TY - JOUR
T1 - Testing an Integrated Model of Program Implementation
T2 - the Food, Health & Choices School-Based Childhood Obesity Prevention Intervention Process Evaluation
AU - Burgermaster, Marissa
AU - Gray, Heewon Lee
AU - Tipton, Elizabeth
AU - Contento, Isobel
AU - Koch, Pamela
N1 - Funding Information:
The authors state they have no conflict of interest. Dr. Burgermaster’s involvement in the preparation of this manuscript was supported by training grants T15LM007079 and T32HL007343; at the time of this study, she was a doctoral candidate at Teachers College Columbia University.
Publisher Copyright:
© 2016, Society for Prevention Research.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - 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.
AB - 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.
KW - Childhood obesity prevention
KW - Fidelity
KW - Implementation
KW - Process evaluation
KW - Responsiveness
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U2 - 10.1007/s11121-016-0736-2
DO - 10.1007/s11121-016-0736-2
M3 - Article
C2 - 27921200
AN - SCOPUS:85002262415
SN - 1389-4986
VL - 18
SP - 71
EP - 82
JO - Prevention Science
JF - Prevention Science
IS - 1
ER -
