Assessing the effectiveness of training models for national scale-up of an evidence-based nutrition and physical activity intervention: a group randomized trial

Abstract

BackgroundThere is a great need to identify implementation strategies to successfully scale-up public health interventions in order to achieve their intended population impact. The Out-of-school Nutrition and Physical Activity group-randomized trial previously demonstrated improvements in children’s vigorous physical activity and the healthfulness of foods and beverages consumed. This implementation study aimed to assess the effects and costs of two training models to scale-up this evidence-based intervention.MethodsA 3-arm group-randomized trial was conducted to compare effectiveness of in-person and online training models for scaling up the intervention compared to controls. One-third of sites were randomized to the in-person train-the-trainer model: local YMCA facilitators attended a training session and then conducted three learning collaborative meetings and technical assistance. One-third were assigned to the online model, consisting of self-paced monthly learning modules, videos, quizzes, and facilitated discussion boards. Remaining sites served as controls. Fifty-three afterschool sites from three YMCA Associations in different regions of the country completed baseline and follow-up observations using a validated tool of afterschool nutrition and physical activity practices. We used multivariable regression models, accounting for clustering of observations, to assess intervention effects on an aggregate afterschool practice primary outcome, and conducted secondary analyses of nine intervention goals (e.g. serving water). Cost data were collected to determine the resources to implement each training model.ResultsChanges in the primary outcome indicate that, on average, sites in the in-person arm achieved 0.44 additional goals compared to controls (95%CI 0.02, 0.86, p = 0.04). Increases in the number of additional goals achieved in sites in the online arm were not significantly greater than control sites (+ 0.28, 95% CI -0.18, 0.73, p = 0.24). Goal-specific improvements were observed for increasing water offered in the in-person arm and fruits and vegetables offered in the online arm. The cost per person trained was $678 for the in-person training model and $336 for the on-line training model.ConclusionsThis pilot trial presents promising findings on implementation strategies for scale-up. It validated the in-person training model as an effective approach. The less expensive online training may be a useful option for geographically disbursed sites where in-person training is challenging.Trial registrationAlthough this study does not report the results of a health care intervention on human subjects, it is a randomized trial and was therefore retrospectively registered in ClinicalTrials.gov on July 4, 2019 in accordance with the BMC guidelines to ensure the complete publication of all results (NCT04009304).

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“…In Case 1, a slightly different approach was taken wherein a central team trains qualified exercise professionals in the community to deliver the PA program. In the broader literature, the train‐the‐trainer model and capacity building have been shown to successfully equip those delivering interventions with the requisite knowledge, skills and competencies (e.g., Lang et al., 2017; Lee et al., 2019). Across the cases herein, ensuring adequate training of trainers and capacity building was, and continues to be, assessed variably.…”

Expanding Implementation Research to Prevent Chronic Diseases in Community Settings

“…Additionally, out-of-school time programs administered through schools and organizations such as the Boy Scouts of America, 4-H, or YMCA have been the focus of EBPP implementation. Several studies have reported favorable outcomes from the dissemination of various training modalities to improve implementation of healthy eating and physical activity programs (13,41,77); however, evidence of the sustained impact of these efforts on children's physical activity is modest (13).…”

Applying Principles from Prevention and Implementation Sciences to Optimize the Dissemination of Family Feeding Interventions

“…A recent study of the Out-of-school Nutrition and Physical Activity program implementation compared an online and an in-person train-the-trainer approach during the program D&I, and found that the in-person training was more effective at increasing achievement of program goals, but cost twice as much per person as online training. Lee et al [ 35 ] concluded that online training may be a viable alternative. In contrast, Benjamin et al [ 36 ] found in-person and web-based training to be equally effective.…”