MAC Project Report 

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Meade Activity Center Program Evaluation Report 

2012-2013 

for 

Meade Activity Center, Inc., 

the Foundation for a Healthy Kentucky’s

Kentucky Healthy Futures Initiative (KHFI) 

and 

the Corporation for National and Community Service’s (CNCS)

Social Innovation Fund 

Prepared by 

Kristi McClary King, PhD, CHES and Jason Rice, MS 

University of Louisville, Department of Health and Sport Sciences 

Submitted on November 11, 2013 
MAC Project Report 

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TABLE OF CONTENTS 

INTRODUCTION ...............................................................................................................3 

Setting ......................................................................................................................3 

Intervention: The Meade Activity Center (MAC) Project .......................................4 

Purpose .....................................................................................................................5 

METHODS ..........................................................................................................................6

Study Design ............................................................................................................6

Instrumentation ........................................................................................................6

Participants ...............................................................................................................7

Procedures ................................................................................................................8

Data Analysis ...........................................................................................................9

Intervention and Data Collection Implementation .................................................11

RESULTS ..........................................................................................................................12

Children’s Demographics ......................................................................................12 

Program Reach .......................................................................................................13

Health Behaviors and Outcomes ............................................................................13

Results from Coalition Survey ...............................................................................16

Areas of Growth .....................................................................................................18

Areas for Improvement ..........................................................................................19

DISCUSSION ....................................................................................................................21

Future Goal: Meade Activity Center......................................................................22

References ..........................................................................................................................24

List of Figure and Tables 

Figure 1. Children’s Participation in Programming ...........................................................13

Table 1. Children’s Health Behaviors and Outcomes in Year 1.........................................14

Table 2. Comparison of Not-low and Low SES Children’s Health Behaviors in Year 2 ..15 

Table 3. Children’s Participation in MAC Sessions and Health Behaviors .....................16 
MAC Project Report 

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INTRODUCTION 

Rural residency is a leading health indicator linked to health inequity, and suggests that 

communities create social and physical environments to improve public health.1 People living in 

rural areas, as compared to those living in suburban2,3 and urban areas4, are more likely to be 

obese and to be less active, have less access to preventive health services, and quality health 

care;12,16 and have a higher risk of many lifestyle diseases, including heart disease, high blood 

pressure, type II diabetes, obesity and cancer.5 Furthermore, many lifestyle diseases such as high 

blood pressure, type II diabetes, cancer, and heart disease are associated with overweight and 

obesity.6,7 

In order to achieve good health, the Surgeon General and numerous health experts 

recommend that adults and children be physically active.8,9 Developing healthy habits at a young 

age, as well as providing children with the knowledge, attitude, skills, and opportunities to be 

physically active, are crucial when promoting health and preventing disease.10 Overweight or 

obese children who lived in rural areas are more likely than children who live in urban areas to 

be white, poor, female, and live a sedentary lifestyle (i.e. use a computer for non-school related 

activities (e.g. gaming) for more than 3 hours per day and watch television for more than 3 hours 

per day).2 

Children should participate in a variety of age-appropriate and fun moderate to vigorous 

intensity physical activities for at least 60 minutes every day.1,10-15 They should not only be 

educated on the quantity and quality of physical activity but be given equal opportunities to 

participate in physical activity programs, regardless of their income or access to consistent 

transportation 16,21 For children in rural areas, having access to a variety of physical activity 

opportunities is a strong predictor of physical activity.17, 18

Setting

Meade County is a rural county in Kentucky with a population of 29,237 residents.19 In 

Meade County, 49% of students attending public schools are eligible for free or reduced-priced 

meals.20 Furthermore, less than one-quarter (24.2% ) of adolescents consumed two or more fruits 

per day and only 10.9% consumed three or more vegetables per day.21 Recreational facilities are 

non-existent within Meade County boundaries and opportunities to be physically active in 

schools, through physical education programs and sports teams, are minimal. 

* Kentucky County Health Care Profiles: Meade County. Community and Economic Development Initiative of Kentucky at the University of 

Kentucky College of Agriculture. http://www.ca.uky.edu/CEDIK 

SNAPSHOT: MEADE COUNTY*

Population: 29,237 

Population < 18 years: 7,689 

Median Household Income: $42,922 

Poverty Rate: 18.2% 

Unemployment Rate: 13.2% 

Adult obesity prevalence: 33% 

Adult DM-II prevalence: 11.1% 
MAC Project Report 

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Intervention: The Meade Activity Center (MAC) Project 

In the fall of 2008, parents and community leaders of Meade County assembled to 

discuss the lack of a public swimming facility for their children. From that meeting, the residents 

determined that a broad range of community needs existed, among them, increasing access to 

recreational facilities and 

health-related 

programming in Meade 

County. Addressing the 

lack of physical activity 

facilities and resources in 

the community became the 

primary goal for these 

community members, thus 

forming the Meade 

Activity Center, Inc. in 

that same year. The MAC 

board of directors hired an 

executive director and 

immediately began 

offering youth sports and 

physical activities, 

community events, and 

summer camps. The 

primary focus of these 

concerned citizens lives on In this image a young man, aged 6-9, is proudly displaying his wrist band and writing Image 1: A Meade County child at a community event expressing 

utensil while AmeriCorp members are in the background engaging in crafts with the solidarity for the Boston Marathon tragedy. Many MAC activities use today. The current focus other children. “borrowed” spaces, like this school’s multi-purpose room. of the MAC Project is to 

create physical activity opportunities and places that will address the gaps in availability of 

access to services due to income disparity at the individual and county levels. The MAC goals 

are to teach cognitive and behavioral skills, cultivate social support, strengthen organizational 

support, and enhance community access to physical activity opportunities thus ensuring that 

Meade County residents can live physically active lives. 

Creating word-of-mouth and distributing fliers throughout the school district have been 

sufficient advertising for recruiting children 

to participate in MAC Project programs. 

