title: Engaging Stakeholders From Volunteer-Led Out-of-School Time Programs in the Dissemination of Guiding Principles for Healthy Snacking and Physical Activity.
abstract: BACKGROUND
  Little effort has focused on the role of volunteer-led out-of-school time (OST) programs (ie, enrichment and sports programs) as key environments for the promotion of healthy eating and physical activity habits among school-aged children. The Healthy Kids Out of School (HKOS) initiative developed evidence-based, practical guiding principles for healthy snacks, beverages, and physical activity. The goal of this case study was to describe the methods used to engage regional partners to understand how successful implementation and dissemination of these principles could be accomplished.
  
  
  OBJECTIVE
  HKOS partnered with volunteer-led programs from 5 OST organizations in Maine, Massachusetts, and New Hampshire to create a regional "learning laboratory."
  
  
  METHODS
  We engaged partners in phases. In the first phase, we conducted focus groups with local volunteer program leaders; during the second phase, we held roundtable meetings with regional and state program administrators; and in the final phase, we conducted additional outreach to refine and finalize implementation strategies.
  
  
  RESULTS
  Implementation strategies were developed based on themes and information that emerged. For enrichment programs, strategies included new patch and pin programs that were consistent with the organizations' infrastructure and usual practices. For sports programs, the main strategy was integration with online trainings for coaches.
  
  
  CONCLUSIONS
  Through the engagement process, we learned that dissemination of the guiding principles in these large and complex OST organizations was best accomplished by using implementation strategies that were customized, integrated, and aligned with goals and usual practices. The lessons learned can benefit future efforts to prevent obesity in complex environments.
authors.affiliation: Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111. Telephone: 617-636-3423. Email: sara.folta@tufts.edu.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Folta
authors.affiliation: Tufts University, Boston, Massachusetts.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Koomas
authors.affiliation: Tufts University, Boston, Massachusetts.
authors.forename: Nesly
authors.initials: N
authors.lastname: Metayer
authors.affiliation: Tufts University, Boston, Massachusetts.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Fullerton
authors.affiliation: Food and Nutrition Service, US Department of Agriculture, Western Regional Office, San Francisco, California.
authors.forename: Kristie L
authors.initials: KL
authors.lastname: Hubbard
authors.affiliation: Tufts University, Boston, Massachusetts.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Anzman-Frasca
authors.affiliation: City of Hope National Medical Center, Monrovia, California.
authors.forename: Teresa
authors.initials: T
authors.lastname: Hofer
authors.affiliation: Tufts University, Boston, Massachusetts.
authors.forename: Miriam
authors.initials: M
authors.lastname: Nelson
authors.affiliation: private practice, Boston, Massachusetts.
authors.forename: Molly
authors.initials: M
authors.lastname: Newman
authors.affiliation: Tufts University, Boston, Massachusetts.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sacheck
authors.affiliation: Tufts University, Boston, Massachusetts.
authors.forename: Christina
authors.initials: C
authors.lastname: Economos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004059:Diffusion of Innovation; D015444:Exercise; D005260:Female; D017144:Focus Groups; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008281:Maine; D008404:Massachusetts; D008875:Middle Aged; D009513:New Hampshire; D009765:Obesity / Q000517:prevention & control*; D012111:Residence Characteristics; D012574:Schools; D062410:Snacks; D014838:Volunteers; D055815:Young Adult