Development of an innovative process evaluation approach for the Families Improving Together (FIT) for weight loss trial in African American adolescents

Abstract

This study demonstrates how a multi-theoretical, multilevel process evaluation was used to assess implementation of Families Improving Together (FIT) for weight loss intervention. FIT is a randomized controlled trial evaluating a culturally tailored, motivational plus family-based program on weight loss in African American adolescents and their parents. Social Cognitive, Self Determination, Family Systems theories and cultural tailoring principles guided the conceptualization of essential elements across individual/family, facilitator, and group levels. Data collection included an observational rating tool, attendance records, and a validated psychosocial measure. Results. Attendance records (0=absent, 1=present, criteria=≥70%) indicated that 71.5% of families attended each session. The survey (1=false, 6=true, criteria=≥4.5) indicated that participants perceived a positive group climate (M=5.16, SD=.69). A trained evaluator reported that facilitator dose delivered (0=no, 1=yes, criteria=≥75%) was high (99.6%), and fidelity (1=none to 4=all, criteria=≥3) was adequate at facilitator (M=3.63, SD=.41) and group levels (M=3.35, SD=.49). Five cultural topics were raised by participants related to eating (n=3) and physical activity (n=2) behaviors and were integrated as part of the final curriculum. Discussion. Results identify areas for program improvement related to delivery of multi-theoretical and cultural tailoring elements. Findings may inform future strategies for implementing effective weight loss programs for ethnic minority families.

Qualitative perspectives from African American youth and caregivers for developing the Families Improving Together (FIT) for Weight Loss intervention.

“…Cultural tailoring involved messages based on the depth of the parent’s cultural values. Specific details of the online intervention can be found elsewhere (Wilson et al, 2015; Alia et al, 2014). …”

Associations between Culturally Relevant Recruitment Strategies and Participant Interest, Enrollment and Generalizability in a Weight-loss Intervention for African American Families

“…Previous studies have not examined outcomes across the recruitment process such as scheduling a baseline visit (eg, screening) and enrollment into a run-in phase prior to participation. Our study expands on past research by comparing sociocultural and non-sociocultural recruitment mediums on recruitment and enrollment outcomes in a family-based weight-loss program 16,17 to inform more effective recruitment methods for including underrepresented minorities in research.…”

“…16,17 The study aimed to examine potential relationships between the use of culturally relevant recruitment strategies and participant interest, enrollment and generalizability to the African American community. Specifically, we examined whether recruitment strategies channeled through sociocultural mediums had a greater effect on: 1) scheduling a baseline visit (eg, interest); 2) enrolling in a run-in phase (to assess barriers to participation and interest); and 3) enrolling in the intervention program.…”

“…Previous research has indicated that African American parents want more flexibility in scheduling, to complete program content at home, and assistance with child care and transportation in a health promotion program. 23 Future investigators should build in flexibility to their recruitment approaches, enrollment process, and intervention, 17 such as scheduling appointments on evenings or weekends, providing childcare, and assistance with transportation 21 and integrating sociocultural values throughout the recruitment process.…”

“…Interested families were given additional information, screened for eligibility, and offered a baseline visit appointment by phone. At the baseline visit, if eligibility criteria were met, families were given the opportunity 16,17 to inform more effective recruitment methods for including underrepresented minorities in research.…”