Promoting physical activity within under-resourced afterschool programs: A qualitative investigation of staff experiences and motivational strategies for engaging youth

Human-centered participatory co-design with children and adults for a prototype lifestyle intervention and implementation strategy in a rural middle school

PURPOSE

The significance of regular physical activity (PA) in reducing cardiovascular disease (CVD) risk is widely acknowledged. However, children in rural areas encounter specific barriers to PA compared to their urban counterparts. This study employs human-centered participatory co-design, involving community stakeholders in developing a multi-level PA intervention named Hoosier Sport. The primary hypothesis is the co-design sessions leading to the development of a testable intervention protocol.

METHODS

Two co-design teams, each consisting of six children and six adults, were formed using human-centered participatory co-design facilitated by research faculty and graduate students. The process involved five co-design sessions addressing problem identification, solution generation, solution evaluation, operationalization, and prototype evaluation. Thematic analysis was employed to identify key themes and intervention components.

RESULTS

Child co-designers (n = 6) ranged from 6th to 8th grade, averaging 12.6 years (SD = 1.8), while adult co-designers (n = 6) averaged 43.3 years (SD = 8.08). Thematic analysis revealed children emphasizing autonomy, the freedom to choose physical and non-physical activities, and the importance of building peer relationships during PA. Adult interviews echoed the importance of autonomy and choice in activities, with a focus on relatedness through positive role modeling.

CONCLUSION

The prototype intervention and implementation strategies developed constitute a testable intervention aligned with Phase 1 of the ORBIT model. This testable prototype lays the groundwork for a collaborative campus-community partnership between the university and the local community, ensuring mutual benefits and sustainable impact.

The mediating effects of motivation on the relations between occupational stress and physical activity among underresourced afterschool program staff

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.

Changing trajectory of daily physical activity levels among at-risk adolescents: influences of motivational mechanisms

BACKGROUND

Guided by Self-Determination Theory (SDT), the purpose of this study was to determine changes in the 16-week moderate-to-vigorous physical activity (MVPA) trajectory of underserved adolescents who participated in the Connect through PLAY afterschool program intervention and the effects of changes in participating adolescents' intrinsic and autonomous extrinsic motivations on their MVPA trajectory over the 16-week intervention.

METHODS

A subsample of 113 adolescents (56.64% female; 61.06% African American; average age = 11.29) provided complete data throughout the 16-week intervention were examined. Adolescents' objective daily MVPA was measured using 7- day accelerometer data. Changes in adolescents' intrinsic motivation and autonomous extrinsic motivation were assessed using subscales from the Intrinsic Motivation Inventory [1] and the Treatment Self-Regulation Questionnaire [2] respectively. A hierarchical linear model was built and tested to address the research aims.

RESULTS

The results of hierarchical linear models showed that, on average, youth daily MVPA increased 6.36 minutes in each 8-week period. Intrinsic motivation change, but not autonomous extrinsic motivation, was a positive and significant level-2 predictor of daily MVPA changes.

CONCLUSION

The findings provide significant evidence suggesting a benefit of integrating SDT-based approaches and further suggest that nurturing intrinsic motivation can be an effective approach to supporting youth daily MVPA in under-resourced afterschool programs.

TRIAL REGISTRATION

Connect Through PLAY: A Staff-based Physical Activity Intervention for Middle School Youth (Connect). https://clinicaltrials.gov/ct2/show/NCT03732144 . Registered November 6th, 2018.

A Three-Fold Integrated Perspective on Healthy Development: An Opinion Paper

Mental health and wellbeing are increasingly threatened in the current post-pandemic times, with stress, especially in students, reaching preoccupying levels. In addition, while many educational programs are unidimensional (i.e., lacking integration between physical, emotional and cognitive elements), there are ways to promote physical, social and mental health in children and adolescents. In this opinion paper, we will discuss the importance of an integrative approach for health development and examine relevant factors, such as awareness and emotional intelligence. We will highlight evidence ranging from behavioral to electrophysiological, structural and molecular, and report several recent studies supporting the effectiveness of a holistic approach in supporting wellbeing and creativity in children and adults, and detailing a specific paradigm named the Quadrato Motor Training (QMT). QMT is a specifically structured movement meditation, involving cognitive, motor and affective components. Finally, we will support a holistic view on education, integrating motion, emotion and cognition to develop a person-centered, or in this case student-centered, approach to wellbeing and health.

