
complement existing research, training, and core facilities to support rigorous research to evaluate theory-
based behavioral interventions to increase PA and decrease sedentary behavior—with the ultimate goal of 
decreasing NCD prevalence in Colombia. The proposed pilot studies build on existing research, which has 
been largely observational in nature. The goal of the research activities is to facilitate a transition from 
observational studies focused on describing PA levels and determinants to intervention research focused on 
developing innovative new models for PA promotion and rigorous research methodology to evaluate these 
strategies. The training activities will serve as a catalyst for the research activities by providing critical training 
to academic and non-academic stakeholders. The proposed training activities will utilize the training experi-
ence at Stanford to build upon existing training resources at UniAndes. Together the pilot research projects 
and the training programs will help build capacity for theory-based multilevel and multi-sectoral behavioral 
interventions to promote PA. Finally, the shared core facilities will provide critical infrastructure support for the 
proposed planning activities and for future larger-scale research activities that emerge from this project. 
 
B2. Planning for Research Enhancement and Capacity-building Activities 
In line with a CBPR approach, the S-C3 includes plans for training scholars, research partners, and 
community members to enhance research at all levels. Enhancing research capacity within and outside of 
academic settings will promote long-term sustainability and increase the potential for effectiveness. The 
described plans for Colombia provide a road map that can be used in other Latin American contexts as well. 
Stanford’s experience in training will complement existing training activities at UniAndes, resulting in a high-
caliber and comprehensive training program focused on NCD prevention. 
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B.2.1. Stanford training experience. Stanford University and especially the Stanford Prevention Research 
Center (SPRC) in the Department of Medicine and the Department of Health Research and Policy (HRP) are 
global leaders in training top scientists in behavioral intervention research focused on NCD prevention. Dr. 
King (PI) is a Professor in both departments and maintains an active role in training activities in both, and Dr. 
Goldman Rosas plays a central role in teaching activities for SPRC. For the past 35 years, SPRC has offered a 
postdoctoral fellowship that has trained over 200 high-caliber scholars who have gone on to assume faculty 
positions and other leadership roles in governmental and non-governmental organizations. Both SPRC and 
HRP offer the Masters of Science (MS) in Community Health and Prevention Research (CHPR) and 
Epidemiology, respectively. The CHPR MS was recently developed and launched (Fall 2015), which provides 
critical experience that will be translatable to the research enhancement activities proposed for S-C3. 
Additionally, SPRC offers a professional certificate program (Stanford Health 4 All) and other mini-courses for 
community members that will also provide a model that can be adapted for Latin America. Dr. Goldman Rosas 
sits on the faculty governance board for SPRC teaching programs and teaches three courses. Additionally, Dr. 
Haile brings extensive experience developing and delivering teaching programs, having developed one of the 
first genetic epidemiology programs in the country while at UCLA and one of the first international courses in 
genetic epidemiology presented at numerous universities in China. 
B.2.2. UniAndes training experience. The Stanford experience will complement existing activities at 
UniAndes. UniAndes has recently launched a Masters of Public Health and a Doctoral program in Psychology, 
which will serve as a foundation for the proposed research enhancement activities. Additionally, plans are 
currently underway for a Masters of Science in Epidemiology. Professor Sarmiento teaches classes and 
