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French C, Dowrick A, Fudge N, Pinnock H, Taylor SJC. What do we want to get out of this? a critical interpretive synthesis of the value of process evaluations, with a practical planning framework. BMC Med Res Methodol 2022; 22:302. [PMID: 36434520 PMCID: PMC9700891 DOI: 10.1186/s12874-022-01767-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/21/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Process evaluations aim to understand how complex interventions bring about outcomes by examining intervention mechanisms, implementation, and context. While much attention has been paid to the methodology of process evaluations in health research, the value of process evaluations has received less critical attention. We aimed to unpack how value is conceptualised in process evaluations by identifying and critically analysing 1) how process evaluations may create value and 2) what kind of value they may create. METHODS We systematically searched for and identified published literature on process evaluation, including guidance, opinion pieces, primary research, reviews, and discussion of methodological and practical issues. We conducted a critical interpretive synthesis and developed a practical planning framework. RESULTS We identified and included 147 literature items. From these we determined three ways in which process evaluations may create value or negative consequences: 1) through the socio-technical processes of 'doing' the process evaluation, 2) through the features/qualities of process evaluation knowledge, and 3) through using process evaluation knowledge. We identified 15 value themes. We also found that value varies according to the characteristics of individual process evaluations, and is subjective and context dependent. CONCLUSION The concept of value in process evaluations is complex and multi-faceted. Stakeholders in different contexts may have very different expectations of process evaluations and the value that can and should be obtained from them. We propose a planning framework to support an open and transparent process to plan and create value from process evaluations and negotiate trade-offs. This will support the development of joint solutions and, ultimately, generate more value from process evaluations to all.
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Affiliation(s)
- Caroline French
- grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB UK
| | - Anna Dowrick
- grid.4991.50000 0004 1936 8948Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GC UK
| | - Nina Fudge
- grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB UK
| | - Hilary Pinnock
- grid.4305.20000 0004 1936 7988Usher Institute, The University of Edinburgh, Doorway 3, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Stephanie J. C. Taylor
- grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB UK
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Neil-Sztramko SE, Caldwell H, Dobbins M. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev 2021; 9:CD007651. [PMID: 34555181 PMCID: PMC8459921 DOI: 10.1002/14651858.cd007651.pub3] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physical activity among children and adolescents is associated with lower adiposity, improved cardio-metabolic health, and improved fitness. Worldwide, fewer than 30% of children and adolescents meet global physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day. Schools may be ideal sites for interventions given that children and adolescents in most parts of the world spend a substantial amount of time in transit to and from school or attending school. OBJECTIVES The purpose of this review update is to summarise the evidence on effectiveness of school-based interventions in increasing moderate to vigorous physical activity and improving fitness among children and adolescents 6 to 18 years of age. Specific objectives are: • to evaluate the effects of school-based interventions on increasing physical activity and improving fitness among children and adolescents; • to evaluate the effects of school-based interventions on improving body composition; and • to determine whether certain combinations or components (or both) of school-based interventions are more effective than others in promoting physical activity and fitness in this target population. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, BIOSIS, SPORTDiscus, and Sociological Abstracts to 1 June 2020, without language restrictions. We screened reference lists of included articles and relevant systematic reviews. We contacted primary authors of studies to ask for additional information. SELECTION CRITERIA Eligible interventions were relevant to public health practice (i.e. were not delivered by a clinician), were implemented in the school setting, and aimed to increase physical activity among all school-attending children and adolescents (aged 6 to 18) for at least 12 weeks. The review was limited to randomised controlled trials. For this update, we have added two new criteria: the primary aim of the study was to increase physical activity or fitness, and the study used an objective measure of physical activity or fitness. Primary outcomes included proportion of participants meeting physical activity guidelines and duration of moderate to vigorous physical activity and sedentary time (new to this update). Secondary outcomes included measured body mass index (BMI), physical fitness, health-related quality of life (new to this update), and adverse events (new to this update). Television viewing time, blood cholesterol, and blood pressure have been removed from this update. DATA COLLECTION AND ANALYSIS: Two independent review authors used standardised forms to assess each study for relevance, to extract data, and to assess risk of bias. When discrepancies existed, discussion occurred until consensus was reached. Certainty of evidence was assessed according to GRADE. A random-effects meta-analysis based on the inverse variance method was conducted with participants stratified by age (children versus adolescents) when sufficient data were reported. Subgroup analyses explored effects by intervention type. MAIN RESULTS Based on the three new inclusion criteria, we excluded 16 of the 44 studies included in the previous version of this review. We screened an additional 9968 titles (search October 2011 to June 2020), of which 978 unique studies were potentially relevant and 61 met all criteria for this update. We included a total of 89 studies representing complete data for 66,752 study participants. Most studies included children only (n = 56), followed by adolescents only (n = 22), and both (n = 10); one study did not report student age. Multi-component interventions were most common (n = 40), followed by schooltime physical activity (n = 19), enhanced physical education (n = 15), and before and after school programmes (n = 14); one study explored both enhanced physical education and an after school programme. Lack of blinding of participants, personnel, and outcome assessors and loss to follow-up were the most common sources of bias. Results show that school-based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity (mean difference (MD) 0.73 minutes/d, 95% confidence interval (CI) 0.16 to 1.30; 33 studies; moderate-certainty evidence) and may lead to little to no decrease in sedentary time (MD -3.78 minutes/d, 95% CI -7.80 to 0.24; 16 studies; low-certainty evidence). School-based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (VO₂max) (MD 1.19 mL/kg/min, 95% CI 0.57 to 1.82; 13 studies; low-certainty evidence). School-based physical activity interventions may result in a very small decrease in BMI z-scores (MD -0.06, 95% CI -0.09 to -0.02; 21 studies; low-certainty evidence) and may not impact BMI expressed as kg/m² (MD -0.07, 95% CI -0.15 to 0.01; 50 studies; low-certainty evidence). We are very uncertain whether school-based physical activity interventions impact health-related quality of life or adverse events. AUTHORS' CONCLUSIONS Given the variability of results and the overall small effects, school staff and public health professionals must give the matter considerable thought before implementing school-based physical activity interventions. Given the heterogeneity of effects, the risk of bias, and findings that the magnitude of effect is generally small, results should be interpreted cautiously.
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Affiliation(s)
| | - Hilary Caldwell
- Department of Kinesiology, Child Health & Exercise Medicine Program, McMaster University, Hamilton, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
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Morrison JQ, Newman DS, Erickson AG. Process Evaluation of Literacy Practices within a Multi-Tiered System of Supports Framework. JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2020. [DOI: 10.1080/15377903.2020.1804030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Julie Q. Morrison
- School Psychology Program, University of Cincinnati, Cincinnati, Ohio, USA
| | - Daniel S. Newman
- School Psychology Program, University of Cincinnati, Cincinnati, Ohio, USA
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Sharma SV, Chuang RJ, Byrd-Williams C, Vandewater E, Butte N, Hoelscher DM. Using Process Evaluation for Implementation Success of Preschool-Based Programs for Obesity Prevention: The TX Childhood Obesity Research Demonstration Study. THE JOURNAL OF SCHOOL HEALTH 2019; 89:382-392. [PMID: 30932206 DOI: 10.1111/josh.12745] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 04/26/2018] [Accepted: 01/17/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Through the Texas Childhood Obesity Research Demonstration study, we implemented and evaluated a system-oriented model of primary and secondary prevention approaches to mitigate obesity among low-income Texas children aged 2 to 12 years. Primary prevention included implementing the Coordinated Approach To Child Health Early Childhood (CATCH EC) program in Head Start preschools. In this paper, we describe the methods and results of CATCH EC program process evaluation over 2 years of implementation. METHODS We used a quasi-experimental design with serial cross-sectional data collected from Head Start centers across intervention and comparison catchment areas in Houston and Austin, Texas (intervention: N = 12 centers in 2012-2013 [Year 1], N = 12 in 2013-2014 [Year 2]; comparison: N = 13 centers in Year 1, N = 12 in Year 2). Process evaluation included center director and teacher surveys conducted in both years of implementation. We developed indices for implementation of CATCH EC and non-CATCH health events at the centers. RESULTS Implementation scores were higher among intervention centers as compared to comparison centers across both years of implementation, and these differences were statistically significant (p < .01). There was also high variability in program implementation in intervention centers across both years ranging from 55% to 95%. CONCLUSION These implementation index strategies may inform future evaluation of preschool-based obesity prevention program implementation.
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Affiliation(s)
- Shreela V Sharma
- Department of Epidemiology, Human Genetics & Environmental Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler, RAS E603, Houston, TX 77030
| | - Ru-Jye Chuang
- Department of Epidemiology, Human Genetics & Environmental Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, 1200 Pressler, RAS E603, Houston, TX 77030
| | - Courtney Byrd-Williams
- Health Promotion & Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health in Austin, 1616 Guadalupe, UTA 6.304, Austin, TX 78701
| | - Elizabeth Vandewater
- Data Science and Research Services, University of Texas at Austin, 116 Inner Campus Drive, CLA 2.608, Austin, TX 78712
| | - Nancy Butte
- Pediatrics-Nutrition, Baylor College of Medicine, Houston, TX
| | - Deanna M Hoelscher
- Health Promotion & Behavioral Sciences, Chair, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health in Austin, 1616 Guadalupe, UTA 6.310, Austin, Texas 78701
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Lepe S, Goodwin J, Mulligan KT, Balestracci K, Sebelia L, Greene G. Process Evaluation of a Policy, Systems, and Environmental Change Intervention in an Urban School District. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:307-317. [PMID: 30274727 DOI: 10.1016/j.jneb.2018.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 07/24/2018] [Accepted: 07/27/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To conduct a comprehensive process evaluation of a policy, systems, and environmental (PSE) change intervention. DESIGN Quasi-experimental, mixed methods. SETTING Low-income urban school district. PARTICIPANTS Fifth-grade students in 4 schools assigned to 2 intervention and 2 comparison schools (intervention, n = 142; comparison, n = 170). INTERVENTION Both groups received a nutrition curriculum delivered by classroom teachers. Intervention schools also received 10 PSE lessons taught by paraprofessional educators. MAIN OUTCOME MEASURES Quantitative data were obtained from fidelity and observation checklists, grading rubrics and self-reported student surveys. Focus group and interviews provided qualitative data. Quantitative measures included assessments of PSE and fruit and vegetable knowledge, as well as assessment of times fruits and vegetables (FV) were consumed yesterday. ANALYSES Qualitative data were analyzed using inductive content analysis. Quantitative data were analyzed using repeated measures analysis of variance and analysis of co-variance. RESULTS Fidelity, dose, reach, and acceptance of PSE intervention were high; students felt more empowered, although PSE lessons were considered lengthy and complicated. Intervention PSE and FV knowledge scores were significantly higher than comparison scores (F37.56, P < .001; and F3.94, P < .05, respectively). However, issues in communication were identified between school staff and researchers. CONCLUSIONS AND IMPLICATIONS Policy, systems, and environmental classroom interventions commented on the differences between quantitative and qualitative assessments, and this suggests the need for more sensitive quantitative assessments. Future research should look at long-term outcomes as this study only looked at short-term outcomes.