The influence of social support, social affiliation and intrinsic motivation for increasing underserved youth's physical activity: A social climate-based intervention study

The purpose of this study was to investigate the influences of intrinsic motivation, social affiliation orientations and reciprocal social support for physical activity (PA) on underserved youths' afterschool period moderate-to-vigorous (MVPA) changing trajectories across the 16-week Connect through PLAY intervention, a social-motivational climate intervention. A total of 113 youth (61.06% African American, 56.64% girls) provided full data. Youths' intrinsic motivation, social affiliation orientations and social support were measured by youth responses to a set of surveys at baseline and post-intervention. Youths' afterschool period MVPA was measured using data from 7-day ActiGraph accelerometer wear at baseline, midpoint and post-intervention. Hierarchical linear modelling analysis found that youth daily afterschool period (3pm-6pm) MVPA increased, on average, 37.94 min across the 16-week intervention. Increases in intrinsic motivation, social affiliation orientations and social support were positive predictors of youth afterschool MVPA changing trajectory. The findings clarify the contributions that a social-motivational climate intervention can have on youth afterschool period MVPA through increasing youth intrinsic motivation, social affiliation and reciprocal social support.

Holistic Functioning from a Developmental Perspective: A New Synthesis with a Focus on a Multi-tiered System Support Structure

While research in specific academic disciplines has individually advanced knowledge and practice for promoting multiple aspects of health and well-being in children and adolescents, still missing is an understanding of the interconnectedness of many critical aspects of development and how to intentionally weave these factors to advance a more holistic approach. The need for a more holistic and inclusive approach to child and adolescent development is increasingly evident to promote long-term health and well-being as the overall percentage of children, adolescents, and adults who suffer from mental health disorders is increasing. To address this issue, our authorship team consists of researchers in the areas of developmental psychology, neuroscience, motor development, exercise science, and mental health. The collective ideas outlined in this paper are aligned to address the need to remove disciplinary-specific boundaries and elucidate synergistic linkages across multiple research domains that support holistic development and lifespan health and wellness. We propose a conceptual framework that comprehensively addresses the integration of physical, cognitive, psychological, social, and emotional domains of child and adolescent development. In addition, we also provide a holistic preventative approach that is aligned with a contemporary intervention structure (i.e., Multi-tiered Systems of Support) to promote, from a developmental perspective, positive trajectories of health and well-being across childhood and adolescence.

Connect through PLAY: a randomized-controlled trial in afterschool programs to increase adolescents' physical activity

The current study is a randomized controlled trial to test a novel 10-week climate-based intervention within pre-existing afterschool programs, designed to increase moderate-to-vigorous physical activity (MVPA) in underserved (low-income, minority status) middle school youth by addressing youth social developmental needs. Participants (n = 167; 56% female; 62% Black; 50% overweight/obese) enrolled in 6 middle schools were randomized to either the Connect through PLAY intervention or a wait-list control. Process evaluation measures (i.e., observations of external evaluators; staff surveys) indicated that essential elements were implemented with fidelity, and staff endorsed implementation ease/feasibility and acceptability. Regression analysis demonstrated that participation in the intervention (vs. control) was associated with an increase of 8.17 min of daily accelerometry-measured MVPA (56 min of additional weekly MVPA) at post-intervention controlling for baseline MVPA, school, gender, and weight status. The results provide support for social-motivational climate-based interventions for increasing MVPA in underserved youth that can inform future school-based health initiatives.Trial Registration: NCT03850821: https://clinicaltrials.gov/ct2/show/study/NCT03850821?term=NCT03850821&rank=1.

