Using group model building to understand factors that influence childhood obesity in an urban environment.

BACKGROUND: Despite increased attention, conventional views of obesity are based upon individual behaviors, and children and parents living with obesity are assumed to be the primary problem solvers. Instead of focusing exclusively on individual reduction behaviors for childhood obesity, greater focus should be placed on better understanding existing community systems and their effects on obesity. The Milwaukee Childhood Obesity Prevention Project is a community-based coalition established to develop policy and environmental change strategies to impact childhood obesity in Milwaukee, Wisconsin. The coalition conducted a Group Model Building exercise to better understand root causes of childhood obesity in its community. METHODS: Group Model Building is a process by which a group systematically engages in model construction to better understand the systems that are in place. It helps participants make their mental models explicit through a careful and consistent process to test assumptions. This process has 3 main components: (1) assembling a team of participants; (2) conducting a behavior-over-time graphs exercise; and (3) drawing the causal loop diagram exercise. RESULTS: The behavior-over-time graph portion produced 61 graphs in 10 categories. The causal loop diagram yielded 5 major themes and 7 subthemes. CONCLUSIONS: Factors that influence childhood obesity are varied, and it is important to recognize that no single solution exists. The perspectives from this exercise provided a means to create a process for dialogue and commitment by stakeholders and partnerships to build capacity for change within the community.

"I am very, very proud of myself": improving youth activity levels using self-determination theory in program development.

Many adolescents are not meeting recommended levels for physical activity. Increasing physical activity among urban African American youth is both a challenge and a public health priority. Most research in community-based interventions has taken a didactic approach, focusing on skill and knowledge development alone, with inconclusive results. This 10-week progressive activity intervention with adolescents in an urban faith community introduced a self-determination theory (SDT) approach with the aim of promoting the adoption of self-management skills necessary for sustaining activity. Components of SDT included relatedness, competence, and autonomy. Together with didactics, aligning activities with participant interests, and using existing social structures for health message delivery, the approach led to high satisfaction ratings for the three components of SDT along with improved skills, knowledge, and outcomes in cardiovascular fitness. Understanding and utilizing approaches that enhance enjoyment, personal choice, confidence, and social affiliation may lead to more lasting healthy activity behaviors and attitudes than didactic approaches alone in this and other adolescent populations. The SDT is reviewed in the context of this youth intervention.

Maintaining physical activity over time: the importance of basic psychological need satisfaction in developing the physically active self.

PURPOSE: Drawing from self-determination theory, this study investigated adults' perceptions of the process of long-term maintenance of physical activity and how it may relate to their self-identity. DESIGN: Qualitative study included 22 in-depth interviews and participants' recorded personal reflective journals. SETTING: Health/fitness facility in a Midwestern city. PARTICIPANTS: Purposeful sample of 12 adult (age range 29-73 years) members who had engaged in regular physical activity for at least 3 years. METHODS: Data were collected on participants' perceptions of processes associated with physical activity maintenance. Grounded theory data analysis techniques were used to develop an understanding of participants' long-term physical activity adherence. RESULTS. Analysis revealed three themes organized around basic psychological need satisfaction: (1) Relatedness included receiving and giving support. (2) Competence included challenge and competition, managing weight, and strategies for health management. (3) Autonomy included confidence in the established routine, valuing fitness status, and feeling self-directed. The final theme of physically active self included the personal fit of an active lifestyle, identity as an active person, and attachment to physical activity as life enhancing. CONCLUSION: Our results suggest that long-term physical activity adherence may be strengthened by promotion of the individual's basic psychological need satisfaction. Adherence is most likely to occur when the value of participation becomes internalized over time as a component of the physically active self.

An investigation of pre-activity cardiovascular screening procedures in health/fitness facilities--part II: rationale for low adherence with national standards.

The purpose of this study was to explore the rationale provided by program directors and general managers of health/fitness facilities for low adherence to nationally accepted standards related to pre-activity cardiovascular screening procedures (PACSPs) for members and clients of personal trainers. Qualitative interviews were conducted with the directors/managers in a Midwest region representing 76 facilities who indicated they did not conduct PACSPs for members and clients of personal trainers. Analysis of the rationale provided revealed 6 major clusters: (1) Purpose or need for screening; (2) time and staffing; (3) barrier to participation; (4) personal responsibility for health and actions; (5) legal issues; and (6) company or franchise policy that categorized the reasons for low adherence to PACSPs. These findings highlight the need to increase awareness of the relevance of PACSPs among health/fitness managers, staff members, and current exercise science students as well as engage those in risk management for informed dialogue for consistent application of the standard of care.

An investigation of pre-activity cardiovascular screening procedures in health/fitness facilities--part I: is adherence with national standards decreasing?

This investigation determined the number of health/fitness facilities within a Midwestern region conducting pre-activity cardiovascular screening procedures (PACSPs) consistent with American Heart Association/American College of Sports Medicine (AHA/ACSM) standards. Interviews were conducted with 123 commercial, community, corporate, and academic settings (84% response rate), with 40 (33%) facilities requiring members to complete a pre-activity screening device. Of those, 20 (50%) required physician clearance for "at-risk" members prior to physical activity participation. Personal training clients completed a pre-activity screening device at 50 (61%) facilities, with 32 (64%) requiring physician clearance for at-risk clients. The data were analyzed by setting, with corporate facilities having a significantly higher (P=.0049) adherence rate with AHA/ACSM standards than other facilities. Data were compared with previous studies and indicated a decrease in the number of facilities conducting PACSPs. Findings indicate that health/fitness personnel need to become aware of the relevance of conducting PACSPs.