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Affiliation(s)
- Silvia Lepe
- Department of Nutrition and Food Sciences, University of Rhode Island, Providence, RI
| | - Jennifer Goodwin
- Department of Nutrition and Food Sciences, University of Rhode Island, Providence, RI
| | - Katie T Mulligan
- Department of Nutrition and Food Sciences, University of Rhode Island, Providence, RI
| | - Kate Balestracci
- Department of Nutrition and Food Sciences, University of Rhode Island, Providence, RI
| | - Linda Sebelia
- Department of Nutrition and Food Sciences, University of Rhode Island, Providence, RI.
| | - Geoffrey Greene
- Department of Nutrition and Food Sciences, University of Rhode Island, Providence, RI
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Implementation and scale up of population physical activity interventions for clinical and community settings: the PRACTIS guide. Int J Behav Nutr Phys Act 2018; 15:51. [PMID: 29884236 PMCID: PMC5994105 DOI: 10.1186/s12966-018-0678-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/15/2018] [Indexed: 01/07/2023] Open
Abstract
Background Few efficacious physical activity interventions are successfully translated and sustained in practice. We propose a practical guide for researchers to increase the likelihood of successful implementation and scale up of physical activity interventions in practice contexts. The guide is based on two principles: (i) differences between the research and practice context can be addressed during intervention development and implementation planning by focusing on system, delivery personnel, and intervention characteristics; and (ii) early planning for implementation barriers and facilitators can improve subsequent translation into practice. Methods From the published literature, we identified evidence of strategies to improve research-practice translation, along with narrative descriptions of different approaches to addressing translational challenges. These, along with constructs taken from widely cited implementation outcome, process, and mechanistic models were collated and inform the guide. Results The resultant PRACTIS guide (PRACTical planning for Implementation and Scale-up) comprised the following four iterative steps: Step 1) Characterize the parameters of the implementation setting; Step 2) Identify and engage key stakeholders across multiple levels within the delivery system(s); Step 3) Identify contextual barriers and facilitators to implementation, and; Step 4) Address potential barriers to effective implementation. Conclusions A lack of practical guidance for researchers on how to effectively plan implementation and scale up of physical activity interventions prevents us moving quickly from evidence to action. We recommend that intervention development and adaptation for broad and sustained implementation be prioritized early in intervention planning and include active engagement from delivery organizations and stakeholders. The PRACTIS guide is also relevant for clinical and public health researchers in other areas of prevention. Electronic supplementary material The online version of this article (10.1186/s12966-018-0678-0) contains supplementary material, which is available to authorized users.
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Trude ACB, Kharmats AY, Jones-Smith JC, Gittelsohn J. Exposure to a multi-level multi-component childhood obesity prevention community-randomized controlled trial: patterns, determinants, and implications. Trials 2018; 19:287. [PMID: 29788977 PMCID: PMC5964684 DOI: 10.1186/s13063-018-2663-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 05/03/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND For community interventions to be effective in real-world conditions, participants need to have sufficient exposure to the intervention. It is unclear how the dose and intensity of the intervention differ among study participants in low-income areas. We aimed to understand patterns of exposure to different components of a multi-level multi-component obesity prevention program to inform our future impact analyses. METHODS B'more Healthy Communities for Kids (BHCK) was a community-randomized controlled trial implemented in 28 low-income zones in Baltimore in two rounds (waves). Exposure to three different intervention components (corner store/carryout restaurants, social media/text messaging, and youth-led nutrition education) was assessed via post-intervention interviews with 385 low-income urban youths and their caregivers. Exposure scores were generated based on self-reported viewing of BHCK materials (posters, handouts, educational displays, and social media posts) and participating in activities, including taste tests during the intervention. For each intervention component, points were assigned for exposure to study materials and activities, then scaled (0-1 range), yielding an overall BHCK exposure score [youths: mean 1.1 (range 0-7.6 points); caregivers: 1.1 (0-6.7), possible highest score: 13]. Ordered logit regression analyses were used to investigate correlates of youths' and caregivers' exposure level (quartile of exposure). RESULTS Mean intervention exposure scores were significantly higher for intervention than comparison youths (mean 1.6 vs 0.5, p < 0.001) and caregivers (mean 1.6 vs 0.6, p < 0.001). However, exposure scores were low in both groups and 10% of the comparison group was moderately exposed to the intervention. For each 1-year increase in age, there was a 33% lower odds of being highly exposed to the intervention (odds ratio 0.77, 95% confidence interval 0.69; 0.88) in the unadjusted and adjusted model controlling for youths' sex and household income. CONCLUSION Treatment effects may be attenuated in community-based trials, as participants may be differentially exposed to intervention components and the comparison group may also be exposed. Exposure should be measured to provide context to impact evaluations in multi-level trials. Future analyses linking exposure scores to the outcome should control for potential confounders in the treatment-on-the-treated approach, while recognizing that confounding and selection bias may exist affecting causal inference. TRIAL REGISTRATION ClinicalTrials.gov, NCT02181010 . Retrospectively registered on 2 July 2014.
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Affiliation(s)
- Angela Cristina Bizzotto Trude
- Global Obesity Prevention Center and Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Anna Yevgenyevna Kharmats
- Global Obesity Prevention Center and Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Jessica C Jones-Smith
- Nutritional Sciences Program, University of Washington School of Public Health University of Washington, 353410, 306B Raitt Hall, Seattle, WA, USA
| | - Joel Gittelsohn
- Global Obesity Prevention Center and Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Hind D, Parkin J, Whitworth V, Rex S, Young T, Hampson L, Sheehan J, Maguire C, Cantrill H, Scott E, Epps H, Main M, Geary M, McMurchie H, Pallant L, Woods D, Freeman J, Lee E, Eagle M, Willis T, Muntoni F, Baxter P. Aquatic therapy for children with Duchenne muscular dystrophy: a pilot feasibility randomised controlled trial and mixed-methods process evaluation. Health Technol Assess 2018. [PMID: 28627356 DOI: 10.3310/hta21270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is a rare disease that causes the progressive loss of motor abilities such as walking. Standard treatment includes physiotherapy. No trial has evaluated whether or not adding aquatic therapy (AT) to land-based therapy (LBT) exercises helps to keep muscles strong and children independent. OBJECTIVES To assess the feasibility of recruiting boys with DMD to a randomised trial evaluating AT (primary objective) and to collect data from them; to assess how, and how well, the intervention and trial procedures work. DESIGN Parallel-group, single-blind, randomised pilot trial with nested qualitative research. SETTING Six paediatric neuromuscular units. PARTICIPANTS Children with DMD aged 7-16 years, established on corticosteroids, with a North Star Ambulatory Assessment (NSAA) score of 8-34 and able to complete a 10-m walk without aids/assistance. Exclusions: > 20% variation between baseline screens 4 weeks apart and contraindications. INTERVENTIONS Participants were allocated on a 1 : 1 ratio to (1) optimised, manualised LBT (prescribed by specialist neuromuscular physiotherapists) or (2) the same plus manualised AT (30 minutes, twice weekly for 6 months: active assisted and/or passive stretching regime; simulated or real functional activities; submaximal exercise). Semistructured interviews with participants, parents (n = 8) and professionals (n = 8) were analysed using Framework analysis. An independent rater reviewed patient records to determine the extent to which treatment was optimised. A cost-impact analysis was performed. Quantitative and qualitative data were mixed using a triangulation exercise. MAIN OUTCOME MEASURES Feasibility of recruiting 40 participants in 6 months, participant and therapist views on the acceptability of the intervention and research protocols, clinical outcomes including NSAA, independent assessment of treatment optimisation and intervention costs. RESULTS Over 6 months, 348 children were screened - most lived too far from centres or were enrolled in other trials. Twelve (30% of target) were randomised to AT (n = 8) or control (n = 4). People in the AT (n = 8) and control (n = 2: attrition because of parental report) arms contributed outcome data. The mean change in NSAA score at 6 months was -5.5 [standard deviation (SD) 7.8] for LBT and -2.8 (SD 4.1) in the AT arm. One boy suffered pain and fatigue after AT, which resolved the same day. Physiotherapists and parents valued AT and believed that it should be delivered in community settings. The independent rater considered AT optimised for three out of eight children, with other children given programmes that were too extensive and insufficiently focused. The estimated NHS costs of 6-month service were between £1970 and £2734 per patient. LIMITATIONS The focus on delivery in hospitals limits generalisability. CONCLUSIONS Neither a full-scale frequentist randomised controlled trial (RCT) recruiting in the UK alone nor a twice-weekly open-ended AT course delivered at tertiary centres is feasible. Further intervention development research is needed to identify how community-based pools can be accessed, and how families can link with each other and community physiotherapists to access tailored AT programmes guided by highly specialised physiotherapists. Bayesian RCTs may be feasible; otherwise, time series designs are recommended. TRIAL REGISTRATION Current Controlled Trials ISRCTN41002956. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 27. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Daniel Hind
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - James Parkin
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Victoria Whitworth
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Saleema Rex
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Tracey Young
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Lisa Hampson
- Department of Mathematics and Statistics, University of Lancaster, Lancaster, UK
| | - Jennie Sheehan
- Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Chin Maguire
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Hannah Cantrill
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - Elaine Scott
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Marion Main
- Dubowitz Neuromuscular Centre (DNC), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Michelle Geary
- Children's Therapy Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Heather McMurchie
- Paediatric Physiotherapy, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Lindsey Pallant
- Regional Paediatric Neuromuscular Team, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Jennifer Freeman
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ellen Lee
- Sheffield Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | - Tracey Willis
- The Oswestry Inherited Neuromuscular Service, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre (DNC), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Peter Baxter
- Paediatric Neurology, Sheffield Children's Hospital, Sheffield, UK
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Hunt MK, Lederman R, Stoddard AM, LaMontagne AD, McLellan D, Combe C, Barbeau E, Sorensen G. Process Evaluation of an Integrated Health Promotion/Occupational Health Model in WellWorks-2. HEALTH EDUCATION & BEHAVIOR 2016; 32:10-26. [PMID: 15642751 DOI: 10.1177/1090198104264216] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Disparities in chronic disease risk by occupation call for newapproaches to health promotion. Well Works-2 was a randomized, controlled study comparing the effectiveness of a health promotion/occupational health program (HP/OHS) with a standard intervention (HP). Interventions in both studies were based on the same theoretical foundations. Results from process evaluation revealed that a similar number of activities were offered in both conditions and that in the HP/OHS condition there were higher levels of worker participation using three measures: mean participation per activity (HP: 14.2% vs. HP/OHS: 21.2%), mean minutes of worker exposure to the intervention/site (HP: 14.9 vs. HP/OHS: 33.3), and overall mean participation per site (HP: 34.4% vs. HP/ OHS: 45.8%). There were a greater number of contacts with management (HP: 8.8 vs. HP/OHS: 24.9) in the HP/ OHS condition. Addressing occupational health may have contributed to higher levels of worker and management participation and smoking cessation among blue-collar workers.
