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Watkins JM, Greeven SJ, Heeter KN, Brunnemer JE, Otile J, Solá PAF, Dutta S, Hobson JM, Evanovich JM, Coble CJ, Werner NE, Martinez Kercher VM, Kercher KA. Human-centered participatory co-design with children and adults for a prototype lifestyle intervention and implementation strategy in a rural middle school. BMC Public Health 2024; 24:845. [PMID: 38504193 PMCID: PMC10949632 DOI: 10.1186/s12889-024-18351-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: 12/05/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
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.
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Affiliation(s)
- Janette M Watkins
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
- Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN, USA
| | - Sarah J Greeven
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Kathleen N Heeter
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Julia E Brunnemer
- Department of Health & Wellness Design, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Jacob Otile
- Department of Epidemiology & Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Paola A Fernández Solá
- Department of Epidemiology & Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Sandeep Dutta
- Neag School of Education, University of Connecticut, Storrs, CT, USA
| | | | | | - Cassandra J Coble
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Nicole E Werner
- Department of Health & Wellness Design, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Vanessa M Martinez Kercher
- Department of Health & Wellness Design, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Kyle A Kercher
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA.
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Greeven SJ, Fernández Solá PA, (Martinez) Kercher VM, Coble CJ, Pope KJ, Erinosho TO, Grube A, Evanovich JM, Werner NE, Kercher KA. Hoosier Sport: a research protocol for a multilevel physical activity-based intervention in rural Indiana. Front Public Health 2023; 11:1243560. [PMID: 37575109 PMCID: PMC10412824 DOI: 10.3389/fpubh.2023.1243560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Currently, only 1 in 4 children in the U.S. engage in the recommended amount of physical activity (PA) and disparities in PA participation increase as income inequities increase. Moreover, leading health organizations have identified rural health as a critical area of need for programming, research, and policy. Thus, there is a critical need for the development and testing of evidence-based PA interventions that have the potential to be scalable to improve health disparities in children from under-resourced rural backgrounds. As such, the present study utilizes human-centered design, a technique that puts community stakeholders at the center of the intervention development process, to increase our specific understanding about how the PA-based needs of children from rural communities manifest themselves in context, at the level of detail needed to make intervention design decisions. The present study connects the first two stages of the NIH Stage Model for Behavioral Intervention Development with a promising conceptual foundation and potentially sustainable college student mentor implementation strategy. Methods We will conduct a three-phase study utilizing human-centered community-based participatory research (CBPR) in three aims: (Aim 1) conduct a CBPR needs assessment with middle school students, parents, and teachers/administrators to identify perceptions, attributes, barriers, and facilitators of PA that are responsive to the community context and preferences; (Aim 2) co-design with children and adults to develop a prototype multi-level PA intervention protocol called Hoosier Sport; (Aim 3) assess Hoosier Sport's trial- and intervention-related feasibility indicators. The conceptual foundation of this study is built on three complementary theoretical elements: (1) Basic Psychological Needs mini-theory within Self-Determination Theory; (2) the Biopsychosocial Model; and (3) the multilevel Research Framework from the National Institute on Minority Health and Health Disparities. Discussion Our CBPR protocol takes a human-centered approach to integrating the first two stages of the NIH Stage Model with a potentially sustainable college student mentor implementation strategy. This multidisciplinary approach can be used by researchers pursuing multilevel PA-based intervention development for children.
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Affiliation(s)
- Sarah J. Greeven
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Paola A. Fernández Solá
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Vanessa M. (Martinez) Kercher
- Department of Health and Wellness Design, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Cassandra J. Coble
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Katherine J. Pope
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Temitope O. Erinosho
- Department of Applied Health Science, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Aidrik Grube
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | | | - Nicole E. Werner
- Department of Health and Wellness Design, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
| | - Kyle A. Kercher
- Department of Kinesiology, School of Public Health-Bloomington, Indiana University, Bloomington, IN, United States
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Oliver TL, Diewald LK, McKeever A, George CA, Shenkman R. Empowering Community Leadership: Perspectives of Peer Mentors Facilitating a Food Pantry-Based Nutrition Education Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2604. [PMID: 36767968 PMCID: PMC9915877 DOI: 10.3390/ijerph20032604] [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: 01/07/2023] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
Peer Mentors (PMs) are valuable health educators within food-insecure communities; however, little is known about PMs' perspectives and experiences after serving in their peer mentor role. Therefore, this qualitative study explored PMs' (n = 10) perceptions and analyzed data using thematic analysis based on descriptive phenomenology. Four themes emerged: (1) Successes and Struggles in Sharing Nutrition Knowledge; (2) Establishing a Conducive Learning Environment; (3) The Peer Mentor and Mentee Connection: Impact of Shared Experiences; (4) Empowerment of the Peer Mentor Experience. PMs have many advantages; however, more research is needed to evaluate the sustainability and efficacy of PMs within food-insecure communities.
