Systematic dissemination of a preschool physical activity intervention to the control preschools

For public health interventions to have a meaningful impact on public health, they must be disseminated to the wider population. Systematic planning and evaluation of dissemination efforts can aid translation from experimental trials to larger dissemination programs. The Study of Health and Activity in Preschool Environments (SHAPES) was a group-randomized intervention trial conducted in 16 preschools that successfully increased the physical activity of preschool age children. Following the completion of the research study protocol, the intervention was abbreviated, modified and implemented in four preschools that participated as control preschools in the original research study. The purposes of the current study were to describe the process of refining the intervention for dissemination to the control preschools, and to assess the acceptability of the resulting abbreviated intervention delivery. Five overarching behavioral objectives, informed by process evaluation, data from the original trial and collaboration with intervention teachers, were used to guide the implementation. Teachers in the dissemination classrooms reported high levels of acceptability, potential for sustainability of the program, and positive results in knowledge, skills, and child outcomes. Researchers can include a systematic approach to dissemination of effective intervention elements to the control participants in experimental studies to inform future dissemination efforts and begin to bridge the dissemination gap.     

Physical activity and nutrition program for adults with metabolic syndrome: Process evaluation

IntroductionThe Vietnam Physical Activity and Nutrition (VPAN) program aimed to improve physical activity and nutrition for adults aged 50–65 years with Metabolic Syndrome in Vietnam. The VPAN program consisted of a range of resources and strategies, including an information booklet, resistance band, face-to-face education sessions, and walking groups. This process evaluation assessed the participation, fidelity, satisfaction, and reasons for completing and not-completing the VPAN.MethodsData were collected by mixed-methods from a sample of 214 intervention participants. Quantitative data were collected via surveys (n = 163); qualitative data via face-to-face exit interviews with intervention program completers (n = 10) and non-completers (n = 10), and brief post education session discussions.ResultsMost participants (87%–96%) reported the program resources and strategies useful, assisting them to increase their physical activity level and improving their diet. The education sessions were the most preferred strategy (97%) with high attendance (>78% of participants). The main reasons for withdrawal were work commitments and being too busy.ConclusionThe evaluation indicated that the program reached and engaged the majority of participants throughout the six-month intervention. The combination of printed resources and face-to-face intervention components was a suitable approach to support lifestyle behavioural change in the Vietnamese population.     

Process evaluation of “Girls on the Run”: Exploring implementation in a physical activity-based positive youth development program

Many positive youth development programs rely on physical activity as a primary program component. Referred to as physical activity-based youth development programs, these program designs have great potential for promoting healthy youth development. This study examined how one such physical activity-based positive youth development program was implemented in order to identify design features critical to maximizing positive youth outcomes. This mixed method, multi-site process evaluation of Girls on the Run (GOTR) utilized focus groups, site visits, and self-report implementation checklists. Implementation scores were calculated to assess implementation fidelity across twenty-nine sites, and qualitative data were inductively analyzed to identify factors influential for implementation. Results reveal variability in how GOTR was implemented. Five themes emerged from the data that represented factors serving as facilitators or barriers to programmatic implementation. These included contextual/environmental factors (e.g., parental involvement, relationships with school personnel), organizational factors (e.g., implementation support and responsiveness of staff), program-specific factors (e.g., curriculum design), coach factors (e.g., existing relationships with participants, responsiveness to participant's needs), and youth factors (e.g., behavioral and discipline issues). Study findings have implications for improving the design of physical activity-based and other positive youth development programs, with relevance to evaluators, program planners, youth development leaders, and others working with children and youth.     

