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

Steckler, Allan; Ethelbah, Becky; Martin, Catherine J.; Stewart, Dawn; Pardilla, Marla; Gittelsohn, Joel; Stone, Elaine J.; Fenn, David; Smyth, Mary; Vu, Maihan B.

doi:10.1016/j.ypmed.2003.08.002

Cited by 81 publications

(85 citation statements)

References 17 publications

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“…The barriers and facilitators documented during the HEALTHY study are similar to those reported in similar school-based intervention studies promoting physical activity and/or nutrition, including Lifestyle Education for Activity Program (LEAP), Middle-School Physical Activity and Nutrition (M-SPAN), Pathways, Peers Running Organized Play (PROPS), Physical Activity Across the Curriculum (PAAC), and Trial of Activity for Adolescent Girls (TAAG) [18][19][20][21][22][23][24][25]. Common facilitators reported include interest and support from various school members (i.e., school board member, school administrators, school office staff, teachers, students, and parents), schools that had made physical activity and nutrition a priority prior to study, schools already implementing practices and strategies similar to intervention components, teachers collaborating with one another during implementation, and teachers and food service staff who were motivated and actively engaged in intervention implementation [18][19][20][21][22].…”

Section: Discussionmentioning

confidence: 58%

“…These barriers include financial constraints in the school food service system, inadequate facility space to implement activities or store equipment, lack of school personnel to deliver intervention components, and faculty and staff turnover [18][19][20][22][23][24]. Other barriers related to logistical issues in terms of food and beverage ordering problems, school districts with highly centralized food service systems impeding individual school nutrition changes, school scheduling problems, and teacher time constraints [18][19][20][22][23][24][25]. Some teachers reported being unable to implement intervention components due to school prioritization of nonhealth-related curricula and standardized testing requirements.…”

Section: Discussionmentioning

confidence: 99%

“…Some teachers reported being unable to implement intervention components due to school prioritization of nonhealth-related curricula and standardized testing requirements. A number of barriers related to teachers or food service staff, including resistance to change, lack of motivation and participation in intervention delivery, lack of compliance in intervention delivery, and lack of communication and cooperation among teachers and staff in intervention implementation [18,20,22,25]. Finally, student barriers related to decreases in student interest in intervention activities over time [19,22].…”

Section: Discussionmentioning

confidence: 99%

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School factors as barriers to and facilitators of a preventive intervention for pediatric type 2 diabetes

Hall

Schneider

Thompson

et al. 2013

Behav. Med. Pract. Policy Res.

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School-based interventions are essential to prevent pediatric obesity and type 2 diabetes. School environmental factors influence implementation of these interventions. This article examines how school factors acted as barriers to and facilitators of the HEALTHY intervention. The HEALTHY study was a cluster-randomized trial of a multicomponent intervention implemented in 21 schools. Interview data were analyzed to identify barriers and facilitators. Barriers included teacher frustration that intervention activities detracted from tested subjects, student resistance and misbehavior, classroom management problems, communication equipment problems, lack of teacher/staff engagement, high cost and limited availability of nutritious products, inadequate facility space, and large class sizes. Facilitators included teacher/staff engagement, effective classroom management, student engagement, schools with direct control over food service, support from school leaders, and adequate facilities and equipment. Contextual barriers and facilitators must be taken into account in the design and implementation of school-based health interventions. KEYWORDSSchool, Intervention, Prevention, Health behavior, Diabetes, Obesity Type 2 diabetes is a chronic and progressive disease with complications that can include heart disease, stroke, kidney failure, loss of vision, and limb amputation [1]. The alarming prevalence of overweight and obesity among American children and adolescents and the connection with type 2 diabetes represent a serious public health concern for the twenty-first century [2,3]. Researchers estimated that approximately one in three children born in the year 2000 in the United States will develop diabetes in their lifetime [4].Recent findings on activity and dietary patterns of children and adolescents in the United States demonstrate the presence of problematic health behaviors. Findings from the National Survey of Children's Health and the Youth Risk Behavior Survey showed that approximately 78 % of youth did not eat fruits or vegetables five or more times per day [5], 29 % of youth drank a nondiet soda at least once per day [5], 64 % of youth did not engage in 20 min of daily vigorous physical activity for most days of the week [6], and 50 % of youth engaged in sedentary behaviors, such as playing video games or watching television for multiple hours a day [6].In light of the prevalence of unhealthful dietary and activity patterns among youth and their connections with overweight, obesity, and type 2 diabetes, population-level approaches to improve environmental contexts by promoting physical activity and healthful diet are essential. Schools are ideal settings for basing public health interventions aimed at preventing the development of serious health conditions because of the existing resources and infrastructure, and aside from the home, Implications Practice: School-based obesity interventions should take into account student interests and involvement, classroom skills of teachers delivering the interv...

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

School factors as barriers to and facilitators of a preventive intervention for pediatric type 2 diabetes

Hall

Schneider

Thompson

et al. 2013

Behav. Med. Pract. Policy Res.

