Testing an Integrated Model of Program Implementation: the Food, Health & Choices School-Based Childhood Obesity Prevention Intervention Process Evaluation
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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.
KeywordsChildhood obesity prevention Process evaluation Implementation Fidelity Responsiveness
The authors would like to thank the FHC Instructors Emily Abrams, Lorraine Bandelli, Casey Luber, Jennifer Markowitz, Betsy Ginn, Greta Kollman, Shien Chiou; FHC Research assistants/data collectors; FHC schools, teachers, and students. The authors would also like to thank the reviewers for their insightful comments.
Compliance with Ethical Standards
USDA AFRI NIFA grant #2010-85215-20661
Conflict of Interest
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.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
We obtained informed consent from all participants included in this study.
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