Purpose: Physical activity (PA) is effective for preventing and treating multiple mental health symptoms. Training mental health practitioners (MHPs) to integrate PA recommendations into therapy may accelerate the reach of PA promotion efforts. The purpose of this study was to evaluate MHPs’ receptiveness to a Park Prescription (ParkRx) training, which would equip MHPs to recommend park-based PA as part of their clients’ treatment plans.

Methods: Four focus group sessions were conducted to ascertain MHPs’ current practices and reactions to ParkRx. A total of 14 MHPs with 8.7 average years of experience in various settings participated.

Results: Most participants reported asking about PA in their current practice; about half reported regularly recommending PA to clients, but none had heard of ParkRx. MHPs identified several existing skills to facilitate PA counseling, including assisting clients with coping planning, recommending enjoyable movement instead of ‘exercise’, and using ‘baby steps’ to facilitate mastery experiences. Participants appreciated ParkRx’s holistic health benefits and believed clients would be receptive to outdoor PA. Some disliked the idea of ‘prescribing’ PA and felt it could conflict with their therapeutic approach, particularly for clients presenting certain concerns (e.g., eating disorders, feelings of shame, suicidal ideation). All MHPs expressed the importance of a clear message on promoting wellbeing rather than a focus on exercise. Some MHPs shared concerns about whether ParkRx would add to their workload, but others were excited about the idea of going beyond the traditional ‘walls of therapy’ to rethink holistic therapeutic approaches. MHPs were receptive to training, especially if continuing education credits were provided. MHPs identified useful components of ParkRx training including: education about the mechanisms through which outdoor PA improves mental health, lists of parks and PA resources in the community, cards or pamphlets to distribute to clients, and practice with behavioral counseling techniques.

Conclusions: Few MHPs currently provide formal PA ‘prescriptions,’ but many had positive reactions to ParkRx and expressed interest in further training. Given their existing behavioral counseling skills and the frequency and duration of client interactions, MHPs represent a promising pathway for promoting park-based PA to enhance physical and mental health.

Background: Careful consideration and planning are required to establish “sufficient” evidence to ensure an investment in a larger, more-well powered behavioral intervention trial is worthwhile. In the behavioral sciences, this process typically occurs where smaller-scale studies inform larger-scale trials. Believing that one can do the same things and expect the same outcomes in a larger-scale trial that were done in a smaller-scale preliminary study (i.e., pilot/feasibility) is wishful thinking, yet common practice. Starting small makes sense, but small studies come with big decisions that can influence the usefulness of the evidence designed to inform decisions about moving forward with a larger-scale trial. The purpose of this presentation is to discuss what may constitute sufficient evidence for moving forward to a definitive trial. The presentation focuses on challenges often encountered when conducting pilot/feasibility studies, referred to as common (mis)steps, that can lead to inflated estimates of initial promise, and how the intentional design and execution of one or more, often small, pilot/feasibility studies can play a central role in developing an intervention that scales beyond a highly localized context.

Main Body: For any given intervention, the type and amount of evidence necessary to be deemed sufficient is inherently variable and can range anywhere from qualitative interviews of individuals representative of the target population to a small-scale randomized trial that mimics the anticipated larger scaled trial. Major challenges and common (mis)steps in the execution of pilot/feasibility studies discussed are those focused on selecting the right sample size, issues with scaling, adaptations and their influence on the preliminary signal observed, as well as the growing pains of progressing from really small to really large samples. Finally, funding and resource constraints for conducting informative pilot/feasibility study(ies) are discussed.

Conclusion: Sufficient evidence to scale will always remain in the eye of the beholder. An understanding of how to design informative small pilot/feasibility studies can assist in speeding up incremental science (where everything needs to be piloted) while slowing down premature scale-up (where any evidence is sufficient for scaling).

Purpose: Nutrition Incentive (NI) projects aim to increase purchase/consumption of fruits and vegetables (FVs) among low-income consumers by providing incentives (e.g., dollar-for-dollar match) at point-of-purchase. Produce Prescription (PPR) projects also aim to increase purchase/consumption of FVs among low-income consumers at elevated risk for chronic disease. PPR projects include partnering with healthcare providers and aim to reduce healthcare utilization and costs. The purpose of this study is to describe NI and PPR project characteristics across the United States (U.S.)

