Wellness Program Implementation: School & Student Toolkits
Condition: Overweight; Obesity
MeSH terms: Overweight
Study type: Interventional

Summary: 
      The project is designed to evaluate a participatory implementation model in HealthCorps (HC)
      high schools and to assess outcomes within and across school settings . The behavioral
      objectives from the 2010 Dietary Guidelines to address obesity in youth include: 1)
      decreasing sugary beverage intake; 2) increasing frequency of breakfast; 3) increasing
      vegetable and fruit intake to 2½ cups per day;4) decreasing frequency of fast food meals;5)
      becoming physically active (goal of 1 hour per day); and 6) reducing sedentary behavior time
      (<2 hour day). The study is employing system dynamics modeling (SDM) to assess wellness
      programming options and to evaluate the program implementation within the context of diverse
      school ecologies. The RE-AIM evaluation metric (Reach, Effectiveness, Adoption,
      Implementation, and Maintenance) is used to guide SDM development and validation.

      The Specific Aims are:

        1. To use PAR (Participatory Action Research) methods to refine the school wellness program
           model and toolkit components that address institutional/community level program
           implementation barriers and individual level barriers to achieving healthy lifestyle
           recommendations.

        2. To assess the effectiveness of program components using process evaluation techniques
           guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance)
           model.

        3. To evaluate implementation with system dynamics modeling to facilitate dissemination.
           The simulation analysis will apply the RE-AIM framework to address: Reach (participation
           rates), effectiveness (outcomes), adoption (acceptability), implementation (intervention
           fidelity), and maintenance (sustainability of lifestyle changes by students and programs
           by schools), in order to facilitate refining the toolkits and training program for
           dissemination to other school setting and diverse educational venues.
    

Detailed description: 
      This research project focuses on enhancing implementation of school wellness activities with
      the goal of achieving federal lifestyle recommendations to reduce obesity. The study will
      evaluate whether using a toolkit approach with problem-solving and other strategies helps
      schools and students develop healthier lifestyle choices.

      At the school level, we will focus on implementation barriers identified by (or brought to)
      the school Wellness Champion Network (e.g., crowded gym, lack of equipment, food service
      issues) using a toolkit approach that builds on the Alliance for a Healthier Generation
      school toolkits.

      At the student level, the toolkit will focus on a self-assessed health-behavior feedback
      mechanism to personalize behavioral goal setting when addressing obesity related lifestyle
      recommendations.

      An iterative intervention dissemination will be used to achieve sequential roll out to all
      HealthCorps-affiliated Living Lab schools over time. This design allows for an increasingly
      larger selection of schools to receive the enhanced support through participation research
      principles to determine how to address obesity-related school mandates. Consistent with
      participatory research principles, all HealthCorps coordinators have received training to
      function as Wellness Council facilitators. This study will evaluate a participatory
      implementation model designed to extend wellness and stakeholder collaborations towards
      achieving policy standards and goals focusing on the school wellness network. By the end of
      the study, all HealthCorps Living Labs schools will be implementing this participatory
      implementation for wellness programming.

      This implementation approach increases the potential for learning lessons that can be
      generalized more widely as in pragmatic trials. In keeping with participatory research
      principles, school Wellness Councils will use data obtained during the trial as feedback for
      potential refinement of their toolkit components.

      The research team will work with school Wellness Councils and key stakeholders to develop
      additional school toolkit items utilizing problem-solving strategies and low-cost methods to
      address implementation barriers. The elements of participatory action research focus on
      forming a school Wellness Council partnership to build trust, shared vision, and mutual
      capacity, and includes engagement at multiple levels as well as active participation of
      stakeholders to create more salient and effective programs. The HealthCorps coordinator will
      guide stakeholders via the Wellness Council network and by specific program area to engage in
      a 6-step iterative process listed below:

        1. Examine local indicator data e.g., FitnessGram, Health Behavior Survey with Youth
           Behavioral Risk Factor Surveillance System (YBRFSS) items, food service data, school
           environment/climate data, community data

        2. Consider how current programs/curricula and alternatives relate to behavioral indicators
           (using a social ecological framework) to student, family, school, and community
           consideration of media and other spheres of influence,

        3. Develop program/curriculum S.M.A.R.T. (specific, measurable, attainable, realistic and
           time limited (considering semester/school year)) goals focusing on Dietary Guidelines,
           mental resilience, and FitnessGram indicators

        4. Identify barriers and develop strategies for the school and student toolkit

        5. Implement school program elements with ongoing monitoring by stakeholders and the
           Wellness Council

        6. Use an iterative process to adapt to new needs and sustain program

      Basic simulation models will be used to demonstrate the potential effects of implementing a
      given toolkit option. The school and student toolkits developed during the formative
      evaluation will serve as a template to be used with the intervention schools. The initial
      training and guide/toolkit formatting will be based on those used by the Alliance for a
      Healthier Generation in their school wellness programming. Initial feedback from HealthCorps
      coordinators indicates that the Alliance Wellness Council guide/toolkit can be readily
      implemented in HealthCorps high schools. The HealthCorps coordinators will build on the
      Alliance's collaborative guidelines and training to enhance collaboration as an active
      Wellness Council. In addition, to build youth leadership thereby obtaining student support,
      the toolkit will include demonstration exercises to be lead by HealthCorps coordinators in
      collaboration with student leaders and school wellness stakeholders. These demonstration
      activities, linked to the intervention's behavioral objectives, provide share-able knowledge
      and skills to promote positive health behavior change.

      The outcomes simulation will expand the types of data used to include the survey's
      psychosocial variables and extensive administrative data such as attendance, demographics,
      and reduced/free lunch and student, teacher and parent school evaluations.
    

Intervention name(s): Toolkit Intervention
Intervention type(s): Behavioral
Intervention description(s): The toolkit intervention consists of strategies and activities to engage students (student toolkit) and school wellness councils (school toolkit) in addressing the six targeted behaviors of the 2010 Dietary Guidelines based on the principles of participatory action research. The intervention will promote goal setting and school-based food and physical promotion activities led by students as well as school wellness network development.
Other intervention name(s): Student and School Toolkits
Allocation: Non-Randomized
Intervention model: Factorial Assignment
Intervention model description: During the 2014-2015 school year a 2-arm design was used to compare outcomes between intervention and comparison schools. Subsequent years utilized a single-arm design to analyse trends between and within intervention schools only.
Masking: None (Open Label)
Primary purpose: Other