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Beemer LR, Tackett W, Schwartz A, Schliebe M, Miller A, Eisman AB, Robinson LE, Templin T, Brown SH, Hasson RE. Use of a Novel Theory-Based Pragmatic Tool to Evaluate the Quality of Instructor-Led Exercise Videos to Promote Youth Physical Activity at Home: Preliminary Findings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6561. [PMID: 37623147 PMCID: PMC10454029 DOI: 10.3390/ijerph20166561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Exercise videos that work to minimize cognitive load (the amount of information that working memory can hold at one time) are hypothesized to be more engaging, leading to increased PA participation. PURPOSE To use a theory-based pragmatic tool to evaluate the cognitive load of instructor-led exercise videos associated with the Interrupting Prolonged Sitting with ACTivity (InPACT) program. METHODS Exercise videos were created by physical education teachers and fitness professionals. An evaluation rubric was created to identify elements each video must contain to reduce cognitive load, which included three domains with four components each [technical (visual quality, audio quality, matching modality, signaling), content (instructional objective, met objective, call-to-action, bias), and instructional (learner engagement, content organization, segmenting, weeding)]. Each category was scored on a 3-point scale from 0 (absent) to 2 (proficient). A video scoring 20-24 points induced low cognitive load, 13-19 points induced moderate cognitive load, and less than 13 points induced high cognitive load. Three reviewers independently evaluated the videos and then agreed on scores and feedback. RESULTS All 132 videos were evaluated. Mean video total score was 20.1 ± 0.7 points out of 24. Eighty-five percent of videos were rated low cognitive load, 15% were rated moderate cognitive load, and 0% were rated high cognitive load. The following components scored the highest: audio quality and matching modality. The following components scored the lowest: signaling and call-to-action. CONCLUSIONS Understanding the use of a pragmatic tool is a first step in the evaluation of InPACT at Home exercise videos. Our preliminary findings suggest that the InPACT at Home videos had low cognitive load. If future research confirms our findings, using a more rigorous study design, then developing a collection of instructor-led exercise videos that induce low cognitive load may help to enhance youth physical activity participation in the home environment.
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Affiliation(s)
- Lexie R. Beemer
- School of Kinesiology, University of Michigan-Ann Arbor, Ann Arbor, MI 48109, USA; (L.R.B.); (A.S.); (M.S.); (A.M.); (L.E.R.); (T.T.); (S.H.B.)
| | | | - Anna Schwartz
- School of Kinesiology, University of Michigan-Ann Arbor, Ann Arbor, MI 48109, USA; (L.R.B.); (A.S.); (M.S.); (A.M.); (L.E.R.); (T.T.); (S.H.B.)
| | - Melia Schliebe
- School of Kinesiology, University of Michigan-Ann Arbor, Ann Arbor, MI 48109, USA; (L.R.B.); (A.S.); (M.S.); (A.M.); (L.E.R.); (T.T.); (S.H.B.)
| | - Alison Miller
- School of Kinesiology, University of Michigan-Ann Arbor, Ann Arbor, MI 48109, USA; (L.R.B.); (A.S.); (M.S.); (A.M.); (L.E.R.); (T.T.); (S.H.B.)
| | - Andria B. Eisman
- College of Education, Wayne State University, Detroit, MI 48202, USA;
| | - Leah E. Robinson
- School of Kinesiology, University of Michigan-Ann Arbor, Ann Arbor, MI 48109, USA; (L.R.B.); (A.S.); (M.S.); (A.M.); (L.E.R.); (T.T.); (S.H.B.)
| | - Thomas Templin
- School of Kinesiology, University of Michigan-Ann Arbor, Ann Arbor, MI 48109, USA; (L.R.B.); (A.S.); (M.S.); (A.M.); (L.E.R.); (T.T.); (S.H.B.)
| | - Susan H. Brown
- School of Kinesiology, University of Michigan-Ann Arbor, Ann Arbor, MI 48109, USA; (L.R.B.); (A.S.); (M.S.); (A.M.); (L.E.R.); (T.T.); (S.H.B.)
| | - Rebecca E. Hasson
- School of Kinesiology, University of Michigan-Ann Arbor, Ann Arbor, MI 48109, USA; (L.R.B.); (A.S.); (M.S.); (A.M.); (L.E.R.); (T.T.); (S.H.B.)
