1. Family Public Health Clinics Implementing a Physical Activity Group: A Feasibility Assessment Mariah Martin

2. Background Half of infants born in US participate in WIC (USDA, 2005) Half of infants born in US participate in WIC (USDA, 2005) 1992-1998: 20% increase in childhood overweight in WIC (Cole, 2001) 1992-1998: 20% increase in childhood overweight in WIC (Cole, 2001) –King County WIC: 1/3 of children are overweight (Oberg, 2005) Increased PA in childhood decreases Bp and body fat (Gutin et al., 1995; Mcmurray et al., 2002) Increased PA in childhood decreases Bp and body fat (Gutin et al., 1995; Mcmurray et al., 2002) Healthy childhood weight interventions that involve parents are more successful (Golan et al., 1998; Wrotniak et al., 2004) Healthy childhood weight interventions that involve parents are more successful (Golan et al., 1998; Wrotniak et al., 2004) WIC educational groups offer an intervention method that can involve children and caregivers WIC educational groups offer an intervention method that can involve children and caregivers

3. WIC Educational Programs Factors associated with implementation Factors associated with implementation –Available time/resources (Havas et al., 2000; Aquilino et al., 2003) –Training (Aquilino et al., 2003; Fit WIC; Campbell, 2005) –Clinic priorities (importance) (Aquilino et al., 2003; Campbell, 2005) –Staff health habits (Fit WIC) –Staff pairing (Havas et al.) FNS policy change specifically included PA as part of nutrition education (FNS, 2004-5) FNS policy change specifically included PA as part of nutrition education (FNS, 2004-5) –Not much known about implementing PA groups in WIC

4. Research Aim What factors are associated with implementation of a physical activity educational group in WIC clinics? What factors are associated with implementation of a physical activity educational group in WIC clinics? 3 Types of Factors 3 Types of Factors –Staff personal factors –Clinic factors –Training/management factors

5. Conceptual Model Personal PA Important Comfort Level Self-Efficacy Clinic Client Incentives Clinic supports healthy habits Client Interest in PA Resources (staff, time, space) Training/Management Ongoing training and support FNS policy change -King County WIC push for groups WIC Clinic Implementation

6. Methods Participants: 18 WIC Clinics in King County Participants: 18 WIC Clinics in King County Phase I (2 days): Exposure Data Phase I (2 days): Exposure Data –4 Staff Trainings: Leading Playing Together  83 staff members –Phase I Survey (Paper): Collected information about factors present in each clinic (Quantitative & Qualitative) Phase II (6 months): Implementation Phase II (6 months): Implementation –Clinics signed up to implement group and received start-up kits –Monitored implementation practices and provided extra support when requested by clinics –Phase II Survey (Online): Influential factors for and barriers to implementation (Qualitative)

7. Analysis Outcome variable classification Outcome variable classification –Implementation: ≥ 2 group sessions per/month –No Implementation: 0 group sessions Quantitative Data Quantitative Data –Fisher’s Exact Tests Qualitative Data Qualitative Data –Looked for overall themes and differences/similarities between implementing and non-implementing clinics

8. Quantitative Results Mean Total Number Of Staff Mean Portion of Staff Who Attended Training Mean Clinic Client Caseload Mean Personal Factors Mean Training/ Management Factors Mean Clinic Factors Implemented (6)7.3387%24334.224.3485% Non- Implemented (12) 5.0864%12464.194.2363% Significance Level* *Fisher’s Exact.042.11.0091.00.24.10 Summary of Clinic Characteristics  Space associated with implementation (P =.053)  All other individual personal, training/management, and clinic factors similar between implementing and non-implementing clinics

9. Qualitative Results Phase I Survey Phase I Survey –Staff generally liked the curriculum  Some suggested Spanish materials –80% of positive additional comments came from staff in implementing clinics Phase II Survey Phase II Survey –Influential Factors: client interest, training, organized curriculum and materials, FNS push for PA groups –Barriers: insufficient space, small staff, small caseload Implementation Practices Implementation Practices –All clinics offered the group in English and Spanish –4 of 6 clinics preferred leading the group in teaching pairs

10. Limitations No known validated instrument No known validated instrument Small sample size Small sample size Each county administers WIC slightly differently, affecting generalizability Each county administers WIC slightly differently, affecting generalizability Exposure data came from WIC staff verses direct observation Exposure data came from WIC staff verses direct observation Relatively short follow-up time Relatively short follow-up time

11. Conclusion Implications for PA Group Implementation Implications for PA Group Implementation –Clinic size and resources are key –High quality training/materials are important –Staff member enthusiasm could play a role –Staff pairing for leading groups More Research Needed More Research Needed –Differences between implementing and non- implementing large clinics –Overcoming barriers of limited size/resources  In King County alone, 2,255 clients are served by WIC clinics serving less than 1,000 clients

12. Acknowledgements Donna B Johnson, RD PhD Betty Lucas, RD MPH Donna Oberg, RD MPH Lisa DiGiorgio, RD MPH Carrie Nelson-Pfab, RD MS The Lee Family King County WIC Clients and Staff Family and Friends This study was supported by grant T76 MC 00011 from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, U.S. Department of Health and Human Services.