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Affiliation(s)
- Mary Kay Hunt
- Dana-Farber Cancer Institute, Center for Community Based Research, Boston, MA, USA.
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Scudder MR, Drollette ES, Szabo-Reed AN, Lambourne K, Fenton CI, Donnelly JE, Hillman CH. Tracking the relationship between children's aerobic fitness and cognitive control. Health Psychol 2016; 35:967-78. [PMID: 27089460 DOI: 10.1037/hea0000343] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate if changes in aerobic fitness over a 3-year period are associated with modulations in children's cognitive control. METHOD A sample of 2nd/3rd-grade children (N = 290) completed baseline measures in Fall of 2011, and again in Spring of 2014 at the end of 4th/5th grade. Children completed the Progressive Aerobic Cardiovascular Endurance Run (PACER) test to measure aerobic capacity, a flanker task to evaluate inhibitory control, and an n-back task to assess working memory. Aerobic fitness was included as an independent variable in hierarchical regression analyses conducted at both time points, in addition to analyses examining changes in cognition over time. RESULTS At baseline, higher fit children exhibited shorter overall flanker reaction time (RT), as well as superior accuracy and d' scores (i.e., target discrimination) for both 1- and 2-back conditions. Approximately 3 years later, higher levels of fitness were associated with better performance for only the most difficult conditions of each task, including greater incongruent flanker accuracy and less interference during the compatible condition, as well as better accuracy and target discrimination for the 2-back condition of the n-back task. Importantly, increases in fitness were independently related to improvements in incongruent flanker accuracy and 2-back d' scores. CONCLUSIONS The current findings indicate that both higher aerobic fitness levels as well as increases in children's fitness are associated with better performance for task conditions eliciting greater cognitive demand. Such evidence is vital for implementing future health recommendations intended to foster improved cognitive performance in children. (PsycINFO Database Record
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Affiliation(s)
- Mark R Scudder
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
| | - Eric S Drollette
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
| | - Amanda N Szabo-Reed
- Department of Internal Medicine, Cardiovascular Research Institute, University of Kansas Medical Center
| | - Kate Lambourne
- Department of Health, Sport, and Exercise Sciences, University of Kansas
| | - Cameron I Fenton
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
| | - Joseph E Donnelly
- Department of Internal Medicine, Cardiovascular Research Institute, University of Kansas Medical Center
| | - Charles H Hillman
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign
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Physical activity and academic achievement across the curriculum (A + PAAC): rationale and design of a 3-year, cluster-randomized trial. BMC Public Health 2013; 13:307. [PMID: 23565969 PMCID: PMC3626787 DOI: 10.1186/1471-2458-13-307] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 03/22/2013] [Indexed: 11/12/2022] Open
Abstract
Background Improving academic achievement and reducing the rates of obesity in elementary school students are both of considerable interest. Increased physical activity during academic instruction time during school offers a potential intervention to address both issues. A program titled “Physical Activity Across the Curriculum” (PAAC) was developed in which classroom teachers in 22 elementary schools were trained to deliver academic instruction using physical activity with a primary aim of preventing increased BMI. A secondary analysis of data assessed the impact of PAAC on academic achievement using the Weschler Individual Achievement Test-II and significant improvements were shown for reading, math and spelling in students who participated in PAAC. Based on the results from PAAC, an adequately powered trial will be conducted to assess differences in academic achievement between intervention and control schools called, “Academic Achievement and Physical Activity Across the Curriculum (A + PAAC).” Methods/design Seventeen elementary schools were cluster randomized to A + PAAC or control for a 3-year trial. Classroom teachers were trained to deliver academic instruction through moderate-to-vigorous physical activity with a target of 100+ minutes of A + PAAC activities per week. The primary outcome measure is academic achievement measured by the Weschler Individual Achievement Test-III, which was administered at baseline (Fall 2011) and will be repeated in the spring of each year by assessors blinded to condition. Potential mediators of any association between A + PAAC and academic achievement will be examined on the same schedule and include changes in cognitive function, cardiovascular fitness, daily physical activity, BMI, and attention-to-task. An extensive process analysis will be conducted to document the fidelity of the intervention. School and student recruitment/randomization, teacher training, and baseline testing for A + PAAC have been completed. Nine schools were randomized to the intervention and 8 to control. A random sample of students in each school, stratified by gender and grade (A + PAAC = 370, Control = 317), was selected for outcome assessments from those who provided parental consent/child assent. Baseline data by intervention group are presented. Discussion If successful, the A + PAAC approach could be easily and inexpensively scaled and disseminated across elementary schools to improve both educational quality and health. Funding source: R01- DK85317. Trial registration: US NIH Clinical Trials, http://NCT01699295.
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Lee H, Contento IR, Koch P. Using a systematic conceptual model for a process evaluation of a middle school obesity risk-reduction nutrition curriculum intervention: choice, control & change. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2013; 45:126-136. [PMID: 23321021 PMCID: PMC3595367 DOI: 10.1016/j.jneb.2012.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 06/19/2012] [Accepted: 07/22/2012] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To use and review a conceptual model of process evaluation and to examine the implementation of a nutrition education curriculum, Choice, Control & Change, designed to promote dietary and physical activity behaviors that reduce obesity risk. DESIGN A process evaluation study based on a systematic conceptual model. SETTING Five middle schools in New York City. PARTICIPANTS Five hundred sixty-two students in 20 classes and their science teachers (n = 8). MAIN OUTCOME MEASURES Based on the model, teacher professional development, teacher implementation, and student reception were evaluated. Also measured were teacher characteristics, teachers' curriculum evaluation, and satisfaction with teaching the curriculum. ANALYSIS Descriptive statistics and Spearman ρ correlation for quantitative analysis and content analysis for qualitative data were used. RESULTS Mean score of the teacher professional development evaluation was 4.75 on a 5-point scale. Average teacher implementation rate was 73%, and the student reception rate was 69%. Ongoing teacher support was highly valued by teachers. Teacher satisfaction with teaching the curriculum was highly correlated with student satisfaction (P < .05). Teacher perception of amount of student work was negatively correlated with implementation and with student satisfaction (P < .05). CONCLUSIONS AND IMPLICATIONS Use of a systematic conceptual model and comprehensive process measures improves understanding of the implementation process and helps educators to better implement interventions as designed.
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Affiliation(s)
- Heewon Lee
- Center for Food and Environment, Program in Nutrition, Department of Health and Behavior Studies, Teachers College Columbia University, New York, NY 10027, USA.
