Date of Award

12-2016

Level of Access

Open-Access Thesis

Degree Name

Master of Science (MS)

Department

Food Science and Human Nutrition

Advisor

Adrienne White

Second Committee Member

Angela Myracle

Third Committee Member

Kathryn Yerxa

Abstract

While much effort has gone into the creation of obesity prevention programs like iCook 4-H, such programs remain largely under-utilized. The disconnect between research and practice highlights the necessity of dissemination and implementation strategies to ensure programs become adopted into practice. Creating a well-informed systematic approach to implementation will ensure that the iCook 4-H program will be implemented efficaciously and sustainably to improve the health of generations to come. The goal of this research was to implement the pilot dissemination and describe the findings in the context of the Quality Implementation Framework. The objectives were to report outcomes of the iCook 4-H pilot dissemination, identify factors that promoted or inhibited successful dissemination, and provide suggestions QIF-based suggestion for improvement of future iCook 4-H dissemination and implementation.

Careful attention to detail was paid in earlier stages of the iCook study while developing the iCook 4-H three-pronged approach of program, process, and fidelity evaluation to be consistent and reliable over time. This system of evaluation generates data on effectiveness of the iCook program (which was adressed in the iCook intervention study). In the context of dissemination and implementation it also illuminates the successes and failures in program packaging and determines if actual program delivery aligns with intended program delivery. Process evaluation results of the iCook 4-H pilot dissemination showed that both youth and adult participants identified the key components (concrete as well as abstract) of the program which is an indicator of efficacy. Program evaluation analysis demonstrated significantly increased scores from pre to post intervention in overall outcome measures (and the majority of youth subscales) 87.44±10.57 to 90.89±6.98 in adults and 180.26±29.74 to 200.10±28.67 in youth. Fidelity evaluations demonstrated that sites maintained high attendance (average of 91%) and participants were highly engaged in sessions (session averages of 3-4 on a 1-4 scale). Through third-party fidelity assessment, leaders were categorized as effective to highly effective (3.3-4 on a 1-4 scale) and were able to cover session materials and meet objectives within or below the intended session duration. Based on this assessment, the resources provided to leaders were deemed sufficient.

While novel and well designed, this three-pronged approach to evaluation was not intended to serve as a complete dissemination and implementation (D&I) plan. Significant exploration into dissemination and implementation strategies and frameworks was not completed prior to the pilot dissemination study. By evaluating the iCook 4-H pilot dissemination through the lens of the Quality Implementation Framework, a myriad of potential strategies for improvement of iCook 4-H D&I were discovered. Suggested avenues for improvement of future dissemination and implementation include: creation of a resource/needs/fit assessment, creation of a capacity/readiness assessment, generation of multiple iCook curriculum adaptations, creation of materials for marketing the program to potential champions, generating a system for

documenting and sharing effective responses to implementation barriers, development of more extensive training for non-Extension staff leaders and new second-tier staff, determining the ultimate hierarchy of staff members and roles of each level, developing a timeline of steps for new site pre-program preparation, developing a timeline of steps for across-site implementation coordination, establishing mechanisms for timely supportive feedback, providing opportunities for the sharing of experiences and community building between structure levels, and providing opportunities for the celebration of program success.

Ultimately, it is up to the iCook 4-H principal investigation team to determine which strategies should be incorporated into future dissemination and implementation efforts to ensure iCook 4-H continues to be implemented and generates a lasting impact on communities as an evidence-based practice.

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