advises theses of Masters of Public Health students, and is among the faculty designing the Masters of 
Science in Epidemiology. Professor Finck teaches classes and advises theses of the students in the Doctoral 
program of Psychology. The training programs (Table 2), coupled with the research opportunities provided by 
the pilot studies and other future larger scale studies, will provide critical infrastructure to train scholars and 
other professionals in theory-based multilevel and multi-sectorial behavioral interventions to promote physical 
activity. The limited availability of training opportunities is a major barrier to advancing research in physical 
activity promotion for NCD prevention.59 
B.2.3. Research enhancement plans. Building on the experience at Stanford and UniAndes, the research 
enhancement activities will encompass four strategies aimed at reaching distinct constituent groups to promote 
long-term sustainability in Colombia (Table 2). Additionally, these strategies were selected because of their 
potential for replication in other Latin American countries.  
Table 2. Capacity building through research training 
Program 
Sources of trainees 
Brief Description 
Potential for capacity building 
Scholar 
exchange 
Stanford and UniAndes 
students and researchers at 
various levels of training 
Short research visits to partici-
pate in courses or gain research 
experience in specific areas 
Training in effective intervention 
design, evaluation, & knowledge 
about the Colombian context 
Masters 
program 
Graduates of various disci-
plines, practitioners in health 
related context (medicine, 
psychology, PA) at UniAndes 
Track of the masters program in 
Epidemiology at UniAndes  
Comprehensive training in 
design and implementation as 
well as evaluation of 
interventions to promote PA 
Professional 
certificate 
program 
Graduates of various disci-
plines, practitioners in health 
related context (medicine, 
psychology, physical activity). 
Graduate students at UniAndes 
Short course as elective for 
graduate studies in the MPH in 
Epidemiology or the Psychology 
training programs 
Knowledge and practical 
implementation of behavior 
change theories on health 
promotion (specifically PA 
promotion) 
1-day 
courses 
Members of partner 
organizations and community 
members 
Mini courses focused on the 
importance of behavioral 
interventions for NCD promotion 
and skills for engaging in 
research as community partners 
Widespread dissemination of 
research skills will promote 
sustained and long-term 
investment in multiple 
stakeholder groups. 
B.2.4. Assessment of comprehension. Ongoing evaluation of each research training activity is vital to its 
continued success and sustainability. A specific evaluation plan is planned for each training activity over both 
the short- and long-term (Table 3). 
B.2.5. Plan for ensuring that research talent remains in Colombia and Latin America. One of the main 
concerns when building research capacity in low to middle income countries is “brain drain”. To prevent this, 
we will conduct most of the training in Colombia with students of different regions of the country. Both Drs. 
Sarmiento and Finck are researchers highly trained outside of Colombia who came back to the country more 
than ten years ago to teach and build research capacity in the region. In fact, they belong to multiple networks 
Research Strategy                                                                                             Page 164
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and groups that will prevent brain drain. Figure 
1 illustrates graphically institutions that are part 
of academic networks like the Network of 
Physical Activity of the Americas, Network of 
Ciclovías of the Americas, Active Healthy Kids 
Global Alliance and the Network of Urban 
Health (the arrow shows UniAndes). In 
addition, we are members of the Ceiba group 
that started seven years ago in response to a 
call from the National Department of Science, 
Technology and Innovation to create 
Excellence Centers in Colombia, and have had 
more than 40 affiliated doctoral students. A 
goal of Ceiba is to train and retain top scholars 
in the region. 
 