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Dobbins M, Husson H, DeCorby K, LaRocca RL. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev 2013; 2013:CD007651. [PMID: 23450577 PMCID: PMC7197501 DOI: 10.1002/14651858.cd007651.pub2] [Citation(s) in RCA: 424] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The World Health Organization (WHO) estimates that 1.9 million deaths worldwide are attributable to physical inactivity and at least 2.6 million deaths are a result of being overweight or obese. In addition, WHO estimates that physical inactivity causes 10% to 16% of cases each of breast cancer, colon, and rectal cancers as well as type 2 diabetes, and 22% of coronary heart disease and the burden of these and other chronic diseases has rapidly increased in recent decades. OBJECTIVES The purpose of this systematic review was to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents. SEARCH METHODS The search strategy included searching several databases to October 2011. In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews. Primary authors of included studies were contacted as needed for additional information. SELECTION CRITERIA To be included, the intervention had to be relevant to public health practice (focused on health promotion activities), not conducted by physicians, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, included all school-attending children, and be implemented for a minimum of 12 weeks. In addition, the review was limited to randomized controlled trials and those that reported on outcomes for children and adolescents (aged 6 to 18 years). Primary outcomes included: rates of moderate to vigorous physical activity during the school day, time engaged in moderate to vigorous physical activity during the school day, and time spent watching television. Secondary outcomes related to physical health status measures including: systolic and diastolic blood pressure, blood cholesterol, body mass index (BMI), maximal oxygen uptake (VO2max), and pulse rate. DATA COLLECTION AND ANALYSIS Standardized tools were used by two independent reviewers to assess each study for relevance and for data extraction. In addition, each study was assessed for risk of bias as specified in the Cochrane Handbook for Systematic Reviews of Interventions. Where discrepancies existed, discussion occurred until consensus was reached. The results were summarized narratively due to wide variations in the populations, interventions evaluated, and outcomes measured. MAIN RESULTS In the original review, 13,841 records were identified and screened, 302 studies were assessed for eligibility, and 26 studies were included in the review. There was some evidence that school-based physical activity interventions had a positive impact on four of the nine outcome measures. Specifically positive effects were observed for duration of physical activity, television viewing, VO2 max, and blood cholesterol. Generally, school-based interventions had little effect on physical activity rates, systolic and diastolic blood pressure, BMI, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity resulted in positive effects.In this update, given the addition of three new inclusion criteria (randomized design, all school-attending children invited to participate, minimum 12-week intervention) 12 of the original 26 studies were excluded. In addition, studies published between July 2007 and October 2011 evaluating the effectiveness of school-based physical interventions were identified and if relevant included. In total an additional 2378 titles were screened of which 285 unique studies were deemed potentially relevant. Of those 30 met all relevance criteria and have been included in this update. This update includes 44 studies and represents complete data for 36,593 study participants. Duration of interventions ranged from 12 weeks to six years.Generally, the majority of studies included in this update, despite being randomized controlled trials, are, at a minimum, at moderate risk of bias. The results therefore must be interpreted with caution. Few changes in outcomes were observed in this update with the exception of blood cholesterol and physical activity rates. For example blood cholesterol was no longer positively impacted upon by school-based physical activity interventions. However, there was some evidence to suggest that school-based physical activity interventions led to an improvement in the proportion of children who engaged in moderate to vigorous physical activity during school hours (odds ratio (OR) 2.74, 95% confidence interval (CI), 2.01 to 3.75). Improvements in physical activity rates were not observed in the original review. Children and adolescents exposed to the intervention also spent more time engaged in moderate to vigorous physical activity (with results across studies ranging from five to 45 min more), spent less time watching television (results range from five to 60 min less per day), and had improved VO2max (results across studies ranged from 1.6 to 3.7 mL/kg per min). However, the overall conclusions of this update do not differ significantly from those reported in the original review. AUTHORS' CONCLUSIONS The evidence suggests the ongoing implementation of school-based physical activity interventions at this time, given the positive effects on behavior and one physical health status measure. However, given these studies are at a minimum of moderate risk of bias, and the magnitude of effect is generally small, these results should be interpreted cautiously. Additional research on the long-term impact of these interventions is needed.
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Coleman KJ. Mobilizing a Low Income Border Community to Address State Mandated Coordinated School Health. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2006.10598873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Karen J. Coleman
- a Graduate School of Public Health , San Diego State University , 5500 Campanile Drive, San Diego , CA , 92182-4162
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15
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Newton RL, Thomson JL, Rau KK, Ragusa SA, Sample AD, Singleton NN, Anton SD, Webber LS, Williamson DA. Psychometric characteristics of process evaluation measures for a rural school-based childhood obesity prevention study: Louisiana Health. Am J Health Promot 2011; 25:417-21. [PMID: 21721969 DOI: 10.4278/ajhp.090914-arb-297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the implementation of intervention components of the Louisiana Health study, which was a multicomponent childhood obesity prevention program conducted in rural schools. DESIGN Content analysis. SETTING Process evaluation assessed implementation in classrooms, gym classes, and cafeterias. SUBJECTS Classroom teachers (n = 232), physical education teachers (n = 53), food service managers (n = 33), and trained observers (n = 9). MEASURES Five process evaluation measures were created: Physical Education Questionnaire (PEQ), Intervention Questionnaire (IQ), Food Service Manager Questionnaire (FSMQ), Classroom Observation (CO), and School Nutrition Environment Observation (SNEO). ANALYSIS Interrater reliability and internal consistency were assessed on all measures. Analysis of variance and χ(2) were used to compare differences across study groups on questionnaires and observations. RESULTS The PEQ and one subscale from the FSMQ were eliminated because their reliability coefficients fell below acceptable standards. The subscale internal consistencies for the IQ, FSMQ, CO, and SNEO (all Cronbach α > .60) were acceptable. CONCLUSIONS After the initial 4 months of intervention, there was evidence that the Louisiana Health intervention was being implemented as it was designed. In summary, four process evaluation measures were found to be sufficiently reliable and valid for assessing the delivery of various aspects of a school-based obesity prevention program. These process measures could be modified to evaluate the delivery of other similar school-based interventions.
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Affiliation(s)
- Robert L Newton
- Pennington Biomedical Research Center, LSU System, Baton Rouge, Louisiana 70808, USA.
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Abstract
Nationally representative surveys of food intake in U.S. children show large increases in snacking between the 1989-91 to 1994-98 and 1994-98 to 2003-06 periods. Childhood snacking trends are moving toward three snacks per day, and more than 27 percent of children's daily calories are coming from snacks. The largest increases have been in salty snacks and candy. Desserts and sweetened beverages remain the major sources of calories from snacks.
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Affiliation(s)
- Carmen Piernas
- Carolina Population Center, University of North Carolina at Chapel Hill, USA
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17
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Serrano E, McFerren M, Lambur M, Ellerbock M, Hosig K, Franz N, Townsend M, Baker S, Muennig P, Davis G. Cost-effectiveness model for youth EFNEP programs: what do we measure and how do we do it? JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2011; 43:295-302. [PMID: 21377936 DOI: 10.1016/j.jneb.2010.03.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 03/24/2010] [Accepted: 03/27/2010] [Indexed: 05/30/2023]
Abstract
The Youth Expanded Food and Nutrition Education Program (EFNEP) is one of the United States Department of Agriculture's hallmark nutrition education programs for limited-resource youth. The objective of this study was to gather opinions from experts in EFNEP and related content areas to identify costs, effects (impacts), and related instruments to develop a cost-effectiveness model (instrument) for youth EFNEP, which does not exist. A cost-effectiveness model determines the economic or financial cost of producing an impact. The findings highlight several challenges in identifying inputs through consensus and provide a roadmap for the creation of a model that can be adopted by state EFNEP coordinators.
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Affiliation(s)
- Elena Serrano
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061-0430, USA.
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18
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Dobbins M, DeCorby K, Robeson P, Husson H, Tirilis D. Cochrane review: School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6-18. ACTA ACUST UNITED AC 2009. [DOI: 10.1002/ebch.461] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Muckelbauer R, Libuda L, Clausen K, Kersting M. Long-term process evaluation of a school-based programme for overweight prevention. Child Care Health Dev 2009; 35:851-7. [PMID: 19702638 DOI: 10.1111/j.1365-2214.2009.00993.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The epidemic increase in childhood overweight demands effective and also feasible prevention programmes. A school-based environmental and educational intervention focusing on the promotion of water consumption was found to be effective for overweight prevention in children. Process evaluation and long-term surveillance are necessary to evaluate the feasibility and sustainability of the intervention programme in a school setting. METHODS Process evaluation was conducted during the intervention period (one school year) and a 19-month follow-up after the intervention trial on the prevention of overweight in 17 elementary schools. Data were collected through measuring the water flow of water fountains installed in schools, and questionnaires and interviews were administered to teachers and headmasters of intervention schools. Main outcomes were implementation of the intervention components, behavioural modification of the children concerning water consumption, and teacher and headmaster attitudes towards the intervention. RESULTS Eleven out of 17 intervention schools maintained the water fountains until 19-month follow-up. The mean water flow of the fountains decreased initially, but remained stable after the during the follow-up period. The implementation rate of the educational units by teachers varied between the units from 13% to 84%. Teachers graded the overall concept of the intervention as good, continuously during the intervention and follow-up period. The majority of teachers organized the water supply of the fountains on the class level during the intervention period but not during the follow-up. CONCLUSIONS The long-term process evaluation showed that the combined educational and environmental intervention has potential for sustained modifications in the beverage consumption habits of children. It also identified barriers and promoting factors of a sustainable and feasible implementation of the preventive programme in a school setting.
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Affiliation(s)
- R Muckelbauer
- Research Institute of Child Nutrition Dortmund, Dortmund, Germany.
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20
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Escoffery C, Glanz K, Hall D, Elliott T. A multi-method process evaluation for a skin cancer prevention diffusion trial. Eval Health Prof 2009; 32:184-203. [PMID: 19448162 DOI: 10.1177/0163278709333154] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes process evaluation methods for the Pool Cool diffusion trial across 4 years. Pool Cool is a skin cancer prevention program that was found to improve behaviors and environments for sun protection at swimming pools in a randomized efficacy trial, which was followed by a national diffusion trial. The process evaluation focus shifted from measuring program satisfaction to assessing widespread program implementation, barriers and facilitators to implementation, and program maintenance and sustainability. Data collection methods include training surveys, database tracking, field coordinator activity logs, e-mails, surveys of parents, lifeguards and pool managers, and process evaluation interviews and site visits. The data revealed high levels of implementation of major program components when disseminated in the diffusion trial, including sun safety lessons, sun safety signs, and sunscreen use. This article describes program features and participant factors that facilitated local implementation, maintenance and sustainability across dispersed pools such as linkage agents, a packaged program, and adaptations of program elements.
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Affiliation(s)
- Cam Escoffery
- Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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21
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MCBRIDE NYANDAT, MDFORD RICHARD, FARRINGDON FIONAH. Alcohol harm reduction education in schools: planning an efficacy study in Australia. Drug Alcohol Rev 2009. [DOI: 10.1080/09595230096183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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22
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Forneris T, Danish SJ, Fries E. How Perceptions of an Intervention Program Affect Outcomes. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2009. [DOI: 10.1080/10474410902888673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Glanz K. Measuring food environments: a historical perspective. Am J Prev Med 2009; 36:S93-8. [PMID: 19285215 DOI: 10.1016/j.amepre.2009.01.010] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 12/08/2008] [Accepted: 01/06/2009] [Indexed: 10/21/2022]
Abstract
Food and nutrition environments are believed to contribute to obesity and chronic diseases. There is a need for valid, reliable measures of nutrition environments. Familiarity with previous efforts to measure food and nutrition environments can help researchers and practitioners build on past accomplishments. This article describes sources of food-environment data, discusses how they have been used, and places the definition and measurement of food and nutrition environments in historical context. Review articles, agency websites, and peer-reviewed articles were the main sources of information. The review is organized around three main types of data sources identified as historic traditions: government, industry, and research. Types of data include archives, business monitoring records, surveys, observational assessments, and self-report surveys. Future development of clear, adaptable measures of food and nutrition environments will build on lessons of the past and will update and improve on past tools.
