1. Chapter 18: Group Level Intervention Strategies

2. Coming together is a beginning, staying together is progress, working together is success. Henry Ford

3.  People do come together and engage in physical activity programs in group settings in private fitness clubs, community centers, universities, and so on.  Some maintain their involvement  But, what about working together— what Ford called success? Group Level Intervention Strategies

4.  Zander (1982) suggested that a collection of individuals can be classified as a group when they: ________________ ________________ Identify the __________________ and other collectives as ________ Identify the __________________ and other collectives as ________ __________ and _____________ in group functions __________ and _____________ in group functions Are primarily interested in _______, not _________ accomplishments Are primarily interested in _______, not _________ accomplishments Are interested in the ________________________ Are interested in the ________________________ Group Level Intervention Strategies

5. The Dyersville Experience  The Beginning The first step in the project was to bring people together. The first step in the project was to bring people together. Advertised a program for community members interested in losing weight within a supportive social environment. Advertised a program for community members interested in losing weight within a supportive social environment. Over 450 participants in a town of 3,800! Over 450 participants in a town of 3,800!  Ford’s beginning had been realized— participants had come together.

6. The Dyersville Experience  The Progress è Strategies to assist the participants in their efforts to maintain involvement in the weekly diet, physical activity, and motivational sessions è Participants were assigned to teams è Teams decided a name and T-shirts è Participants enjoyed the weekly meetings and were rarely absent  Progress also had been realized— participants stayed together

7. The Dyersville Experience  THE SUCCESS!!  Based on weight loss  Entire teams stepped onto a giant truck scale to monitor their progress  The winning teams were those that had lost the most collective weight.  How successful was the Dyersville campaign?  The 450 plus participants lost a combined 7,500 pounds!

8.  The Dyersville project was not a scientific study  Why did the project work?  What were the group processes that facilitated behavior change?  What components were necessary to ensure sustained participation?  Will such a program ensure long-term adherence to healthy eating and/or physical activity? Theoretical Foundation for Group Level Physical Activity Interventions

9.  Carron and Spink (1993) proposed a conceptual framework for the application of group dynamics’ principles in physical activity classes  Based on the assumption that various __________________________ can lead to ______________________________  Based upon the tenet that ____________ is ___________________________________ Theoretical Foundation for Group Level Physical Activity Interventions

10. GroupCohesion Attractions to the group-Task GroupIntegration-TaskGroupIntegration-Social Attractions to the group-Social TASKSOCIAL GROUP INDIVIDUAL Group Cohesion Model Review (Carron, Widmeyer, Brawley, 1985)

11.  The inputs = the group environment and structure ___________ ___________ _____________________ _____________________  The throughputs = group processes ______________ ______________ _____________________________ _____________________________  The output = __________________________ Theoretical Foundation for Group Level Physical Activity Interventions

12. GROUP ENVIRONMENT ---------------------- Distinctiveness GROUP STRUCTURE --------------------- Group Norms Group Positions GROUP PROCESSES ------------------- Interaction & Communication Sacrifices Conceptual Framework for the Application of Group Dynamics’ principles in Physical Activity Classes (Carron & Spink, 1993) Inputs Throughputs GROUP COHESION ------------------- ATG-Task ATG-Social GI-Task GI-Social Outputs

13.  In Dyersville è Weight-loss teams also were encouraged to select a catchy name and have t-shirts made = feelings of distinctiveness è Members developed common expectations around collective goals = group norms è The length of the program provided ample time for the development of group interaction and communication = group processes Theoretical Foundation for Group Level Physical Activity Interventions

14.  Carron and Spink (1993) first applied their framework to female participants in 17 university aerobic fitness classes  Classes met 3 times/week for 13 weeks  Randomly assigned to either a team- building or control condition  A four-stage process consisting of an introductory, a conceptual, a practical, and an intervention stage Team Building in Physical Activity Settings

15.  _________________ stage--20-minute presentation to class instructors  ________________ stage--provided the class instructors with an understanding of the conceptual framework  ________________stage--the class instructors become active agents in the development of specific strategies  ________________stage--specific intervention strategies were introduced and maintained throughout the program Team Building in Physical Activity Settings

16. Specific strategies developed in practical stage and implemented in intervention stage: (See Table 18-1 in Textbook) Group Environment/Distinctiveness: –_______________________________ – __________________________ Group Structure/Individual Positions: –_______________________________depending on fitness level Group Structure/Group norms – __________________________________ –_________________ to lose weight together

17. Team Building in Physical Activity Settings Group Processes/Individual Sacrifices: –Ask two or three people for a goal for the day –_______________________________ Group Processes/Interaction & Communication: –Use ______________ and have them ________________ –_______________________________________________

18.  The intervention was successful: team- building increased perceptions of cohesion  Individuals in the team-building and control conditions did not differ on______________  But Fewer _____________ from classes that had experienced the team-building intervention and participants were _______________________________ Team Building in Physical Activity Settings

