Examining reach, dose, and fidelity of the “Girls on the Move” after-school physical activity club: a process evaluation
Procedure
The PA club was evaluated via attendance records, accelerometers, and session observations. Table 1 presents the process evaluation methods for the PA club. Data were collected by the intervention coordinator, PA club coaches and managers, and independent process evaluators. Accelerometer data were analyzed by research assistants trained by the study’s measurement coordinator. The blinded process evaluators and research assistants analyzing the PA data were not informed about the intervention or study outcomes.
Process evaluation methods for the physical activity club
ALT-PE academic learning time – physical education, PA physical activity, SOFIT system for observing fitness instruction time
During each PA club day at every intervention school, 3 coaches were scheduled to deliver the PA sessions, and a club manager tracked attendance, prepared the list of girls who needed bus transportation, and managed behavioral issues. The coaches in the 12 intervention schools ranged in age from 20–50 years, and all were female except 3. At the end of every club day, each PA club manager or team reported directly to the intervention coordinator, who was either housed at the university or present at the club, so that the intervention coordinator could record the types of activities offered each day in the PA club, provide support to the manager and PA club coaches as needed, and provide necessary equipment or assist with maintaining proper functioning of the equipment.
To create a manageable group size, ensure adequate supervision to keep disruptive behavior down to a minimum, and provide opportunities for the girls to have some choice regarding their PA, girls were divided into 1, 2, or 3 groups (number of groups varied each day depending on club attendance) either randomly or stratified by grade level. The number of girls in each group ranged from 7–27, and 1 or 2 coaches led each group. Although the number of coaches assigned to a school’s club varied at times based on the usual number of girls attending the club, the intervention coordinator strove to ensure a ratio of approximately 15 adolescents to 1 coach, as recommended in previous similar studies [39]. On rare occasions (e.g., coach absent or ill), a coach managed more than 15 girls.
Two to 3 types of MVPA were always offered every day at each club, but the girls were not always divided into 2 or 3 groups unless attendance was high (15 or 30 girls total present, respectively). Each group rotated either once after completing an initial 30-min MVPA session, or sometimes twice, if the first MVPA session lasted 20 min, to a different MVPA session until participation totaled 60 min. Most, or all, girls in each group participated in 2 types of activities for 30 min each during the majority of the 60-min MVPA sessions offered in each school. At times, some girls chose to remain in the same MVPA session longer than 20 or 30 min, and coaches allowed them to do so. The various types of MVPA offered during the 20- to 30-min sessions included: 1) fun games (tag; flicker ball; kickball; boot camp stations, including sit-ups, squats, mountain climbers, agility exercises with a ladder; use of hand weights, hula hoops, and jump ropes; activities with Omnikin ball; scavenger hunts; capture the flag; cup stacking; fitness challenge); 2) dance (video games projected on a large screen, zumba taught by a coach having expertise in teaching zumba, line dances popular among girls, dance fitness routines and aerobics; pilates); and 3) walking or sport skills (soccer, basketball, volleyball, lacrosse, running, weight lifting, tennis, martial arts, track, floor hockey, badminton; ultimate disc). Small-sized groups and rotations to coaches offering a different type of MVPA provided girls with the opportunity to engage in and develop skills in different activities and avoid boredom. The approach also prevented cliques from forming [39]. If only a small number of girls attended the PA club (?15 girls total), they remained as a single group and participated together in the 2 types of MVPA offered for the day.
In year 1, at the beginning of every club day, coaches selected 2 or 3 PAs (based on the number of girls attending) from an ‘activity box’ and then determined whether the majority of girls were interested in engaging in the selected PAs by allowing girls to vote. This approach provided too much freedom to choose, and achieving consensus among the girls was a challenge. Coaches expressed concern about not being able to plan in advance and requested increased structure regarding the PAs offered. In year 2, a ‘horizontal calendar’ approach was used with the same 2 or 3 PA modules being offered for 1 or 2 weeks. So, for example, if a PA module focused on basketball, then girls would learn at least 1 new basketball skill per day during the 1- or 2-week period (e.g., day 1, dribbling; day 2, shooting; and so on). The issue with this approach was that girls did not come to the club on all 3 days per week if they did not like the PA offered during a particular week or 2. In year 3, a ‘vertical calendar’ approach was implemented with the 2 or 3 PAs offered daily varying from day to day in a single week, but remaining the same on a particular weekday for 3 weeks. Positive verbal feedback from the managers, coaches, and girls indicated that the latter approach was well-received. The approach was also helpful in hiring the most qualified coaches, some of whom could only conduct the club sessions on the same day each week.
Also, in year 3, at the beginning of the first club day each week, the manager and coaches asked for a few girls to share what PAs they had done by themselves or with others during the past 4 days when the club was not being conducted. At the beginning of the middle club day each week, the manager and coaches asked for a girl to share a strategy/tip that she used or could use to attain the recommended 60 min of MVPA daily (e.g., dance to music at home). At the beginning of the last club day each week, the manager and coaches shared and also asked for a few girls to share what PAs they had planned to do by themselves or with others over the next 4 days when the club was not conducted so they could continue to try to attain adequate MVPA.
A point-system was created to manage negative behavioral issues identified as being a common occurrence in several after-school programs [28, 40]. Girls who attained 4 points per day (1 point each for attending, arriving on time, actually participating in the activities offered, and exhibiting appropriate behavior based on a mutually agreed-upon code of conduct established by the coaches, managers, and girls at the initial club session) had an opportunity to receive an incentive.
Incentives and related strategies varied across the intervention years. In year 1, $25 raffles were held at the end of each club week. Every day that a girl attended the club and received the full number of points, she received a ticket to enter into the week’s raffle. If a girl did not win the raffle drawing in a particular week, she received a small consolation prize (e.g., lip gloss rings, sunglasses, notebooks). Although girls were able to choose their prize from a broad selection of items, they expressed some dissatisfaction with the “small” prizes and the fact that sometimes girls who did not attend regularly won the raffle. Based on the year 1 feedback and recommendations from the girls, we allowed girls participating in the intervention in year 2 to accumulate points to exchange for a “large” item (e.g., athletic socks, movie passes, water bottles, basketball, iPod shuffle) from a Girls on the Move “gift” store. However, the girls did not want to wait to accumulate points to exchange for a store item. Therefore, in year 3, an immediate gratification monetary incentive was used. At the end of each week, girls received $5.00 in cash for attaining the full number of points on all 3 days, $2.00 for attaining the full number of points on 2 days, and $1.00 for doing so on 1 of the 3 possible attendance days. This latter approach increased club attendance from 38 % in year 1 and 37 % in year 2 to 49 % in year 3. The incentives were essential for not only increasing girls’ attendance but also reducing behavioral problems interfering with the delivery of the club activities by the coaches.
Team members, including the intervention coordinator and club managers, worked together to contact parents/guardians of girls who missed a full week of the PA club sessions over the initial 3-weeks of the intervention. To ensure consistency across the telephone conversations, all team members used a script developed specifically for this study as a guide to: 1) provide positive communication strategies to parents/guardians to help them gently encourage their daughters to attend the club; 2) emphasize reasons for and importance of having their daughters attend; 3) explore barriers that prevent their daughters from attending the club and strategies to overcome them; 4) review national PA and screen time recommendations for youth [3, 41]; and 5) discuss ways that parents/guardians could help their daughters attain adequate PA outside the PA club so that their daughters could meet the recommendations calling for daily PA [3, 41].