1
|
Sweeney AM, Wilson DK, Zarrett N, Simmons T, Mansfield M, Decker L. Using formative process evaluation to improve program implementation and accessibility of competitive group-based physical activity in the TEAM-PA trial. Int J Behav Nutr Phys Act 2024; 21:88. [PMID: 39138496 PMCID: PMC11321224 DOI: 10.1186/s12966-024-01635-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/23/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND This study demonstrates how formative process evaluation was used to assess implementation and improve dose and fidelity in the Together Everyone Achieves More Physical Activity (TEAM-PA) randomized controlled trial. TEAM-PA uses a randomized group cohort design to evaluate the efficacy of a group-based intervention for increasing physical activity among African American women. METHODS Intervention groups met for 10 weeks and were co-led by female African American facilitators, with intervention sessions consisting of group feedback, a health curriculum, group-based physical activity games, and group-based goal-setting. Drawing from a multi-theoretical framework, the intervention targeted social affiliation using collaborative and competitive group strategies, including essential elements focused on group-based behavioral skills, peer-to-peer positive communication, collectivism, optimal challenge, social facilitation, and peer to peer challenges. Formative process evaluation was used to monitor reach, dose, and fidelity, and implement feedback and solutions. RESULTS Across two cohorts, four groups (n = 54) were randomized to the TEAM-PA intervention. On average 84.8% of participants attended each week, which exceeded the a priori criteria. Results from the systematic observations indicated that on average 93% of the dose items were completed in each session and adequate levels of fidelity were achieved at both the facilitator and group-levels. Participants were compliant with wearing the FitBits (6.73 ± 0.42 days/week) and most participants successfully contributed to meeting the group-based goals. The use of open-ended items also revealed the need for additional modifications to the group-based PA games, including allowing for individuals to take breaks, incorporating a broader range of exercises, minimizing activities that required bending/reaching down without assistance, and providing facilitators with additional training for implementing the games. Initial evidence suggests that these changes were successful in increasing participants' comprehension of the games from Cohort 1 (M = 1.83, SD = 0.71) to Cohort 2 (M = 3.33, SD = 0.69). CONCLUSION Findings from this study demonstrated high levels of reach, dose, and fidelity, while also highlighting strategies for implementing competitive group-based PA games that are accessible across physical fitness levels. Formative process evaluation, including open-ended items and collaborative brainstorming, holds tremendous potential for improving future interventions. TRIAL REGISTRATION This study was registered on Clinicaltrials.gov (# NCT05519696) on August 22, 2022 prior to the enrollment of the first participant on September 12, 2022 ( https://clinicaltrials.gov/study/NCT05519696?term=NCT05519696&rank=1 ).
Collapse
Affiliation(s)
- Allison M Sweeney
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29201, USA.
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, 29201, USA
| | - Nicole Zarrett
- Department of Psychology, University of South Carolina, Columbia, SC, 29201, USA
| | - Timothy Simmons
- Department of Psychology, University of South Carolina, Columbia, SC, 29201, USA
| | - Makayla Mansfield
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29201, USA
| | - Lindsay Decker
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29201, USA
| |
Collapse
|
2
|
Kipp C, Wilson DK, Brown A, Quattlebaum M, Loncar H, Sweeney AM, Abshire DA. Compounding effects of stress on diet, physical activity, and wellbeing among African American parents: a qualitative study to inform the LEADS health promotion trial. J Behav Med 2024; 47:647-661. [PMID: 38460063 DOI: 10.1007/s10865-024-00477-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 02/01/2024] [Indexed: 03/11/2024]
Abstract
The purpose of the study was to conduct in-depth qualitative interviews to understand the lived experiences of African American parents of overweight adolescents who had previously participated in a family-based weight loss program and to utilize these insights to inform the essential elements of the LEADS trial, an integrated resilience stress management and health promotion intervention. Participants (N = 30) were African American parents and/or caregivers (96.7% female; Mage = 49.73, SD = 10.88; MBMI = 37.63, SD = 8.21) of adolescents with overweight and/or obesity. Interviews were transcribed and coded using inductive and deductive approaches for themes by two independent coders. Inter-rater reliability was acceptable (r = 0.70-0.80) and discrepancies were resolved to 100% agreement. Prominent stress themes included caregiver responsibilities, work, interpersonal family conflict, and physical and emotional consequences of chronic stress. Participants also noted decreases in physical activity and poor food choices due to stress. Coping mechanisms included prayer/meditation, church social support, and talking with family/partner. Results highlight the importance of mitigating stress among African American parents through stress management and cultural/familial resilience approaches to increase the likelihood of engagement in behavioral strategies in health promotion programs. Future studies should assess the utility of incorporating stress management components and health promotion techniques to improve health outcomes among African American families.