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Affiliation(s)
- Tracy L. Oliver
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA
| | - Lisa K. Diewald
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA
- MacDonald Center for Obesity Prevention and Education, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA
| | - Amy McKeever
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA
| | - Cerena A. George
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA
| | - Rebecca Shenkman
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA
- MacDonald Center for Obesity Prevention and Education, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA 19085, USA
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Corder KL, Brown HE, Croxson CHD, Jong ST, Sharp SJ, Vignoles A, Wilkinson PO, Wilson ECF, van Sluijs EMF. A school-based, peer-led programme to increase physical activity among 13- to 14-year-old adolescents: the GoActive cluster RCT. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Adolescent physical activity levels are low and are associated with rising disease risk and social disadvantage. The Get Others Active (GoActive) intervention was co-designed with adolescents and teachers to increase physical activity in adolescents.
Objective
To assess the effectiveness and cost-effectiveness of the school-based GoActive programme in increasing adolescents’ moderate-to-vigorous physical activity.
Design
A cluster randomised controlled trial with an embedded mixed-methods process evaluation.
Setting
Non-fee-paying schools in Cambridgeshire and Essex, UK (n = 16). Schools were computer randomised and stratified by socioeconomic position and county.
Participants
A total of 2862 Year 9 students (aged 13–14 years; 84% of eligible students).
Intervention
The iteratively developed feasibility-tested refined 12-week intervention trained older adolescents (mentors) and in-class peer leaders to encourage classes to undertake two new weekly activities. Mentors met with classes weekly. Students and classes gained points and rewards for activity in and out of school.
Main outcome measures
The primary outcome was average daily minutes of accelerometer-assessed moderate-to-vigorous physical activity at 10 months post intervention. Secondary outcomes included accelerometer-assessed activity during school, after school and at weekends; self-reported physical activity and psychosocial outcomes; cost-effectiveness; well-being and a mixed-methods process evaluation. Measurement staff were blinded to allocation.
Results
Of 2862 recruited participants, 2167 (76%) attended 10-month follow-up measurements and we analysed the primary outcome for 1874 (65.5%) participants. At 10 months, there was a mean decrease in moderate-to-vigorous physical activity of 8.3 (standard deviation 19.3) minutes in control participants and 10.4 (standard deviation 22.7) minutes in intervention participants (baseline-adjusted difference –1.91 minutes, 95% confidence interval –5.53 to 1.70 minutes; p = 0.316). The programme cost £13 per student compared with control. Therefore, it was not cost-effective. Non-significant indications of differential impacts suggested detrimental effects among boys (boys –3.44, 95% confidence interval –7.42 to 0.54; girls –0.20, 95% confidence interval –3.56 to 3.16), but favoured adolescents from lower socioeconomic backgrounds (medium/low 4.25, 95% confidence interval –0.66 to 9.16; high –2.72, 95% confidence interval –6.33 to 0.89). Mediation analysis did not support the use of any included intervention components to increase physical activity. Some may have potential for improving well-being. Students, teachers and mentors mostly reported enjoying the GoActive intervention (56%, 87% and 50%, respectively), but struggled to conceptualise their roles. Facilitators of implementation included school support, embedding a routine, and mentor and tutor support. Challenges to implementation included having limited school space for activities, time, and uncertainty of teacher and mentor roles.
Limitations
Retention on the primary outcome at 10-month follow-up was low (65.5%), but we achieved our intended sample size, with retention comparable to similar trials.
Conclusions
A rigorously developed school-based intervention (i.e. GoActive) was not effective in countering the age-related decline in adolescent physical activity. Overall, this mixed-methods evaluation provides transferable insights for future intervention development, implementation and evaluation.
Future work
Interdisciplinary research is required to understand educational setting-specific implementation challenges. School leaders and authorities should be realistic about expectations of the effect of school-based physical activity promotion strategies implemented at scale.