19.  How do these findings generalize?  Previous research has shown that exercise class cohesion can be improved through team-building techniques  As cohesion is a predictor of exercise participation in older exercisers, a similar intervention should improve adherence to an exercise class developed for older adults Team Building in Physical Activity Settings

20.  Estabrooks & Carron (1999) examined the effect of a team-building intervention on exercise attendance and program return rate of older adult exercisers  Participants were first time registrants in a fitness program for seniors.  Physical activity classes met for 1 hour 2 times per week for 6 weeks. Team Building in Physical Activity Settings

21.  Participants were randomly assigned to the team-building, attention-placebo, or control condition.  The control condition received a standard- care physical activity class.  The attention-placebo condition received a standard-care physical activity class plus a weekly visit from a research assistant. Team Building in Physical Activity Settings

22.  The team-building intervention was based upon strategies from group dynamics: è Promote distinctiveness è Introduce roles within the group è Set group goals è Foster increased interaction and communication among group members Carron & Spink, 1993 Team Building in Physical Activity Settings

25.  Annesi (1999) -- changes in participation rates might be the result of leader attention  Examined the effectiveness of a group cohesion based intervention when there is minimal leader contact  New members of the facility participated  All given the standard orientation and prescribed a 3-time weekly exercise program lasting 15 weeks Team Building in Physical Activity Settings

26.  The participants in the intervention arm attended more sessions (65% vs 48%) and had less drop-out (29% vs 50%)  It was concluded that simply having new exercisers warm-up and cool down together should increase the probability of program adherence Team Building in Physical Activity Settings

27.  King and her associates (1998) questioned utility of group-based approaches  May be effective __________________ but counter productive _____________________ Participants could become ___________________ environment for sustained participation Participants could become ___________________ environment for sustained participation Programs invariably end either for a summer or winter break or because the program’s objectives have been met Programs invariably end either for a summer or winter break or because the program’s objectives have been met Those individuals who depend upon the group’s support ___________________________ if/when the group _____________ Those individuals who depend upon the group’s support ___________________________ if/when the group _____________ Concerns About Group-based Interventions

28.  Does the above concern have merit? è Studies rarely, if ever, report physical activity rates once the program ends è Estabrooks and Carron (1999) did not assess physical activity between the completion of the 1 st program and the initiation of the 2 nd è Participants may have become relatively or completely inactive during the hiatus è The participants might not have the confidence or skills necessary to complete a similar program at home Concerns About Group-based Interventions

29.  The question that remains is—can group-based intervention continue to exert an influence on independent individual behavior after the group ceases to exist? Concerns About Group-based Interventions

30.  Brawley and his associates (2000) examined if a group-based intervention could be effective for increasing individual participation not only during the life of the program but also when the program was terminated  Healthy previously sedentary older adults (> 65 years) were recruited and assigned to one of three conditions—group-motivated cognitive-behavioral, standard physical activity, or wait-list control Group-Based Interventions as Agents of Change

31.  The study was carried out in three periods of 3 months each  Throughout those periods questionnaires were administered to assess levels of physical activity and perceptions about quality of life Group-Based Interventions as Agents of Change

32.  1 st 3-month period, the intervention was introduced  The group-motivated cognitive- behavioral condition and the standard physical activity condition participated in a structured program that included physical activities at home  Individuals in these two conditions were exposed to considerably different sets of experiences Group-Based Interventions as Agents of Change

33.  The intervention used with the group- motivated cognitive-behavioral condition included many components of Carron and Spink’s (1993) conceptual model Group-Based Interventions as Agents of Change

34.  The participants selected and adopted a group name  Told that their group was “above average” in their members’ potential to change  Facilitated interaction and communication  Taught a number of self-regulatory skills and then asked to pair up for the purpose of practicing the new skills  Discussed group-relevant goals for monitoring and behavior Group-Based Interventions as Agents of Change

35.  The group discussed individual and group goals, possible reasons for failure associated with the goals  The participants were also encouraged to begin discussing how to maintain individual physical activity and to identify and overcome cues to relapsing into sedentary lifestyle.  The group discussed the implications of decreasing contact between the project staff and participants. Group-Based Interventions as Agents of Change

36.  In the final 3-month period, the program was terminated  The participants in the group-mediated cognitive-behavioral condition Higher average frequency of physical activity Higher average frequency of physical activity Greater total amount of physical activity during the initial 6 months of the intervention Greater total amount of physical activity during the initial 6 months of the intervention ___________________________________ after the completion of the program ___________________________________ after the completion of the program Group-Based Interventions as Agents of Change

37.  END

38. Web Assignment: RE-AIM: Way to evaluation Health Behavior interventions Visit www.re-aim.org Under “Community Leaders” section –Take the RE-AIM Self-Rating Quiz –And click on and read the tips to help improve in the various elements of interventions