THE MEADE ACTIVITY CENTER Advertising for programming occurs 

 VISION: through distributing MAC program guides 

To create a community focused on to all elementary schools and the middle 

improving the lives of children, families, school and high school, churches, and 

adults, and seniors of all income levels, frequently visited businesses (e.g. grocery 

races and creeds by promoting healthy stores) in the district prior to a registration 

lifestyles, social familiarity, and economic period. Most activities last approximately 1 

prosperity. hour per session, exceptions are summer day 

camps, which last approximately 6 hours per 

day. There are five rounds of 6-week 
MAC Project Report 

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program sessions per year - Fall 1, Fall 2, Winter, Spring, and Summer. During each session, 

approximately 10 different activities are offered. Additionally, an after-school CATCH Kids 

Club met twice per week throughout the school year. The CATCH Kids Club curriculum teaches 

children and reinforces the skills necessary to make healthy nutrition and physical activity 

choices during the program and in their lives. The program provides the curricula, equipment, 

and coaches’ training and is offered as a free MAC program to any elementary school aged child. 

All MAC programs are offered in borrowed locations throughout Meade County such as 

elementary schools, high schools, as well as on the Meade Activity Center land. 

Purpose 

The purposes of this study are to determine if the implementation of physical activity 

programming improves the health behaviors and outcomes of children who would not have 

otherwise had access to physical activity opportunities and places in a rural community, and to 

determine the extent to which a community coalition is effective at achieving its mission of 

improving its’ communities’ health. The individual, social, and organizational levels of the 

Social Ecological Model,27 the individual, behavioral, and social and environmental aspects of 

the Social Cognitive Theory,22-24 and the coalition characteristics, structures, and processes of the 

Community Coalition Action Theory25 will serve as the theoretical foundations from which 

individual health behaviors and outcomes and the effectiveness of a communities’ coalition 

functioning will be measured. 
MAC Project Report 

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METHODS 

Study Design 

This study employed mixed-methods approaches to evaluate effectiveness of the 

children’s programming with comparisons of an intervention (exposed) and a comparison 

(unexposed) group. Additionally, longitudinal intervention participation was collected. A single 

case study design of the coalition effectiveness was employed in Year 1 and sustained impact 

design data will be tracked over time. Cross-sectional data collection methods included survey 

administration, semi-structured interviews and focus groups, as well as meeting and event 

observations. While a single case study design may not be generalizable to other populations, in 

Meade County, determining the efficacy and fidelity of programming and infrastructure 

sustainability serve tremendous purposes. Three primary research questions guided the MAC 

Project: 

1. Did the MAC Project provide programming to Meade County children who otherwise did

not have access to physical activity programming or places;

2. To what extent did the MAC Project’s children’s programming improve children’s

behaviors and outcomes; and,

3. To what extent was the MAC Project Coalition effective?

In addition to these research questions, the extent to which the MAC Project was 

implemented as intended was measured. Ongoing process evaluation continues regarding the 

strengths and areas of improvement for MAC programming, coalition effectiveness, and MAC 

sustainability. 

Instrumentation

Children’s health behaviors were measured by using the Children’s Health Survey (CHS) 

which included items modified from the Youth Risk Behavior Surveillance Survey and 

Children’s Physical Activity Correlates Survey.26,27 Children’s height and weight were converted 

to a body mass index (BMI) score and the number of 20-meter laps run in a gymnasium were 

converted to a cardiovascular fitness score. Both BMI and cardiovascular fitness measures 

followed the Fitnessgram protocol which is a physical fitness assessment series of instruments 

and criteria for children.28 

Other measures collected for children were completed through the DAXCO program 

software in which demographic information was gathered by a MAC administrative assistant 

upon children’s enrollment in any MAC Programs. The frequency of children’s participation in 

MAC programming was collected by MAC Coaches on attendance rosters at each session. 

The Coalition Effectiveness Inventory (CEI)25 survey questions were used to evaluate the 

coalition’s characteristics, structures, and processes. Additionally, coalition members and other 

key stakeholders were interviewed by the researcher to determine the strengths and areas for 

improvement of MAC programming and MAC goals. 
MAC Project Report 

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Participants

Prior to participant recruitment or study involvement, the researcher’s Institutional 

Review Board approved all study protocols. Informed consent was obtained by all adult 

participants and parental/guardian consent and child assent for the survey were obtained for 

children. No adult or child was excluded from any MAC Project programming due to not 

participating in the study. Further, neither participants nor program implementers were notified 

as to whether any MAC participants or coalition members were a part of the study or not to 

ensure equal treatment and non-bias in treatment fidelity. 

During year one, January 2012 through May 2012, all children who enrolled in the 

CATCH Kids Club after-school program in 5 public schools were invited to participate in the 

study. A total of 68 of the 75 children (90% response rate) provided parental informed consent 

and child assent to participate in the CHS survey and fitness testing portions of the study.

Also during year one, in June 2012, purposive sampling techniques were employed to 

select the setting and participants for the coalition effectiveness portion of the study. Twenty-five 

coalition members, included board members, past board members, programming volunteers, and 

other influential key stakeholders (as determined by the MAC Executive Director) were invited 

to participate in the survey study. The response rate for the survey was 60% (n = 15). 

Additionally, 13 of the 15 survey respondents agreed to participate in the interview process with 

the researcher. 

Beginning in August 

2012, the scope of the 

evaluation expanded to assess 

health behaviors and outcomes 

of all children who participated 

in MAC programs, not just 

children’s enrolled in the 

CATCH Kids Club after-school 

program. Unfortunately, a 

disappointingly small sample 

(5.5%) of the 766 children who 

were enrolled in the MAC 

database provided parental 

informed consent and child 

assent needed to participate in 

the CHS survey portion of the study. To create a matched comparison of children exposed and 

unexposed to MAC programming, the researcher incorporated two sources of data. The Meade 

County Public Schools agreed to incorporate fitness testing into their regularly scheduled 

physical education curriculum in all six elementary schools district-wide. These data were 

gathered through Fitnessgram fitness testing protocols purchased by the MAC and housed in the 

public schools. The researcher collaborated with the MAC coalition members and Meade 

County Public Schools’ Information Technology personnel to retrieve matched fitness data (n = 

54) from the schools’ Fitnessgram database. Matching of exposed to unexposed children of

Image 2: Swim lessons at the restored MAC pool
MAC Project Report 

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MAC Project programming were determined by selecting children (de-identified) within the 

public schools who did not participate in MAC Project programming and who had similar 

demographic characteristics (i.e. grade, gender, and body mass index) of children in the MAC 

Project programming. 