Trial registration
Current Controlled Trials ISRCTN31583496.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 6. See the NIHR Journals Library website for further project information. This work was additionally supported by the Medical Research Council (London, UK) (Unit Programme number MC_UU_12015/7) and undertaken under the auspices of the Centre for Diet and Activity Research (Cambridge, UK), a UK Clinical Research Collaboration Public Health Research Centre of Excellence. Funding from the British Heart Foundation (London, UK), Cancer Research UK (London, UK), Economic and Social Research Council (Swindon, UK), Medical Research Council, the National Institute for Health Research (Southampton, UK) and the Wellcome Trust (London, UK), under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged (087636/Z/08/Z; ES/G007462/1; MR/K023187/1). GoActive facilitator costs were borne by Essex and Cambridgeshire County Councils.
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Affiliation(s)
- Kirsten L Corder
- Centre for Diet and Activity Research and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Helen E Brown
- Centre for Diet and Activity Research and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Caroline HD Croxson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stephanie T Jong
- Centre for Diet and Activity Research and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Stephen J Sharp
- Centre for Diet and Activity Research and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Anna Vignoles
- Faculty of Education, University of Cambridge, Cambridge, UK
| | - Paul O Wilkinson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Edward CF Wilson
- Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Esther MF van Sluijs
- Centre for Diet and Activity Research and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Oliver TL, McKeever A, Shenkman R, Diewald LK. Successes and challenges of using a peer Mentor model for nutrition education within a food pantry: a qualitative study. BMC Nutr 2020; 6:27. [PMID: 32685182 PMCID: PMC7359598 DOI: 10.1186/s40795-020-00352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 05/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Delivering nutrition education within an emergency food pantry (EFP) provides an opportunity to reach many food insecure households and underserved populations. However, little is known about using a peer mentor model, “Community Cooks,” as a modality to deliver nutrition education within this setting. This research aimed to identify the successes and challenges of using a peer mentor model within an EFP to better understand the best approaches to deliver nutrition education among community residents. Methods In spring 2018, semi-structured interviews were conducted with 11 peer mentors after they delivered a series of nutrition workshops to community members of the EFP. Interviews were audio-recorded and transcribed verbatim. Qualitative content analysis was used to analyze the data. Results All peer mentors were women over 40 years-of-age, were recruited from the EFP community; most were high school graduates and currently received some form of federal nutrition assistance. All peer mentors reported that the “Community Cooks” nutrition education program offered many benefits. Key successes of the program included serving in the role as a peer mentor was an empowering experience which gave them a sense of community, purpose, and camaraderie; 2) the nutrition education was appropriately tailored towards those living with food insecurity; 3) the recipes required minimal cooking skills and included low-cost easily accessible foods available at the EFP. Key challenges of the program were the lack of community member engagement in the nutrition education workshops. Conclusion Challenges continue to exist when delivering nutrition education within a community EFP setting. While the use of peer mentors to deliver nutrition education messages is promising, more research is needed to quantify the impact of using a peer mentor model in underserved and food insecure communities.
