The Effects of Teacher Fidelity of Implementation of Pathways to Health on Student Outcomes

Previous research has demonstrated the importance of ensuring that programs are implemented as intended by program developers in order to achieve desired program effects. The current study examined implementation fidelity of Pathways to Health (Pathways), a newly developed obesity prevention program for fourth- through sixth-grade children. We explored the associations between self-reported and observed implementation fidelity scores and whether implementation fidelity differed across the first 2 years of program implementation. Additionally, we examined whether implementation fidelity affected program outcomes and whether teacher beliefs were associated with implementation fidelity. The program was better received, and implementation fidelity had more effects on program outcomes in fifth grade than in fourth grade. Findings suggest that implementation in school-based obesity programs may affect junk food intake and intentions to eat healthfully and exercise. School support was associated with implementation fidelity, suggesting that prevention programs may benefit from including a component that boosts school-wide support.

[1]  K. Grimmer-Somers,et al.  School-based interventions on childhood obesity: a meta-analysis. , 2009, American journal of preventive medicine.

[2]  Alan C. Acock,et al.  School Climate and Teachers’ Beliefs and Attitudes Associated with Implementation of the Positive Action Program: A Diffusion of Innovations Model , 2008, Prevention Science.

[3]  Huey-tsyh Chen Theory-driven evaluations , 1990 .

[4]  William B. Hansen,et al.  Effects of Program Implementation on Adolescent Drug Use Behavior , 1990 .

[5]  Cynthia Roberts-Gray,et al.  Bridge-It: A System for Predicting Implementation Fidelity for School-Based Tobacco Prevention Programs , 2006, Prevention Science.

[6]  Andrew V. Dane,et al.  Program integrity in primary and early secondary prevention: are implementation effects out of control? , 1998, Clinical psychology review.

[7]  M. Pentz,et al.  Translating evidence based violence and drug use prevention to obesity prevention: development and construction of the pathways program. , 2012, Health education research.

[8]  C. Perry,et al.  5-a-Day Power Plus: Process Evaluation of a Multicomponent Elementary School Program to Increase Fruit and Vegetable Consumption , 2000, Health education & behavior : the official publication of the Society for Public Health Education.

[9]  G. Botvin,et al.  A cognitive-behavioral approach to substance abuse prevention: one-year follow-up. , 1990, Addictive behaviors.

[10]  F. Shaya,et al.  School-based obesity interventions: a literature review. , 2008, The Journal of school health.

[11]  D. Berrigan,et al.  School-based nutrition programs produced a moderate increase in fruit and vegetable consumption: meta and pooling analyses from 7 studies. , 2007, Journal of nutrition education and behavior.

[12]  S. Kelder,et al.  Reproducibility and validity of the secondary level School-Based Nutrition Monitoring student questionnaire. , 2003, Journal of the American Dietetic Association.

[13]  E. Stone,et al.  Using process data to explain outcomes. An illustration from the Child and Adolescent Trial for Cardiovascular Health (CATCH). , 1998, Evaluation review.

[14]  Cynthia Roberts-Gray,et al.  Evaluating school capacity to implement new programs. , 2007, Evaluation and program planning.

[15]  Mark T. Greenberg,et al.  Promoting Social and Emotional Development in Deaf Children: The Paths Project , 1993 .

[16]  Ruth P Saunders,et al.  Examining the link between program implementation and behavior outcomes in the lifestyle education for activity program (LEAP). , 2006, Evaluation and program planning.

[17]  D. Spruijt-Metz Etiology, Treatment and Prevention of Obesity in Childhood and Adolescence: A Decade in Review. , 2011, Journal of research on adolescence : the official journal of the Society for Research on Adolescence.

[18]  Catherine J. Lillehoj,et al.  Program Provider and Observer Ratings of School-Based Preventive Intervention Implementation: Agreement and Relation to Youth Outcomes , 2004, Health education & behavior : the official publication of the Society for Public Health Education.

[19]  S. Ennett,et al.  Factors Associated with Fidelity to Substance Use Prevention Curriculum Guides in the Nation's Middle Schools , 2003, Health education & behavior : the official publication of the Society for Public Health Education.

[20]  D. Olweus,et al.  Predicting Teachers' and Schools' Implementation of the Olweus Bullying Prevention Program: A Multilevel Study. , 2003 .

[21]  Mary Kay Rayens,et al.  Efficacy of training and fidelity of implementation of the life skills training program. , 2002, The Journal of school health.

[22]  Jeffrey P Koplan,et al.  Preventing childhood obesity: health in the balance: executive summary. , 2005, Journal of the American Dietetic Association.

[23]  I. Ajzen The theory of planned behavior , 1991 .

[24]  S. Donaldson,et al.  Understanding Self-Report Bias in Organizational Behavior Research , 2002 .

