Accepted Manuscript Title: Staff’s perceptions of the use of evidence-based physical activity promotion strategies for promoting girls’ physical activity at afterschool programs: A qualitative study Author: Danae Dinkel Jennifer Huberty Michael Beets Melissa Tibbits PII: DOI: Reference:

S0149-7189(14)00039-1 http://dx.doi.org/doi:10.1016/j.evalprogplan.2014.03.013 EPP 1107

To appear in: Received date: Revised date: Accepted date:

14-10-2013 26-3-2014 29-3-2014

Please cite this article as: Dinkel, D., Huberty, J., Beets, M., & Tibbits, M.,Staff’s perceptions of the use of evidence-based physical activity promotion strategies for promoting girls’ physical activity at afterschool programs: A qualitative study, Evaluation and Program Planning (2014), http://dx.doi.org/10.1016/j.evalprogplan.2014.03.013 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Title: Staff’s perceptions of the use of evidence-based physical activity promotion strategies for promoting girls’ physical activity at afterschool programs: A qualitative study

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Jennifer Huberty, Ph.D Associate Professor Exercise and Wellness School of Nutrition and Health Promotion Arizona State University 500 N 3rd. St. Phoenix, AZ 85004, USA [email protected]

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Danae Dinkel, Ph.D* Assistant Professor School of Health, Physical Education, and Recreation University of Nebraska Omaha 6001 Dodge Street Omaha, NE 68182, USA [email protected] 1-402-554-3259 *Corresponding Author

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Michael Beets, Ph.D, MPH Associate Professor Director · Master of Public Health in Physical Activity and Public Health (MPH-PAPH) Department of Exercise Science Division of Health Aspects of Physical Activity Arnold School of Public Health University of South Carolina 921 Assembly St., 1st Fl. Suite, RM 131 Columbia, SC 29208, USA [email protected] Melissa Tibbits, Ph.D Assistant Professor College of Public Health University of Nebraska Medical Center 984355 Medical Center Omaha, NE 68198, USA [email protected]

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Abstract There is a need to improve girls’ physical activity (PA) in afterschool programs as girls’ PA levels are consistently lower than boys’. An evidence-based professional development

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framework, the 5 Ms, has been effective in helping staff to improve PA in both girls and boys but further improvements in girls’ PA are needed. Little is known about staff’s perceptions of using

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PA promotion strategies to promote girls’ PA. Therefore, the purpose of this study was to

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explore staff perceptions of the use of evidence-based PA promotion strategies for promoting PA in girls. Semi-structured interviews were conducted with staff from three community-based

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afterschool programs located within a school setting (n=18). Data were analyzed using the process of immersion/crystallization. A majority of staff had some knowledge of PA promotion

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strategies but few staff consistently utilized these strategies and a majority felt several strategies

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were unnecessary (i.e., having a PA policy). Newer staff reported depending on senior staff to

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promote PA in girls. Overall, findings suggest that staff’s perceptions may impact their use of PA promotions strategies. The results of this study will contribute to the enhancement of an

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existing staff training framework (5 Ms) to improve girls’ PA in afterschool programs.

Key Words: Physical activity, afterschool programs, girls, staff training, program planning

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1. Introduction Physical activity (PA) offers many physical and psychological benefits to children

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(Biddle & Asare, 2011; CDC, 2011; USDHHS, 2008). Despite these benefits, a majority of children are not meeting the PA recommendations (60 minutes of moderate-to-vigorous PA

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(MVPA) every day) (USDHHS, 2008; Troiano et al., 2008). Research in the U.S. has found girls

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especially are consistently less active than boys, regardless of race, parental income level, weight status, or age (Belcher, et al., 2010; Troiano, et al., 2008; Whitt-Glover, et al., 2009). In fact, only

compared to 48% of boys (Troiano, et al., 2008).