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Affiliation(s)
- Tracy L Oliver
- MacDonald Center for Obesity Prevention and Education, Villanova University M. Louise Fitzpatrick College of Nursing, 800 Lancaster Avenue, Villanova, PA 19085 USA
| | - Amy McKeever
- MacDonald Center for Obesity Prevention and Education, Villanova University M. Louise Fitzpatrick College of Nursing, 800 Lancaster Avenue, Villanova, PA 19085 USA
| | - Rebecca Shenkman
- MacDonald Center for Obesity Prevention and Education, Villanova University M. Louise Fitzpatrick College of Nursing, 800 Lancaster Avenue, Villanova, PA 19085 USA
| | - Lisa K Diewald
- MacDonald Center for Obesity Prevention and Education, Villanova University M. Louise Fitzpatrick College of Nursing, 800 Lancaster Avenue, Villanova, PA 19085 USA
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Pathways to Increasing Adolescent Physical Activity and Wellbeing: A Mediation Analysis of Intervention Components Designed Using a Participatory Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020390. [PMID: 31936074 PMCID: PMC7014090 DOI: 10.3390/ijerph17020390] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 11/28/2022]
Abstract
We assessed which intervention components were associated with change in moderate-to-vigorous physical activity (MVPA) and wellbeing through proposed psychosocial mediators. Eight schools (n = 1319; 13–14 years) ran GoActive, where older mentors and in-class-peer-leaders encouraged classes to conduct two new activities/week; students gained points and rewards for activity. We assessed exposures: participant-perceived engagement with components (post-intervention): older mentorship, peer leadership, class sessions, competition, rewards, points entered online; potential mediators (change from baseline): social support, self-efficacy, group cohesion, friendship quality, self-esteem; and outcomes (change from baseline): accelerometer-assessed MVPA (min/day), wellbeing (Warwick-Edinburgh). Mediation was assessed using linear regression models stratified by gender (adjusted for age, ethnicity, language, school, BMI z-score, baseline values), assessing associations between (1) exposures and mediators, (2) exposures and outcomes (without mediators) and (3) exposure and mediator with outcome using bootstrap resampling. No evidence was found to support the use of these components to increase physical activity. Among boys, higher perceived teacher and mentor support were associated with improved wellbeing via various mediators. Among girls, higher perceived mentor support and perception of competition and rewards were positively associated with wellbeing via self-efficacy, self-esteem and social support. If implemented well, mentorship could increase wellbeing among adolescents. Teacher support and class-based activity sessions may be important for boys’ wellbeing, whereas rewards and competition warrant consideration among girls.
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The Feasibility of a Novel School Peer-Led Mentoring Model to Improve the Physical Activity Levels and Sedentary Time of Adolescent Girls: The Girls Peer Activity (G-PACT) Project. CHILDREN-BASEL 2018; 5:children5060067. [PMID: 29857554 PMCID: PMC6028908 DOI: 10.3390/children5060067] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 05/27/2018] [Accepted: 05/30/2018] [Indexed: 11/16/2022]
Abstract
Regular physical activity (PA) is associated with numerous physical and psychological health benefits. Adolescents, specifically girls, are at risk of physical inactivity. To date, there is limited research on PA interventions involving peers, which could encourage more adolescent girls to engage in PA. The investigation aimed to evaluate the feasibility of a novel school three-tier peer-led mentoring model designed to improve PA levels and reduce sedentary time (ST) of adolescent girls. Two-hundred and forty-nine Year 9 adolescent girls (13⁻15 years old) from three UK secondary schools were invited to participate in a peer-led mentoring intervention (Girls Peer Activity (G-PACT) project). The peer-led mentoring model was delivered in all three schools. Two of the schools received an additional after-school PA component. PA and ST were assessed through wrist-worn accelerometry. Girls who received an exercise class after-school component significantly increased their whole day moderate-to-vigorous PA (MVPA) (3.2 min, p = 0.009, d = 0.33). Girls who received no after-school component significantly decreased their MVPA (3.5 min, p = 0.016, d = 0.36) and increased their ST (17.2 min, p = 0.006, d = 0.43). The G-PACT intervention demonstrated feasibility of recruitment and data collection procedures for adolescent girls. The peer-led mentoring model shows promise for impacting girls' MVPA levels when combined with an after-school club PA opportunity.
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Smith LH, Petosa RL, Shoben A. Peer mentor versus teacher delivery of a physical activity program on the effects of BMI and daily activity: protocol of a school-based group randomized controlled trial in Appalachia. BMC Public Health 2018; 18:633. [PMID: 29769106 PMCID: PMC5956615 DOI: 10.1186/s12889-018-5537-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rural Appalachian populations have poorer health and fewer positive health-related behaviors compared to other United States populations. Appalachians are the most sedentary U.S. population and teens are particularly sedentary. Obesity prevention through improving physical activity is a top priority in Rural Healthy People 2020. Obesity prevalence among Appalachian teens exceeds the national rates of 13.9% and has consistently been greater than 26%. Organized sports has not been effective at improving daily physical activity or health outcomes for Appalachian teens. The purpose of this study is to test the efficacy of a 10-week school-based intervention in promoting self-regulation of physical activity among adolescents not participating in organized sports. By using accelerometers, our study will measure both sedentary time and planned exercise during waking hours. METHODS The design for this four-year study is a group-randomized controlled trial (G-RCT). We will recruit high schools in 3 waves, with 4 in Wave 1, 8 in Wave 2, and 8 in Wave 3, for a total of 20 schools. For each wave of schools, we will randomly assign half of the schools to each condition--intervention (peer-to-peer mentoring [MBA]) and comparison (teacher-led [PBA])--for a total of 10 schools in each of the two conditions by study's end. We will collect data at baseline (T1), 3 months post intervention (T2), and 6 months post intervention (T3). Linear Mixed Models (LMMs) and Generalized Linear Mixed Models (GLMMs) will be used to test the main hypotheses. Power for this study was based the primary analysis comparing BMI outcomes at T2 between the groups, adjusting for baseline BMI values. DISCUSSION This study provides age-appropriate lifestyle education and skill building. Peer-to-peer mentoring by local high school students and school-based tailored support strengthens sustainable behavioral change. Focusing on unique healthy-lifestyle challenges prevalent in low-resource areas such as Appalachia such as overcoming environmental, social, and psychological barriers may improve adherence to physical activity. Serving as role models, peer mentors may improve their own lifestyle behaviors, providing a dual intervention. TRIAL REGISTRATION NCT02329262 .