Procedures 

During year one (January 2012-May 2102), all children who participated in the CATCH 

Kids Club after-school programming were invited to participate in the CHS and fitness portions 

of study. Prior to data collection (December 2011), the researcher met with the CATCH Kids 

Club Coaches, Executive Director, and a coalition members to train them on the 

parental/guardian and child assent processes, and the CHS and fitness testing data collection 

procedures. Data were collected by the CATCH Kids Club Coaches at baseline (January 2012) 

and post-test (May 2012) then given to the researcher. 

Beginning in August 2012, all children who participated in any MAC Project 

programming were invited to participate in the CHS portion of the study. In August and again in 

May 2013, an invitation letter was mailed from the MAC Executive Director, the Children’s 

Health Survey (CHS), two parental/guardian informed consent forms, two child assent forms, 

and a pre-stamped, MAC-addressed envelope to all children‘s home addresses (n = 766, ages 5-

18 years) who were previously or currently enrolled in any MAC programming. 

Parents/guardians were instructed to sign the parental/guardian informed consent form, ask their 

child to sign the child assent form, ask their child to complete the CHS, and mail the three items 

to the MAC. Only surveys that were returned accompanied by signed parental informed consent 

forms and child assent forms were used for data analysis 

During the summer of year two, prior to fitness data collection, the researcher met with 

all Meade County Public School physical education teachers, the MAC executive director, and 

several coalition members to train all personnel on Fitnessgram fitness testing procedures. 

Beginning in the fall of year two (September 2012), district-wide (n = 6 elementary schools) 

fitness data (cardiorespiratory fitness and body mass index) were collected by each school’s 

physical education teacher from all school children (n = 1771 children) as part of their regularly 

scheduled physical education curriculum. The researcher retrieved all MAC Project participants’ 

fitness data and compared it to non-MAC Project participants’ fitness data using a betweengroup study design (n = 54). Further, for those children who were in the original cohort of the 

CATCH Kids Club after-school program, subsequent years’ (year two) changes in which they 

participated in any MAC Project program over time were evaluated. Also during year two, 

attendance rosters were kept by program. At the end of each session (five sessions per year and 

approximately 10 programs per session) all data were manually entered into an “attendance” 

database developed by the External Evaluator. 

In July 2012, an invitation letter from the Executive Director, the Coalition Effectiveness 

Inventory (CEI), and informed consent forms were mailed to the home addresses of all coalition 

members (n = 20) and other influential key stakeholders (n = 5). Participants were asked to 

complete and mail the survey, along with their signed informed consent form, back to the Meade 

Activity Center within two weeks. Since Meade County is a relatively small community in which 
MAC Project Report 

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many of the coalition members and key stakeholders “run into” each other, the Executive 

Director reminded the participants to complete their surveys and mail them and reassured them 

that he would not see the individuals results or know if they completed the surveys or not. The 

researcher collected the surveys from the Meade Activity Center. 

In addition, the researchers used conducted qualitative interviews using a semi-structured 

interview guide consisting of questions adapted from the CEI about the participant’s perception 

of the current stage of the coalition, strengths and weaknesses of the coalition, and their thoughts 

on the future of the coalition. 

Approximately two weeks after the surveys 

were mailed to the coalition members and 

key stakeholders, a community volunteer, 

along with the researchers, began calling 

participants to recruit their participation in 

an interview and/or focus group. The 

community volunteer was valuable in 

recruiting participants since she knew each 

of them and could reassure them that their 

participation in the study would remain 

confidential to the researchers only. Four 

one-on-one interviews and three group 

interviews (n = 2, 3, and 4) were conducted 

by the principal investigator and trained 

graduate research assistants for a total of 13 

participants. Interviews and focus groups 

were designed to take 30 to 60 minutes and to 

further garnering participant’s perception of the 

coalition effectiveness as well as the strengths and weaknesses of the MAC. The interviews were 

recorded and transcribed immediately upon completion of the meeting. 

Data Analysis

For all of the quantitative data described in each of the research questions, each item on 

the surveys or fitness score tests, including items left blank, were coded and the data were 

entered into an Excel spreadsheet. Blank items were coded as “.” to represent missing data. 

When an item was missing, the mean of answered items were the imputed value for the missing 

response. Quantitative data were imported into Statistical Package for the Social Sciences 

(SPSS®) version 20.0 (SPSS, Inc.) for analyses. A significance value of α = .05 was set for 

analyses in this study. 

For year one (January 2012-May 2012) 59 out of 69 children (85%) who completed the 

CATCH Kids Club program, were analyzed. Paired sample t-tests were employed to analyze 

baseline and post-intervention physical activity self-efficacy, physical activity levels, sedentary 

time, and nutrition behaviors. The percent of participants who responded “yes” to the May 2012

CHS item “Are you physically active because you participated in Meade Activity Center 

Image 3: First Tee golf program emphasizing

sportsmanship and problem-solving skills.
MAC Project Report 

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Programs?” compared to “no” was calculated. Descriptive statistics illustrated the demographic, 

access, and health behavior items. 

In year two, August 2012 through May 2013, a repeated measures ANOVA was 

employed for all children enrolled in any MAC program to determine changes in behaviors and 

health outcomes. An independent sample t-test comparing number of opportunities for physical 

activity for not-low SES compared to low SES was conducted. Pearson product moment 

correlation was employed to determine if there was a relationship between socioeconomic status 

and whether children perceived that they were physically active because of the MAC. 

Also in year two, 54 MAC participants were matched with 54 non-MAC participants on 

age, gender and a fall 2012 measure of BMI (within .50). Additionally, 46 MAC participants 

were matched with 46 non-MAC participants on age, gender, and a fall 2012 Pacer score. A 

paired sample t-test of the matched pairs was conducted with MAC participants’ scores with 

non-MAC participants’ scores (n = 54 pairs).

The frequency of participation in MAC sessions, cardiovascular fitness levels, school TV 

time, school Gaming/Video time, and after-school physical activity were converted to ordinal 

data in year two. Participation was categorized into 5 equidistant levels. After-school physical 

activity time was converted to ≥ 60 minutes or < 60 minutes and television viewing time and 

computer/video time were converted to < 120 minutes or ≥120 minutes. Cross tabs and 

Spearman’s correlations were generated to 

determine the association between number 

of individual program sessions children 

attended and their physical activity and 

sedentary behaviors. 