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35% of 6-11 year old girls currently achieve the recommended 60 minutes of daily MVPA as

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Few interventions have been successful at meaningfully increasing MVPA in girls across a variety of settings (e.g., afterschool programs (ASPs), community, family, and school) (Beets,

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Beighle, Erwin, & Huberty, 2009; van Sluijs, McMinn, & Griffin, 2008). In interventions

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targeting boys and girls, several studies have shown greater improvements in boys PA as

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compared to girls (Huberty, Beets, Beighle, & Welk, 2011; Magnusson, Sigurgeirsson, Sveinsson, & Johannsson, 2011; Ridgers, Stratton, Fairclough, & Twisk, 2007; Rosenkranza, Welk, & Dzewaltowski, 2011). Unfortunately, interventions that specifically target girls have not been any more successful at improving girls’ MVPA than studies targeting both boys and girls (Klesges, et al., 2010; Kumanyika, Obarzanek, Robinson, Beech, 2003; Robinson, et al., 2010; Webber, et al., 2008). There is a need for novel interventions to increase PA in girls. ASPs are a prime opportunity to increase girls’ PA (Afterschool Alliance, 2009; Beets, et al., 2009; Beighle, et al., 2010; Pate & O’Neil, 2009; Webber, et al., 2008) and have been called upon to do so (Beets, Huberty, Beighle, 2013). ASPs are defined as programs that take place immediately after the regular school day (approximately 3-6 pm), are available daily throughout 3 Page 3 of 34

the academic year (Monday through Friday), and provide a combination of scheduled activities such as a snack, homework assistance/tutoring, enrichment activities (e.g., arts and crafts, music), and PA (Afterschool Alliance, 2009). In the U.S., over 8 million children attend ASPs

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every year and according to findings from a survey conducted in a nationally representative

sample, an additional 18.5 million children would attend if an ASP was available (Afterschool

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Alliance, 2009). Previous research in ASPs has found that interventions targeting PA can

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improve children’s PA levels; however, more comprehensive assessments are needed (Beets, et al., 2009; Pate & O’Neill, 2009). Future research is needed on the type and variety of activities

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offered, content and frequency of trainings, and staff perceptions of these programs as well as the specific components of ASPs that best promote PA (Beets, et al., 2009; Pate & O’Neill, 2009).

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A critical component to the success of ASPs is staff. Staff are especially important for the

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successful implementation of an environment conducive to opportunities for PA (e.g., organized

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games, participation in free play). This may be especially true in girls. A recent study found girls were most active at ASPs when staff were actively promoting PA and MVPA increased with

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each PA promotion strategy that was implemented (i.e., staff verbally promoted PA, staff organized PA) (Huberty, et al., 2012). Unfortunately, few staff are trained in PA promotion, especially PA promotion for girls (Ajja, et al., 2012; Huberty, et al., 2012). Interventions are needed to train staff to serve as active role models by engaging in PA, supporting PA, and facilitating opportunities for girls to be active (Ajja, et al., 2012). One promising ASP staff training framework focused on teaching staff how to effectively promote PA is the 5 Ms (Weaver, et al., 2012). The 5 Ms is an evidence-based professional development framework that has been effective in helping staff to improve PA in the afterschool setting (Beets, Huberty, & Beighle, 2013; Huberty, Beets, & Beighle, 2013). A policy-level

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intervention targeting improvements in girls and boys PA where staff were trained in the 5 Ms yielded increases in vigorous activity and walking and decreases in sedentary time for both girls and boys (Beets, et al., 2013). However, the percentage of girls participating in walking and

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vigorous activity was still less than the percentage of boys (31% vs. 35% and 17.9% vs. 24.5%). No interaction effect was reported based on gender; however more research is necessary about

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how to train staff to improve PA in girls specifically.

