Whole-of-Community Youth Population Physical Activity
Condition: Physical Activity
Study type: Interventional

Summary: 
      This study will evaluate the impact of a whole-of-community multi-level adaptive systems
      intervention on implementation of community change and youth population physical activity.
      Building on local health department partnerships, the investigators will conduct a two-wave
      staggered-start community randomized trial with four volunteer rural communities (each having
      nested school, after-school, scouting/4-H club, youth sport organizations) randomly assigned
      to intervention or standard public health practice.
    

Detailed description: 
      The underlying conditions where youth live are associated with population health outcomes,
      with rural communities facing under-studied challenges. Youth physical activity (PA), a key
      risk factor linked to later cancer occurrence, is an outcome of community conditions. The
      proposed work will address a critical public health need by evaluating the impact of a
      whole-of-community multi-level adaptive systems intervention on implementation of community
      change and youth population PA. The intervention, Wellscapes, is based on a hierarchical
      patch dynamics paradigm, given that communities are "wellness landscapes" of spatially
      heterogeneous geographic areas, characterized by a patchwork of interacting organization and
      activity settings. The intervention will establish a multi-level system infrastructure
      (Community Hub, Organization Wellness Teams, Activity Setting/Leaders) and provide training
      and support for population health quality improvement cycle processes targeting two
      evidence-based practices (EBPs): (1) stacking time segments of PA episodes within an
      organization's daily routine, and (2) improving the quality of PA episodes (% time in PA).
      The omnibus hypothesis is that intervention communities (plus organizations and leaders
      nested within) will have synergy and capacity to implement EBPs, adapting to continuously
      changing local system drivers to create a whole-of-community ecosystem of diverse and
      equitable youth PA opportunities. Building on local health department partnerships, the
      investigators will conduct a two-wave staggered-start community randomized trial with four
      volunteer rural communities (each having nested school, after-school, scouting/4-H club,
      youth sport organizations) randomly assigned to intervention or standard public health
      practice. For baseline and intervention years, one day per month in the fall (3 days) and
      spring (3 days), organization activity settings (e.g., classrooms, teams) that house 480
      children in 3rd through 6th grades will be assessed, resulting in observed community
      condition data, PA accelerometer data, and setting reach data (children % attendance by
      gender, ethnicity, free/reduced lunch status, and grade). The investigators will also obtain
      estimates of population level PA with the use of the calibrated Youth Activity Profile, as
      well as community system qualitative data. The specific aims are to: (1) Determine the impact
      of the intervention on multi-level community system outcomes; and (2) Determine the
      implementation system drivers of multi-level youth population PA. The investigators will use
      "big data" multi- level modeling methods for this effectiveness-implementation hybrid design,
      because there is a dual focus on testing an implementation strategy while simultaneously
      evaluating youth population PA impact. The research is significant because it evaluates a
      method for improving population health, theory-based systems, and behavior change processes
      in low-resource rural communities. The proposed research is novel because the adaptive patch
      dynamics approach builds capacity for both equitable collaboration and EBPs implementation
      across multiple local systems that are individually and collectively, dynamic and
      unpredictable.
    

Intervention name(s): Wellness Landscape Intervention; Standard Practice
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Community and organization systems intervention targeting youth population physical activity; Community development intervention
Other intervention name(s): Wellscapes; Collective Impact
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This design can be described as a staggered-start, stepped-wedge, community randomized trial. The design includes two sequential intervention waves.
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Children; Cancer Prevention; Population Health; Rural; Community; School; After School; Youth Sport; Intervention; Multilevel; Systems