Examining the link between program implementation and behavior outcomes in the lifestyle education for activity program (LEAP)

Lifestyle Education for Activity Program (LEAP) was a comprehensive, school-based intervention designed to promote physical activity in high school girls. The intervention focused on changes in instructional practices and the school environment to affect personal, social, and environmental factors related to physical activity. Multiple process evaluation tools and an organizational assessment tool were developed to monitor program implementation from a framework called the LEAP essential elements, which characterized complete and acceptable intervention delivery; secular trends were also monitored. Using process data, LEAP intervention schools were categorized into low- and high-implementing groups and compared with control schools on nine essential elements assessed at the organizational level. The Wilcoxon scores test revealed that low- and high-implementing intervention, and control schools differed significantly on two of nine administrator-reported organizational-level components: having a physical activity team and having a faculty-staff health promotion program. A mixed-model analysis of covariance indicated that, compared to control schools, a greater percentage of girls in high-implementing schools reported engaging in vigorous physical activity. Process evaluation can be used to understand the relationship between level of implementation and successful program outcome.     

Process evaluation of a diversity training program: the value of a mixed method strategy

Patients’ health and health needs are influenced by categories of difference like sex, gender, ethnic origin and socioeconomic status (SES). To enhance awareness of this diversity among patients and to provide holistic care for them, health professionals should first be aware of the relation between dimensions of diversity and patients’ health and health demands. This paper presents a formative process evaluation of a diversity sensitivity training programme for healthcare professionals. The training was implemented in three healthcare settings (mental healthcare, nursing home and hospital care). Mixed methods were used to monitor the implementation of the training and its effects after three years. Findings demonstrate that the training stimulated participants’ awareness, knowledge and critical attitudes towards diversity. Their motivation and willingness to take action regarding diversity was also enhanced. Yet these developments were less apparent among nursing home participants who felt less satisfied and did not develop a critical perspective on this issue. Qualitative data were helpful to explain differences between the settings. By means of the combination of quantitative and qualitative data, we can conclude that individual learning was not enough to guarantee a sensitive approach to diversity at the organizational level.     

Perceptions of participants and staff of implementing a physical activity program in rural primary care

Addressing the lack of physical activity (PA) in rural adults is vital because of the role it plays in the risk for many chronic diseases. The purpose of the study was to explore the feasibility of conducting a 12-week intervention utilizing a Fitbit to increase PA behavior in inactive rural adults recruited from a primary care clinic. Semi-structured interviews were conducted with study participants (n=10) and a focus group was held with nurses (n=7) from the primary care clinic. Data were analyzed using the process of immersion/crystallization. Participants and nurses both felt the program had a positive impact on PA and that the program was needed in the community. Study participants most often reported their favorite part of the study was being able to track their activity as well as the goal setting. However, study participants reported barriers to continued participation in PA related to a lack of time and ability to be active in cold weather. Further, nursing staff reported barriers in regard to a lack of resources (staffing and money) These barriers need to be examined further and addressed in order to implement a sustainable PA program that can be maintained through a primary care clinic.     

Formative evaluation on a physical activity health promotion program for the group home setting

Physical inactivity and high rates of chronic conditions is a public health concern for adults with intellectual disability. Few health promotion programs target the group home setting which is the pre-dominant form of residential accommodation for persons with intellectual disability. A process evaluation of a physical activity health promotion program, Menu-Choice, was conducted with five group home sites for adults with intellectual and developmental disabilities. Menu-Choice assists group home staff in including physical activity goals within resident schedules. The physical activity program was designed based on theoretical frameworks, community-based participatory approaches, and established health promotion guidelines for adults with disabilities. Fourteen program coordinators (age M 39; 77% females), 22 staff (age M 39; 82% females), and 18 residents (age M 59; 72% females; 56% ambulatory) participated. Results from the fidelity survey and program completion highlight potential challenges with implementation. Findings will assist with the refinement of the program for continued implementation trials in the group home community.     

Case study of a health optimizing physical education-based comprehensive school physical activity program

In this article, we report a qualitative case study, in which we examined enablers and barriers related to the development, implementation, and sustainability of a comprehensive school physical activity program (CSPAP) aligned with the Health Optimizing Physical Education (HOPE) curriculum model at a middle school. Literature on program-diffusion and school-university partnerships guided data collection and analysis. Data sources included semi-structured interviews with the program implementation team (n = 9) and the school’s health and physical education teachers (n = 7); a focus group interview with students; documents (e.g., lesson plans), and observations. Constant comparison techniques were used to code and draw out themes from the data. Findings revealed the extensive effort needed for program implementation and highlighted the importance of strong external support mechanisms, conducting needs assessments, and training teachers to market physical activity programming. Partnerships may provide critical support for schools in their efforts to generate and sustain CSPAPs.     