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An area that has received little attention is the perceptions of ASP staff related to promoting PA utilizing evidence-based strategies. This information may be a critical component

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to the development of ASP staff trainings aimed at improving PA in girls’. For example, in the school setting even though PE teachers were aware of better strategies to motivate children to be

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active, perceived time constraints and cultural norms (i.e., appropriate methods for interacting

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with students) impacted the motivational strategies PE teachers used to encourage participation

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(Taylor, Ntoumanis, & Smith, 2009). Other research in school settings has suggested that obtaining an in-depth understanding of teacher’s perceptions of children’s behaviors and

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interventions greatly contributed to knowing how to improve staff trainings and teachers desires to use these interventions (Dutton, Varjas, Meyers, & Smith Collins, 2010; Reinke, Stormont, Herman, Puri, & Goel, 2011). Considering the potential impact of staff’s perceptions on their use of PA strategies, conducting a formative qualitative evaluation to better understand staff’s perception is imperative to the modification of an existing staff training framework. Findings can be used to ensure that potential barriers due to staff perceptions are addressed prior to the implementation of a newly developed staff training. To date, no studies have explored ASP staff’s perceptions of evidence-based PA promotion strategies and their current use of PA promotion strategies. A better understanding of 5 Page 5 of 34

staff’s perceptions may be essential elements to inform the modification of staff trainings to improve PA in girls. Therefore, the purpose of the present study was to explore staff perceptions of the use of evidence-based PA promotion strategies (based on the 5 Ms) for promoting PA in

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framework (the 5 Ms) to improve PA in ASPs specifically related to girls.

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girls. The results of this study will contribute to the enhancement of an existing staff training

Methods

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This was a qualitative study with a collective case study design. A collective case study

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uses multiple programs or sites (ASPs) to illustrate the exploration of a specific topic (i.e., PA promotion strategies) (Creswell, 2007). The boundaries of this study were staff at community-

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based ASPs located within a school setting. ASPs that focused solely on a single activity such as tutoring or specifically promoted PA (e.g., Girls on the Run, intramurals) were not included in

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this study. All data were collected at ASPs in a Midwestern city in the U.S. during

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February/March of 2013. This particular Midwestern city was chosen because ASPs in the area

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serve a diverse demographic of children (55% African American, 23% Caucasian, 10% Hispanic/Latino) and the researchers previous work in ASPs within this community have indicated that girls PA accumulation is lower than boys (Deichert, Rolf, & Smith, 2007; Huberty et al., 2012). The study was approved by an Institutional Review Board at a Medical Center. 2.1. Participants

Participants were staff recruited from three community-based ASPs located within three separate schools. An overview of site recruitment is available in Figure 1. Sites were excluded if they did not meet five days a week, were not located within an elementary school, had received similar PA training, and/or district research offices did not approve the study. Sites were

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contacted until an appropriate sample of ASPs serving various race/ethnicity and income levels agreed to participate. There were no major differences between the ASPs who did and did not agree to participate. All staff at recruited ASPs were invited to participate in the study. The

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population of children at one site was primarily African American (site 1) and the populations at the other two ASPs were primarily Caucasian (sites 2 and 3). Enrollment of children at the three

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sites ranged from 59 to 134. The principal investigator received referrals of potential ASPs from

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community organizations and then contacted the organizational and site directors to explain the study. Once approved by the directors, the principal investigator met with staff to explain the

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study. At this time staff were provided with the informed consent and encouraged to take up to one week to review the form and decide if they wanted to participate in the study. All staff

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members who volunteered to participate completed an informed consent and a short

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demographic questionnaire. The demographic questionnaire included questions on age, gender,

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race/ethnicity, whether they were currently enrolled in school, number of days in the last week they were active for at least 30 minutes/day, and how long they had been employed at the ASP.

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After the informed consent and demographic questionnaire were complete, staff took part in a semi-structured interview.

2.2.

