Implementation of B’More Healthy Communities for Kids: process evaluation of a multi-level, multi-component obesity prevention intervention

Abstract

B'More Healthy Communities for Kids was a multi-level, multi-component obesity prevention intervention to improve access, demand and consumption of healthier foods and beverages in 28 low-income neighborhoods in Baltimore City, MD. Process evaluation assesses the implementation of an intervention and monitor progress. To the best of our knowledge, little detailed process data from multi-level obesity prevention trials have been published. Implementation of each intervention component (wholesaler, recreation center, carryout restaurant, corner store, policy and social media/text messaging) was classified as high, medium or low according to set standards. The wholesaler component achieved high implementation for reach, dose delivered and fidelity. Recreation center and carryout restaurant components achieved medium reach, dose delivered and fidelity. Corner stores achieved medium reach and dose delivered and high fidelity. The policy component achieved high reach and medium dose delivered and fidelity. Social media/text messaging achieved medium reach and high dose delivered and fidelity. Overall, study reach and dose delivered achieved a high implementation level, whereas fidelity achieved a medium level. Varying levels of implementation may have balanced the performance of an intervention component for each process evaluation construct. This detailed process evaluation of the B'More Healthy Communities for Kids allowed the assessment of implementation successes, failures and challenges of each intervention component.

The impact of a multilevel childhood obesity prevention intervention on healthful food acquisition, preparation, and fruit and vegetable consumption on African-American adult caregivers

“…The intervention was implemented with overall moderate- to high-reach, dose delivered, and fidelity. (45)…”

Challenges and Lessons Learned from Multi-Level Multi-Component Interventions to Prevent and Reduce Childhood Obesity

“…All three MLMC intervention trials conducted some form of process evaluation, with ongoing feedback. Perhaps the most formal version was employed by BHCK [18]. In BHCK, each intervention component had multiple measures for reach, dose delivered and fidelity [31,34,35,36,37].…”

“…Every two months, roughly timed to coincide with the end of an intervention phase, the intervention team met and reviewed how well each standard was being met, and developed plans for improvement if reach, dose delivered and/or fidelity was below the minimum high standard (Figure 2). These regular meetings allowed the team to strengthen its efforts to improve specific aspects of the intervention, and over time led to enhanced program delivery [18].…”

“…All three MLMC interventions were grounded in ecological systems theory and applied the social ecological model to the design and implementation of the interventions. Each of the three cases (BHCK, CHL, SoL) have published multiple papers describing design [13,14], formative research [15,16], process evaluation [17,18], and impact findings [19,20,21]. The principal investigators (PIs) of the three interventions have presented and discussed their findings and experiences through a series of five consecutive ISBNPA (International Society of Behavioral Nutrition and Physical Activity) symposia.…”

B’more Healthy Corner Stores for Moms and Kids: Identifying Optimal Behavioral Economic Strategies to Increase WIC Redemptions in Small Urban Corner Stores

“…Process evaluation, defined in terms of reach, dose delivered, and fidelity, was conducted during each week of the intervention to monitor implementation quality. Implementation standards were set a priori ( Table 2) based on standards utilized in similar study populations and settings [39,40,41,42]. Johns Hopkins University undergraduate and graduate students, as well as study staff were trained and performed all data collection and intervention activities.…”