Utilizing the RE-AIM framework to determine effectiveness of a preschool intervention program on social-emotional outcomes

Social-emotional issues in preschoolers continue to be an area of concern across the nation. Models to determine effective implementation practices are needed. The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework is one model that can be used to evaluate program implementation in preschool settings. The Jump Start program provided short-term intervention to children in low-income preschools from multiethnic backgrounds. The goal was to promote prosocial behaviors while minimizing problem behaviors. Various evidenced-based practices (i.e., I Can Problem Solve, play therapy, Pyramid Model) were utilized. 305 children from 73 childcare centers participated in the program. The majority of participants were from ethnic minority backgrounds and resided in high-poverty areas of the county. The RE-AIM framework was utilized to determine program outcomes. Results showed successes on each level of RE-AIM with an at-risk population. The Jump Start program significantly increased positive behaviors and decreased challenging behaviors in preschool-aged children. Results indicated medium to large effect sizes. One year following program participation, the majority of children who participated in the program were at decreased risk of special education services and expulsion.     

Evaluation of a comprehensive school physical activity program: Be a Champion!

BackgroundComprehensive School Physical Activity Programs (CSPAPs) are widely supported to increase physical activity (PA) in schools, but little has been reported to inform a comprehensive evaluation effort. The purpose of this report is to describe a comprehensive evaluation and monitoring strategy for CSPAP implementation.MethodsThe System for Observing Staff Promotion of Activity and Nutrition (SOSPAN), System for Observing Student Movement in Academic Routines and Transitions (SOSMART), and System for Observing Play and Leisure Activity (SOPLAY) were employed to record student and staff behaviors (2642 total scans). To assess policies, practices, and environments, a CSPAP Policies and Practices questionnaire was used, which included components of the School Health Index, the School PA Policy Assessment, the School Environment and Policies Survey, and the School Health Policies and Practices Study. Youth PA (minutes/day) was assessed using accelerometers.ResultsWorking with school sites to ascertain the number of opportunities that are provided for PA and the amount of PA students engage in is challenging but feasible. The use of systematic observation, accelerometers, and questionnaires can provide a comprehensive representation of policies, practices, and behaviors to aid in establishing targeted PA action items.ConclusionsDeveloping an evaluation framework that was rigorous enough to assess the physical, social, and policy environment of a school in order to answer the overarching research questions of the study but flexible enough to be feasibly streamlined for utilization by a school implementation team proved to be challenging but possible.     

Aging effects on joint proprioception: the role of physical activity in proprioception preservation

Throughout the human life span the functions of several physiological systems dramatically change, including proprioception. Impaired proprioception leads to less accurate detection of body position changes increasing the risk of fall, and to abnormal joint biomechanics during functional activities so, over a period of time, degenerative joint disease may result. Altered neuromuscular control of the lower limb and consequently poor balance resulting from changes in the proprioceptive function could be related to the high incidence of harmful falls that occur in old age subjects. There is evidence of proprioception deterioration with aging. Regular physical activity seems to be a beneficial strategy to preserve proprioception and prevent falls among older subjects. Some studies have demonstrated that the regular physical activity can attenuate age-related decline in proprioception. This paper reviews the evidence of age effects on joint proprioception. We will discuss the possible mechanisms behind these effects and the role of regular physical activity in the attenuation of age-related decline in proprioception.     