Elementary Classroom Teachers' Self-Reported Use of Movement Integration Products and Perceived Facilitators and Barriers Related to Product Use

Movement integration (MI) products are designed to provide children with physical activity during general education classroom time. The purpose of this study was to examine elementary classroom teachers' self-reported use of MI products and subsequent perceptions of the facilitators of and barriers to MI product use. This study utilized a mixed-methods design. Elementary classroom teachers (n = 40) at four schools each tested four of six common MI products in their classroom for one week. Teachers completed a daily diary, documenting duration and frequency of product use. Following each product test, focus groups were conducted with teachers to assess facilitators and barriers. MI product use lasted for 11.2 (Standard Deviation (SD) = 7.5) min/occasion and MI products were used 4.1 (SD = 3.5) times/week on average. Activity Bursts in the Classroom for Fitness, GoNoodle, and Physical Activity Across the Curriculum were most frequently used. Facilitators of and barriers to MI product use were identified within three central areas-logistics, alignment with teaching goals, and student needs and interests. Teachers were receptive to MI products and used them frequently throughout the week. When considering the adoption of MI products, teachers, administrators, and policy makers should consider products that are readily usable, align with teaching goals, and are consistent with student needs and interests.

Availability of public open space and the practice of leisure-time physical activity among the Brazilian adult population

OBJECTIVES

To analyze the perceived availability of public open space (POS) in the neighborhood for physical activity (PA) over the years and its association to practice of leisure-time physical activity (LTPA) among Brazilian adult population.

METHODS

Data from the surveillance system of risk and protection factors for chronic diseases by telephone survey (Vigitel) from 2011 to 2015 were analyzed (n = 247,548). Prais-Winsten regression was used to investigate the trend of the perceived availability of POS, and Poisson regression to analyze its association to the LTPA.

RESULTS

The perceived availability of POS in the neighborhood for PA remained fairly stable, from 73.4% in 2011 to 74.0% in 2015. The perception of this availability positively associated with the sufficient practice of LTPA (≥ 150 min/week) (RP = 1.27; p < 0.05), and with the practice of different types, weekly frequency and daily duration of the activities.

CONCLUSIONS

In addition to the building and maintenance of POS, the proximity and physical accessibility of the population must be guaranteed, so that those spaces are perceived as a favorable environment for the practice of LTPA.

Canadian after-school care providers' perceived role promoting healthy lifestyles: a focused ethnography

BACKGROUND

After-school care programs have garnered interest in recent years as the hours of 3:00-6:00 p.m. are an opportune time for children to engage in healthy behaviours, specifically healthy eating and physical activity. Care providers are major influencers within the after-school care setting, impacting health promoting opportunities for children. However, little is known regarding the role care providers play in health promotion interventions in the after-school care setting, specifically those using comprehensive approaches. The purpose of this research was to explore care providers' role and experience promoting healthy eating and physical activity through the after-school care health promotion intervention School's Out … Let's Move (SOLMo). SOLMo was guided by the evidence-based comprehensive school health framework. SOLMo had two main goals: [1] to serve a healthy snack with vegetable or fruit, and milk or water as the drink; [2] to include 30 min of moderate to vigorous physical activity. The intervention included resources and coaching for care providers to promote healthy eating and physical activity for children and took place in four after-school sites over a six-month period. Three of four sites were located in a school. The primary researcher was engaged with the sites over 22-months.

METHODS

This research was guided by the qualitative method focused ethnography. Semi-structured interviews with care providers (n = 13) taking part in SOLMo were conducted. Participant observation was included as part of data generation to further understand care provider roles. Latent content analysis was utilized iteratively and concurrently throughout data generation.

RESULTS

Overall, care providers were supportive of promoting health behaviours in the after-school setting. Through analysis, five themes and eight subthemes emerged related to care providers' role and experience promoting healthy eating and physical activity through SOLMo: 1) enhanced awareness; 2) improved programming; 3) strong relationships; 4) collaborative approach; and 5) role tension.