Self Cite

View full text Add to dashboard Cite

show abstract

“…Some studies focused on an intervention that utilized a promotora or community-health worker only model [29]. Other studies focused their intervention on one specific form of activity, such as dance [27]; others used a combination of 2-3 activities [31,32]. One study included multiple components, including the environmental activity of a schoolbased committee, to assist with recommendations for improvements in nutrition and physical activity [33].…”

Section: Discussionmentioning

confidence: 99%

A Comprehensive School Health Program to Reduce Disparities and Risk for Type 2 Diabetes in Overweight At-Risk Youth

Wright

Norris²,

Giger

2012

Endocrinol Metabol Syndrome

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With the significant increase in the number of racial/ethnic minority youth with obesity and type 2 diabetes mellitus (T2DM), effective approaches are urgently needed. Although previous school-based studies have demonstrated that programs combining environmental, behavioral and educational components can be successful in preventing cardiovascular disease in youth such studies have not focused on youth at higher risk for T2DM-inner city, racial/ ethnic minority youth. Engaging in regular physical activity is widely accepted as an effective preventative measure for a variety of obesity-related chronic diseases including diabetes and metabolic syndrome. Disparities exist where racial/ethnic minority and low-income youth do not meet these physical activity recommendations. Schools, through the provision of culturally and developmentally appropriate healthy lifestyle programs, have the power to decrease body mass index (BMI) and increase physical activity, especially for racial/ethnic, inner-city at youth at risk for T2DM. The present clustered, randomized controlled trial study utilized a community-based participatory research approach to evaluate the impact of a family-centered, culturally sensitive, comprehensive school health program, called Kids N Fitness © , on BMI z-scores and physical activity behaviors of the youth participant from baseline to the 12-month followup among a sample of Mexican-American, inner-city elementary school youth (N = 97) in Los Angeles County at risk for T2DM. Results: Youth who participated in the KNF © program had significant decreases in BMI (p = 0.05), BMI body mass index z-scores (p = 0.03), vigorous daily physical activity (p = 0.01) and PE class attendance (p = 0.02) from baseline to the 12 month follow-up. Conclusions: These results suggest that a culturally appropriate, comprehensive school health program may have promise for decreasing BMI and BMI z-scores and increasing activity in this high risk sample. Clinicians and teachers can incorporate the approaches used in this study to reduce the risk of T2DM in youth at risk. Comprehensive school health programs and prevention of T2DMGiven the rapid rise in obesity among youth, researchers have focused on developing comprehensive programs with the goal of reducing or preventing increases in BMI. A Cochrane review of 64 randomized clinical interventions designed to treat obesity in youth concluded that behavior lifestyle interventions had a significant effect on reducing BMI in youth up to 12 months post-intervention, noting that the most effective interventions combined dietary, physical activity and behavioral components [12]. Schools serve as an excellent venue to provide students with the opportunity for daily physical activity and to teach the importance of regular physical activity and a healthy diet in order to build skills that support active lifestyles [13][14][15] and decrease their risk for T2DM. Schools have access to school nurses who can provide screening, counseling and continuum of care [13][14][15]. In co...

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“…Interventions that address the organizational food environment have emerged as a new strategy to support individual behaviour change, especially in worksite and school settings (19)(20)(21)(22) , but the combined contributions of environmental change and educational programming have not been examined in community residential settings such as those for treatment of substance abuse.…”

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confidence: 99%

Process evaluation of an environmental and educational nutrition intervention in residential drug-treatment facilities

Cowan

Devine

2012

Public Health Nutr.

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Objective: To evaluate the implementation of a controlled, 6-week, environmental and educational intervention to improve dietary intake and body composition, and to study the association of implementation fidelity with diet and body composition outcomes. Design: A process evaluation documented participation, dose of nutrition education delivered, participant satisfaction, fidelity and completeness of the food environment intervention implementation, and context through observations and interviews with staff and residents. Intervention sites were scored and categorized as high or low participation and implementation and compared on essential elements of the food environment and on diet and body composition outcomes. Setting: Six urban residential drug-treatment facilities in Upstate New York. Subjects: Fifty-five primarily black and white men in residential drug-treatment programmes. Results: Participants were exposed to 94 % and 69 % of the educational and environmental elements, respectively. High implementation sites were significantly more likely to provide water and 100 % juice, offer fruit or vegetable salad, offer choices of fruits and vegetables, and limit fried foods. Mixed-model analysis of covariance revealed that participants in the high participation and implementation sites reported greater reductions in total energy, percentage of energy from sweets, daily servings of fats, oils and sweets, and BMI over the intervention period. Participants in low participation and implementation sites reported greater reductions in percentage of energy from fat. Differential implementation of environmental elements limited the intervention impact. Conclusions: These findings document the contribution of changes in eating environments to facilitate dietary behaviour change in community residential substance-abuse settings.

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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

Cited by 81 publications

References 17 publications

School factors as barriers to and facilitators of a preventive intervention for pediatric type 2 diabetes

School factors as barriers to and facilitators of a preventive intervention for pediatric type 2 diabetes

A Comprehensive School Health Program to Reduce Disparities and Risk for Type 2 Diabetes in Overweight At-Risk Youth

Process evaluation of an environmental and educational nutrition intervention in residential drug-treatment facilities

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