-Insert Figure 1 Here-

Data collection

Semi-structured interviews with staff explored staff perceptions of the use of PA promotion strategies and their current strategies for promoting PA in girls. Interviews were conducted by trained research personnel whose only contact with the ASP was through data collection for this study. Interview questions were guided by the 5 Ms. The 5 Ms framework includes: mission – having defined policies around PA and training staff to promote PA; 7 Page 7 of 34

motivate – providing choices, developmentally appropriate activities, feedback and encouragement; manage – structuring and managing the environment for safety and discipline; monitor – implementing consistent evaluation of children’s PA, and maximize – using the Ms

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collectively (Weaver, et al., 2012). Additional details of the 5 Ms framework are provided

elsewhere (Weaver, et al., 2012). Semi-structured interview questions are listed in Table 1.

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Interviews occurred at a time and place that was convenient for the staff member, were audio

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recorded, and lasted no longer than one hour.

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-Insert Table 1 Here2.3. Data Analysis

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All interviews were transcribed verbatim into Word documents by trained research

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personnel. Each staff member was given a numeric code and any identifying information (e.g.,

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name) was not included within the transcript. After transcriptions were complete the documents were uploaded into QSR NVivo10 (Cambridge, MA, 2010). Data were analyzed using the

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process of immersion/crystallization (Borkan, 1999, p. 179-194). Two trained coders immersed themselves in the data by reading all interviews. The two coders created lists of codes independently based on a latent coding technique which “involves interpretation”, not strictly the words verbatim and explored differences between ASPs (Bernard & Ryan, 2010, p. 292). Then the coders met to discuss codes and came to a consensus on all codes. Next, the coders categorized the codes based on the overall themes of the 5 Ms. After the codes and themes were complete the coders revisited the transcripts and coded based on these updated codes. Coders also explored any differences between ASPs and assessed the data to determine if additional information was needed or analysis had reached a point of saturation (i.e., coders were not seeing

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any new information). Data were validated through the process of peer debriefing (an individual who provides an external review of the research process) and thick description (providing

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detailed description of participants/setting for transferability of findings) (Creswell, 2007). 3. Results

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Of the 19 available staff from the three ASPs, 18 volunteered to participate. The average

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age of staff was 27.4 years (range 18-50 years old). A majority of staff were female (72.2%), Caucasian (77.8%), and college or high school students (55.6%). Less than half of staff (37.5%)

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participated in PA on 5 or more days per week. Staff had worked for their ASP organization for various lengths of time ranging from 5 days to 19 years. Staff demographics are available in

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Table 2. It is important to note that even though data were analyzed for differences between sites,

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motivate, manage, and monitor.

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there were no major differences. The results are organized around the 5 Ms framework: mission,

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-Insert Table 2 Here-

3.1. Mission: Having defined policies around PA and training staff to promote PA When asked if their ASP had any policies related to PA, less than a quarter of staff expressed that having a PA policy was important and a majority of staff did not know if there was a policy related to PA at their ASP. Staff at two sites stated they had a policy to offer PA for 30 minutes every day. Staff who mentioned that a PA policy was unnecessary thought that either their site was already effectively promoting PA or they thought a policy would not impact children’s PA. One staff member explained “…the fact of the thing is if you (girls) are not gonna (participate in PA) we can’t force you to do something” (male, site 1).

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Few staff had received any type of PA training and those that did had difficulty remembering any specifics of the training. One staff member attempted to describe a PA training he had attended, “Well I think the idea of some of the PA was to ummm…was to I can’t even

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think of anything…” (male, site 1). Only a few staff members reported that they were interested in a PA training. In order to compel staff to attend a staff training, staff reported that trainings

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needed to be interactive, fun, “hands on” and “not be boring” (females, site 2). Another staff

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member discussed that the key component was, “being active, like being put into situations that you know you would see with the kids” (female, site 2). Staff who had been employed by the

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ASP for more than three years desired that trainings be on new subjects as they reported often sitting through the same basic trainings with new staff every year.

Motivate: Providing choices, developmentally appropriate activities, feedback, and

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3.2.