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Hasson RE, Eisman AB, Wassmann A, Beemer LR, Templin T, Malinoff L, Zernicke R, Rabaut L. Aligning Organizational Priorities and System Policies to Support Implementation Scale-Up of a Tailored Classroom-Based Physical Activity Intervention in Low-Resource Schools. THE JOURNAL OF SCHOOL HEALTH 2023; 93:464-474. [PMID: 36918350 PMCID: PMC10276353 DOI: 10.1111/josh.13321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND A mismatch between organizational priorities and system-level policies can negatively impact implementation and sustainment of classroom-based physical activity (PA) interventions. The purpose of this study was twofold: (1) present methods to systematically identify organization- and system-level implementation barriers, and (2) align organizational priorities and system policies by designing multi-level implementation strategies. This alignment will support implementation scale-up of a tailored PA intervention in one low-resource intermediate school district (ISD; 16 districts, 32 schools) in central Michigan. METHODS Multi-level assessments of organizational readiness were conducted using the Hexagon Discussion and Analysis Tool to assess intervention-context fit, the Wellness School Assessment Tool 3.0 to evaluate district PA policy strength and comprehensiveness, and semi-structured interviews were conducted to assess administrative support and priorities related to PA programming. RESULTS Our assessments revealed three implementation barriers: limited structural capacity to sustain teacher training, limited resources across districts and school buildings to support teachers, and misalignment of ISD and district PA policies and priorities. CONCLUSIONS Greater attention to organizational capacity and existing infrastructure should be considered a priori to support effective implementation and sustainment of PA interventions in low-resource schools.
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Affiliation(s)
- Rebecca E Hasson
- University of Michigan School of Kinesiology, Ann Arbor, MI 48109; University of Michigan Exercise & Sports Science Initiative, Ann Arbor, MI 48109
| | - Andria B Eisman
- Wayne State University College of Education, Detroit, MI 48202; Wayne State Center for Health and Community Impact, Detroit, MI 48202
| | - Amy Wassmann
- Saginaw Intermediate School District, Saginaw, MI 48603
| | - Lexie R Beemer
- University of Michigan School of Kinesiology, Ann Arbor, MI 48109
| | - Thomas Templin
- University of Michigan School of Kinesiology, Ann Arbor, MI 48109
| | | | - Ronald Zernicke
- University of Michigan School of Kinesiology, Ann Arbor, MI 48109; University of Michigan Exercise & Sports Science Initiative, Ann Arbor, MI 48109
| | - Lisa Rabaut
- University of Michigan Exercise & Sports Science Initiative, Ann Arbor, MI 48109
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Friday PJ, Beemer LR, Martindale D, Wassmann A, Eisman AB, Templin T, Zernicke RF, Malinoff L, Schwartz A, Ajibewa TA, Marenus MW, Hasson RE. A Novel Policy Alignment and Enhancement Process to Improve Sustainment of School-Based Physical Activity Programming. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20031791. [PMID: 36767157 PMCID: PMC9914935 DOI: 10.3390/ijerph20031791] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 05/25/2023]
Abstract
The purpose of the current study was twofold: (1) to evaluate the strength and comprehensiveness of district wellness policies in one central Michigan intermediate school district (ISD; 16 districts), and (2) to pilot a novel policy alignment and enhancement process in one district within the ISD to improve sustainment of district-wide physical activity (PA) programming. Policy evaluation and alignment were determined using WellSAT 3.0. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework was used to guide a seven-step policy alignment and enhancement process. Initial evaluation of the PA policy for the ISD revealed a strength score of 19/100 (i.e., included weak and non-specific language) and 31/100 for comprehensiveness (i.e., mentioned few components of the Comprehensive School Physical Activity Program). For the pilot school district, initial strength scores were 19/100 and 38/100 for comprehensiveness (exploration). An alignment of the tailored PA policy with current practices resulted in a 100% increase in strength (score of 38/100), and 132% increase in comprehensiveness (score of 88/100; preparation). However, district administrators encountered barriers to adopting the tailored policy and subsequently integrated the PA requirements into their curriculum guide and school improvement plan (implementation and sustainment). Future research should examine the effectiveness of our EPIS-informed policy evaluation, alignment, and enhancement process to promote widespread increases in student PA.
