Social Mechanisms for Promoting Physical Activity in After School Programs for Underserved Middle School Youth
Condition: Physical Activity; Obesity Prevention
Study type: Interventional

Summary: 
      The primary goal of the Connect feasibility trial was to develop and test the feasibility of
      a physical activity (PA) social-climate-based intervention within pre-existing after school
      programs (ASPs) that targets youth social goals (e.g., building friendships through PA) and
      social competencies (e.g., friendship-building skills) to increase the positive PA affect,
      cognitions, and moderate-to-vigorous (MV) PA of underserved (i.e., low income, minority
      status) middle school youth. The 8-week intervention was designed to improve several key
      social mechanisms within ASPs overlooked in previous interventions (e.g., developing
      friendship and connection to peers and staff through PA; group belonging, including positive
      peer PA norms and tangible support) that are key predictors of youth PA and included: 1) "Get
      to know you" sessions aimed at providing youth guided social opportunities to foster
      friendship-building skills, and to promote acceptance, cooperation, contribution, and
      friendship affiliation, and; 2) a novel socially-oriented physical activity curriculum
      tailored to meet the social goals and needs of program staff and participating youth.
      Comparison of ASPs receiving the 8-week "Connect" intervention (N=3 ASPs) with ASPs
      randomized to receive the general ASP curriculum (wait-list control condition; N=3 ASPs) will
      yield preliminary data on the effectiveness of social mediators for improving
      moderate-to-vigorous physical activity (MVPA) and preventing obesity among at-risk youth that
      can inform future intervention design and youth programming policy. Results of this proposed
      project will provide the basis for conducting a large scale efficacy trial.

      First, it is hypothesized that the Connect program will be documented to be feasible as shown
      by: 1) youth's greater perceived connectedness and PA affiliation goal orientation from
      baseline to post-intervention; 2). changes in targeted social climate components from
      baseline to post-intervention as measured by systematic observations, and; 3) adequate dose
      and fidelity of program implementation as indicated by weekly process evaluations. Second, it
      is hypothesized that youth in the social climate program (vs. comparison) demonstrate greater
      increases in positive PA affect, cognitions, and MVPA from baseline to post-intervention.
    

Detailed description: 
      Physical inactivity has been identified as a primary contributor of childhood obesity and
      related diseases, with underserved youth (minority and low-income status) at greatest risk of
      inactivity and its health consequences. However, physical activity (PA) interventions have
      attained limited-to-no sustained behavior change and thus, have rarely affected targeted
      physiological or anthropometric health outcomes. Extensive research on participation
      motivation in sport and physical education shows highly engaged youth report an affiliation
      orientation towards PA, identifying social reasons and goals (e.g., being with, and making
      friends) as their primary motivations for participation, and defining PA competence as
      achieving these social goals. Despite substantial research noting the importance of social
      goals on PA-based self-determined motivation and participation, PA-based interventions have
      almost exclusively emphasized approaches centered on constructs related to physical ability
      (e.g., mastery, self-efficacy). To date, little research has focused on understanding the
      contributions that affiliation orientations (social goals) make toward promoting sustained
      youth PA. The investigators argue that adolescents' desire for social connections is a
      primary goal of action underpinning their PA behavior and thus, a key mechanism to target for
      sustained behavior change. The Active by Choice Today (ACT) program, conducted by the
      investigative team is one of the first after school programs (ASPs) to implement a
      climate-based intervention based on Self-Determination theory that showed significant
      improvements in PA in underserved youth. However, limited sustained effects found
      post-intervention, and data from interviews with ACT staff and youth which indicated the
      presence of several interpersonal barriers (e.g., cliques, teasing) to program effectiveness,
      suggests additional socially-based climate components still need to be addressed. Systematic
      observations of ASPs using an observational tool that the PI has developed and tested and
      additional interviews conducted with ASP staff and youth further suggests that targeting
      youth social goals (e.g., building friendships through PA) and social competencies (e.g.,
      Friendship-building skills) may be particularly effective for increasing and sustaining the
      PA of underserved youth. Thus, the proposed study aims to test the feasibility of augmenting
      the Active by Choice Today (ACT) program through the addition of three key "PA affiliation
      orientation" elements shown by previous research to be particularly important to adolescents
      within physical domains: 1) Connecting strengthened friendships to increased PA (developing
      youth social skills and providing a PA environment that emphasizes friendship building as the
      goal of PA), 2) Improving peer connectedness and group belonging through PA participation,
      and 3) Improving interpersonal connections with ASP staff through PA participation. These
      elements have not been explored in prior research. Enhancing ACT to include these elements in
      the resultant ACT version 2-Connect intervention is expected to lead to sustained positive PA
      affect, cognitions, and behaviors in underserved youth. Comparison of ASPs receiving the
      "Connect" intervention (N=3 ASPs) with ASPs randomized to receive the general ASP curriculum
      (control condition; N=3 ASPs) will yield preliminary data on the effectiveness of social
      mediators for improving moderate-to-vigorous (MV)PA and preventing obesity among at-risk
      youth that can inform future intervention design and youth programming policy. Results of
      this proposed project will provide the basis for conducting a large scale efficacy trial.

