Abstract
To date, there is limited published literature on process evaluation of adolescent health promotion programs. In this paper, we describe the methods and results of PAWS Club process evaluation over 2 years of implementation to compare the effectiveness of delivery by peer and adult leaders. PAWS (Peer-education About Weight Steadiness) Club was a 12-week healthy lifestyle program, delivered to 6th and 7th graders by peer and adult educators, using cluster randomized controlled design. Peer educators were 8th graders in the program schools and adult educators were staff/teachers in the program schools. Trained university students filled out fidelity logs at each session led by peer and adult educators to assess program delivery. The fidelity logs included questions to collect information about the number of participants, duration of the session, percent of activities completed, and if lessons started on time, lesson objectives were clearly stated, lesson objectives were emphasized, demonstrations were visible to participants, all activities were completed, the leader was familiar with lessons, the leader maintained an appropriate pace, the leader kept participants on track, and the leader asked if participants had any questions. Adult educators had a higher mean performance for all questions compared to peer leaders. Significant differences were observed for emphasizing lesson objectives (p = 0.005), making demonstrations visible to participants (p = 0.031), being familiar with the lesson plan (p = 0.000), maintaining an appropriate pace (p = 0.000), keeping participants on track (p = 0.000), and asking if participants had any questions (p = 0.000). Significance was set at p < 0.05. Findings from the current study have implications for designing and conducting a process evaluation of complex healthy lifestyle programs with adolescents in schools. Additional training of peer educators may be needed to enhance program delivery.
Highlights
Obesity in childhood and adolescence is a serious public health challenge due to its associated adverse health and social consequences [1,2]
This paper describes the results of a process evaluation undertaken to compare the fidelity of the PAWS (Peer-education About Weight Steadiness) Club intervention delivered by peer or adult educators over two years of implementation in four different schools in Eastern Illinois
Each fidelity log had questions asking if: (1) Lesson started on time; (2) Lesson objectives were clearly stated; (3) Emphasized regular physical activity and healthy weight maintenance; (4) Demonstrations were clearly visible to participants; (5) All activities were completed; (6) Leader was familiar with lesson; (7) Leader maintained an appropriate pace; (8) Leader was able to keep participants on topic/task; (9) Leader asked if participants had any questions, and (10) Lesson ended on time
Summary
Obesity in childhood and adolescence is a serious public health challenge due to its associated adverse health and social consequences [1,2]. Obesity prevention programs for children and adolescents present opportunities to establish healthy lifestyle behaviors that minimize the risk of gaining excess weight [4]. Studies suggest that there are fewer obesity prevention programs for adolescents than for children [5]. The built environment and organizational, social, and communication frameworks of schools make them an ideal setting to deliver obesity prevention programs to school children and their families [6]. In the past 20 years, the afterschool environment has been recognized as a suitable setting for delivering health promotion programs [7]. Afterschool programs are usually multi-component and target both physical activity and healthy eating and are tied to key public health recommendations [7]. Intervention fidelity results are of value to distinguish between desired outcomes not achieved due to the ineffectiveness of the program or lack of program fidelity [11,12]
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