Communities for Healthy Living (CHL) A Community-based Intervention to Prevent Obesity in Low-Income Preschool Children: Process Evaluation Protocol

Abstract

Background: Process evaluation can illuminate barriers and facilitators to intervention implementation as well as the drivers of intervention outcomes. However, few obesity intervention studies have documented process evaluation methods and results. Community-based participatory research (CBPR) requires that process evaluation methods be developed to (a) prioritize community members' power to adapt the program to local needs over strict adherence to intervention protocols, (b) share process evaluation data with implementers to maximize benefit to participants, and (c) ensure partner organizations are not overburdened. Co-designed with low-income parents using CBPR, Communities for Healthy Living (CHL) is a family-centered intervention implemented within Head Start to prevent childhood obesity and promote family well-being. We are currently undertaking a randomized controlled trial to test the effectiveness of CHL in 23 Head Start centers in the greater Boston area. In this protocol paper, we outline an embedded process evaluation designed to monitor intervention adherence and adaptation, support ongoing quality improvement, and examine contextual factors that may moderate intervention implementation and/or effectiveness. Methods: This mixed methods process evaluation was developed using the Pérez et al. framework for evaluating adaptive interventions and is reported following guidelines outlined by Grant et al. Trained research assistants will conduct structured observations of intervention sessions. Intervention facilitators and recipients, along with Head Start staff, will complete surveys and semi-structured interviews. De-identified data for all eligible children and families will be extracted from Head Start administrative records. Qualitative data will be analyzed thematically. Quantitative and qualitative data will be integrated using triangulation methods to assess intervention adherence, monitor adaptations, and identify moderators of intervention implementation and effectiveness.

Navigating process evaluation in co-creation: a Health CASCADE scoping review of used frameworks and assessed components

“…Eight studies (14%) 42 43 47 49 54–56 cited evaluation or process evaluation frameworks developed by Moore et al, 9 three studies (5%) 62 48 51 58 62 cited Steckler and Linnan, 62 three (5%) 35 67 68 cited Saunders et al, 8 three (5%) 63 69 70 cited Nielsen and Randall; 55 two studies (3%) 40 71 cited Greer et al, 40 and two (3%) 64 65 citied Glasgow et al, 66 one study (1%) 34 cited Damschroder et al 72 , one study (1%) 73 Nielsen and Abildgaard, 74 one study (1%) 59 Rowe and Frewer 75 and one study (1%) 76 Grant et al 77 …”

“…Studies explored implementation barriers and enablers, 31 45 58 93 94 some focusing specifically on existing organisational structures, professional values or sociopolitical context that enable successful implementation, 95 96 environmental factors, 30 resources available 52 56 or events that occurred and influenced the content of the execution of the action plan. 63 Beckerman-Hsu et al 76 also specifically looked at moderators and the extent to which their role impacts implementation.…”

Family sports interventions for the treatment of obesity in childhood: a meta-analysis

“…Places family at the center of the intervention, as they are required to provide continuous exercise therapy, thereby cultivating an exemplary teaching environment for children in shaping their behavior habits. Family members are encouraged to supervise and manage the implementation of children's sports plans [ 41 – 43 ].…”