      Specific Objectives:

      Apply essential social climate elements identified from interviews and the investigators'
      previous research to design and test the feasibility of the 8-week "Connect" social climate
      intervention for increasing PA affect, cognition, and MVPA of underserved youth within ASPs.

      Primary Aims (Program Development and Feasibility):

        1. Through qualitative interviews with program staff and youth at 4 ASP sites serving
           at-risk youth: a) identify conceptual constructs most relevant for facilitating and
           supporting youth PA social affiliation goals; b) determine the barriers present within
           ASPs for meeting youth PA social goals, and; c) obtain staff/youth input on the
           feasibility and acceptability of initially- developed program components.

        2. Explore the feasibility of the Connect program. The Connect program will be documented
           to be feasible in these ASP programs as shown by: 1) youth's greater perceived
           connectedness and affiliation goal orientation toward PA from baseline to 12- weeks
           post-intervention; 2). changes in targeted social climate components from baseline to
           post-intervention as measured by systematic observations, and; 3) adequate dose and
           fidelity of program implementation as indicated by weekly process evaluations.

      Secondary Aims (Document the preliminary impact of the Connect program on PA outcomes):

        1. Assess whether youth in the social climate program (vs. comparison) demonstrate greater
           increases in positive PA affect, cognitions, and MVPA from baseline to 2-weeks
           post-intervention.

        2. Explore whether youth in the social climate program (vs. comparison) demonstrate
           healthier BMI trajectories (e.g., slight reduction) from baseline to 2-weeks
           post-intervention.

        3. Assess whether changes in targeted social mechanisms will mediate the effects of the
           intervention on changes in PA affect, cognitions, and MVPA from baseline to
           post-intervention.
    

Intervention name(s): Connect Social Mechanisms Intervention
Intervention type(s): Behavioral
Intervention description(s): The "Get-to-Know-You" small group sessions (30 minutes) were designed to increase friendship building skills and involved interactive student-led discussions and activities designed to foster the assets needed to build and support friendships, group cohesion, and staff connections through PA. The PA component of the program (60 minutes) was designed to promote a positive PA social experience and meet youth social affiliation goals. Available games to choose from were novel, inclusive, emphasized teamwork, and centered on social goals. Three different PA stations were offered each program day in which youth rotated. One day each week was designated as a "choice day", whereby youth activity preference ratings were used to determine which activities were offered that day.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A randomized study design will be implemented in which 6 ASPs are randomly assigned to either the Connect Social Mechanisms intervention condition or the active-wait list control condition (8-week intervention, with a 2 week post-intervention data collection).
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Physical Activity; Community-based Intervention; Social Motivational Theories; Behavioral Change; Social Mechanisms