Methods: In 2019, grantees of the Gus Schumacher Nutrition Incentive Program (GusNIP) funded by the U.S. Department of Agriculture (USDA) reported quarterly descriptive data from participating firms to the coordinating center. Firms included brick and mortar (B&M) and farm-direct retail outlets that redeem incentives and clinics (PPR only). Variables reported included: food retail type, financial instrument (e.g., token), FVs eligible, other food assistance benefits accepted, incentive level ratio, and nutrition education provided.

Results: Across 23 grantees, there were 773 firms that reported data from B&M outlets (e.g., grocery stores) (n=206), farm-direct outlets (n=534), and clinics (n=33). Within B&M, the majority of NI projects operated in large supermarkets (31.8%) and independent grocery stores (29.9%), while the majority of PPR firms were small food stores (59.5%) and medium chain supermarkets (27.0%). The majority of farm-direct outlets for NI/PPR projects were farmers markets (82.6%-83.0%) and mobiles markets (8.0%). For B&M, common financial instruments for redemption (i.e., purchases using incentive) were loyalty cards (35.1%), automatic discounts (21.5%), or paper vouchers (19.4%). For farm-direct, common financial instruments included tokens (60.9%) and paper vouchers (32.5%). Nutrition education was most common in clinics and mainly consisted of individual dietary consultation (39.3%), 1-on-1 coaching (35.7%), and diabetes prevention classes (28.6%). Other program characteristics will be compared and contrasted during the presentation.

Conclusions: This descriptive data provide a comprehensive portrayal of the nuances and differences in how NI and PPR projects are administered across settings in the U.S. Further research is needed to understand outcomes (e.g., redemption, behavior change) across these firm types and characteristics to help NI/PPR practitioners design and implement effective and efficient projects.

The COVID-19 (COVID) pandemic shifted way of life for all Canadians. ‘Stay-at-home’ public health directives counter transmission of COVID but may cause, or exacerbate, older adults’ physical and social health challenges. To counter unintentional consequences of these directives, we rapidly adapted an effective health promoting intervention for older adults (Choose to Move, CTM) to the home environment in British Columbia (BC).

Purpose: To 1) discern if it is feasible to adapt and implement CTM virtually (CTM-at-Home); 2) describe the impact, facilitators, and barriers of CTM-at-Home on older adult participant (OAP) mobility, physical activity (PA), and social connectedness (SC).  

Methods: We conducted a mixed-methods triangulation design 4-stage formative evaluation of CTM-at-Home – a 3-month, single-group pre-post study with a convenience sample of OAPs and delivery partners (organization leads, provincial coordinators, recreation coordinators, activity coaches). We implemented 33 programs via Zoom during BC’s acute and recovery stages of COVID (April-October 2020). Objective 1: We conducted semi-structured 30-45min telephone interviews with delivery partners (0-, 3-months). Objective 2: We collected survey data with validated tools to assess mobility, PA, and SC (0-, 3-months). We used basic descriptive analysis to describe health outcomes over time. We conducted semi-structured 30-45min telephone interviews with OAPs (0-, 3-months, follow-up during 2nd COVID wave). We used deductive framework analysis for all qualitative data to identify themes.

Findings: Objective 1: Delivery partners felt that CTM-at-Home was acceptable and feasible to deliver despite a few recruitment and technological challenges. They offered solutions to increase accessibility. Objective 2: 153 OAPs were included (86% female; 73+/-6 years). Approximately 2/3 of OAPs maintained or increased their mobility, PA, and SC while isolated at home (non-significant). Facilitators: PA motivation; accountability; SC. Barriers: lack of inclusive (age and ability) at-home exercise options; accessibility. Follow-up interviews suggested a severe decline in mobility, PA, and SC when at-home program support was withdrawn.