The potential role of physical activity on driving performance and safety among older adults

The elderly represent the fastest growing driving population. Older drivers have a high crash rate per distance traveled, a high risk of injury or death in traffic accidents, and are commonly found to be ‘at fault’ in crashes. This reality has focused more interest on issues associated with the fitness to drive and the safety of older drivers. Many older adults depend greatly on their personal vehicle for transportation and suffer a marked loss of quality of life when, as a consequence of no longer being able or permitted to drive, their mobility becomes significantly restricted. The reasons for the deterioration of driving performance that occur during the aging process are multi-factorial and a great deal of research has focused on the identification of those factors. Nevertheless, some studies incorporating training programs have tried, with some success, to improve the driving-related abilities of older drivers. It has been demonstrated that physical activity can promote several skills that are associated with driving performance in older drivers. Few studies, though, have conducted exercise interventions among older drivers intended to enhance their driving-related abilities and promote road safety. In this context, the purpose of this work consists of examining the perceptual, cognitive, health, and physical factors related to fitness to drive in older adults and identifying possible strategies that can enhance their driving-related abilities. Moreover, potential mechanisms underlying the relationship among physical activity, driving ability, and road safety are discussed.     

An innovative medical and dental hygiene clinic for street youth: Results of a process evaluation

Canada has a noteworthy reputation for high quality health care. Nonetheless, street youth are one of our most vulnerable yet underserved populations. Consequently, a medical and dental clinic was created in downtown Ottawa, Ontario to respond to their needs. The purpose of this study is to describe a process evaluation of the clinic during its first year of operation with a focus on program fidelity, dose, reach, and satisfaction. A mixed methods approach was used involving interviews with providers, focus groups with street youth, analysis of Electronic Medical Record (EMR) data, and supplemental information such as document reviews. The evaluation identified areas that were working well along with challenges to program implementation. Areas of concerns and possible solutions were presented to the management team that then helped to plan and make improvements to the clinic. Our evaluation design and working relationship with clinic management promoted the integration of real-time evidence into program improvements.     

Formative evaluation of a motivational intervention for increasing physical activity in underserved youth

The present study was designed to develop an innovative motivational intervention (based on Self-Determination Theory and Social Cognitive Theory) to increase physical activity (PA) in underserved adolescents. Sixty-four adolescents (35 females, 29 males; 50% minority; 65% on reduced lunch program; ages 11-13 yr) participated in either an 8-week motivational intervention after-school (n = 32) or a typical after-school program (n = 32). The conceptual framework for the intervention targeted the social environment (perceived autonomy, perceived social support, participation, fun), cognitive mediators (perceived choice, self-efficacy, and relatedness/belongingness), and motivational orientation (intrinsic motivation, commitment, positive self-concept). Formative evaluation data was collected by staff through daily forms throughout the 8-week program and through observational data completed by independent objective observers during 2 weeks of the program. The major themes that were identified addressed theoretical concepts regarding the intervention and logistical issues in delivering the intervention. The data revealed information regarding the importance of the cognitive appropriateness of the PA and motivational activities, the environmental climate for promoting nurturing relationships, developing specific strategies for increasing intrinsic rather than extrinsic reinforcement, and developing methods for preventing social "cliques" and gender conflicts to maintain an appropriate level of support in the social climate. Themes for training staff included focusing on team building, leadership, and nurturing. This formative evaluation is being used to formalize a randomized trial to test the effects of a student-centered motivational intervention on increasing PA in underserved 6th graders.     

A process evaluation of an intervention to promote home smoking bans among low income households

Exposure to secondhand smoke occurs primarily in the home due to passage of smoke-free legislation. Creation of a total household smoking ban can reduce associated health conditions such as asthma, lung cancer, heart disease and stroke. This paper describes the results of a randomized control trial of a minimal intervention to create smoke-free homes. 2-1-1 callers were invited to participate in the trial and were randomized to an intervention (mailings and a coaching call) or a control group (no intervention). We assessed reach, dose, fidelity, and receptivity to the intervention through program records and a 3-month follow-up survey with intervention participants. For the intervention materials, materials were mailed to 244 participants (99.2%) and 227 participants (92.3%) received the coaching call intervention. 92.3% received all intervention components. Participants who had full household bans at 3 months were more likely to conduct behaviors leading to a smoke-free home (i.e., making a list of reasons, having a family talk, posting a pledge) than were those with no/partial ban. The intervention materials also were rated higher in relevance and usefulness by non-smokers than smokers. Results demonstrate that this minimal intervention had high fidelity to the delivery of components and relatively high receptivity.     

