An intervention to increase staff promotion of healthy eating and physical activity in out-of-school-time-programs.

摘要

Frontline-staff are critical to achieving standards related to child physical activity and nutrition (PAaN) in out-of-school-time-programs (OSTP). This research project encompasses four studies.;The first study fills the gap between policy mandates and staff behaviors by describing the development of the System for Observing Staff Promotion of Activity and Nutrition (SOSPAN) in OSTP. SOSPAN items were aligned with existing OSTP policies. Reliability and validity data of SOSPAN were collected across 8 OSTP: 4 summer day camps and 4 afterschool programs. Validity of SOSPAN staff behaviors/management of PA was established using the percent of children active measured concurrently via direct observation. A total of 6,437 scans were performed. Inter-rater percent agreement ranged from 74-99% across PAaN behaviors. Children's activity was associated with staff facilitative behaviors/management, such as playing with the children and providing two or more activities for children to choose, while prohibitive behaviors/management, such as waiting-in-line were related to increased sedentary behavior. Staff nutrition behaviors were observed in less than 0.6% of scans. SOSPAN was found to be a reliable and valid tool to assess staff behaviors/management of PAaN in OSTPs.;The purpose of the second study was to evaluate a comprehensive intervention designed to support staff and program leaders in the implementation of the YMCA of USA Healthy Eating and Physical Activity (HEPA) Standards for their afterschool programs (ASP, 3-6pm). Utilizing a pre (Fall 2011) and post (Spring 2012) assessment no control-group design, four large-scale YMCA ASPs serving approximately 500 children were included in this study. Professional development training founded in the 5Ms (i.e. Mission, Model, Manage, Monitor, Maximize) and LET US Play principles (i.e. lines, elimination, team size, uninvolved staff/kids, and space, equipment and rules), on-site booster training sessions, workshops, and ongoing technical support was provided for staff and program leaders from January to May 2012. The main outcome measure was the System for Observing Staff Promotion of Activity and Nutrition (SOSPAN). Multilevel mixed effects linear (i.e., staff behaviors expressed as a percentage of the number of scans observed) and logistic regression was used to examine changes in staff behaviors. A total of 5328 SOSPAN scans were completed over the two measurement periods. Of the 20 staff behaviors identified in HEPA Standards and measured in this study, 17 increased or decreased in the appropriate direction. Comprehensive professional development training and ongoing technical assistance can have a sizable impact on key staff behaviors identified by HEPA Standards for ASPs. Similarly the YMCA of USA adopted Healthy Eating and Physical Activity (HEPA) Standards for summer-day-camps (SDCs).;The purpose of the third study was to evaluate a comprehensive intervention designed to support staff and program leaders in the implementation of the YMCA of USA Healthy Eating and Physical Activity (HEPA) Standards for their SDCs. Four large-scale YMCA summer-day-camps serving ~800 children per week participated in this no control group pre/post pilot study. Professional development training founded in the 5Ms (Mission, Model, Manage, Monitor, Maximize) and LET US Play principles (lines, elimination, team size, uninvolved staff/kids, and space, equipment and rules) were delivered to staff. Outcomes were staff promotion behaviors and child activity assessed with established systematic observation instruments. Twelve of 17 HEPA staff behaviors changed in the appropriate direction from baseline to post-assessment. The percentage of girls and boys observed in moderate-to-vigorous-physical-activity increased from 15.3% to 18.3% and 17.9% to 21.2% whereas sedentary behavior decreased from 66.8% to 59.8% and 62.3% to 53.6%, respectively. Evidence suggests that the professional development training designed to assist SDCs to meet the HEPA Standards can lead to changes in staff behaviors and children's physical activity.;The fourth study was conducted to provide feedback to the YMCA ASPs attempting to implement physical activity standards. Factors affecting implementation of standards were examined via semi-structured and informal interviews and observations in 4 ASPs across one year. Perspectives from three levels of the organizational structure of the ASPs (i.e., branch directors, ASP leaders and frontline-staff) were collected. Data were analyzed via modified analytic induction where themes were mapped onto the Framework for Effective Implementation (FEI). Themes were compared between and within organizational levels. Themes represented sixteen factors in the FEI. Within and across organizations, participants working at different ASP levels had different perspectives of how certain factors affected the implementation of the standards. For example, there were differing views of the influence of parents on standards implementation. Branch directors and ASP leaders saw parents as barriers to implementation (believing parents mainly prioritized their children's homework completion) whereas frontline staff saw parents as enablers (believing parents mainly wanted their children to be "worn out" by the end of the ASP). During the study, participants' communicated that their beliefs changed in ways that enabled standards implementation. (Abstract shortened by UMI.).