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

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

The Readiness, Resilience and Recovery Tool: An Emerging Approach to Enhance Readiness Amidst Disruption

Disruptions of varying severity often occur in the course of an organization’s work to implement new programs or projects. These disruptions may slow their progress or even derail the work altogether. Resilient organizations must be prepared to respond in a thoughtful and timely way to disruptions. Readiness, Resilience and Recovery is an adaptable readiness assessment tool that organizations can use to proceed with their work with insight about their readiness status and how their readiness has been impacted by a disruption. The resulting information can then be used to guide the development of solutions for recovery and build the organization’s overall capacity for resilience. Based on our early experience, the Readiness, Resilience and Recovery approach is emerging as a tool that can be useful when organizations face significant disruptions. We have found it to be adaptable to different types of projects, at various points in the implementation cycle, and with multiple types of disruptions. To demonstrate its use, this illustrative paper provides five examples from different projects and settings: Substance Abuse Treatment Services, Multi-Site Sexual Assault Prevention Initiative, Serve and Connect (a Police-Community Relationships Initiative), Carolina Family Engagement Center (family engagement in schools), and Action for Equity (an equity intervention). Practical uses of the tool and conceptualizing it within important implementation science concepts are discussed.

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

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

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

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

A practical implementation science heuristic for organizational readiness: R = MC2

There are many challenges when an innovation (i.e., a program, process, or policy that is new to an organization) is actively introduced into an organization. One critical component for successful implementation is the organization's readiness for the innovation. In this article, we propose a practical implementation science heuristic, abbreviated as R= MC² . We propose that organizational readiness involves: 1) the motivation to implement an innovation, 2) the general capacities of an organization, and 3) the innovation-specific capacities needed for a particular innovation. Each of these components can be assessed independently and be used formatively. The heuristic can be used by organizations to assess readiness to implement and by training and technical assistance providers to help build organizational readiness. We present an illustration of the heuristic by showing how behavioral health organizations differ in readiness to implement a peer specialist initiative. Implications for research and practice of organizational readiness are discussed.

Recovery of postoperative swallowing in patients undergoing partial laryngectomy

This study assessed the achievement of postoperative swallowing in patients undergoing partial laryngectomy surgery. Oropharyngeal swallow efficiency was used to predict time to achievement of outcome. Fifty-five patients were followed for up to 1 year in two hemilaryngectomy and four supraglottic laryngectomy groups. Within 10 days of healing, a videofluoroscopic evaluation enabled the measurement of swallowing efficiency. Times to achievement of oral intake, removal of feeding tube, preoperative diet, and normal swallow were analyzed using actuarial curves. Patients with hemilaryngectomies achieved swallowing rehabilitation sooner than patients with nonextended supraglottic laryngectomies (p < .05) who, in turn, achieved swallowing function sooner than did patients undergoing supraglottic laryngectomies with tongue base resection (p < .05). Median time to attainment of preoperative diet in these three groups was 28 days, 91 days, and > 335 days, respectively. Higher early postoperative oropharyngeal swallow efficiency was related to earlier achievement of oral food intake and of preoperative diet (p < .05). Results show that the time course for swallowing rehabilitation covers an extended postoperative period. In some surgical groups, functional swallowing and eating may be achieved within 3 months of surgery while for other types, significant impairment remains up to 9 months postoperatively Early radiographic assessments of swallowing function are useful in predicting the time to swallow recovery. Recovery of swallowing ability may be delayed in patients who have not achieved oral intake before radiotherapy is started.