Statewide dissemination and implementation of physical activity standards in afterschool programs: two-year results

Abstract

BackgroundIn 2015, YMCA afterschool programs (ASPs) across South Carolina, USA pledged to achieve the YMCA physical activity standard calling for all children to accumulate 30 min of moderate-to-vigorous physical activity (MVPA) while attending their ASPs. This study presents the final two-year outcomes from the dissemination and implementation efforts associated with achieving this MVPA standard.MethodsTwenty ASPs were sampled from all South Carolina YMCA-operated ASPs (N = 97) and visited at baseline (2015) and first (2016) and second year (2017) follow-up. All ASPs were provided training to increase MVPA during the program by extending the scheduled time for activity opportunities and modifying commonly played games to increase MVPA. The RE-AIM framework was used to evaluate the statewide intervention. Accelerometer-derived MVPA was the primary outcome. Intent-to-treat (ITT) models were conducted summer 2017. Programs were also classified, based on changes in MVPA from 2015 to 2016 and 2016–2017, into one of three categories: gain, maintain, or lost. Implementation, within the three groups, was evaluated via direct observation and document review.ResultsAdoption during the first year was 45% of staff attending training, with this increasing to 67% of staff during the second year. ITT models indicated no increase in the odds of accumulating 30 min of MVPA after the first year for either boys (odds ratio [OR] 1.06, 95CI 0.86–1.31) or girls (OR 1.14, 95CI 0.87–1.50), whereas an increase in the odds was observed during the second year for boys (OR 1.31, 95CI 1.04–1.64) and girls (OR 1.50 95CI 1.01–1.80). Programs that lost MVPA (avg. − 5 to − 7.5 min/d MVPA) elected to modify their program in a greater number of non-supportive ways (e.g., reduce time for activity opportunities, less time spent outdoors), whereas ASPs that gained MVPA (avg. + 5.5 to + 10.1 min MVPA) elected to modify their program in more supportive ways.ConclusionsThe statewide study demonstrated minimal improvements in overall MVPA. However, child MVPA was dramatically influenced by ASPs who elected to modify their daily program in more supportive than non-supportive ways, with no one program modifying their program consistently across the multi-year initiative. These findings have important implications for organizations seeking to achieve the MVPA standard.Trial registrationClinical Trial Registration: NCT02394717.

Identification and evaluation of risk of generalizability biases in pilot versus efficacy/effectiveness trials: a systematic review and meta-analysis

“…Cohen 2015 [27] Sutherland 2017 [28] How much of the intervention was provided? Beets 2018 [30] How much support to implement the intervention was provided? How much support to implement the intervention was provided?…”

“…In Table 1, we present examples from a sample of six interventions [25][26][27][28][29][30][32][33][34][35][36][37] related to childhood obesity that have a published efficacy and a subsequent effectiveness trial and one intervention [31] with only an efficacy evaluation published. In these studies [25][26][27][28][29][30][31][32][33][34][35][36][37], the authors indicate the substantially reduced or null effects observed in the effectiveness trial may be due to a feature of the efficacy study, such as delivery of the intervention by study personnel, being removed in the effectiveness trial [38]. These are but a few of the adaptations interventionists could make [39] that may lead to possible biases that distort the estimated impact of an intervention, especially during pilot testing.…”

Physical activity and sedentary time of youth in structured settings: a systematic review and meta-analysis

“…The 14 included studies [17,149,156,[182][183][184][185][186][187][188][189][190][191][192][193] were conducted in only two countries, with the majority taking place in United States and the one other study conducted in Australia. The total sample size for all studies combined was 12,021 children (range 82 to 2,053, mean age = 8.3 years).…”

“…Five studies had more than 600 children [17,[182][183][184][185]. Cross-sectional studies represented the most common design [17,156,183,184,[186][187][188][189][190][191][192], and Actigraph was the only accelerometer brand used to measure PA and ST. The majority of the studies addressed the outcomes during afterschool hours only, while one considered all waking hours in addition to activity and sedentary during afterschool hours.…”

“…2:05 hours). A variety of cut-points were used with the most frequent being Freedson (2005) [189,191,193], Evenson (2008), and Matthews (2008) [17,183,185,188].…”