For the qualitative portion of the 

data, audio from each coalition member or 

key stakeholder interview was recorded, deidentified, and transcribed verbatim. The 

researcher used deductive coding 

techniques, and adopted codes based on 

constructs from the CEI25 to code data 

related to constructs within the Community 

Coalition Action Theory, Social Ecological 

Model. Further, emergent themes regarding 

the fidelity of the implementation of 

programming that surfaced outside of these 

theories were analyzed by the researcher.

Image 4: A sign of the Times: The home of the future 

Meade Activity Center in Brandenburg, Kentucky
MAC Project Report 

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Intervention and Data Collection Implementation 

To determine the fidelity to which the MAC Project was implemented as intended, a 

variety of observational, content analysis, and informal and semi-structured interview were 

conducted by the researcher. Since physical activity programming and coalition development 

were new innovations implemented in this rural community, significant time, training, and 

financial resources were dedicated to start-up operations, staffing, equipment, and curricula. For 

example, in order to collect and store participant information, DAXCO Operations & Accounting 

systems were purchased during year one. MAC staff has continued efforts to work with DAXCO 

support to create the necessary reports to determine quarterly enrollment reports including 

participant numbers and financial assistance figures. While DAXCO has been an excellent 

system for managing membership data, one limitation of the system is that it does not allow for 

the tracking of individual-level participation data. For example, a query could be “run” to list the 

number of programs in which a child has enrolled (i.e. golf in Spring 2012, swim camp and 

horseback riding camp in Summer 2012, and CATCH After-school Kids Club and flippers in the 

winter session of year one, 2012), but it did not have the capabilities to record the child’s 

frequency or dates of participation. 

To address this need to capture individual-level participation data, the External Evaluator 

created “attendance sheets” for each of the youth sport coaches and instructors to take attendance 

during every session. At the end of each session (five sessions per year), the coaches and 

instructors mail their “attendance sheets” to the Executive Director, who then gives them to the 

External Evaluator. The External Evaluator manually entered each child’s frequency of 

participation in programs into an Excel database. 

With this increase in individual-level longitudinal data coming from three different 

systems, Fitnessgram, DAXKO, and Excel spreadsheets, the data management system (i.e. 

Excel) was maxed out. To address this influx of data, a data analyst was hired through a local 

university by the researcher to “merge” all data and house the data in one system. The hiring of a 

new personnel and creation of a new system will allow data analysis to flow more efficiently in 

future years. 

In many ways year one two data cannot be compared side-by-side, as a direct 

comparative may be misleading. Initially, children enrolled in CATCH Kids Club programing 

was proposed for data collection opposed to year two, when all children in MAC programming 

were used for data collection. With this said, year one and year two results are provided where 

appropriate. When the original MAC Project began, CHS and fitness testing were required of 

only the children who were enrolled in CATCH After-school Kids Club. As the MAC Project 

grew, fitness testing now is conducted within the public school system and is required of all 

children (including children involved in MAC programming) and surveys were mailed to all 

MAC children’s home address. There was a reduction in useable data from the CHS, BMI, and 

cardiovascular testing because of a lack of signed informed consent forms. Also, many sets of 

data were incomplete because the student was absent on either the pretest or post-test data 

collection dates. 
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RESULTS 

Children’s Demographics

The breakdown of male and female participants in MAC programming is very 

encouraging. Traditionally in rural counties, although there is equal number of sports for boys 

and girls, the number of boys and girls who can participate in the sports is different. For 

example, a boys’ football team can accommodate up to 50 boys while a girls’ cheerleading team 

can only accommodate 15 girls. The MAC programming has closed this gender discrepancy gap 

that rural counties tend to experience. The latest enrollment records (June 2013) indicate that 141 

boys (44%) and 176 girls (56%) participated in MAC programs during the summer day camps. 

Although efforts are made by the MAC to offer programs to a racially/ethnically diverse 

group of children, Meade county census records indicated that the majority of the residents are 

white (92%). Thus, the make-up of participants in MAC programming is largely white. In fact, 

of the 214 registration forms where applicants disclosed their race/ethnicity, 202 listed white 

(94%), seven Asian (3.3%), three African American (1.4%), and two Hispanic (<1%) as the 

race/ethnicity categories. Interestingly, 35% of registrants (113/327) did not report a 

race/ethnicity. Further exploration into the race/ethnicity categories on the registration forms or 

reasons as to why participants did not indicate their race/ethnicity may help programming to 

understand their reach and promotion. Further, barriers that may be present to engaging diverse 

children may emerge and be addressed. 

The MAC is committed to assuring that programs were accessible to children regardless 

of socioeconomic status. MAC offered and publicized a scholarship program for families in 

need. While general program fees range from $30-$50 per 6-week session, the CATCH Kids 

Club after-school program that is offered in all of the elementary schools is free for all children 

and meets twice per week during the entire school year. Participants have access to reduced fees 

by filling out a short application. A sliding scale for fees is based upon the household income 

and number of children and adults living in the home. For example, a family of four, (i.e. two 

adults and two children or one adult with three children) with an annual household income of 

$22,350 may receive 75% reduction in programming fees. So a child who wishes to play 

basketball would only pay $7.50 for the entire 6-week session. Further, scholarships are also 

available for children who cannot afford the sliding scale fees. An administrative assistant in the 

MAC office works closely with families to ensure that all who want to participate in 

programming are not deterred because of fees. Renewal of financial aid is required annually. 

According to an administrative assistant, approximately 25% of the children who participate in 

MAC programs receive some percentage of financial assistance. In the Executive Director’s 

latest report to the Foundation for a Healthy Kentucky, 24 families received financial assistance 

for programing that began in Summer 2013. 

According to the Executive Director, “the MAC has full intention to work with other area 

agencies again such as the health department, University of Kentucky Cooperative Extension 

Office, and school personnel. The MAC will evaluate registrations and make a consorted effort 

to ensure that students who are most in need of the program will receive first priority in the 

registration process.”
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Program Reach

The scope and amount of MAC programing increased dramatically from the first to the 

second year (Figure 1). As data collection began in Spring 2012, the MAC offered nine different 

interventions for kids. Programming increased by adding week-long summer camps (n = 17). 