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Affiliation(s)
| | - Lexie R. Beemer
- School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Amy Wassmann
- Saginaw Intermediate School District, Saginaw, MI 48603, USA
| | - Andria B. Eisman
- Division of Kinesiology, Health and Sport Studies, College of Education, Wayne State University, Detroit, MI 48202, USA
- Center for Health and Community Impact, College of Education, Wayne State University, Detroit, MI 48202, USA
| | - Thomas Templin
- School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ronald F. Zernicke
- School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, USA
- Departments of Orthopaedic Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Lynn Malinoff
- Institute for the Study of Children, Families, and Communities, Eastern Michigan University, Ypsilanti, MI 48197, USA
| | - Anna Schwartz
- School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, USA
| | | | | | - Rebecca E. Hasson
- School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, USA
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Hasson RE, Eisman AB, Wassmann A, Martin S, Pugh P, Winkelseth K, Zernicke R, Rabaut L. Rapid cycle adaptation of a classroom-based intervention to promote equity in access to youth physical activity. Transl Behav Med 2022; 12:945-955. [PMID: 36205474 PMCID: PMC9540976 DOI: 10.1093/tbm/ibac049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Our objective was to systematically adapt Interrupting Prolonged sitting with ACTivity (InPACT), a classroom-based physical activity intervention, for home delivery to equitably increase access to structured youth physical activity opportunities during the COVID-19 pandemic. Key steps in the rapid-cycle research adaptation process included: (Step 1) identifying partner organizations; (Steps 2 and 3) engaging in problem and knowledge exploration to examine the problem from different perspectives; (Steps 4 and 5) initiating solution development and testing by selecting an intervention and adapting the format and content for home delivery. Using Rapid RE-AIM to guide online assessment and refinement of InPACT at Home; and (Step 6) utilizing dissemination strategies to extend the reach of the program. Core elements of the InPACT program that were retained included: the use of exercise videos, maintenance of the intervention dose, and teacher-led physical activities. Key adaptations included: utilization of physical education specialists to develop the exercise videos, incorporation of health messaging in videos, and utilization of dissemination strategies (intervention website) to reach K-12 students across the state. Intervention website reach included all 83 counties in Michigan, but goals were not met for website pageviews (5,147; 85% of goal) and video view duration (7 min 19 sec; 37% of goal). Accordingly, dissemination was expanded to include public television broadcasting (monthly viewers: 500,000) and videos were shortened to 8 minutes. Dissemination and implementation science frameworks guided the rapid adaptation of an existing intervention, InPACT, to equitably increase access to structured youth physical activity opportunities at home during the pandemic.
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Affiliation(s)
- Rebecca E Hasson
- University of Michigan, School of Kinesiology, Ann Arbor, MI, USA
- University of Michigan, Exercise & Sport Science Initiative, Ann Arbor, MI, USA
| | - Andria B Eisman
- Wayne State University, College of Education, Detroit, MI, USA
- Wayne State University, Center for Health and Community Impact, Detroit, MI, USA
| | - Amy Wassmann
- Saginaw Intermediate School District, Saginaw, MI, USA
| | - Scott Martin
- Michigan Department of Education, Lansing, MI, USA
| | - Pamela Pugh
- Michigan State Board of Education Vice President, Lansing, MI, USA
| | - Kerry Winkelseth
- University of Michigan, School of Kinesiology, Ann Arbor, MI, USA
| | - Ronald Zernicke
- University of Michigan, Exercise & Sport Science Initiative, Ann Arbor, MI, USA
- University of Michigan Department of Orthopaedic Surgery, Ann Arbor, MI, USA
| | - Lisa Rabaut
- University of Michigan, Exercise & Sport Science Initiative, Ann Arbor, MI, USA
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Eisman AB, Kim B, Salloum RG, Shuman CJ, Glasgow RE. Advancing rapid adaptation for urgent public health crises: Using implementation science to facilitate effective and efficient responses. Front Public Health 2022; 10:959567. [PMID: 36091566 PMCID: PMC9448975 DOI: 10.3389/fpubh.2022.959567] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023] Open
Abstract
Responding rapidly to emerging public health crises is vital to reducing their escalation, spread, and impact on population health. These responses, however, are challenging and disparate processes for researchers and practitioners. Researchers often develop new interventions that take significant time and resources, with little exportability. In contrast, community-serving systems are often poorly equipped to properly adopt new interventions or adapt existing ones in a data-driven way during crises' onset and escalation. This results in significant delays in deploying evidence-based interventions (EBIs) with notable public health consequences. This prolonged timeline for EBI development and implementation results in significant morbidity and mortality that is costly and preventable. As public health emergencies have demonstrated (e.g., COVID-19 pandemic), the negative consequences often exacerbate existing health disparities. Implementation science has the potential to bridge the extant gap between research and practice, and enhance equity in rapid public health responses, but is underutilized. For the field to have a greater "real-world" impact, it needs to be more rapid, iterative, participatory, and work within the timeframes of community-serving systems. This paper focuses on rapid adaptation as a developing implementation science area to facilitate system responses during public health crises. We highlight frameworks to guide rapid adaptation for optimizing existing EBIs when responding to urgent public health issues. We also explore the economic implications of rapid adaptation. Resource limitations are frequently a central reason for implementation failure; thus, we consider the economic impacts of rapid adaptation. Finally, we provide examples and propose directions for future research and application.