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Affiliation(s)
- Karen Glanz
- Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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24
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Dobbins M, De Corby K, Robeson P, Husson H, Tirilis D. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6-18. Cochrane Database Syst Rev 2009:CD007651. [PMID: 19160341 DOI: 10.1002/14651858.cd007651] [Citation(s) in RCA: 207] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The World Health Organization estimates that 1.9 million deaths worldwide are attributable to physical inactivity. Chronic diseases associated with physical inactivity include cancer, diabetes and coronary heart disease. OBJECTIVES The purpose of this systematic review is to summarize the evidence of the effectiveness of school-based interventions in promoting physical activity and fitness in children and adolescents. SEARCH STRATEGY The search strategy included searching several databases. In addition, reference lists of included articles and background papers were reviewed for potentially relevant studies, as well as references from relevant Cochrane reviews. Primary authors of included studies were contacted as needed for additional information. SELECTION CRITERIA To be included, the intervention had to be relevant to public health practice, implemented, facilitated, or promoted by staff in local public health units, implemented in a school setting and aimed at increasing physical activity, report on outcomes for children and adolescents (aged 6 to 18 years), and use a prospective design with a control group. DATA COLLECTION AND ANALYSIS Standardized tools were used by two independent reviewers to rate each study's methodological quality and for data extraction. Where discrepancies existed discussion occurred until consensus was reached. The results were summarized narratively due to wide variations in the populations, interventions evaluated and outcomes measured. MAIN RESULTS 13,841 titles were identified and screened and 482 articles were retrieved. Multiple publications on the same project were combined and counted as one project, resulting in 395 distinct project accounts (studies). Of the 395 studies 104 were deemed relevant and of those, four were assessed as having strong methodological quality, 22 were of moderate quality and 78 were considered weak. In total 26 studies were included in the review. There is good evidence that school-based physical activity interventions have a positive impact on four of the nine outcome measures. Specifically positive effects were observed for duration of physical activity, television viewing, VO2 max, and blood cholesterol. Generally school-based interventions had no effect on leisure time physical activity rates, systolic and diastolic blood pressure, body mass index, and pulse rate. At a minimum, a combination of printed educational materials and changes to the school curriculum that promote physical activity result in positive effects. AUTHORS' CONCLUSIONS Given that there are no harmful effects and that there is some evidence of positive effects on lifestyle behaviours and physical health status measures, ongoing physical activity promotion in schools is recommended at this time.
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Affiliation(s)
- Maureen Dobbins
- School of Nursing, McMaster University, Rm 3N25G, 1200 Main Street West, Hamilton, Ontario, Canada, L8N 3Z5.
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25
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Jones RA, Warren JM, Okely AD, Collins CE, Morgan PJ, Cliff DP, Burrows T, Cleary J, Baur LA. Process Evaluation of the Hunter Illawarra Kids Challenge Using Parent Support Study: A Multisite Randomized Controlled Trial for the Management of Child Obesity. Health Promot Pract 2009; 11:917-27. [DOI: 10.1177/1524839908328994] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purposes of this article are to (a) outline findings from secondary or process outcome data of the Hunter Illawarra Kids Challenge Using Parent Support (HIKCUPS) study and (b) inform the design and development of future research interventions and practice in the management of child obesity. Data were collected by means of facilitator evaluations, independent session observation, attendance records, and parent questionnaires. Internal validity and reliability of the program delivery were high. All parents reported positive changes in their children as a result of the physical activity program, the dietary modification program, or both. Most participants completed the home activities, but more than half reported that finding time to do them was problematic. Facilitator review indicated that future programs should specifically cater to children of similar age or same sex, allow adequate time for explanation of complex nutritional concepts, and use intrinsic motivators for participants. Recommendations for future interventions, specifically the implementation of subsequent HIKCUPS or other multisite effectiveness studies, are detailed.
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Affiliation(s)
- Rachel A. Jones
- Child Obesity Research Centre, Faculty of Education, University of Wollongong, in Wollongong, New South Wales (NSW), Australia,
| | - Janet M. Warren
- School of Health Sciences, Faculty of Health, University of Newcastle, in Newcastle, NSW, Australia
| | - Anthony D. Okely
- Child Obesity Research Centre, Faculty of Education, University of Wollongong, in Wollongong, NSW, Australia
| | - Clare E. Collins
- School of Health Sciences, Faculty of Health, University of Newcastle, in Newcastle, NSW, Australia
| | - Philip J. Morgan
- Faculty of Education and Arts, University of Newcastle, in Newcastle, NSW, Australia
| | - Dylan P. Cliff
- Child Obesity Research Centre, Faculty of Education, University of Wollongong, in Wollongong, NSW, Australia
| | - Tracy Burrows
- School of Health Sciences, Faculty of Health, University of Newcastle, in Newcastle, NSW, Australia
| | - Jane Cleary
- Department of Clinical Nutrition, Wollongong Hospital, in Wollongong, NSW, Australia
| | - Louise A. Baur
- Discipline of Paediatrics and Child Health Sydney, the Children's Hospital at Westmead, Sydney, Australia
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26
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Gibson CA, Smith BK, Dubose KD, Greene JL, Bailey BW, Williams SL, Ryan JJ, Schmelzle KH, Washburn RA, Sullivan DK, Mayo MS, Donnelly JE. Physical activity across the curriculum: year one process evaluation results. Int J Behav Nutr Phys Act 2008; 5:36. [PMID: 18606013 PMCID: PMC2474855 DOI: 10.1186/1479-5868-5-36] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Accepted: 07/07/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical Activity Across the Curriculum (PAAC) is a 3-year elementary school-based intervention to determine if increased amounts of moderate intensity physical activity performed in the classroom will diminish gains in body mass index (BMI). It is a cluster-randomized, controlled trial, involving 4905 children (2505 intervention, 2400 control). METHODS We collected both qualitative and quantitative process evaluation data from 24 schools (14 intervention and 10 control), which included tracking teacher training issues, challenges and barriers to effective implementation of PAAC lessons, initial and continual use of program specified activities, and potential competing factors, which might contaminate or lessen program effects. RESULTS Overall teacher attendance at training sessions showed exceptional reach. Teachers incorporated active lessons on most days, resulting in significantly greater student physical activity levels compared to controls (p < 0.0001). Enjoyment ratings for classroom-based lessons were also higher for intervention students. Competing factors, which might influence program results, were not carried out at intervention or control schools or were judged to be minimal. CONCLUSION In the first year of the PAAC intervention, process evaluation results were instrumental in identifying successes and challenges faced by teachers when trying to modify existing academic lessons to incorporate physical activity.
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Affiliation(s)
- Cheryl A Gibson
- Department of Internal Medicine, University of Kansas School of Medicine, 3901 Rainbow Blvd,, Mail Stop 1020, Kansas City, KS, 66160, USA.
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27
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Christopher S, Dunnagan T, Haynes G, Stiff L. Determining client need in a multi-state fetal alcohol syndrome consortium: from training to practice. Behav Brain Funct 2007; 3:10. [PMID: 17302985 PMCID: PMC1803792 DOI: 10.1186/1744-9081-3-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Accepted: 02/15/2007] [Indexed: 11/15/2022] Open
Abstract
Background A multi-state consortium was developed in the US to conduct baseline data collection and intervention research on fetal alcohol syndrome. Each state employed support specialists whose job it was to reduce or eliminate alcohol consumption in women who were at high risk for drinking alcohol during their pregnancy. The purpose of this paper is to report how support specialists in three primarily rural/frontier states were trained to assess client need and how client need was actually assessed in the field. Methods A qualitative process evaluation was conducted using semi-structured interviews. Interviews were conducted with state staff involved in support specialist training and consortium activities and the support specialists themselves. Inductive analyses were conducted with interview data. Results Need determination varied by state and for one state within the state. How support specialists were trained to assess need and how need was assessed in the field was mostly congruent. Conclusion Process evaluation is an effective method for providing practical and useful answers to questions that cannot be answered by outcome evaluation alone.
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Affiliation(s)
- Suzanne Christopher
- Department of Health and Human Development, Herrick Hall, Montana State University, Bozeman, MT 59717, USA
| | - Tim Dunnagan
- Department of Health and Human Development, Herrick Hall, Montana State University, Bozeman, MT 59717, USA
| | - George Haynes
- Department of Health and Human Development, Herrick Hall, Montana State University, Bozeman, MT 59717, USA
| | - Lili Stiff
- Department of Health and Human Development, Haley Road, Bozeman, MT 59715, USA
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Maiorana A, Kegeles S, Fernandez P, Salazar X, Cáceres C, Sandoval C, Rosasco AM, Coates T. Implementation and evaluation of an HIV/STD intervention in Peru. EVALUATION AND PROGRAM PLANNING 2007; 30:82-93. [PMID: 17689315 PMCID: PMC2739095 DOI: 10.1016/j.evalprogplan.2006.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This paper presents the lessons learned through a process evaluation (PE) after 1 year of implementation of a 2-year community intervention in Lima, Peru. The intervention consisted of training and motivating community popular opinion leaders (CPOLs) for three marginal population segments to disseminate prevention messages among their peers. PE data included: observations, qualitative interviews with CPOLS, conversations and messages delivered by CPOLs, training facilitators' perceptions about implementation, and a survey of CPOLs. The PE helped to document and enhance the intervention. CPOLs were motivated to talk to their peers. CPOLs perceived that their participation had an effect on their own risk behaviors and saw their role as beneficial to their community. The PE was helpful in examining training delivery and the feasibility and acceptability of the intervention in order to assess the elements related to program success necessary to replicate the CPOL model.
