A qualitative study of staff's perspectives on implementing an after school program promoting youth physical activity

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Abstract

Minimal effects found across youth physical activity (PA) interventions, and increased attention to circumstances that impede adequate delivery of program components, has highlighted the importance of learning from staff what is needed to foster staff comprehension and engagement for developing, adopting, and successfully implementing PA-based youth interventions. The purpose of this study is to address this knowledge gap by conducting a qualitative assessment of school staff perspectives on the positive aspects and challenges of implementing the 17-week ACT program, an after-school intervention that integrated motivational and behavioral components to promote PA in underserved adolescents. Interviews were conducted with one school staff member from each participating school for all four trial cohorts (N = 12). Transcripts were coded by independent coders (r = .84) and content analyses of themes was performed using QSR NVivo. Themes were organized into five meta-themes: (1) Logistics; (2) Essential Elements; (3) Staff and Child Challenges; (4) Staff Comprehension, Value, and Enjoyment; (5) Spill-Over Effects. Findings indicate that staff can be successful at understanding, valuing, and reaching fidelity in implementing climate-based mediation components. The insight gained from this study lays the foundation for understanding the components needed for establishing well-implemented, effective, and generalizable interventions for increasing youth PA.

Highlights

► Assessed staff perspectives on implementing a youth physical activity intervention. ► Identified factors influencing fidelity and feasibility of program implementation. ► Staff comprehension and engagement in program facilitates behavior change in youth. ► Informs future interventions and training procedures to optimize on staff strengths.

Section snippets

Characteristics of the individual and the physical activity setting climate

The developmental systems theoretical model of positive youth development (PYD) stresses that all young people have the potential for positive development, and that this potential is actualized when the strengths of youth are aligned with interpersonal and institutional supports for healthy development in adolescents’ ecologies (Lerner, 2006). Application of this theoretical model leads us to consider the relation between the characteristics of the activity context and of the individual for

Method

The purpose of the current study was to conduct a qualitative assessment of school staff perspectives on the positive aspects and challenges of implementing the 17-week ACT program. The ACT program was a randomized controlled school-based trial testing the efficacy of a motivational plus behavioral skills intervention on increasing MVPA in underserved adolescents. The study consisted of a group-randomized cohort design with 4 trial cohorts (three intervention and three comparison schools per

Participants

At the end of each 17-week trial cohort, interviews were conducted with ACT team leaders, the principal, school liaison, and one participating school staff member from each of the participating schools. For this study, we focused specifically on the interviews with school staff of the intervention schools for all four trial cohorts (N = 12 intervention school staff members). Each staff member that was selected for the interview was randomly chosen from the 5 members that served as ACT

Procedures and interview questions

Trained interviewers (1 Caucasian, and 1 African American woman) conducted the interviews at each of the middle schools using a standardized protocol that outlined the core questions and probes. The questions asked staff about the most positive and the most challenging aspects of the program, their views on implementing each of the program components (e.g. small group activities, physical activity, snack, homework, transition times, etc.), and their suggestions for improving the program.

Results

Individual themes that emerged from staff interviews were organized into five meta-themes: (1) Logistics; (2) Essential Elements; (3) Staff and Child Challenges; (4) Staff Comprehension, Value, and Enjoyment; (5) Spill-Over Effects. These meta-themes encompassed 44 individual themes, some of which were collapsed into composite themes after the coding process to facilitate data analysis and interpretation. Table 3 details all the individual themes classified under these five meta-themes that

Logistics

A number of themes regarding program logistics emerged when staff were asked about the strengths and challenges of the program, and ways in which the program can be improved. Prominent logistical strengths included general comments about the high quality of the staff hired, and positive comments about the program activities. A majority of the staff (58% or 7 out of 12) across trial cohorts reported being highly satisfied with the organization and structure of the program and with the quality of

Successes in implementing program climate for PA

The qualitative interview data demonstrated the positive relationships and social climate for PA that can be created when SDT and SCT components are successfully implemented. Specifically, the interviews yielded information about staff's observations of students’ response to program components that corresponded to the SDT and SCT components of belongingness, competence, autonomy, engagement in PA, intrinsic motivation (e.g., fun), behavioral life skills (e.g., motivation and implementation of

