Social Mechanisms for Promoting Physical Activity in After School Programs for Underserved Middle School Youth

University of South Carolina

Status: Completed

Conditions: Obesity Prevention; Physical Activity

Treatments: Behavioral: Connect Social Mechanisms Intervention

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT03850821

R21HD077357 (U.S. NIH Grant/Contract)

Pro00037559

Details and patient eligibility

About

The primary goal of the Connect feasibility trial was to develop and test the feasibility of a physical activity (PA) social-climate-based intervention within pre-existing after school programs (ASPs) that targets youth social goals (e.g., building friendships through PA) and social competencies (e.g., friendship-building skills) to increase the positive PA affect, cognitions, and moderate-to-vigorous (MV) PA of underserved (i.e., low income, minority status) middle school youth. The 8-week intervention was designed to improve several key social mechanisms within ASPs overlooked in previous interventions (e.g., developing friendship and connection to peers and staff through PA; group belonging, including positive peer PA norms and tangible support) that are key predictors of youth PA and included: 1) "Get to know you" sessions aimed at providing youth guided social opportunities to foster friendship-building skills, and to promote acceptance, cooperation, contribution, and friendship affiliation, and; 2) a novel socially-oriented physical activity curriculum tailored to meet the social goals and needs of program staff and participating youth. Comparison of ASPs receiving the 8-week "Connect" intervention (N=3 ASPs) with ASPs randomized to receive the general ASP curriculum (wait-list control condition; N=3 ASPs) will yield preliminary data on the effectiveness of social mediators for improving moderate-to-vigorous physical activity (MVPA) and preventing obesity among at-risk youth that can inform future intervention design and youth programming policy. Results of this proposed project will provide the basis for conducting a large scale efficacy trial.

First, it is hypothesized that the Connect program will be documented to be feasible as shown by: 1) youth's greater perceived connectedness and PA affiliation goal orientation from baseline to post-intervention; 2). changes in targeted social climate components from baseline to post-intervention as measured by systematic observations, and; 3) adequate dose and fidelity of program implementation as indicated by weekly process evaluations. Second, it is hypothesized that youth in the social climate program (vs. comparison) demonstrate greater increases in positive PA affect, cognitions, and MVPA from baseline to post-intervention.

Full description

Physical inactivity has been identified as a primary contributor of childhood obesity and related diseases, with underserved youth (minority and low-income status) at greatest risk of inactivity and its health consequences. However, physical activity (PA) interventions have attained limited-to-no sustained behavior change and thus, have rarely affected targeted physiological or anthropometric health outcomes. Extensive research on participation motivation in sport and physical education shows highly engaged youth report an affiliation orientation towards PA, identifying social reasons and goals (e.g., being with, and making friends) as their primary motivations for participation, and defining PA competence as achieving these social goals. Despite substantial research noting the importance of social goals on PA-based self-determined motivation and participation, PA-based interventions have almost exclusively emphasized approaches centered on constructs related to physical ability (e.g., mastery, self-efficacy). To date, little research has focused on understanding the contributions that affiliation orientations (social goals) make toward promoting sustained youth PA. The investigators argue that adolescents' desire for social connections is a primary goal of action underpinning their PA behavior and thus, a key mechanism to target for sustained behavior change. The Active by Choice Today (ACT) program, conducted by the investigative team is one of the first after school programs (ASPs) to implement a climate-based intervention based on Self-Determination theory that showed significant improvements in PA in underserved youth. However, limited sustained effects found post-intervention, and data from interviews with ACT staff and youth which indicated the presence of several interpersonal barriers (e.g., cliques, teasing) to program effectiveness, suggests additional socially-based climate components still need to be addressed. Systematic observations of ASPs using an observational tool that the PI has developed and tested and additional interviews conducted with ASP staff and youth further suggests that targeting youth social goals (e.g., building friendships through PA) and social competencies (e.g., Friendship-building skills) may be particularly effective for increasing and sustaining the PA of underserved youth. Thus, the proposed study aims to test the feasibility of augmenting the Active by Choice Today (ACT) program through the addition of three key "PA affiliation orientation" elements shown by previous research to be particularly important to adolescents within physical domains: 1) Connecting strengthened friendships to increased PA (developing youth social skills and providing a PA environment that emphasizes friendship building as the goal of PA), 2) Improving peer connectedness and group belonging through PA participation, and 3) Improving interpersonal connections with ASP staff through PA participation. These elements have not been explored in prior research. Enhancing ACT to include these elements in the resultant ACT version 2-Connect intervention is expected to lead to sustained positive PA affect, cognitions, and behaviors in underserved youth. Comparison of ASPs receiving the "Connect" intervention (N=3 ASPs) with ASPs randomized to receive the general ASP curriculum (control condition; N=3 ASPs) will yield preliminary data on the effectiveness of social mediators for improving moderate-to-vigorous (MV)PA and preventing obesity among at-risk youth that can inform future intervention design and youth programming policy. Results of this proposed project will provide the basis for conducting a large scale efficacy trial.