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Affiliation(s)
- Andre Maiorana
- Center for AIDS Prevention Studies, University of California, San Francisco, 50 Beale Street, suite 1300, San Francisco, CA 94105, USA.
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Saunders RP, Ward D, Felton GM, Dowda M, Pate RR. Examining the link between program implementation and behavior outcomes in the lifestyle education for activity program (LEAP). EVALUATION AND PROGRAM PLANNING 2006; 29:352-364. [PMID: 17950863 DOI: 10.1016/j.evalprogplan.2006.08.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Lifestyle Education for Activity Program (LEAP) was a comprehensive, school-based intervention designed to promote physical activity in high school girls. The intervention focused on changes in instructional practices and the school environment to affect personal, social, and environmental factors related to physical activity. Multiple process evaluation tools and an organizational assessment tool were developed to monitor program implementation from a framework called the LEAP essential elements, which characterized complete and acceptable intervention delivery; secular trends were also monitored. Using process data, LEAP intervention schools were categorized into low- and high-implementing groups and compared with control schools on nine essential elements assessed at the organizational level. The Wilcoxon scores test revealed that low- and high-implementing intervention, and control schools differed significantly on two of nine administrator-reported organizational-level components: having a physical activity team and having a faculty-staff health promotion program. A mixed-model analysis of covariance indicated that, compared to control schools, a greater percentage of girls in high-implementing schools reported engaging in vigorous physical activity. Process evaluation can be used to understand the relationship between level of implementation and successful program outcome.
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Affiliation(s)
- Ruth P Saunders
- Department of Health Education, Promotion, and Behavior; Arnold School of Public Health, University of South Carolina, c/o Room 216D, Columbia, SC 29208, USA
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Hunt MK, Barbeau EM, Lederman R, Stoddard AM, Chetkovich C, Goldman R, Wallace L, Sorensen G. Process evaluation results from the Healthy Directions-Small Business study. HEALTH EDUCATION & BEHAVIOR 2006; 34:90-107. [PMID: 16740502 DOI: 10.1177/1090198105277971] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Healthy Directions-Small Business randomized, controlled study aimed to reduce cancer risk among multiethnic workers in small manufacturing businesses by increasing fruit and vegetable consumption, physical activity, and daily multivitamin in take and decreasing consumption of red meat. The intervention incorporated participatory strategies and was built on a social-contextual framework that addressed people with varying cultural backgrounds and literacy levels. In addition, the intervention aimed to reduce worker exposure to occupational hazards. Process evaluation was conducted using quantitative and qualitative research methods. Quantitative results showed high levels of worker awareness of and participation in programs. Qualitative findings suggested that management support, worker input, and a history of social interaction between workers and management may have contributed to high participation rates. Future studies need to examine characteristics associated with participation and nonparticipation of both managers and nonmanagers to increase the likelihood of participation and ultimately improve health behavior.
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Affiliation(s)
- Mary K Hunt
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
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Curran S, Gittelsohn J, Anliker J, Ethelbah B, Blake K, Sharma S, Caballero B. Process evaluation of a store-based environmental obesity intervention on two American Indian Reservations. HEALTH EDUCATION RESEARCH 2005; 20:719-29. [PMID: 15872001 DOI: 10.1093/her/cyh032] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Obesity and other diet-related chronic diseases are widespread in American Indian communities. Inadequate access to healthy food on many reservations has led to a high-fat, high-sugar diet. The purpose of this paper is to report on the results of the process evaluation of a food store-based program to improve diet on two American Indian reservations. Process data were collected from 11 intervention stores to document the implementation of the Apache Healthy Stores (AHS) program. Process evaluation instruments recorded the stocking of promoted foods, presence of in-store communication materials, implementation of and participation in the cooking demonstrations and taste tests, and the transmission of mass-media messages. At the store level, the program was implemented with a high level of dose and reach, and a moderate to high level of fidelity. At the community level, the AHS program was implemented with a moderate degree of fidelity and dose. At the individual level, the cooking demonstrations and taste tests reached a large number of community members with a high dose. Implementing the AHS program on multiple levels (store, community, individual) was challenging, and differed between levels. Overall, improvements were seen from start to finish as program staff monitored, documented and responded to barriers to implementation. Process data will be tied to outcomes and will be useful for the planning of future store-based programs.
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Affiliation(s)
- Sarah Curran
- Center for Human Nutrition, Johns Hopkins University, Bloomberg School of Public Health, Cambridge, MA 02138, USA.
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Saunders RP, Evans MH, Joshi P. Developing a process-evaluation plan for assessing health promotion program implementation: a how-to guide. Health Promot Pract 2005; 6:134-47. [PMID: 15855283 DOI: 10.1177/1524839904273387] [Citation(s) in RCA: 589] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Process evaluation is used to monitor and document program implementation and can aid in understanding the relationship between specific program elements and program outcomes. The scope and implementation of process evaluation has grown in complexity as its importance and utility have become more widely recognized. Several practical frameworks and models are available to practitioners to guide the development of a comprehensive evaluation plan, including process evaluation for collaborative community initiatives. However, frameworks for developing a comprehensive process-evaluation plan for targeted programs are less common. Building from previous frameworks, the authors present a comprehensive and systematic approach for developing a process-evaluation plan to assess the implementation of a targeted health promotion intervention. Suggested elements for process-evaluation plans include fidelity, dose (delivered and received), reach, recruitment, and context. The purpose of this article is to describe and illustrate the steps involved in developing a process evaluation plan for any health promotion program.
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Affiliation(s)
- Ruth P Saunders
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina 29208, USA.
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Schwimmer JB, McGreal N, Deutsch R, Finegold MJ, Lavine JE. Influence of gender, race, and ethnicity on suspected fatty liver in obese adolescents. Pediatrics 2005; 115:e561-5. [PMID: 15867021 DOI: 10.1542/peds.2004-1832] [Citation(s) in RCA: 260] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Fatty liver is a common cause of liver disease in children. However, the epidemiology of pediatric fatty liver is limited to single-center case series of nonalcoholic fatty liver disease (NAFLD). Obesity and insulin resistance are major established risk factors for NAFLD. The role of gender, race, and ethnicity on the prevalence of fatty liver in obese children is unknown. METHODS We recruited obese 12th-grade participants from the Child and Adolescent Trial for Cardiovascular Health in California, Louisiana, Minnesota, and Texas. Serum samples were collected at school when the participants were well. Alanine aminotransferase (ALT) was measured by kinetic enzymatic assay, and ALT >40 U/L was defined as abnormal. Causes of abnormal ALT other than NAFLD were excluded by serum testing. RESULTS A total of 127 obese students (73 female, 54 male) had a mean BMI of 35.2 kg/m2. Unexplained ALT elevation was present in 23% of participants overall. The mean ALT for participants with normal values was 28 U/L and for participants with an abnormal ALT was 56 U/L. Abnormal ALT was significantly more prevalent in boys (44%) than in girls (7%). The prevalence of abnormal ALT differed significantly by race and ethnicity (Hispanic: 36%; white: 22%; black: 14%). Serum ALT value was significantly predicted by the combination of gender, race/ethnicity, and BMI. After controlling for gender and BMI, Hispanic ethnicity significantly predicted greater ALT than black race. CONCLUSIONS In a national, school-based sample of obese adolescents, boys were 6 times more likely than girls to have an unexplained elevated ALT. Given that participants were well and causes of chronic liver disease were excluded, we speculate that obese adolescent boys have an increased prevalence of fatty liver compared with obese adolescent girls. This population-based study also supports the hypothesis that NAFLD is more common in Hispanic adolescents. These findings have implications for both disease screening and studies of fatty liver pathophysiology.
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Affiliation(s)
- Jeffrey B Schwimmer
- Division of Gastroenterology, Hepatology, and Nutrition, University of California, 200 W Arbor Dr, San Diego, CA 92103-8450, USA.
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Feasibility of implementing intervention methods in an adolescent worksite tobacco control study. Tob Control 2005; 12 Suppl 4:IV40-5. [PMID: 14645939 DOI: 10.1136/tc.12.suppl_4.iv40] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To present feasibility data on SMART, the first teen worksite behavioural tobacco control intervention. DESIGN This phase II study was designed to estimate the efficacy and feasibility of a small scale, randomised, controlled intervention. SETTING AND SUBJECTS This study, addressing youths aged 15-18 years, was implemented in four intervention and five control grocery stores that had an average of 44 eligible teens. INTERVENTIONS The tobacco use cessation and prevention interventions were based on social influences and peer leader models. Employee break rooms served as centres both for interactive activities including open houses, teen advisory boards, peer leader interviews, games and contests; and non-interactive interventions including bulletin boards and table tents with health messages and home mailings. MAIN PROCESS MEASURES: Project staff collected process data on the extent of implementation of intervention activities, participation rates in activities, and contacts with peer leaders. On the final survey, teens reported on awareness of, participation in, and motivation for participating in project activities. RESULTS Indicators of feasibility were identified and discussed, including the number of activities implemented, teen participation, management support, cost, and barriers to and facilitators of implementation. During the 12 month intervention, a mean of 24.1 interactive activities and 55.3 non-interactive activities were implemented, and a mean 14.2% participation rate per activity per site was achieved. Eighty four per cent of teens reported being aware of SMART, and 39% reported participating in interactive and 67% in non-interactive activities. CONCLUSIONS Teen smoking cessation rates in worksite programmes might be improved if they are conducted in companies where there is job stability and if teen programmes are part of worksite-wide tobacco control programmes that include both teens and adults.
