title: Testing an Integrated Model of Program Implementation: the Food, Health & Choices School-Based Childhood Obesity Prevention Intervention Process Evaluation.
abstract: Childhood obesity is a complex, worldwide problem. Significant resources are invested in its prevention, and high-quality evaluations of these efforts are important. Conducting trials in school settings is complicated, making process evaluations useful for explaining results. Intervention fidelity has been demonstrated to influence outcomes, but others have suggested that other aspects of implementation, including participant responsiveness, should be examined more systematically. During Food, Health & Choices (FHC), a school-based childhood obesity prevention trial designed to test a curriculum and wellness policy taught by trained FHC instructors to fifth grade students in 20 schools during 2012-2013, we assessed relationships among facilitator behaviors (i.e., fidelity and teacher interest); participant behaviors (i.e., student satisfaction and recall); and program outcomes (i.e., energy balance-related behaviors) using hierarchical linear models, controlling for student, class, and school characteristics. We found positive relationships between student satisfaction and recall and program outcomes, but not fidelity and program outcomes. We also found relationships between teacher interest and fidelity when teachers participated in implementation. Finally, we found a significant interaction between fidelity and satisfaction on behavioral outcomes. These findings suggest that individual students in the same class responded differently to the same intervention. They also suggest the importance of teacher buy-in for successful intervention implementation. Future studies should examine how facilitator and participant behaviors together are related to both outcomes and implementation. Assessing multiple aspects of implementation using models that account for contextual influences on behavioral outcomes is an important step forward for prevention intervention process evaluations.
authors.affiliation: Department of Biomedical Informatics, Columbia University Medical Center, 622 West 168th Street, PH-20, New York, NY, 10032, USA. mb3381@cumc.columbia.edu.
authors.forename: Marissa
authors.identifier: 0000-0002-4891-3314
authors.initials: M
authors.lastname: Burgermaster
authors.affiliation: Program in Nutrition, Department of Health and Behavior Studies, Teachers College Columbia University, 525 West 120th Street, Box 137, New York, NY, 10027, USA.
authors.forename: Heewon Lee
authors.initials: HL
authors.lastname: Gray
authors.affiliation: Applied Statistics, Department of Human Development, Teachers College Columbia University, 525 West 120th Street, Box 118, New York, NY, 10027, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tipton
authors.affiliation: Program in Nutrition, Department of Health and Behavior Studies, Teachers College Columbia University, 525 West 120th Street, Box 137, New York, NY, 10027, USA.
authors.forename: Isobel
authors.initials: I
authors.lastname: Contento
authors.affiliation: Program in Nutrition, Department of Health and Behavior Studies, Teachers College Columbia University, 525 West 120th Street, Box 137, New York, NY, 10027, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Koch
mesh_terms: D002755:Choice Behavior; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008297:Male; D017146:Models, Organizational; D015233:Models, Statistical; D063766:Pediatric Obesity / Q000517:prevention & control*; D015397:Program Evaluation; D012574:Schools
keywords: Childhood obesity prevention; Fidelity; Implementation; Process evaluation; Responsiveness