Testing an Integrated Model of Program Implementation: the Food, Health & Choices School-Based Childhood Obesity Prevention Intervention Process Evaluation

Abstract

Childhood obesity is a complex, worldwide problem. Significant resources are invested in its prevention, and high-quality evaluations of these efforts are important. Conducting trials in school settings is complicated, making process evaluations useful for explaining results. Intervention fidelity has been demonstrated to influence outcomes, but others have suggested that other aspects of implementation, including participant responsiveness, should be examined more systematically. During Food, Health & Choices (FHC), a school-based childhood obesity prevention trial designed to test a curriculum and wellness policy taught by trained FHC instructors to fifth grade students in 20 schools during 2012–2013, we assessed relationships among facilitator behaviors (i.e., fidelity and teacher interest), participant behaviors (i.e., student satisfaction and recall), and program outcomes (i.e., energy balance-related behaviors) using hierarchical linear models, controlling for student, class, and school characteristics. We found positive relationships between student satisfaction and recall and program outcomes, but not fidelity and program outcomes. We also found relationships between teacher interest and fidelity when teachers participated in implementation. Finally, we found a significant interaction between fidelity and satisfaction on behavioral outcomes. These findings suggest that individual students in the same class responded differently to the same intervention. They also suggest the importance of teacher buy-in for successful intervention implementation. Future studies should examine how facilitator and participant behaviors together are related to both outcomes and implementation. Assessing multiple aspects of implementation using models that account for contextual influences on behavioral outcomes is an important step forward for prevention intervention process evaluations.

Measuring implementation fidelity of school-based obesity prevention programmes: a systematic review

“…Data collection methods N = 8 [ 29 , 47 – 49 , 60 , 68 , 70 , 86 , 90 ] 5. Quantitative fidelity measures N = 13 [ 25 , 28 , 36 – 38 , 46 – 49 , 51 , 56 , 60 , 68 , 71 , 72 , 77 , 81 , 87 ] 6. Frequency of data collection N = 22 [ 24 , 28 , 29 , 32 , 35 – 38 , 44 , 46 , 48 , 51 , 56 , 60 , 61 , 68 – 72 , 77 , 81 , 85 – 87 , 90 ] 7.…”

Evaluating The Implementation of The SWITCH® School Wellness Intervention Through Mixed Methods

“…School-based wellness programming provides an important opportunity to promote children's physical activity and nutrition behavior (1,2). However, factors within and outside the school environment have been found to hinder adoption, implementation, and sustainability of comprehensive interventions (3)(4)(5)(6). To advance research on school wellness programming, it is important to test approaches aimed at building capacity for more effective school wellness programming.…”

Engaging Stakeholders in the Adaptation of the Connect for Health Pediatric Weight Management Program for National Implementation

“…The high prevalence of childhood obesity necessitates the translation of evidence-based interventions into routine clinical care to improve child health outcomes. Effective pediatric weight management interventions are being implemented in school-systems, community programs, and child-care programs (27)(28)(29)(30), but few have been implemented into the primary care setting (19). The primary care setting offers many opportunities, as most children annually attend a well-child visit and families look to clinicians for health advice and support, but this setting also has many challenges (4,7).…”