Themes related to general program challenges

Staff interviews also identified multiple social climate challenges that can affect program implementation. Discipline issues were a primary theme reported by staff across all cohorts of implementation (see Table 3). Staff reported some concern with children who “acted out” and “cliques” undermining the program's mission. One staff reported that “an overweight boy didn’t want to come any more because he felt that the other boys were picking on him,” and another staff stated “we had the name

Themes related to staff's comprehension, value, and enjoyment

An additional set of themes emerged that indicated the potential for staff to comprehend (feel competent), value, and enjoy, implementing this type of program. Across all 4 trial cohorts, staff expressed high engagement with program materials and with engaging the children in program games and small group exercises. For example, one staff stated, “It was easy to participate once you saw the kids having fun, it made you want to join them. Just make it more fun for them.” Another staff reported “

Themes related to spill-over effects: changes in school climate

Staff members also reported unexpected health, social, and school-based benefits from their participation, further indicating their high engagement and value in program components. Across all cohorts, staff reported their own pursuit of a healthier lifestyle as a result of the program. Many staff reported increased activity (e.g., “it got me off the couch,” and “we got our pedometers and we are ready”) and that the program got them “thinking about their health and “being physically fit,” and

Discussion

Despite the physical and psychosocial benefits of PA, recent reviews have indicated that most PA-based youth interventions have attained limited or no behavior changes, have rarely affected targeted physiological or anthropometric health outcomes, or identified common patterns of effects that distinguish the few successful from unsuccessful programs (Baranowski et al., 2009, Lemmens et al., 2008, Salmon et al., 2007, Summerbell et al., 2005). A lack of a focus on mediation factors (e.g., the

Limitations

This research carries with it the common limitations of most exploratory qualitative research including limited generalizability due to the selectivity of the sample, the limited number of individuals participating in the interviews and the potential for biased responses. First, due to limited resources, the number of staff participating in the interviews was small and the perspectives of staff who did not partake in the interview may differ from those of participants who were interviewed.

Implications for practice and future directions

There is a critical need for theoretical driven research that focuses on understanding mediational factors especially linked to staff motivation to provide detailed documentation of behavior and behavior change processes as youth interventions are implemented and sustained overtime. This mediating variable model (Baranowski et al., 2009) asserts that interventions change target behaviors by inducing change in mediating factors, such as the SDT and SCT social and motivational essential elements

Acknowledgements

This article was supported by a grant (R01 HD 045693) funded by the National Institutes of Child Health and Human Development to Dawn K. Wilson, Ph.D.

Nicole Zarrett (Ph.D.) is an Assistant Professor in the Department of Psychology at the University of South Carolina. Her research focuses on the role of out-of-school activities in promoting healthy physical, psychosocial, and achievement-related developmental pathways of underserved youth. This research has included an examination of community, school, family, and intrapersonal predictors of youth activity participation and the evaluation of the social-motivational climate of youth activity

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    Nicole Zarrett (Ph.D.) is an Assistant Professor in the Department of Psychology at the University of South Carolina. Her research focuses on the role of out-of-school activities in promoting healthy physical, psychosocial, and achievement-related developmental pathways of underserved youth. This research has included an examination of community, school, family, and intrapersonal predictors of youth activity participation and the evaluation of the social-motivational climate of youth activity program settings.

    Brittany Skiles is a doctoral graduate student in the Clinical-Community Psychology program at the University of South Carolina. Her research interests include the impact of extracurricular activities and ecological factors on positive adolescent development and physical health.

    Dawn Wilson (Ph.D.) is a Professor of Psychology at the University of South Carolina. Her work has primarily focused on developing innovative, theoretically-based motivational interventions for health promotion in underserved adolescents and their families. Dr. Wilson has conducted numerous large-scale intervention studies on improving youth health behaviors in low-income, high crime communities including the Active Choice Today (ACT) trial (R01HD045693) and the “Positive Action for Today's Health” (PATH) trial (R01DK067615).

    Lauren McClintock is an undergraduate research assistant in the Clinical-Community Psychology program at the University of South Carolina.

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