Keeping a Step Ahead: formative phase of a workplace intervention trial to prevent obesity.
OBJECTIVE
Ecological interventions hold promise for promoting overweight and obesity prevention in worksites. Given the paucity of evaluative research in the hospital worksite setting, considerable formative work is required for successful implementation and evaluation. This paper describes the formative phases of Step Ahead, a site-randomized controlled trial of a multilevel intervention that promotes physical activity and healthy eating in six hospitals in central Massachusetts. The purpose of the formative research phase was to increase the feasibility, effectiveness, and likelihood of sustainability of the intervention.


METHODS
The Step Ahead ecological intervention approach targets change at the organization, interpersonal work environment, and individual levels. The intervention was developed using fundamental steps of intervention mapping and important tenets of participatory research. Formative research methods were used to engage leadership support and assistance and to develop an intervention plan that is both theoretically and practically grounded. This report uses observational data, program minutes and reports, and process tracking data.


RESULTS
Leadership involvement (key informant interviews and advisory boards), employee focus groups and advisory boards, and quantitative environmental assessments cultivated participation and support. Determining multiple foci of change and designing measurable objectives and generic assessment tools to document progress are complex challenges encountered in planning phases.


CONCLUSIONS
Multilevel trials in diverse organizations require flexibility and balance of theory application and practice-based perspectives to affect impact and outcome objectives. Formative research is an essential component.
Zapka
Jane
J
Medical University of South Carolina, 135 Cannon Street, P.O. Box 250835, Charleston, SC 29425. zapka@musc.edu
Lemon
Stephenie C
SC
Estabrook
Barbara B
BB
Jolicoeur
Denise G
DG
D004032:Diet; D004777:Environment; D015444:Exercise; D005240:Feasibility Studies; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006739:Hospital Administration; D006761:Hospitals; D006801:Humans; D008297:Male; D008404:Massachusetts; D009765:Obesity / Q000517:prevention & control* / Q000628:therapy; D009786:Occupational Health Services; D016032:Randomized Controlled Trials as Topic; D017132:Workplace