When the regular classes began again in Fall 2012, the MAC offered six different activity 

programs, the initial Fall session (Fall “1”) offered the fewest number of programs since was in 

the beginning of the academic school year. This may be because parents are focused on their 

child’s school routine and many of MACs coaching staff are teachers, and their available time is 

also limited as the school year begins. MAC felt that limiting program offerings was the most 

respectful strategy given its close partnerships with local schools. Once school routines are 

established, the MAC began offering more and more programs to meet the demand for greater 

diversity in program offerings. Comparing programs year to year where there is overlap, shows 

this increase. Where there were nine programs offered in Spring 2012, that number increased by 

56% to 14 programs in Spring 2013. A similar increase occurred between Summer 2012 and 

Summer 2013 when program offerings increased from 14 to 17 programs, representing a 21% 

increase over the previous year. By August 2012, interventions were rolled out to the entire 

school district and included summer camps, Sports Saturdays, along with the CATCH Kids Club 

after-school program. In general, Fall 2, Spring, and Summer sessions are the most popular, and 

therefore MAC offers more variety and quantity of youth programs during these times. 

Figure 1. MAC Programming sma

MAC Programs

ogr

17 20 14 14

of Pr

11 9 9

10 6

 er

0

bm

0

Nu

Baseline Spring '12 Summer '12 Fall "A" '12 Fall "B" '12 Winter '13 Spring '13 Summer '13

Program Session

What originally started as an emphasis on after-school programming has grown into yearround programming. Not only is the number of programs increasing, but the level of 

participation is increasing as well. The original cohort of children who participated in the 

CATCH Kids Club after-school program in January 2012 was 75 children. To date, over 800

unique children have participated in at least one program, and approximately 300 children are 

enrolled for participation in each session in a variety of MAC programs. Program records for 

youth programs documented quarterly participation as follows, these numbers contain duplicates 

quarter-to-quarter (Figure 2). 
MAC Project Report 

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Figure 2. MAC Participation 

450 401

400

330 327 350

299

300 250

250 204

200

150 113

100

50

0

MAC Participants (< 18 y.o)

Children’s Health Behaviors and Health Outcomes

Of the 76 CATCH Kids Club enrolled in the first CATCH session, 68 completed the 

Children’s Health Survey (CHS) with required parental/guardian consent and child assent. The 

participants were 64.7% (n = 44) female, 85.3% (n = 58) white, and 45.6% (n = 31) with low 

SES. The mean age was 10.51 (SD = 1.23) and 71% of respondents indicate that they were 

physically active because of participation in MAC program. Forty-three of the 76 children 

enrolled in CATCH participated in the pre- and post-testing of the CHS and fitness testing. The 

results of paired sample t-tests are presented in Table 1. The overall effects of year one CATCH 

Kids Club after-school program were successful in improving children’s aerobic capacity, 

increasing their daily physical activity time, as well as improving their belief that they could be 

physically active afterschool. No change in sedentary behaviors (TV and other screen time) was 

detected.

Table 1. Children’s Health Behaviors and Outcomes in Year 1

Variables Baseline Post-intervention T p-value

n M (SD) n M (SD)

Physical Activity Levels 43 .94 (.78)

< 30 min

43 2.0 

60-89

(1.03)

 min

-6.02 p < .01

Aerobic Capacity (Pacer Laps) 41 12.9 (8.4) 43 17.23 (14.05) -3.08 p < .01

TV Time 43 2.9 (1.69)

60-89 min

43 2.67 

60-8

(1.54)

9 min

.93 p = .36

Computer/Gaming Time 43 1.84 (1.58) 43 1.56 (1.44) 1.25 p = .22
MAC Project Report 

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< 60 min < 60 min

Physical Activity Self-Efficacy 42 3.07 (.75) 42 3.4 (.54) -2.75 p < .01

In year two, 42 of the 766 MAC participants completed the CHS with required 

parental/guardian consent and child assent. The participants were 59.5% (n = 25) female, 100% 

(n = 42) White, and 16.7% (n = 7) with low SES. Low SES children (n = 7) were less active than 

not-low SES children (n = 35). There was a statistically significant difference in mean number of 

sports or physical activity programs participated in for low SES (M = 1.57, SD = 0.79) and not 

low SES (M = 4.23, SD = 2.00), t (40) = -3.432, p = 0.001. Although it appears that low SES 

children may not use the MAC programming, this finding should be interpreted with caution. It 

is important to note that prior to MAC programming, no extracurricular physical activity 

opportunities existed in Meade County for any children, regardless of their socioeconomic status. 

It was noticed by the original coalition members in 2008 that the affluent children’s parents were 

able to drive them to Louisville or Corydon to participate in sports and other physically active 

camps. Therefore, the CHS question that asks if children were physically active because of the 

MAC is a more specific indication of the MAC’s reach to “children who would have otherwise 

not had access to physically activity opportunities.” 

Other selected health behaviors and outcomes of low compared to not-low SES children 

(see Table 2) showed positive changes, although not statistically significant, which may have 

been due to small sample size. One half (50%) of the children indicated that they were physically 

active because of their participation in MAC programs. Pearson’s correlation revealed there was 

no statistical difference between SES and children’s perception of access to MAC physically 

active programs, r (40) = 0.064, p = 0.688.

Table 2. Comparison of Not-low and Low SES Children’s Health Behaviors in Year 2

Variables Not-low SES Low SES T p-value

n M (SD) n M (SD)

Fruit and 

Vegetables

35 3.71 (2.32) 7 5.43 (3.91) 2.495 p = .122

TV Time 35 .89 (.32)

<60 min

7 .86 (.37)

<60 min

.043 p = .836

Computer/Gaming 

Time

35 .97 (.16)

<60 min

7 .86 (.37)

<60 min

1.667 p = .204

Self-Efficacy 35 3.71 (2.32) 7 5.43 (3.91) .144 p = .706

In the Spring of 2013, results of the matched, paired sample t-test indicated that there 

were no significant difference, t (53)= -.73, p = .47, in BMI of MAC participants (M = 18.91) 

compared to non-MAC participants (M = 18.66) and that that there was no significant difference 

t (45) = -1.37, p = .176, in mean number of laps run by MAC participants (M = 16.39) and nonMAC participants (M = 17.94). 
MAC Project Report 

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During year two, 

children participated in an 

average of 15 program 

sessions. A typical 

program met over 6 

sessions, so children 

participated, on average, 

in 2 1⁄2 programs. Physical 

activity and sedentary 

behavior data retrieved 

from 14 children who 

returned the Children’s 

Health Survey in May 

2013 and who had ever 

been MAC participants. 