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Affiliation(s)
- Andria B. Eisman
- Community Health, Division of Kinesiology, Health and Sport Studies, College of Education, Wayne State University, Detroit, MI, United States,Center for Health and Community Impact (CHCI), Wayne State University, Detroit, MI, United States,*Correspondence: Andria B. Eisman
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Ramzi G. Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, United States
| | - Clayton J. Shuman
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Russell E. Glasgow
- Dissemination and Implementation Science Program of ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), University of Colorado School of Medicine, Aurora, CO, United States
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Beemer LR, Lewis TC, Ajibewa TA, Dopp R, B Eisman A, Hasson RE. Classroom-Based Strategies to Reduce Disparities in Physical Activity Among Children with Asthma. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:587-597. [PMID: 35080712 DOI: 10.1007/s11121-022-01347-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Abstract
Children with asthma often experience physical activity (PA) induced symptoms 5-15 min following the start of exercise. Classroom PA breaks provide short intermittent bouts of PA and may represent a novel strategy to safely promote PA participation in this clinical population. The purpose of this study was to determine the feasibility of a classroom-based PA intervention, Interrupting Prolonged Sitting with Activity (InPACT), where teachers implement 5 × 4-min moderate-to-vigorous physical activity (MVPA) breaks throughout the school day. Nine classrooms at one elementary-middle school in Detroit, MI (student demographics: 79% Hispanic; 80% on free/reduced lunch; 31% prevalence of asthma and asthma-like symptoms) participated in this 20-week intervention. Asthma status was self-reported via the International Study of Asthma and Allergies in Childhood (ISAAC) Video Questionnaire in conjunction with nurse documentation. PA participation, exercise intensity, and asthmatic symptom occurrence were assessed via direct observation. Students accumulated approximately 17 min of activity per day during PA breaks. Compared to students without asthma, a higher percentage of students with asthma participated in MVPA (asthma: 52.9% ± 1.2%; non-asthma: 46.2% ± 0.8%; p = 0.01), a lower percentage participated in light PA (asthma: 25.9% ± 1.0%; non-asthma: 30.1% ± 0.7%; p = 0.01), and sedentary time during activity breaks (asthma: 21.2% ± 0.9%; non-asthma: 23.8% ± 0.7%; p = 0.02). Out of 294 observations, six instances of asthmatic symptoms (coughing) were observed in students with asthma 5-15 min following the PA break. Symptoms self-resolved within 15-min of the PA break and did not result in sustained exercise-induced bronchoconstriction. Classroom-based interventions that incorporate short intermittent bouts of PA represent safe exercises for children with asthma and may help to reduce PA disparities in this clinical population.
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Affiliation(s)
- Lexie R Beemer
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.,Childhood Disparities Research Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Toby C Lewis
- School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Tiwaloluwa A Ajibewa
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.,Childhood Disparities Research Laboratory, University of Michigan, Ann Arbor, MI, USA
| | - Richard Dopp
- Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Andria B Eisman
- College of Education, Wayne State University, Detroit, MI, USA
| | - Rebecca E Hasson
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA. .,Childhood Disparities Research Laboratory, University of Michigan, Ann Arbor, MI, USA. .,School of Public Health, University of Michigan, Ann Arbor, MI, USA.
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