Conclusions: It is feasible and acceptable to adapt and deliver CTM virtually across BC. Longer-term, CTM-at-Home provides a preventive health program that can be scaled-up across Canada to promote older adults’ physical and social health more generally, or in response to subsequent COVID waves. 

Purpose: In-depth fidelity evaluations remain understudied. Fidelity evaluations examine the extent an intervention is delivered as intended and increases confidence that intervention results are due to the intervention itself. As a program translates from one context to another, knowing exactly what and how it was implemented is critical to understand program outcomes and provide feedback to subsequently scale and inform future research. The purpose of this study was to examine the delivery of, and engagement with, an evidence-based diet and exercise diabetes prevention program when delivered by fitness facility staff within a community organization.

Methods: This pragmatic study investigates the implementation of a community-based diabetes prevention program by a local community organization. Ten staff from this organization were trained to deliver an evidence-based program. Between August 2019 - March 2020, 26 clients enrolled in the program. Three fidelity assessments were completed. First, staff completed session-specific fidelity checklists (n = 156). Second, two audio-recorded counseling sessions from all clients underwent an independent coder fidelity check (n = 52). Third, staff recorded client goals on session-specific fidelity checklists and all goals were independently assessed for (a) staff goal-setting fidelity, (b) client intervention receipt, and (c) client goal enactment by two coders (n = 285). Fidelity scores were calculated for each checklist, converted into a percentage, and compared to independent coder fidelity checklists. Content analysis was used for staff goal-setting fidelity, client receipt of intervention, and client goal enactment.

Results: Average self-reported fidelity was 89.5% for all six sessions. Independent coder fidelity scores for the two assessed counseling sessions were 83% and 81%. Overall, staff helped clients create goals in line with program content clients indicated receipt of the program as intended and had a high goal achievement of 79%.

Conclusion: This study demonstrates relatively low-resource methods to assess program fidelity and client engagement. The program was implemented with high fidelity by fitness facility staff at a community organization and clients engaged with the program as intended. Findings increase confidence that program outcomes are due to the intervention itself and provide feedback to refine implementation strategies to support future scale-up efforts.

Purpose: Before the COVID-19 pandemic, only 22% of adolescents in Antigua and Barbuda were meeting the World Health Organization’s (WHO) physical activity (PA) guidelines (Aguilar-Farias et al., 2018). Relatedly, up to 28.5% of adolescents in Antigua and Barbuda are overweight or obese (Walwyn & Hunte, 2012; World Health Organization, 2017). Opportunities for adolescent PA have likely decreased due to COVID-related closures and other lockdown restrictions. Integrating school-based PA strategies into policymakers’ Building Back Better efforts is critical. The purpose of this study was to identify implementation challenges and facilitators to cultivating active secondary school environments in Antigua.

Methods: Eight interviews and 9 focus groups were conducted with Physical Education (PE) teachers and Grade 7 students from 9 secondary schools in Antigua, respectively. The schools were identified for study by the Antiguan and Barbudan Ministry of Education, Science and Technology. The socioecological model (McLeroy, Bibeau, Steckler, & Glanz, 1988; Stokols, 1996) guided the development of the interview and focus group questions to explore PA barriers and facilitators within the school environment. Thematic analysis was used to analyse the data. 

Findings: Teachers and students discussed circumstances within their school environments that may hinder and facilitate the cultivation of active schools. One major hindrance is a culture of under-prioritization of PA in favour of key academic subjects, which translates into a lack of funding and resources allocated to PA opportunities and investment in supportive human resources to facilitate the implementation of PA opportunities. The lack of or poor maintenance of facilities and equipment also hinders the implementation of quality PE, sport, and non-competitive PA. Alternatively, existing activities such as mandatory PE until Grade 9 and other unique programs that celebrate PA including annual active days and competitions, create a conducive environment for implementing PA opportunities.  

Conclusion: This study provides insight into an understudied population and context. Findings highlight some of the major barriers and facilitators to implementing PA opportunities in schools in Antigua and Barbuda, which can be explored and leveraged to cultivate active secondary schools in a time when active opportunities for adolescents are needed most.