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Charlebois P, Brendgen M, Vitaro F, Normandeau S, Boudreau JF. Examining dosage effects on prevention outcomes: Results from a multi-modal longitudinal preventive intervention for young disruptive boys. J Sch Psychol 2004. [DOI: 10.1016/j.jsp.2003.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Escoffery C, McCormick L, Bateman K. Development and process evaluation of a web-based smoking cessation program for college smokers: innovative tool for education. PATIENT EDUCATION AND COUNSELING 2004; 53:217-225. [PMID: 15140462 DOI: 10.1016/s0738-3991(03)00163-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2002] [Revised: 04/23/2003] [Accepted: 05/05/2003] [Indexed: 05/24/2023]
Abstract
Smoking cessation interventions are needed for young adults. Innovative approaches to behavior change for this population should be tested. Formative research and process evaluation of those approaches would result in more effective programs. This paper presents the development process and process evaluation of a web-based smoking cessation program. A description of the stages of development is presented with formative research, development of the web-based intervention, formative evaluation, and process evaluation. The smokers reported high usage of the intervention and satisfaction with the intervention in that it helped to raise their consciousness about quitting, encouraged them to set behavioral goals, provided stages of change feedback, and offered interactivity in presenting information and strategies about quitting. The Internet may be a promising tool for patient education according to the process results.
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Affiliation(s)
- Cam Escoffery
- Rollins School of Public Health, Emory University, 1525 Clifton Road, Room 105, Atlanta, GA 30322, USA.
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Dunnagan T, Haynes G, Christopher S, Leonardson G. Formative evaluation of a multisite alcohol consumption intervention in pregnant women. Neurotoxicol Teratol 2004; 25:745-55. [PMID: 14624975 DOI: 10.1016/j.ntt.2003.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this preliminary study was to conduct an analysis of the time spent in intervention activities designed to decrease alcohol consumption in high-risk pregnant women across three States. Based on the program's logic model an intervention dosage form was developed specifically for the process evaluation. The form enabled the researchers to generate six client measures of intervention dosage. Descriptive statistics of time spent in various intervention domains were generated for the three states. Also, logistic regression and Tobit estimations were used to see if at risk clients received more intervention dosage than their no risk counterparts. The data were collected on 109 pregnant women who had been involved with the intervention for 6 months or less. The results revealed dramatic differences in the amount of dosage given to clients across the three states in categories such as average time spent with each client and the distribution of time across the logic model domains. The detailed information generated through the analysis allowed the consortium members to identify how much and what type of intervention was being given to clients in the multisite FAS intervention. A number of important questions were generated that will be used to promote dialogue and discussion among the consortium members. Through this interaction it is hoped that the consortium members will be able to enhance the quality and effectiveness of the program's intervention.
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Affiliation(s)
- Tim Dunnagan
- Department of Health and Human Development, 105 Hosaeus Complex, Bozeman, MT 59717-3360, USA.
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Steckler A, Ethelbah B, Martin CJ, Stewart D, Pardilla M, Gittelsohn J, Stone E, Fenn D, Smyth M, Vu M. Pathways process evaluation results: a school-based prevention trial to promote healthful diet and physical activity in American Indian third, fourth, and fifth grade students. Prev Med 2003; 37:S80-90. [PMID: 14636812 DOI: 10.1016/j.ypmed.2003.08.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pathways was a large-scale, multisite, 3-year, study testing a school-based intervention designed to lower percent body fat in American Indian children. METHODS At the 21 intervention schools process evaluation data were collected for training of school personnel; implementation of the classroom and physical activity curricula; implementation of the project's food service guidelines in the school cafeterias; adult participation in the family events; and, students' perceived exposure to the Pathways interventions. RESULTS Students received about 93% of the classroom curriculum lessons. The minimum requirement of physical education being taught three times per week for at least 30 minutes duration was achieved by the fifth grade. The implementation of the food service behavioral guidelines increased from 51% in the third grade to 87% in the fifth grade. The family events had lower than anticipated adult participation. The participation rates were 45% during the third grade, and 41 and 63% during the fourth and fifth grades, respectively. There was a significant difference between intervention and control students' perceived exposure to Pathways type interventions. CONCLUSION The Pathways interventions were successfully implemented with good reach, high extent, and fidelity.
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Affiliation(s)
- Allan Steckler
- Department of Health Behavior and Health Education, School of Public Health, University of North Carolina, Chapel Hill, NC 27514, USA.
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Brener ND, Kann L, Smith TK. Reliability and validity of the School Health Policies and Programs Study 2000 questionnaires. THE JOURNAL OF SCHOOL HEALTH 2003; 73:29-37. [PMID: 12621721 DOI: 10.1111/j.1746-1561.2003.tb06556.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
To help assess the quality of the questionnaires developed for the School Health Policies and Programs Study (SHPPS) 2000, the Centers for Disease Control and Prevention (CDC) conducted a data quality substudy in conjunction with SHPPS 2000. The substudy assessed validity of the state- and district-level questionnaires through telephone interviews with a subsample of the original state- and district-level respondents, and the test-retest reliability of the school- and classroom-level questionnaires through computer-assisted repeat interviews with a subsample of the school- and classroom-level respondents. Results indicated that although a few threats to the validity of responses to the state- and district-level questionnaires were identified, the questionnaires generally produced valid data. Among the school- and classroom-level questionnaires, some questions demonstrated poor reliability, but most exhibited moderate or substantial reliability, and some exhibited almost perfect reliability. CDC will use these results to revise the SHPPS 2000 questionnaires and will consider alternative methods of data collection to improve the quality of data collected in future versions of SHPPS.
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Affiliation(s)
- Nancy D Brener
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, MS K-33, 4770 Buford Highway, NE, Atlanta, GA 30341, USA.
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Bauman AE, Sallis JF, Dzewaltowski DA, Owen N. Toward a better understanding of the influences on physical activity: the role of determinants, correlates, causal variables, mediators, moderators, and confounders. Am J Prev Med 2002; 23:5-14. [PMID: 12133733 DOI: 10.1016/s0749-3797(02)00469-5] [Citation(s) in RCA: 508] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND For research on physical activity interventions to progress systematically, the mechanisms of action must be studied. In doing so, the research methods and their associated concepts and terminology become more complex. It is particularly important to clearly distinguish among determinants, correlates, mediators, moderators, and confounder variables used in physical activity research. This article examines the factors that are correlated with and that may have a causal relationship to physical activity. METHODS AND RESULTS We propose that the term "correlate" be used, instead of "determinant," to describe statistical associations or correlations between measured variables and physical activity. Studies of the correlates of physical activity are reviewed. The findings of these studies can help to critique existing theories of health behavior change and can provide hypotheses to be tested in intervention studies from which it is possible to draw causal inferences. Mediator, moderator, and confounder variables can act to influence measured changes in physical activity. Intervening causal variables that are necessary to complete a cause-effect pathway between an intervention and physical activity are termed "mediators." The relationship between an intervention and physical activity behaviors may vary for different groups; the strata by which they vary are levels of "moderators" of the relationship. Other factors may distort or affect the observed relationships between program exposure and physical activity, and are known as "confounders." CONCLUSIONS Consistent use of terms and additional research on mediators and moderators of intervention effects will improve our ability to understand and influence physical activity.
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Affiliation(s)
- Adrian E Bauman
- School of Community Medicine and Public Health, University of New South Wales, Sydney, Australia.
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Heath EM, Coleman KJ. Evaluation of the institutionalization of the coordinated approach to child health (CATCH) in a U.S./Mexico border community. HEALTH EDUCATION & BEHAVIOR 2002; 29:444-60. [PMID: 12137238 DOI: 10.1177/109019810202900405] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
El Paso Coordinated Approach to Child Health (El Paso CATCH) was evaluated in 24 schools for outcome measures of moderate to vigorous physical activity (MVPA) during physical education (PE), content of PE lessons, content of school meals, and numerous process measures. Chi-square analyses compared frequency data across time for activity during PE and percentage fat in school meals. Descriptive summaries were used for process questionnaire results. Data were also compared to CATCH program goals. For most intervention schools, El Paso CATCH significantly increased MVPA, decreased fat in school meals, and decreased sodium in school breakfasts. However, some schools were not meeting the fat content goals for school lunches, and no schools met the vigorous physical activity (VPA) goals for PE or the sodium goals for school lunches.
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Affiliation(s)
- Edward M Heath
- Department of Health, Physical Education, & Recreation, Utah State University, Logan, USA
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Nicklas TA, Dwyer J, Feldman HA, Luepker RV, Kelder SH, Nader PR. Serum cholesterol levels in children are associated with dietary fat and fatty acid intake. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2002; 102:511-7. [PMID: 11985407 DOI: 10.1016/s0002-8223(02)90117-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent studies in adults suggest that individual dietary fatty acids differ markedly in their effects on serum lipids and lipoprotein levels. However, these associations have rarely been studied in children. OBJECTIVE To assess, using regression procedures, the associations in children between specific fatty acids and nonfasting serum lipids and cholesterol after controlling for total energy and total fat intake, SUBJECTS The sample consisted of 1,182 children who participated in the Child and Adolescent Trial for Cardiovascular Health. The sample was equally distributed across 4 sites (Louisiana, Texas, Minnesota, California). The sample was 48% boys; 71% white, 15% Hispanic-American, 10% African-American, 2% Asian, and 2% from other or unspecified racial/ethnic heritage. DESIGN In this randomized multicenter trial with 56 intervention and 40 control elementary schools, food record-assisted 24-hour dietary recalls and serum lipid measurements were collected for each child at baseline (3rd grade) and at the 5th grade follow-up. STATISTICAL ANALYSES Repeated-measures analysis of variance was used to evaluate the association between nutrient composition of the diet and serum lipids. Independent dietary variables included amount and type of fat, individual fatty acids, protein, carbohydrate, and fiber. The dependent variables were the absolute values of serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) both at baseline (3rd grade) and at follow-up (5th grade). RESULTS Increased total fat (b=0.053; P<.03) was associated with increased TC in the model when energy was held constant, whereas increased carbohydrate was associated with decreased TC (b=-0.021, P<.02) and HDL-C (b=-0.010, P<.005) levels. Increased total protein (b=0.017, P<.05) was associated with increased HDL-C when energy was held constant. Saturated fat (b=0.004, P<.04), unsaturated fat (b=0.004, P<.03), and myristic fatty acid (b=0.021, P<.01) all increased TC in the model when total fat and total energy were held constant. CONCLUSIONS/APPLICATIONS We conclude that using a modeling approach, the effect of diet on serum lipids in children is similar to that observed in adults. Total fat and saturated fat were positively associated with TC and HDLC levels, saturated fat was positively associated with TC, and carbohydrate was inversely associated with both TC and HDL-C. In the statistical model, substitution of unsaturated fatty acids, monounsaturated fatty acids, or oleic acid for saturated fat, while holding total fat and energy constant, slightly lowered TC. In contrast, substitution of total fat for carbohydrate in the model increased TC and, thus, did not seem to be associated with an apparent health advantage except for HDL-C elevating effects. However, consumption of individual fats tends to be highly correlated, and we were unable to determine if these biological effects were operating independently.