Using Spearman’s correlation tests, no significant relationships between level of MAC 

participation and physical activity, TV and computer time were detected. See Table 3 to see the 

number of times children participated in MAC sessions and their participation in physical 

activity recommendations (60 minutes or more of physical activity) and screen time 

recommendations (less than 2 hours of TV and less than 2 hours of video/computer gaming). 

Table 3: Children’s Participation in MAC Sessions and Health Behaviors 

# sessions 

attended

Total N 60+ min PA < 120 min TV < 120 min 

Video Games

ANY 14 7 (50%) 12 (85.7%) 13 (92.9%)

0-11 8 4 (50%) 6 (75%) 7 (87.5%)

12-23 4 3 (75%) 4 (100%) 4 (100%)

24-35 0 0 0 0

36-44 1 0 1 (100%) 1 (100%)

45+ 1 0 1 (100%) 1 (100%)

Spearman 

Correlation 

r = -.119

p = .684

r = .341

p = .233

r = .232

p = .425

Results from the Coalition Survey 

During the summer of year one, survey (n = 15) and interview/focus group (n = 13) 

results from coalition members and key stakeholders indicated that participants perceived that 

their community’s lead agency (M = 1.87, SD = .34) and board of directors (M = 1.84, SD = .17) 

were effective in their roles of leading the physical activity programming and securing resources 

for maintaining current and future operations. They expressed satisfaction with hiring an 

executive director to organize and manage the project and felt that their overall mission, goals, 

and objectives were clear and manageable. Their perceptions of the effectiveness of the project 

staff (M = 1.68, SD = .28) and coalition membership (M = 1.48, SD = .44) in implementing 

Image 5: Before the MAC, the closest gymnastics program was in 

Elizabethtown, 45 minutes’ drive from Brandenburg.
MAC Project Report 

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physical activity programming however were not as favorable. Participants felt that finding 

qualified and certified staff to implement the physical activity programming was a challenge. 

Further qualitative inquiry identified that although the coalition structures (M = 1.5, SD = 

.39) and processes (M = 1.5, SD = .37) were low during this beginning stage of the coalition’s 

formation, the participants felt confident about their progress and ability to improve. Using the 

Coalition Effectiveness Index as the theoretical framework for deductively coding data, results 

from the MAC Coalition members and key stakeholders will be discussed in relation to lead 

agency, staff, leaders, coalition members, coalition structures, and coalition operations and 

processes effectiveness.

Lead Agency and Convener Group. The majority of respondents discussed the call to 

action from the community. A few key stakeholders, within the now executive board, conducted 

a survey of community members and their interest in pursuing the creation of a fitness facility 

within the rural Meade County. One respondent indicated “The evidence from those calls (i.e., 

survey) was that the community at large was very much in support of pursuing this type of 

project... a community recreation center that would encompass weight facility, indoor pool, 

indoor gymnasium, and a lot of open rooms for classes.” After the initial survey indicated a 

community need, various members of the community dedicated their time and effort to forming 

an executive board, establishing non-profit status for their organization, and delegating roles in 

order to make their dream into a reality. The chairman of the board stated "I agreed to serve as 

chairman because someone actually had to set the direction of where we were going." By 

stepping into the leadership role, he agreed to convene the coalition and actively pursue funding, 

as well as recruit other community members to assist him in this task. 

Leadership and Staffing. A common theme identified throughout the interviews was the 

dedication of the volunteers. However, the goals and objectives of the coalition required 

assistance of paid employees. Interviewees commended the hiring of an experienced executive 

director with a strong recreational programming background. Additionally the coalition hired 

administrative staff, and other part-time staff to help run programming. Additional staffing 

helped to take the burden off of some of the board members, who were previously serving in 

more of a staff role to get MAC started. Interviewees discussed in anticipation that staff would 

continue to grow, and take responsibility of aspects of the project that are still being managed 

directly by the board. One interviewee noted, “Over time the board of directors will become 

more of an oversight and approval board...more of a classic board of directors.” 

When asked to describe the members of the executive board and others in the community 

who played a role in developing the MAC, one participant indicated “I’ve seen other boards 

where you have too many bankers or lawyers...this group actually does have diversity in how 

people think and they appreciate the different ways of thinking.” Another participant stated "We 

felt like it was very important for us to make sure that we had the ability to set up the right type 

of processes in place to be able to effectively communicate." And lastly, to address long-term 

sustainability, one coalition member said "By us taking the steps to acquire the facility that we're 

at now and start pumping programs into the community it has kinda (sic) built the momentum... 

it also has maybe given us some more credibility with some of our keys stakeholders... they’re 
MAC Project Report 

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starting to see that there’s a staff in place and a group of coalition members who understand what 

it takes to have some longevity and sustainability."

Coalition membership. In forming the coalition, the chairman and community 

stakeholders looked to form an executive board including individuals with expertise in various 

areas (e.g., grantwriting, marketing, technology, finance) to help build the infrastructure with a 

small staff and provide different points of view. Individuals on the committee knew their own 

strengths and served the coalition in that respect which “kept us from getting burned out by 

focusing on our responsibility or areas.” By focusing on job tasks in which individuals excel, and 

not becoming bogged down in areas in which individuals do not excel, is a strategy in which 

coalition members can thrive without becoming burdened with addition tasks in which they are 

not qualified or interested. 

In addition to the diversity in skills of board members, there was an overwhelming sense 

of dedication identified by interviewees. The stakeholders are hard-working and were willing to 

dedicate a significant amount of time and effort to achieve the goals set forth. One respondent 

stated, “The level of time that a few individuals have put in is absolutely incredible.” Members 

of the coalition genuinely care about the community and are all working toward a common goal. 

Another respondent stated this in regard to the other members of the coalition “They are from 

here, they’ve gone off to school and came back to this community and they want to see Meade 

County grow and become a better place to raise your kids.”

While there was an overwhelming amount of support and dedication among the coalition, 

the respondents also identified some challenges. Many interviewees identified the issue of 

relying on volunteers. Others mentioned the difficulty in criticizing the quality of work of people 

who are volunteering their time, or even talking about what could be improved. Some interpreted 

this as a need to shift more work to paid employees to avoid burn out from volunteers. 