Collapse
Affiliation(s)
- Colby Kipp
- Department of Psychology, University of South Carolina, Columbia, SC, USA.
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Asia Brown
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Mary Quattlebaum
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Haylee Loncar
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | | | | |
Collapse
|
3
|
McMahon SK, Lewis BA, Guan W, Wang Q, Hayes SM, Wyman JF, Rothman AJ. Effect of Intrapersonal and Interpersonal Behavior Change Strategies on Physical Activity Among Older Adults: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e240298. [PMID: 38421648 PMCID: PMC10905305 DOI: 10.1001/jamanetworkopen.2024.0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/04/2024] [Indexed: 03/02/2024] Open
Abstract
Importance Despite guidelines that recommend physical activity (PA), little is known about which types of behavior change strategies (BCSs) effectively promote sustained increases in PA in older adults who are insufficiently active. Objective To determine whether intrapersonal BCSs (eg, goal setting) or interpersonal BCSs (eg, peer-to-peer sharing or learning) combined with the Otago Exercise Program (17 strength and balance exercises and a walking program that are learned and individually tailored, with instruction to perform 3 times per week at home or location of choice) and a wearable PA monitor help older adults sustain increases in their PA. Design, Setting, and Participants This 2 × 2 factorial randomized clinical trial (Community-Based Intervention Effects on Older Adults' Physical Activity) of community-dwelling older adults 70 years or older with PA levels below minimum national PA guidelines was conducted in urban community centers. Dates of enrollment were from November 17, 2017, to June 15, 2021, with final follow-up assessments completed on September 2, 2022. Interventions Participants were randomized to intrapersonal (eg, goal setting) BCSs, interpersonal (eg, problem-solving with peer-to-peer sharing and learning) BCSs, intrapersonal and interpersonal BCSs, or an attention control group. All interventions included a PA monitor and 8 weekly small-group meetings with discussion, practice, and instructions to implement the exercise program and relevant BCSs independently between meetings and after the intervention. Main Outcomes and Measures The primary outcome was daily minutes of objectively measured total PA (light, moderate, or vigorous intensities) averaged over 7 to 10 days, measured at baseline and after the intervention at 1 week, 6 months, and 12 months. Results Among 309 participants (mean [SD] age, 77.4 [5.0] years; 240 women [77.7%]), 305 (98.7%) completed the intervention, and 302 (97.7%) had complete data. Participants receiving PA interventions with interpersonal BCS components exhibited greater increases in total PA than did those who did not at 1 week (204 vs 177 PA minutes per day; adjusted difference, 27.1 [95% CI, 17.2-37.0]; P < .001), 6 months (195 vs 175 PA minutes per day; adjusted difference, 20.8 [95% CI, 10.0-31.6]; P < .001), and 12 months (195 vs 168 PA minutes per day; adjusted difference, 27.5 [95% CI, 16.2-38.8]; P < .001) after the intervention. Compared with participants who did not receive interventions with intrapersonal BCS components, participants who received intrapersonal BCSs exhibited no significant changes in total PA at 1 week (192 vs 190 PA minutes per day; adjusted difference, 1.8 [95% CI, -8.6 to 12.2]; P = .73), 6 months (183 vs 187 PA minutes per day; adjusted difference, -3.9 [95% CI, -15.0 to 7.1]; P = .49), or 12 months (177 vs 186 PA minutes per day; adjusted difference, -8.8 [95% CI, -20.5 to 2.9]; P = .14) after the intervention. Interactions between intrapersonal and interpersonal BCSs were not significant. Conclusions and Relevance In this randomized clinical trial, older adults with low levels of PA who received interpersonal BCSs, the exercise program, and a PA monitor exhibited significant increases in their PA for up to 12 months after the intervention. Intrapersonal BCSs elicited no significant PA changes and did not interact with interpersonal BCSs. Our findings suggest that because effects of a PA intervention on sustained increases in older adults' PA were augmented with interpersonal but not intrapersonal BCSs, approaches to disseminating and implementing the intervention should be considered. Trial Registration ClinicalTrials.gov Identifier: NCT03326141.