CONCLUSIONS

As major influencers, care providers play a crucial role in promoting healthy lifestyle behaviours for children. This research provides valuable insight into this role and the implementation of comprehensive health promotion approaches in the after-school setting. Findings contribute to the implementation knowledge base and help inform the promotion of healthy lifestyle behaviours for children.

Formative Process Evaluation of the "Connect" Physical Activity Feasibility Trial for Adolescents

Most interventions do not reach full implementation in real-world settings. Due to this issue, formative process evaluation during pilot programs can be especially useful to understand implementation strengths and areas for improvement so that full implementation can be reached in future iterations. This study demonstrated how a formative process evaluation of the Connect through Positive Leisure Activities for Youth (Connect) pilot informed course corrections for year 2 implementation. Connect is an intervention to promote a positive social motivational climate for physical activity (PA) in pre-existing after school programs. Connect ran 3 days a week for 8 weeks and had 2 components: a 30-minute “Get-to-Know-You” (GTKY) session and a 60-minute PA session. Formative evaluation was assessed using an observational tool and staff surveys. Changes in youth PA during program hours was assessed as a process outcome using the System for Observing Children’s Activity and Relationships during Play (SOCARP). All Connect essential elements were assessed with the observational tool including (a) social goal-oriented support; (b) collaborative, cooperative play; (c) equal treatment/access; and (d) an inclusive and engaging climate. Adequate dose was achieved on all items in all sessions. Although GTKY and PA sessions both reached high fidelity in promoting equal treatment and access, success in reaching fidelity varied for the 3 remaining essential elements. Post-intervention staff surveys indicated acceptability/adoptability of the Connect program and SOCARP observations indicated significant increases in PA from baseline to post-intervention. Changes for year 2 implementation based on the findings are discussed.

Using Connected Technologies in a Continuous Quality Improvement Approach in After-school Settings: The PAX Good Behavior Game

This demonstration study explored the use of connected technologies in a continuous quality improvement (CQI) approach to implementing evidence-based practices in after-school. Focus-group with staff indicated enjoyment of technology and offered feedback for future development. Ecological momentary assessments (EMA) were gathered daily. Three randomized conditions were compared among 4 programs and 12 staff implementing PAX Good Behavior Game (PAX GBG). ANOVA, Post-Hoc Tukey and Chi-square analyses indicated that the tech-enhanced condition showed better implementation using scoreboards than the in-person, while similar in game length. Both were superior to the control in behavioral strategies; highlighting the promise of technology in capacity-building.

Movement integration in elementary classrooms: Teacher perceptions and implications for program planning

Movement integration (MI), which involves infusing physical activity (PA) into regular classroom time in schools, is widely recommended to help children meet the national guideline of 60min of PA each day. Understanding the perspective of elementary classroom teachers (ECTs) toward MI is critical to program planning for interventions/professional development. This study examined the MI perceptions of ECTs in order to inform the design and implementation of a school-based pilot program that focused in part on increasing children's PA through MI. Twelve ECTs (Grades 1-3) from four schools were selected to participate based on their responses to a survey about their use of MI. Based on the idea that MI programming should be designed with particular attention to teachers who integrate relatively few movement opportunities in their classrooms, the intent was to select the teacher who reported integrating movement the least at her/his respective grade level at each school. However, not all of these teachers agreed to participate in the study. The final sample included two groups of ECTs, including eight lowest integrating teachers and four additional teachers. Each ECT participated in an interview during the semester before the pilot program was implemented. Through qualitative analysis of the interview transcripts, four themes emerged: (a) challenges and barriers (e.g., lack of time), (b) current and ideal resources (e.g., school support), (c) current implementation processes (e.g., scheduling MI into daily routines), and (e) teachers' ideas and tips for MI (e.g., stick with it and learn as you go). The themes were supported by data from both groups of teachers. This study's findings can inform future efforts to increase movement opportunities for children during regular classroom time.