Operations and Processes. In regard to operations and processes, various interviewees 

mentioned having to develop infrastructure for MAC (e.g., personnel policy, financial policies, 

how to engage with contractors) from scratch. Not only did the coalition have to develop 

policies, they were also tasked with developing marketing and communication infrastructure to 

increase awareness of MAC and its programs within the community. One respondent stated, "We 

felt like it was very important for us to make sure that we had the ability to set up the right type 

of processes in place to be able to effectively communicate." In order to achieve this goal, the 

coalition contracted with a communications consultant, so the executive board was not 

overwhelmed by this task. 

Structures. There was less discussion about the formal structures of the coalition. This 

could be attributed to the trust among coalition members as well as the dedication to the task. 

Formalized mission and vision statements for the innovation were created, however, the 

interviewees did not focus on formal procedures within their group. One interview stated, “We 

don’t operate like a typical board...it puts a lot of pressure on the chairman... everyone sees this 

as his thing. The board feels like they answer to the chairman, but a real board answers to the 

board.” Otherwise, there was little information regarding structures identified throughout the 

interviews.
MAC Project Report 

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Areas of Growth 

What originally started as an emphasis on data collection for children enrolled in the 

CATCH Kids Club afterschool program at all Meade County district elementary schools has 

grown to collect health behavior and fitness outcomes for all children in Meade County. 

Specifically, the elementary schools are now fitness testing all K-6 grade children as part of their 

regularly scheduled physical education curriculum. The partnership MAC has developed with 

Meade County Public Schools is an excellent example of how communities begin to shift 

cultures in a variety of ways. The physical education teachers have found new enthusiasm for 

their physical education curriculum by implementing Fitnessgram. The MAC Executive Director 

bragged that his recent conversations with the physical education teachers gave him 

encouragement about the future of the MAC’s partnership with the public schools. He said that 

the PE teachers are integrating all of the aspects of the Fitnessgram program into their 

curriculum, testing all of their children’s physical fitness: muscular strength, muscular 

endurance, flexibility as well as their cardiovascular fitness and body mass index. They are using 

the Fitnessgram software program to track their students’ progress from year to year and show 

the children their changes over time. Further, one of the teachers is sending home “report cards” 

of his students’ fitness scores to children’s parents. The PE teachers have expressed their thanks 

to the MAC for housing the Fitnessgram curriculum in their schools. 

Programming has expanded to include adults as well. During the summer (2013) in 

addition to standard programming options, the MAC held two family events that allowed the 

community to participate at no cost. A water safety course was provided as part of the local 

Fatherhood Initiative and a MAC Community Night Open House in which approximately 300 

people attended. MAC staff was available to discuss program options and financial assistance 

opportunities. Both events served as a great venue to build awareness and inform attendees 

about what the MAC provides and how it continues to make facilities, programming, and events 

available to the entire community. 

Senior community members are being integrated into MAC programming as well. 

During the summer of 2013 the MAC began offering yoga, NIA (dance), and strength training 

for senior citizens. In the winter of 2012 and 2013, the MAC hosted the Holiday Fitness Series to 

senior population. In marketing these events, local senior groups from various organizations 

were encouraged to take part in these events which provided adequate physical activity and a 

positive support group for those looking to become or continue being physically active. 

Members of the MAC’s Board of Directors have heavily directed their energies toward 

long-term sustainability of MAC programming as well as directing their focus on building a 

permanent facility. They realize that current “borrowed” spaces have reached their maximum 

capacity and in order to continue to serve the community the capital campaign must produce 

needed funds. To date, approximately $500,000 towards new facility construction has been 

raised. The board of directors hopes to begin construction on the first phase of a facility in the 

winter of 2014. Conversation has been initiated with city council and county magistrates to 

discuss the MAC impact and how the city and county could support the endeavor. As stated 
MAC Project Report 

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previously, the MAC is utilizing funds outside of Grant/Match Dollars to pay for consultation 

services. 

Areas for Improvement 

For rural areas like Meade County where residents might have limited experience with 

research, informed consent protocols, and surveys, such as the mailed Children’s Health Surveys 

may have posed an undue stress or burden to the family. Each packet contained a list of 

directions from the Meade Activity Center’s Executive Director, two parental/guardian informed 

consent forms written in university-language (one form to sign and return, one to keep), two 

child assent forms (one to sign and return, one to keep), the 6-page, 55-item Children’s Health 

Survey, and a stamped, addressed return envelope. To the parent/guardian and/or child, the 

materials in the packet may have seemed like a time-consuming task of filling out all of the 

paperwork and mailing it back, causing a low return rate. Previous research has also indicated 

that readability, familiarity, and trust are attributes that are important for study participants in 

order to participate in research. Year one CHS data was collected by face-to-face interactions by 

the CATCH Kids Program coaches. Despite having similar survey packets response rate was 

much higher when the action was initiated from a trusted source. 

The results indicating that low income children participated in fewer physical activities 

than their more affluent peers is concerning. Seven of the 42 children who participated in the 

survey study indicated they received free or reduced-price lunch, which, in our study is a proxy 

indicator for low socioeconomic status. Of those seven children, only four indicated they were 

physically active because they participated in MAC programs. The incredibly low response rate 

for children who participated in the Children’s Health Survey (42 completed out of 766 that were 

mailed, 5.5%) makes it difficult to draw solid conclusions from this data. The researcher and a 

community volunteer will attempt to achieve a higher response rate by attending the first few 

sessions of each program to pass out forms and surveys while parents/guardians are registering 

their child(ren). By being physically present during data collection (as opposed to mailing the 

surveys), the researcher and/or community volunteer can explain the purpose of the study, the 

parental/guardian informed consent form, and the child assent form. Further, the Principal 

Investigator can ensure all forms are filled out correctly by the parent/guardian and/or child and 

answer any questions or concerns about the study. We anticipate this change in data collection 

will increase the response rate and parent/guardian and child’s comfort with study participation. 