Collapse
Affiliation(s)
| | - Beth A. Lewis
- School of Kinesiology, University of Minnesota, Minneapolis
| | - Weihua Guan
- School of Public Health, University of Minnesota, Minneapolis
| | - Qi Wang
- School of Public Health, University of Minnesota, Minneapolis
| | | | - Jean F. Wyman
- School of Nursing, University of Minnesota, Minneapolis
| | | |
Collapse
|
4
|
Deng A, Zarrett N, Sweeney AM. The mediating effects of motivation on the relations between occupational stress and physical activity among underresourced afterschool program staff. BMC Public Health 2024; 24:327. [PMID: 38291408 PMCID: PMC10826063 DOI: 10.1186/s12889-024-17800-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE Guided by Self-Determination Theory, this study aimed to examine the potential mediating effects of autonomous and controlled motivations on physical activity (PA) experiences of afterschool program (ASP) staff with occupational stress. METHOD A total of 58 ASP staff provided full data. Staff occupational stress and self-determination motivations for PA were assessed. Participants' daily moderate-to-vigorous physical activity (MVPA) was measured using accelerometer wear. A path analysis was used to address the research purpose. RESULTS Occupational stress negatively and indirectly predicted daily MVPA which was mediated by controlled motivation (β = - 4.15, p <.05). Autonomous motivation directly and positively predicted daily MVPA across all types and levels of ASP staff occupational stress (β = 9.93, p =.01). CONCLUSIONS Autonomous motivation is a powerful predictor of staff PA levels despite the degree to which they experience stress. In contrast, controlled motivations are more vulnerable to occupational stress, and can lead to lower MVPA. TRIAL REGISTRATION Connect Through PLAY: A Staff-based Physical Activity Intervention for Middle School Youth (Connect). https://clinicaltrials.gov/ct2/show/NCT03732144 . Registered 11/06/2018. REGISTRATION NUMBER NCT03732144.
Collapse
Affiliation(s)
- Anqi Deng
- Behavioral Medicine Research Group, Department of Psychology, College of Arts and Sciences, University of South Carolina, 1330 Lady Street, Suite 400, 29201, Columbia, SC, USA.
| | - Nicole Zarrett
- Department of Psychology, University of South Carolina, Columbia, USA
| | - Allison M Sweeney
- Department of Biobehavioral and Nursing Science, College of Nursing, University of South Carolina, Columbia, USA
| |
Collapse
|
5
|
Monroe CM, Zosel K, Stansbury M, Younginer N, Davis RE, Dutton G, Newton RL, Cai B, West DS. A focus group study among insufficiently physically active African American adults regarding technology-delivered team-based gamification for physical activity promotion. Mhealth 2024; 10:3. [PMID: 38323152 PMCID: PMC10839515 DOI: 10.21037/mhealth-23-44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/16/2023] [Indexed: 02/08/2024] Open
Abstract
Background Gamification represents a promising approach for facilitating positive social interactions among groups of individuals and is increasingly being leveraged in physical activity (PA) interventions to promote enhanced intervention engagement and PA outcomes. Although African American (AA) adults experience disparities associated with health conditions that can be ameliorated with increased PA, little is known about how best to culturally target PA gamification strategies for this population. The purpose of this study was to gather perspectives from AA adults residing in the Southeast United States and subsequently identify themes to help inform the cultural adaptation of an existing electronic and mobile health (e/mHealth) gamification- and theory-based PA intervention for teams of insufficiently active AA adults. Methods An AA moderator facilitated six online focus groups among AA adults (n=42; 93% female; 45.09±9.77 years; 34.40±57.38 minutes/week of reported moderate-intensity equivalent PA), using a semi-structured focus group guide. Drawing from a content analysis approach, transcripts were coded and salient themes were identified. Results The focus groups revealed the following seven themes: (I) motivation (team-based gamification motivating); (II) accountability (team-based gamification promotes accountability); (III) competition (competitive elements attractive); (IV) weekly challenges (prefer to choose weekly PA challenges); (V) leaderboard feedback (preference for viewing steps and active minutes via a leaderboard); (VI) cultural relevancy (prefer elements reflective of their race and culture that promote team unity); (VII) teammate characteristics (mixed preferences regarding ideal sociodemographic characteristics and starting PA level of teammates). Conclusions Integrating team-based gamification in an e/mHealth-based PA intervention may be acceptable among AA adults. The identification of specific design preferences and perceptions of the value of the social environment points to the need to consider surface-level and deep structure cultural targeting when developing and further exploring best practices regarding gamified PA interventions for insufficiently active AAs.