Specific Objectives:

Apply essential social climate elements identified from interviews and the investigators' previous research to design and test the feasibility of the 8-week "Connect" social climate intervention for increasing PA affect, cognition, and MVPA of underserved youth within ASPs.

Primary Aims (Program Development and Feasibility):

1. Through qualitative interviews with program staff and youth at 4 ASP sites serving at-risk youth: a) identify conceptual constructs most relevant for facilitating and supporting youth PA social affiliation goals; b) determine the barriers present within ASPs for meeting youth PA social goals, and; c) obtain staff/youth input on the feasibility and acceptability of initially- developed program components.
2. Explore the feasibility of the Connect program. The Connect program will be documented to be feasible in these ASP programs as shown by: 1) youth's greater perceived connectedness and affiliation goal orientation toward PA from baseline to 12- weeks post-intervention; 2). changes in targeted social climate components from baseline to post-intervention as measured by systematic observations, and; 3) adequate dose and fidelity of program implementation as indicated by weekly process evaluations.

Secondary Aims (Document the preliminary impact of the Connect program on PA outcomes):

1. Assess whether youth in the social climate program (vs. comparison) demonstrate greater increases in positive PA affect, cognitions, and MVPA from baseline to 2-weeks post-intervention.
2. Explore whether youth in the social climate program (vs. comparison) demonstrate healthier BMI trajectories (e.g., slight reduction) from baseline to 2-weeks post-intervention.
3. Assess whether changes in targeted social mechanisms will mediate the effects of the intervention on changes in PA affect, cognitions, and MVPA from baseline to post-intervention.

Enrollment: 224 patients

Sex: All

Ages: 9 to 16 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Must be currently enrolled in the after school program
• Have parental consent to participate
• Agree to study participation (assent)
• Be available for baseline and post-intervention measurement

Exclusion criteria

• Have a medical condition that would interfere with the prescribed physical activity intervention plan
• Have a developmental delay or are in treatment for a psychiatric disorder such that the intervention materials/measures will not be appropriate

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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224 participants in 2 patient groups

Connect Social Mechanisms Intervention

Experimental group

Description:

The primary components of the intervention included: "Get-to-know-you" sessions aimed specifically at providing youth guided social opportunities to foster friendships, group belonging, and social skills, and novel socially-oriented 'PA sessions' infused within the daily time slot that ASPs' allocated towards recreation. Drawing from theoretical models of motivation, and the investigators' previous ASP studies, key essential elements were identified for facilitating improvements in targeted PA social mechanisms (i.e., friendships, group belonging, and staff connection) and included: 1) social-emotional goal-oriented support, 2) collaborative/cooperative play centered on friendship and informal fun; 3) equal treatment/access, and; 4) inclusive and engaging.

Treatment:

Behavioral: Connect Social Mechanisms Intervention

Typical ASP curriculum wait-list control

No Intervention group

Description:

No intervention was implemented within the active wait-list control condition, which served as the typical ASP curriculum control/comparison. After completion of the 8-week intervention (12 weeks including baseline and post-intervention data collection), the control condition received the social mechanisms curriculum as a token of appreciation for participating in measurement.