Additionally in future years, resources for more elaborate data collection methods and 

technologies (e.g. pedometers to objectively measure physical activity) and time spent collecting 

data may be considered. As the MAC continues to scale the project up to broaden the many 

programs and services needed to be sustainable, the staffing and administration of the project is 

critical. For example, in order to prevent participation loss, strategies to encourage continued 

participation in programming are in place. Currently, the MAC Project Executive Director 

frequently makes “site visits” to meet with program participants – asking for programming, 

location, pricing, etc. feedback and suggestions. The executive director tracked all participation 

frequencies and participant feedback while striving to accommodate participants’ request for 

improvements. MAC has demonstrated needs for expanded use of program staff. As the 
MAC Project Report 

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operations in programming expand, so too does the need for an additional full-time staff person, 

or multiple part-time staff to handle administrative needs of particular programs. 
MAC Project Report 

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DISCUSSION 

Since the MAC Project began as a grassroots organization in 2008 and is steadily 

building its programming and infrastructure toward eventual sustainability. The MAC Project is 

showing moderate levels of evidence that their programming and infrastructure improve 

children’s health behaviors and coalition effectiveness are improving. Unique findings in this 

process evaluation study highlight the importance of coalition members’ and key stakeholders’ 

vested levels of commitment toward the success of the MAC Project. The drive of those in the 

leadership positions to accomplish MAC goals may have influenced the results of this study 

however. For instance, survey respondents felt that the board of directors and lead agency were 

effective, yet programming and membership were less so. Community organization theories 

posit that although it takes time to establish staff, structures, and processes, the locality 

development nature of community organization enhances community buy-in and trust and 

therefore has greater potential for long-term, sustainable success. 

Considering that the Meade Activity Center began with a group of community members 

who recognized that their fellow low-income families did not have proximate places for their 

children to engage in physical activities and that they adopted the lofty goal of creating a health 

equitable community - offering physical activity opportunities for children and adolescents 

within the county in borrowed spaces until an actual facility could be built. In future studies, 

more emphasis will be placed on working with community members in collecting complete data 

sets. The current response rates are inadequate to be able to confidently state whether the MAC 

programing is reaching the children who would not have otherwise had access to physical 

activity programming. 

Coalition members mentioned the difficulty of changing people’s behaviors and the need 

for people to get involved to see how accessible the programs are and that everybody was 

supportive of programs for their kids. They also indicated that the MAC programs were 

compatible with the school offerings—providing a nice complement to what the school already 

offers. However, many coalition members noted that it’s difficult to change people’s behaviors 

and that people who weren’t used to spending time and resources on being physically active 

would be more difficult to engage. That is part of the reason the MAC initially focused on 

programming for children. As one coalition member stated, “the way to get the adults there is to 

get the kids there...people are hungry to have things for their kids to do, and while we have them 

we can try to teach them better nutrition and to be physically active.” For children, the options 

before MAC began offering programming were (1) to travel outside of the county to access 

programs/services, which was not available to many in the community because of the time and 

resources required to take advantage of these programs; and (2) school organized sports, which 

were available in middle and high school for kids who wanted to compete. Other than those 

options, the coalition didn’t feel that there were other formal opportunities for children to be 

physically active. 

Coalition members talked frequently about the importance of getting people involved, 

and increasing word of mouth once people were involved. To promote use, they discussed the 

need for a diverse set of programs targeting everyone in the community—and the value of 

programming that would encourage the entire family to participate. The current MAC facilities 
MAC Project Report 

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were previously owned by a country club, and many coalition members discussed the need to 

overcome the community perception that “it’s a country club” and therefore out of their reach. 

They have offered a sliding scale for programming to increase accessibility to everyone 

throughout the community. As one coalition member stated, “I think people think this MAC is 

for certain people, for certain groups, and you can’t convince people differently until they start 

participating.” They also acknowledged that it’s difficult to begin exercising if you’re out of 

shape, so recognized the need to make programming and facilities as unintimidating as possible. 

For example, “People do not know how to get in shape...I haven’t spent much time in a weight 

room since I was in high school...I wouldn’t know what to do...I know that there are all kinds of 

people that way in the community, that are entirely intimidated by that process.” 

For such an innovative program as the MAC Project, simply offering the programming 

while measuring the fidelity to which programming is implemented serves as an important step 

to future MAC project success. At this point, the only full-time MAC Project Staff person 

consists of an executive director, hired in September 2011. Other MAC Project Staff persons 

include one part-time administrative assistant and one part-time program coordinator, several 

hourly-paid coaches and fitness instructors, and numerous volunteers. The limited human 

resource capacity presents barriers to conducting more rigorous evaluations. In future years, 

when the MAC Project staff becomes more established and infrastructure (e.g. operations and 

processes) becomes more efficient, the MAC Project may design an impact evaluation more 

likely to generate evidence of effectiveness at the “strong” level. The lessons learned from 

offering programming and community events and establishing infrastructure processes and 

structures in the first two years can provide future iterations with implementation guidelines that 

will maximize programming and infrastructure efficacy. The successes or challenges Meade 

County faces may aid potential replication of community-based physical activity interventions in 

other rural, low-socioeconomic status counties. 

Future Goal: An Actual Meade Activity Center 

With broad 

community 

support, the 

Meade Activity 

Center's goal is to 

open a fully 

operational 

activity center, to 

be available on a 

sliding scale to all 

community 

members. 

Children’s 

physical activity 

programming has 

been met with great enthusiasm since the MAC’s inception. Participation rates have steadily 

been increasing, from 388 children in the initial year to over 800 children in 2013. All programs 
MAC Project Report 

Page 24 of 26

are being offered in temporary community spaces, including local schools, churches, and 

businesses. Programs fees are calculated on a sliding scale to ensure that all children can 

participate. The proposed activity center will offer swimming, tennis, golf, hiking trails, and 

nutrition and health classes. It will provide structured after-school activities to low-income 

children, offer a broad range of nutrition and physical activity opportunities to low-income 

families, and provide affordable physical activity opportunities to seniors. When asked “What do 

you think members of your community think about physical activity” one community member 

indicated that "The only thing that was available in this community was little league baseball and 

then youth basketball once the kids hit like fifth grade. So we’ve kind of filled a void as to all the 

things they’ve traveled to Corydon, Indiana, Elizabethtown, Louisville previously for." This 

statement addresses the need for Meade County to address the access inequity that is presented to 

children and families who cannot afford to travel to be physically activity. Expanded sampling in 

Year 3 should allow researchers to more fully understand the extent to which the MAC has been 

successful in serving children who would not have otherwise had access to physical activity 

opportunities. 
MAC Project Report 

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