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Affiliation(s)
- Theresa A Nicklas
- Baylor College of Medicine, Children's Nutrition Research Center, Department of Pediatrics, Houston, Texas 77030, USA
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Levine E, Olander C, Lefebvre C, Cusick P, Biesiadecki L, McGoldrick D. The Team Nutrition pilot study: lessons learned from implementing a comprehensive school-based intervention. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2002; 34:109-116. [PMID: 12047818 DOI: 10.1016/s1499-4046(06)60076-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Team Nutrition (TN) is an educational and promotional initiative developed by the US Department of Agriculture to change children's eating behaviors through social marketing techniques. This article reports on the process evaluation of a TN pilot project targeting students in kindergarten to grade 4 and systematically documents the implementation experience. Even with a very short start-up period, schools implemented most components of this multichannel nutrition intervention and formed new, supportive relationships with local media and community partners. School teachers and administrators, along with foodservice professionals, generally expressed support for and satisfaction with TN, citing the positive experience and gains for students. The lessons learned from this study highlight the management and organizational issues involved in a comprehensive intervention. These include the importance of local coordinators to support and create a bridge between teachers and cafeteria staff and to forge links with key external partners. To function effectively, coordinators themselves may need training in coalition building and working with media. Relationships formed with parents, local businesses, other educational institutions, health organizations, and the media offer promise for helping to sustain nutrition education efforts. The TN process evaluation identified multiple ideas for pursuing these partnerships more successfully.
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Affiliation(s)
- Elyse Levine
- Prospect Associates, Silver Spring, Maryland 20901, USA
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Hoelscher DM, Evans A, Parcel GS, Kelder SH. Designing effective nutrition interventions for adolescents. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2002; 102:S52-63. [PMID: 11902389 DOI: 10.1016/s0002-8223(02)90422-0] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
By altering dietary behaviors, nutrition interventions during adolescence have the potential of affecting children at that time and later in life. The majority of interventions implemented in the teen years have occurred in schools, but other intervention sites have included after-school programs, summer camps, community centers, libraries, and grocery stores. Programs with successful outcomes have tended to be behaviorally based, using theories for the developmental framework; included an environmental component; delivered an adequate number of lessons; and emphasized developmentally appropriate strategies. One planning method that can be used in the development of nutrition interventions is Intervention Mapping. The steps of Intervention Mapping include conducting a needs assessment, developing proximal program objectives, mapping appropriate strategies and methods to address the objectives, planning the program design, planning program adoption and implementation, and evaluation. The use of intervention-planning techniques, coordination of nutrition and physical education interventions, using technological advances such as CD-ROMs, incorporation of policy changes into intervention efforts, and dissemination of effective programs are all trends that will influence the future development of effective nutrition programs for adolescents.
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Affiliation(s)
- Deanna M Hoelscher
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, 77030, USA
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Gill S, Greenberg MT, Vazquez A. Changes in the service delivery model and home visitors' job satisfaction and turnover in an Early Head Start program. Infant Ment Health J 2002. [DOI: 10.1002/imhj.10011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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McKenzie TL, Stone EJ, Feldman HA, Epping JN, Yang M, Strikmiller PK, Lytle LA, Parcel GS. Effects of the CATCH physical education intervention: teacher type and lesson location. Am J Prev Med 2001; 21:101-9. [PMID: 11457629 DOI: 10.1016/s0749-3797(01)00335-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Substantial differences exist in how and where physical education (PE) is conducted in elementary schools throughout the United States. Few effectiveness studies of large-scale interventions to improve PE have been reported. DESIGN Multicenter randomized trial. SETTING/ PARTICIPANTS The Child and Adolescent Trial for Cardiovascular Health (CATCH) was implemented in PE classes in 96 schools (56 intervention, 40 control) in four study centers: California, Louisiana, Minnesota, and Texas. INTERVENTION The 2.5-year PE intervention consisted of professional development sessions, curricula, and follow-up consultations. MAIN OUTCOME MEASURES Intervention effects on student physical activity and lesson context in PE were examined by teacher type (PE specialists and classroom teachers) and lesson location (indoors and outdoors). RESULTS Differential effects by teacher type and lesson location were evidenced for both physical activity and lesson context. Observations of 2016 lessons showed that intervention schools provided more moderate-to-vigorous physical activity (p=0.002) and vigorous physical activity (p=0.02) than controls. Classroom teachers improved physical activity relatively more than PE specialists, but PE specialists still provided longer lessons and more physical activity. Classroom teachers increased lesson length (p=0.02) and time for physical fitness (p=0.03). CONCLUSIONS The intervention improved PE of both specialists' and classroom teachers' lessons. States and districts should ensure that the most qualified staff teaches PE. Interventions need to be tailored to meet local needs and conditions, including teacher type and location of lessons.
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Affiliation(s)
- T L McKenzie
- Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, California 92182, USA.
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Nicklas TA, O'Neil CE. Process of conducting a 5-a-day intervention with high school students: Gimme 5 (Louisiana). HEALTH EDUCATION & BEHAVIOR 2000; 27:201-12. [PMID: 10768801 DOI: 10.1177/109019810002700206] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gimme 5: A Fresh Nutrition Concept for Students (Gimme 5) was a 4-year intervention targeting increased fruit and vegetable consumption by high school students. Twelve schools were randomized to intervention or control conditions. The cohort (2,213 students; 56% female, 84% Euro-American) were followed from 9th to 12th grade. Interventions were composed of a school-based media campaign, classroom workshops, school meal modification, and parental involvement. For each of the four Gimme 5 intervention components, process evaluation measures were developed to assess program dose, penetration, and utilization, as well as external competing factors. Process evaluation results are presented to illustrate the various functions of process evaluation data. These include, but are not limited to, describing program implementation, quality control and monitoring, and explaining study outcomes. The implementation of process evaluation systems to complement the outcome measures in a high school-based intervention provides useful strategies for a more comprehensive approach to program evaluation.
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Affiliation(s)
- T A Nicklas
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030, USA.
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Helitzer D, Yoon SJ, Wallerstein N, Dow y Garcia-Velarde L. The role of process evaluation in the training of facilitators for an adolescent health education program. THE JOURNAL OF SCHOOL HEALTH 2000; 70:141-7. [PMID: 10790837 DOI: 10.1111/j.1746-1561.2000.tb06460.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This article reports on the process evaluation of the training of facilitators for the Adolescent Social Action Program, a health education program in Albuquerque, New Mexico that trained college students and adult volunteers to work with middle school students. From the process evaluation data collected throughout a four-year period (1995-1998), data relevant to training are described: facilitator characteristics, facilitator training, curriculum implementation, and use of the program's model designed to promote critical thinking and dialogue. Results indicated that, though most facilitators reported the training was sufficient to enable them to implement the curriculum, they did not completely do so, especially as groups reached their final sessions. Facilitators covered the core curriculum content, but often failed to follow through with the more abstract activities. The need to perform and report the process evaluation in time to provide ample opportunity for trainers and curriculum designers to make appropriate adjustments is discussed.
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Affiliation(s)
- D Helitzer
- Dept. of Family and Community Medicine, University of New Mexico, Albuquerque 87131, USA.
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Havas S, Anliker J, Damron D, Feldman R, Langenberg P. Uses of process evaluation in the Maryland WIC 5-a-day promotion program. HEALTH EDUCATION & BEHAVIOR 2000; 27:254-63. [PMID: 10768806 DOI: 10.1177/109019810002700211] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Using a crossover design, the authors conducted a 6-month intervention program aimed at increasing fruit and vegetable consumption among women served by the Women, Infants, and Children program in Baltimore City and six Maryland counties. The theoretical framework for the interventions was the Transtheoretical Model of Change. At 2 months postintervention, mean daily consumption had increased significantly more in intervention participants than in control participants. Extensive process evaluation data were collected to assess the quantity and quality of program services delivered. These included participant nutrition session evaluation forms and attendance logs, focus groups of attenders and nonattenders of sessions, information about peer educators, and postintervention surveys. Many lessons were learned about program delivery, factors affecting attendance, and the obstacles to dietary change. Strategies to increase participants' consumption of fruits and vegetables were modified based on these lessons and the process evaluations.
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Affiliation(s)
- S Havas
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, USA.
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Story M, Mays RW, Bishop DB, Perry CL, Taylor G, Smyth M, Gray C. 5-a-day Power Plus: process evaluation of a multicomponent elementary school program to increase fruit and vegetable consumption. HEALTH EDUCATION & BEHAVIOR 2000; 27:187-200. [PMID: 10768800 DOI: 10.1177/109019810002700205] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The 5-a-Day Power Plus program targeted multiethnic fourth- and fifth-grade students in 10 intervention and 10 control urban elementary schools in St. Paul, Minnesota, to increase fruit and vegetable consumption. The intervention included behavioral curricula in classrooms, parental involvement, school food service changes, and food industry support. Process evaluation was conducted by using surveys and classroom and lunchroom observations to assess the characteristics of teachers and food service staff, the degree the intervention was implemented as intended, and exteral factors that may have affected the program results. Results showed high levels of participation, dose, and fidelity for all of the intervention components, with the exception of parental involvement. The process evaluation findings help explain why the increase in fruit and vegetable consumption occurred mostly at school lunch and not at home. Future intervention research should focus on creating new and potent strategies for parental involvement and for increasing the appeal and availability of vegetables.
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Affiliation(s)
- M Story
- Division of Epidemiology, School of Public Health, Minneapolis, Minnesota 55454, USA.
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