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Affiliation(s)
- Laureen H Smith
- The Ohio State University College of Nursing, 240 Newton Hall, 1595 Neil Avenue, Columbus, OH, 43201, USA.
| | - Rick L Petosa
- The Ohio State University College of Education and Human Ecology, Physical Activity and Exercise Science Room 048, Columbus, OH, 43201, USA
| | - Abigail Shoben
- The Ohio State University College of Public Health, 249 Cunz Hall, Columbus, OH, 43201, USA
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Arlinghaus KR, Moreno JP, Reesor L, Hernandez DC, Johnston CA. Compañeros: High School Students Mentor Middle School Students to Address Obesity Among Hispanic Adolescents. Prev Chronic Dis 2017; 14:E92. [PMID: 29023233 PMCID: PMC5645191 DOI: 10.5888/pcd14.170130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Promotoras, Hispanic community health workers, are frequently employed to promote health behavioral change with culturally bound Hispanic lifestyle behaviors. Peer health mentors have been used in schools to promote healthy nutrition and physical activity behaviors among students. This study investigates the efficacy of combining these 2 approaches by training high school health mentors, called compañeros, to engage Hispanic middle school students in a school-based obesity intervention as a strategy to promote and sustain reductions in standardized body mass index (zBMI). METHODS High school compañeros were trained to participate in a 6-month obesity program alongside middle school students in Houston, Texas. Middle school students were randomized to participate in the program either with compañeros (n = 94) or without compañeros (n = 95). The intervention was conducted from 2013 through 2016 in 3 cohorts of students, 1 each school year. Students were followed for 12 months. The primary outcome was zBMI, which was analyzed at baseline, 6 months, and 12 months. RESULTS Significant differences were found between conditions across time (F = 4.58, P = .01). After the 6-month intervention, students in the condition with compañeros had a larger decrease in zBMI (F = 6.94, P = .01) than students in the condition without compañeros. Furthermore, students who received the intervention with compañeros showed greater sustained results at 12 months (F = 7.65, P = .01). CONCLUSION Using high school compañeros in an obesity intervention for Hispanic middle school students could be effective in promoting and maintaining reductions in zBMI.
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Affiliation(s)
- Katherine R Arlinghaus
- Department of Health and Human Performance, University of Houston, 3875 Holman St, Garrison Gymnasium, Rm 104, Houston, TX 77240.
| | - Jennette P Moreno
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Layton Reesor
- Department of Health and Human Performance, University of Houston, Houston, Texas
| | - Daphne C Hernandez
- Department of Health and Human Performance, University of Houston, Houston, Texas
| | - Craig A Johnston
- Department of Health and Human Performance, University of Houston, Houston, Texas
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Sato PM, Steeves EA, Carnell S, Cheskin LJ, Trude AC, Shipley C, Mejía Ruiz MJ, Gittelsohn J. A youth mentor-led nutritional intervention in urban recreation centers: a promising strategy for childhood obesity prevention in low-income neighborhoods. HEALTH EDUCATION RESEARCH 2016; 31:195-206. [PMID: 26936480 PMCID: PMC5007578 DOI: 10.1093/her/cyw011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 02/03/2016] [Indexed: 05/25/2023]
Abstract
B'More Healthy Community for Kids (BHCK) is an ongoing multi-level intervention to prevent childhood obesity in African-American low-income neighborhoods in Baltimore city, MD. Although previous nutrition interventions involving peer mentoring of youth have been successful, there is a lack of studies evaluating the influence of cross-age peers within interventions targeting youth. This article evaluates the implementation of the BHCK intervention in recreation centers, and describes lessons learned. Sixteen youth leaders delivered bi-weekly, interactive sessions to 10- to 14-y olds. Dose, fidelity and reach are assessed, as is qualitative information regarding what worked well during sessions. Dose is operationalized as the number of interactive sessions, and taste tests, giveaways and handouts per session; fidelity as the number of youth leaders participating in the entire intervention and per session and reach as the number of interactions with the target population. Based on a priori set values, number of interactive sessions was high, and number of taste tests, giveaways and handouts was moderate to high (dose). The number of participating youth leaders was also high (fidelity). Of the 14 planned sessions, the intervention was implemented with high/moderate reach. Data suggest that working with cross-age peers is a promising nutritional intervention for recreation centers.
