This article presents a framework for developing and carrying out an implementation monitoring plan of a complex structural intervention in an organizational setting and describes seven steps for analyzing and reporting results for fidelity and completeness of implementation. This process is illustrated using the Environmental Interventions in Children's Homes (ENRICH) Wellness Project. ENRICH aimed to promote physical activity and healthful nutrition behaviors among children residing in children's group homes by working collaboratively with organizational staff. A comprehensive implementation monitoring plan was developed based on the particulars of the setting, context, and the program framework and used multiple data sources, criteria for evidence of implementation, and data triangulation to examine evidence for organizational implementation. Eleven of 17 organizations (65%) met the criteria for nutrition implementation whereas 9 of 17 (53%) met the criteria for physical activity implementation. Implementation data can be used descriptively, as described here, and may also be used in future outcome analyses to better understand project outcomes. The framework and evaluation approach are applicable to complex interventions in other organizational settings.

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The purpose of this study was to examine the relationship between food environments and fruit and vegetable (FV) consumption of adolescents (n=246) living in Residential Children's Homes (RCHs) in North and South Carolina, USA. Administrators of 21 RCHs completed the Physical Activity and Dietary Environmental Assessment (PADEA), an instrument assessing FV-related environmental variables of RCHs: (i) policies, (ii) availability, (iii) social environment, (iv) community collaboration and (v) administrative support. Two different approaches using mixed-effects regression models were used to compare FV consumption of adolescents living in RCHs with more conducive food environments compared with adolescents living in RCHs with less conducive environments. Using one approach, PADEA variables were analyzed as categorical data and in the second approach, PADEA variables were analyzed as continuous data. Results indicated greater FV consumption among adolescents residing in RCHs with more conducive food environments compared with less conducive RCHs. Specifically, adolescents living in RCHs with higher levels of administrative support and more FV policies reported greater FV intake compared with adolescents living in RCHs with less support and fewer policies. Food environments are related to adolescents' dietary behaviors and interventions targeting FV consumption should include strategies to increase administrative support and the development of FV-related policies.

When developing scales not previously assessed in a population, eliciting modal beliefs about a behavior is an important formative step in instrument development.

Background: There is an increasing need to adapt and use community interventions to address modifiable behaviors that lead to poor health outcomes, like obesity, diabetes, and heart disease. Poor health outcomes can be tied to community-level factors, such as food deserts and individual behaviors, like sedentary lifestyles, consuming large portion sizes, and eating high-calorie fast food and processed foods. Methods: Through a social ecological approach with family, organization and community, the Faithful Families Cooking and Eating Smart and Moving for Health (FFCESMH) intervention was created to address these concerns in a rural South Carolina community. FFCESMH used gatekeepers to identify 18 churches and four apartment complexes in low-income areas; 176 participants completed both pre- and post-survey measures. Results: Paired t-test measures found statistically significant change in participant perception of food security (0.39, p-value = 0.005, d = 0.22), self-efficacy with physical activity and healthy eating (0.26, p-value = 000, d = 0.36), and cooking confidence (0.17, p-value = 0.01, d = 0.19). There was not significant change in cooking behaviors, as assessed through the Cooking Behaviors Scale. Conclusion: FFCESMH shows that a social ecological approach can be effective at increasing and improving individual healthy behaviors and addressing community-level factors in low-income rural communities.