Usability testing,initial implementation,and formative evaluation of an evidence-based intervention: Lessons from a demonstration project to reduce long-term foster care

The field of child welfare faces an undersupply of evidence-based interventions to address long-term foster care. The Permanency Innovations Initiative is a five-year federal demonstration project intended to generate evidence to reduce long stays in foster care for those youth who encounter the most substantial barriers to permanency. This article describes a systematic and staged approach to implementation and evaluation of a PII project that included usability testing as one of its key activities. Usability testing is an industry-derived practice which analyzes early implementation processes and evaluation procedures before they are finalized. This article describes the iterative selection, testing, and analysis of nine usability metrics that were designed to assess three important constructs of the project's initial implementation and evaluation: intervening early, obtaining consent, and engaging parents. Results showed that seven of nine metrics met a predetermined target. This study demonstrates how findings from usability testing influenced the initial implementation and formative evaluation of an evidence-supported intervention. Implications are discussed for usability testing as a quality improvement cycle that may contribute to better operationalized interventions and more reliable, valid, and replicable evidence.     

Early truancy intervention: Results of an evaluation using a regression discontinuity design

This study evaluates the effectiveness of a truancy reduction program. A Regression Discontinuity design was used to assess attendance outcomes for 700 children. Approximately half received a case management intervention, while the other half received a warning letter, only. Truancy rates in the control group remained at the pre-intervention levels, while truancy in the treatment group significantly declined (p < .01). Successful case closure was associated with a reduction in truancy (p < .001). The intervention was less effective with non-White children and with those who had been previously retained. Findings substantiate continued support for the intervention; however, additional resources should include culturally-responsive treatment approaches and academic enrichment programs.     

A bio-psycho-social model of successful aging as shown through the variable “physical activity”

In this article, we present and explain a bio-psycho-social model of successful aging with subjective well-being as a criterion of a successful aging process. We focus on physical activity because it is a crucial behavior. Physical activity can support successful aging in two different ways: first, due to its physiological and cognitive effects, and Second, an older person can enhance subjective well-being (SWB) while being physically active. The model points out that an older person can regulate SWB. To do this, an older person should set and pursue personally and culturally valued goals. The strength of the association between setting a goal and goal pursuance, respectively, and SWB depends on the extent a person is able to satisfy psychological needs (autonomy, competence, relatedness). But, the decision as to which goal will be set and pursued does not belong to the older person exclusively. The bio-psycho-social model explains that the chance to enhance SWB is restricted by personal dispositions (e.g., physiological constitution, psychological factors) and social–structural constraints (e.g., predominant stereotype of aging, facilities especially for target groups). Funding credit: Landesstiftung Baden Württemberg gGmbH [Landesstiftung Foundation]     

Design of a collaborative monitoring and evaluation system for a community-based nutrition project in rural Bangladesh

Poor diet and undernutrition are common among children living in Bangladesh. To promote appropriate complementary feeding of young children, an economic development (ED) program involving income-generating asset transfer was implemented alongside a social and behavior change (SBC) program. This paper introduces a collaborative monitoring and evaluation (M&E) system in which diverse collaborators (“research group”, “implementation team”, and “coordinators”) facilitate M&E data acquisition by leveraging their comparative advantages. The implementation team built a monitoring system to track the ED (n = 2960) and SBC participants (n=∼10,000) over 12 months. Based on the baseline design and the monitoring records, the collaborators planned an impact evaluation introducing a quasi-experimental design using two cross-sectional surveys and a prospective cohort survey of child feeding and nutritional status. Using various data sources generated from the M&E system, the collaborators will also reveal the program impact pathway through which each intervention component is delivered, received, and utilized alongside the context-specific facilitators and barriers, including the programs’ uptake. The collaborative M&E system enables the sharing of program goals, strengthens collaborators' commitment to the program, and extends the understanding of the program's progress and evaluation activities.