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Affiliation(s)
- Priscila M Sato
- Department of Health, Clinics and Institutions, Institute of Health and Society, Federal University of São Paulo, Santos, SP 11015-020, Brazil,
| | | | | | - Lawrence J Cheskin
- Department of Medicine, Global Obesity Prevention Center, Johns Hopkins Hospital, Baltimore, MD 21205-2179, USA and
| | - Angela C Trude
- Department of Human Nutrition, Global Obesity Prevention Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205-2179, USA
| | - Cara Shipley
- Department of Human Nutrition, Global Obesity Prevention Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205-2179, USA
| | - M J Mejía Ruiz
- Department of Human Nutrition, Global Obesity Prevention Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205-2179, USA
| | - Joel Gittelsohn
- Department of Human Nutrition, Global Obesity Prevention Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205-2179, USA
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Corder K, Schiff A, Kesten JM, van Sluijs EMF. Development of a universal approach to increase physical activity among adolescents: the GoActive intervention. BMJ Open 2015; 5:e008610. [PMID: 26307618 PMCID: PMC4550709 DOI: 10.1136/bmjopen-2015-008610] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To develop a physical activity (PA) promotion intervention for adolescents using a process addressing gaps in the literature while considering participant engagement. We describe the initial development stages; (1) existing evidence, (2) large scale opinion gathering and (3) developmental qualitative work, aiming (A) to gain insight into how to increase PA among the whole of year 9 (13-14 years-old) by identifying elements for intervention inclusion (B) to improve participant engagement and (C) to develop and refine programme design. METHODS Relevant systematic reviews and longitudinal analyses of change were examined. An intervention was developed iteratively with older adolescents (17.3 ± 0.5 years) and teachers, using the following process: (1) focus groups with (A) adolescents (n=26) and (B) teachers (n=4); (2) individual interviews (n=5) with inactive and shy adolescents focusing on engagement and programme acceptability. Qualitative data were analysed thematically. RESULTS Limitations of the existing literature include lack of evidence on whole population approaches, limited adolescent involvement in intervention development, and poor participant engagement. Qualitative work suggested six themes which may encourage adolescents to do more PA; choice, novelty, mentorship, competition, rewards and flexibility. Teachers discussed time pressures as a barrier to encouraging adolescent PA and suggested between-class competition as a strategy. GoActive aims to increase PA through increased peer support, self-efficacy, group cohesion, self-esteem and friendship quality, and is implemented in tutor groups using a student-led tiered-leadership system. CONCLUSIONS We have followed an evidence-based iterative approach to translate existing evidence into an adolescent PA promotion intervention. Qualitative work with adolescents and teachers supported intervention design and addressed lack of engagement with health promotion programmes within this age group. Future work will examine the feasibility and effectiveness of GoActive to increase PA among adolescents while monitoring potential negative effects. The approach developed is applicable to other population groups and health behaviours. TRIAL REGISTRATION NUMBER ISRCTN31583496.