Collapse
Affiliation(s)
- Courtney M. Monroe
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Kristen Zosel
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Melissa Stansbury
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Nicholas Younginer
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Rachel E. Davis
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Gareth Dutton
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert L. Newton
- Population and Public Health, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Delia Smith West
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
6
|
Sweeney AM, Wilson DK, Zarrett N, Martin P, Hardin JW, Fairchild A, Mitchell S, Decker L. An overview of the Together Everyone Achieves More Physical Activity (TEAM-PA) trial to increase physical activity among African American women. Contemp Clin Trials 2023; 129:107207. [PMID: 37116644 PMCID: PMC10225344 DOI: 10.1016/j.cct.2023.107207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND The Together Everyone Achieves More Physical Activity (TEAM-PA) trial is a randomized controlled trial testing the efficacy of a group-based intervention for increasing physical activity (PA) among insufficiently active African American women. DESIGN The TEAM-PA trial uses a group cohort design, is implemented at community sites, and will involve 360 African American women. The trial compares a 10-week group-based intervention vs. a standard group-delivered PA comparison program. Measures include minutes of total PA/day using 7-day accelerometer estimates (primary outcome), and body mass index, blood pressure, waist circumference, walking speed, sedentary behavior, light physical activity, and the percentage achieving ≥150 min of moderate to vigorous PA/week (secondary outcomes) at baseline, post-intervention, and 6-months post-intervention. INTERVENTION The intervention integrates elements from Social Cognitive Theory, Self-Determination Theory, Group Dynamics Theory, and a focus on collectivism to evaluate different components of social affiliation (relatedness, reciprocal support, group cohesion, and collective efficacy). The intervention integrates shared goal-setting via Fitbits, group-based problem-solving, peer-to-peer positive communication, friendly competition, and cultural topics related to collectivism. Compared to the standard group-delivered PA program, participants in the intervention are expected to show greater improvements from baseline to post- and 6-month follow-up on minutes of total PA/day and secondary outcomes. Social affiliation variables (vs. individual-level factors) will be evaluated as mediators of the treatment effect. IMPLICATIONS The results of the TEAM-PA trial will determine the efficacy of the intervention and identify which aspects of social affiliation are most strongly related to increased PA among African American women. TRIAL REGISTRATION This study was registered on Clinicaltrials.gov (# NCT05519696) in August 2022 prior to initial participant enrollment.
Collapse
Affiliation(s)
- Allison M Sweeney
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC 29201, United States of America.
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, United States of America
| | - Nicole Zarrett
- Department of Psychology, University of South Carolina, Columbia, SC, United States of America
| | - Pamela Martin
- Department of Psychology, University of South Carolina, Columbia, SC, United States of America
| | - James W Hardin
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Amanda Fairchild
- Department of Psychology, University of South Carolina, Columbia, SC, United States of America
| | - Sheryl Mitchell
- Department of Advanced Professional Nursing Practice and Leadership, College of Nursing, University of South Carolina, Columbia, SC, United States of America
| | - Lindsay Decker
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, United States of America
| |
Collapse
|