[25]  J Lomas,et al.  Evidence of self-report bias in assessing adherence to guidelines. , 1999, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[26]  J. Graham,et al.  Diffusion of a school-based substance abuse prevention program: predictors of program implementation. , 1993, Preventive medicine.

[27]  R. Sturm,et al.  Childhood overweight and parent- and teacher-reported behavior problems: evidence from a prospective study of kindergartners. , 2004, Archives of pediatrics & adolescent medicine.

[28]  D M Murray,et al.  Planning for the appropriate analysis in school-based drug-use prevention studies. , 1990, Journal of consulting and clinical psychology.

[29]  W. B. Hansen,et al.  Drug education practice: results of an observational study. , 1999, Health education research.

[30]  M. Pentz,et al.  Implementation issues in drug abuse prevention research. , 1991, NIDA research monograph.

[31]  C. Kam,et al.  Examining the Role of Implementation Quality in School-Based Prevention Using the PATHS Curriculum , 2003, Prevention Science.

[32]  J. Durlak,et al.  Implementation Matters: A Review of Research on the Influence of Implementation on Program Outcomes and the Factors Affecting Implementation , 2008, American journal of community psychology.

[33]  Susan T. Ennett,et al.  A Comparison of Current Practice in School-Based Substance Use Prevention Programs with Meta-Analysis Findings , 2003, Prevention Science.

[34]  Jason L. Horowitz,et al.  Practitioner and Site Characteristics That Relate to Fidelity of Implementation: The Early Risers Prevention Program in a Going-to-Scale Intervention Trial , 2009 .

[35]  S. Sussman,et al.  The Effects of Implementation Fidelity in the Towards No Drug Abuse Dissemination Trial. , 2013, Health education.

[36]  M. Schoeny,et al.  School Climate and Implementation of a Preventive Intervention , 2007, American journal of community psychology.

[37]  Abigail A Fagan,et al.  Bridging Science to Practice: Achieving Prevention Program Implementation Fidelity in the Community Youth Development Study , 2008, American journal of community psychology.

[38]  D B Rubin,et al.  Difficulties with regression analyses of age-adjusted rates. , 1984, Biometrics.

[39]  Jeffrey B. Schwimmer,et al.  Preventing Childhood Obesity: Health in the Balance , 2005, Environmental Health Perspectives.

[40]  D. Hoelscher,et al.  Reproducibility of the School-Based Nutrition Monitoring Questionnaire among fourth-grade students in Texas. , 2008, Journal of nutrition education and behavior.

[41]  W. Willett,et al.  Reproducibility and validity of a semiquantitative food frequency questionnaire. , 1985, American journal of epidemiology.

[42]  R. Strauss,et al.  Psychosocial correlates of physical activity in healthy children. , 2001, Archives of pediatrics & adolescent medicine.

[43]  Mark T. Greenberg,et al.  The Study of Implementation: Current Findings From Effective Programs that Prevent Mental Disorders in School-Aged Children , 2000 .

[44]  D. Spruijt-Metz,et al.  Relationships between executive cognitive function and lifetime substance use and obesity-related behaviors in fourth grade youth , 2012, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[45]  Mathea Falco,et al.  Quality of implementation: developing measures crucial to understanding the diffusion of preventive interventions. , 2005, Health education research.

[46]  L. Linnan,et al.  Y CHAPTER ONE Process Evaluation for Public Health Interventions and Research An Overview , 2002 .

[47]  S. Sussman,et al.  The Project Towards No Drug Abuse (TND) Dissemination Trial: Implementation Fidelity and Immediate Outcomes , 2010, Prevention Science.

[48]  C. Summerbell,et al.  Interventions for treating obesity in children. , 2009, The Cochrane database of systematic reviews.

[49]  Connie Lim,et al.  Youth risk behavior surveillance--United States, 2005. , 2006, The Journal of school health.

[50]  Catherine P. Bradshaw,et al.  Maximizing the Implementation Quality of Evidence-Based Preventive Interventions in Schools: A Conceptual Framework , 2008, Advances in school mental health promotion.

[51]  W H Dietz,et al.  Preventing obesity in children and adolescents. , 2001, Annual review of public health.

[52]  D. Spruijt-Metz,et al.  Executive Cognitive Function as a Correlate and Predictor of Child Food Intake and Physical Activity , 2010, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[53]  M. Dobbins,et al.  School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6-18. , 2009, The Cochrane database of systematic reviews.

[54]  T. Baranowski,et al.  How best to measure implementation of school health curricula: a comparison of three measures. , 1998, Health education research.

[55]  D. Bailey,et al.  Measuring general levels of physical activity: preliminary evidence for the Physical Activity Questionnaire for Older Children. , 1997, Medicine and science in sports and exercise.

[56]  B. Flay,et al.  Balancing program and research integrity in community drug abuse prevention: project STAR approach. , 1986, The Journal of school health.