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Affiliation(s)
- Kirsten Corder
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- MRC Epidemiology Unit, UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Annie Schiff
- MRC Epidemiology Unit, UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Joanna M Kesten
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Esther M F van Sluijs
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
- MRC Epidemiology Unit, UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge, UK
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Ayton D, Joss N. Empowering vulnerable parents through a family mentoring program. Aust J Prim Health 2015; 22:320-326. [PMID: 26268436 DOI: 10.1071/py14174] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 02/18/2015] [Indexed: 11/23/2022]
Abstract
Evidence suggests that mentoring programs can foster positive relationships through role modelling, social support and opportunities to develop new skills. Home visiting programs, where a health professional or volunteer provides parenting support and companionship to at-risk families, have received attention from the health and welfare sector. These programs tend to focus on new mothers and immediate parenting concerns, and do not address broader social determinants of health that impact on the well being and functionality of the family. Herein we report on an evaluation of the Creating Opportunities and Casting Hope (COACH) program, a family mentoring program for vulnerable parents. COACH seeks to break cycles of generational poverty by addressing social determinants, such as housing, employment, health, finances and social support. A mixed-methods approach was used to evaluate the program, involving semistructured interviews with parents (n = 12), surveys with mentors (n = 27) and client case report review (n = 27). Parents experienced improvements in their housing and employment situations, family dynamics, social support and mental health, and decreased drug and alcohol use. Mentors described providing guidance on parenting strategies, financial management and domestic skills. Partnerships with local schools, health services and welfare agencies were vital in the referral processes for families, thereby building a community network of support and care. The COACH model of mentoring highlights the benefits of a flexible and long-standing program to address the social determinants of child health through the family environment and wider social and economic factors.
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Affiliation(s)
- Darshini Ayton
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 6 Alfred Centre, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Nerida Joss
- Melbourne School of Population and Global Health, The University of Melbourne, Level 4, 161 Barry Street, Carlton, Vic. 3010, Australia
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Kohlstadt IC, Steeves ETA, Rice K, Gittelsohn J, Summerfield LM, Gadhoke P. Youth peers put the "invent" into NutriBee's online intervention. Nutr J 2015; 14:60. [PMID: 26077664 PMCID: PMC4470038 DOI: 10.1186/s12937-015-0031-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 04/27/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Early adolescents perceive peers as credible and relatable. Peers therefore have a unique conduit to engage early adolescents in positive health behaviors through nutrition learning such as that recommended by the U.S. Institute of Medicine (IOM). PURPOSE We developed an online, peer leader component to an existing in-person preventive nutrition intervention called NutriBee. We reasoned that youth ages 13-18 could create intervention materials that could remain engaging, credible and relatable to younger peers ages 10-12 online. Peer leaders could potentially derive health benefits from their service-learning experience. METHODS From 2013-2014 youth could apply online to relate a personal interest to nutrition, an opportunity promoted at NutriBee pilot sites and through social media. The peer leaders with diverse backgrounds honed original ideas into tangible projects with the support of adult subject-matter experts chosen by the youth. Nutrition expertise was provided by NutriBee staff who then also converted the youth-invented projects from various media into an online curriculum. RESULTS 19 of 27 (70%) of selected youth from 12 states and diverse backgrounds, created an online curriculum comprising 10% of NutriBee's 20-hour intervention. All 19 online projects modeled 1 or more of NutriBee's 10 positive health behaviors; 8 evoked the chemosenses; 6 conveyed food texture; and 13 provided social context. Peer leaders perceived career advancement and service learning benefits. The dose, pedagogic approach, and project content align with the IOM recommendation. CONCLUSIONS Youth created intervention materials which communicate positive health behaviors online in ways peers can adopt. In a customarily sight-sound digital platform, youth leveraged the senses of smell, taste and touch and social context important for food selection. Peer leaders derived health benefit, as indirectly assessed by IOM criteria.
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Affiliation(s)
- Ingrid C Kohlstadt
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 198 Prince George St., Annapolis, Baltimore, 21401, MD, USA.
| | - Elizabeth T Anderson Steeves
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 198 Prince George St., Annapolis, Baltimore, 21401, MD, USA.
- University of Wisconsin, Milwaukee, WI, USA.
| | - Kerry Rice
- Boise State University, Department of Educational Technology, Boise, ID, USA.
| | - Joel Gittelsohn
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 198 Prince George St., Annapolis, Baltimore, 21401, MD, USA.
| | | | - Preety Gadhoke
- St. John's University, College of Pharmacy and Health Sciences, New York, USA.
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Petosa RL, Smith LH. Peer Mentoring for Health Behavior Change: A Systematic Review. AMERICAN JOURNAL OF HEALTH EDUCATION 2014. [DOI: 10.1080/19325037.2014.945670] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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