B.3. Planning for Shared Research Cores 
The shared core facilities will be informed by the needs assessment conducted in Year 1. The proposed 
shared core facilities were identified during the Latin America Cancer Epidemiology (LACE) Think Tank (April, 
2016) as representing major barriers to advancing the science of chronic disease prevention in Latin America. 
Thus, while the specific activities of the core facilities will be optimized through what is learned in the needs 
assessment, the primary functions will not change. The primary gaps in advancing behavioral intervention 
research in Colombia and the region include: 1) Data management and analysis of observational and 
experimental behavioral intervention studies; 2) Development of theory-based behavioral interventions and 
evaluation design; and 3) Community engagement and translation. The cores are embedded in existing 
academic programs, which make them financially sustainable and support economies of scale. Specifically, 
researchers at Stanford will work with Drs. Finck and Sarmiento from the schools of Medicine and Social 
Sciences. The latter, in turn, will work together with the Schools of Engineering and Government. In order to 
further support the cores, we will apply for additional grants within the Universidad de los Andes and 
Colciencias (Colombian National Science Foundation). Specific education grants from the Universidad de los 
Andes support the creation of blended courses (web based and in person classes). Blended courses, in turn, 
will serve as courses for other academic groups in the Latin American region. 
   
 
Table 3. Assessment of comprehension of training programs 
Program 
Assessment of comprehension  
Scholar 
exchange 
• Report submitted to research mentor with 
concrete plans for incorporating lessons learned 
into future collaborative research plans 
Masters 
program 
• Qualifying exam  
• Masters thesis 
Professional 
certificate 
program 
• Internship program where students apply concepts 
in real-world setting; internship supervisors will 
provide assessment 
1-day 
courses 
• Interactive response system during course (e.g., 
Turning Point)  
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1. Data management and statistical analysis core. This core will focus on data management and analysis of 
data from observational and experimental intervention research. This core will be centered at UniAndes and 
led by Dr. Sarmiento with support from Andrés Medaglia, the director of Industrial Engineering and the program 
of Analytics at UniAndes, and from Dr. Haile at Stanford. Dr. Sarmiento will develop a knowledge bank of 
resources for effective data management tools such as REDCap and other online data collection tools such as 
data visualization tools, as well as data analysis resources with help from Dr. Haile. The core will establish an 
online repository where scientists can share analysis code (e.g., R code for analyzing accelerometry data, 
procedures for analyzing PA diary data) and other analysis resources (e.g., instructions for scoring 
international questionnaires to measure PA, and forms for systematic observation of spaces for PA, GIS data 
analysis, and network analysis).  
2. Development and evaluation of theory-based behavioral interventions. This core will support the 
development of innovative behavioral interventions for increasing PA and decreasing sedentary behavior as 
well as the design of rigorous evaluations of these programs. Dr. King will provide overall leadership for this 
core with support from Dr. Finck and Diana Agudelo PhD, Director of the Psychology Department at UniAndes. 
Dr. King will develop a knowledge bank with the following content: 1) Information on existing evidence-based 
PA interventions; 2) Strategies for successful adaptation of evidence-based interventions in the field; 3) 
Validated measures for evaluation of interventions; and 4) Strategies for validation of other measures.  
3. Community Engagement and Translation: The community engagement and translation core will provide 
knowledge and resources for effectively engaging community members and key stakeholders to support the 
development, evaluation, and dissemination of PA interventions. Dr. Goldman Rosas will lead this core with 
support from Catalina Gonzalez MA, MSc, PhD, Director of the Epidemiology masters program at UniAndes. 
The knowledge bank will include information on best practices for engaging community members and key 
stakeholders in behavioral intervention research, as well as key resources such as partnership agreement 
templates and data sharing plans, training materials for community members engaging in research, and 
information on training in the ethical conduct of research. 
 
B.4. Core Support Functions 
The S-C3 will benefit from existing core support functions that will be further strengthened during the 
planning phases: 
Research ethics committee: The Planning Unit will design and oversee all processes of IRB approvals and 
an ethics committee. It will designate the Coordinating Unit to develop the master human subjects protocols 
and consent forms for each of the intervention and related research projects, and will communicate with the 
Stanford team in order to assess if approval by the Stanford Human Subjects Administrative Panel is needed 
for specific activities. It will assure the approval of all activities by the Committee for Ethics in Research from 
UniAndes. This committee was first established in 2000, has strict processes and procedures, and is accepted 
by the Colombian Ministry for Research and technology (Colciencias) to oversee the ethical issues of research 
projects and activities in which UniAndes members participate. IRB issues will be included at each meeting of 
the Steering Committee. 
Administrative and budget oversight: To facilitate the research mission, the Planning Unit will monitor 
progress and adjust activities to the expenditures on the grant, including all consultant costs, salaries, supplies, 
travel, etc. The Steering Committee will assist the PIs (Sarmiento and King) on financial issues arising from the 
project and will meet with PIs on a regular (monthly or more frequently as appropriate) basis. The project 
budget analyst will provide budget projections on a quarterly basis and the Planning Unit will also work with the 
Coordinating Unit and Steering Committee in examining funding opportunities that make the Collaboratory 
sustainable in the long-term. 
 
B.5. Resource Sharing Plan 
The Collaboratory will have a website to share information and datasets in Spanish and English. Through 
this center, we will also establish an online repository where scientists can share analysis code (e.g., R code 
for analyzing accelerometry data, procedures for analyzing PA diary data) and other analysis resources (e.g., 
instructions for scoring international PA questionnaires, and forms for systematic observation of spaces for PA, 
GIS data analysis, and network analysis). 
In keeping with current requirements, once the data collected through the Collaboratory have undergone 
final data cleaning and analysis, we will make the final data collected as part of the proposed research 
available in electronic form to researchers who request them. We will request that researchers submit a data 
request in writing to the project principal investigators so that the requested data can be made available while 
protecting the confidentiality of study participants. By setting up a centralized data request process, we will be 
able to provide requestors with information that will help to inform external research groups about duplicate 
data analysis activities on the part of other research groups related to the data set in question. 
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