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encouragement

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Overall, staff reported that girls were difficult to motivate to participate in PA and that motivation varied based on the age group. Half of staff mentioned older girls (3rd – 5th grade)

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were more difficult to motivate and half mentioned younger girls (kindergarten – 2nd grade) were more difficult to motivate. Staff reported that girls who were not motived to participate in PA thought they were “too pretty” for PA, had no interest in being active, and preferred arts & crafts (female, site 1). The younger girls who were not motivated for PA were more interested in Barbies, board games, and “would rather draw or play pretend or make believe stuff… than play relay races” (female, site 1). Staff also reported that girls were even more difficult to motivate when their friends sat out of an activity. One staff stated, “Honestly when one girl (is) sitting down that makes other girls want to come and sit down” (female, site 1).

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Staff mentioned a variety of PA promotion strategies they used to motivate girls to participate in PA. The most reported strategy by approximately half of staff was engaging in PA with the girls. Other strategies mentioned were verbal encouragement, being enthusiastic about

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PA, trying to make PA fun, bribing girls to participate with candy or other items, and offering age-specific PA time. Even though staff mentioned strategies they believed increased girls’ PA,

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they were not always utilizing these strategies. One staff member discussed that she thought

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engaging in PA helped girls to be active but “I mean I haven’t played in awhile” (female, site 2). Less than a quarter of staff stated that they were not sure how to motivate girls or did nothing to

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motivate girls to be active.

Staff that reported using motivational strategies (e.g., engaging in PA, verbal

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encouragement) to encourage girls participation in PA typically only mentioned one type of

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motivational strategy that they used and if the strategy did not work, they left the girl alone. For

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example, one staff member said that when a girl did not want to participate in PA he would, “bribe from time to time, not with nothing major, candy if we have something…but I mean other

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than that if they don’t want to do it you can’t just force them…just let them do what they would like to do” (male, site 1). Staff were very careful not to “force” girls to be active which may have been due to a concern of retention (female, site 3). As one staff member explained, “…they (girls) may not want to do that (PA) they just want to sit in the corner to read their books and I don’t want to tear a kid away from what they want to do or else they won’t come back” (female, site 3). When discussing the types of activities offered to motivate children to be active, staff reported boys preferred competitive games (e.g., dodge ball, knock out) and competitive games were the most often requested and implemented games during organized PA time. Girls’ 11 Page 11 of 34

preferred activity was tag. One staff member mentioned, “some of the girls will you know, not play as much, but like if we are playing color tag the numbers raise like you know, 70/30 (girl/boy ratio)” (female, site 3). Staff rarely mentioned that girls enjoyed the same games that

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boys enjoyed (e.g., dodge ball, knockout). Staff also discussed that during group PA time, boys were often very competitive and aggressive. Staff mentioned the aggressiveness of “sweaty”

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boy’s intimidated girls, especially younger girls, and reduced girls’ motivation to participate in

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organized PA (female, site 2). Additionally, one staff member mentioned that they typically had more boys attend their ASP than girls and this “might be a little intimidating (to girls) in a way to

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go out and just do that (play games)” (male, site 1). When discussing the types of games staff were providing, several staff mentioned a desire to learn new age-appropriate games, especially

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related to girls. Long-term staff mentioned they had access to either a national or local

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curriculum at their ASP that offered PA ideas but they rarely used these resources. Staff cited

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several reasons for not utilizing these resources such as the games were too complicated, the

3.3.

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book was too big to take the time to look through, and already knowing what games work. Manage: structuring and managing the environment for safety and discipline

Two of the three sites stated they offered at least one organized 30-minute period of PA for all children after snack (the first activity at all ASP sites) and allowed for free play the remainder of ASP time. Children at these sites had a choice of participating in PA (either organized group or free play) or playing sedentary games (e.g., Barbies, Legos, board games). The third site scheduled organized PA time for different age groups periodically two to three times throughout the week, but typically left the last 20-30 minutes of ASP time for free play. This site provided organized girls-only PA time once a week. Also, when discussing PA scheduling, several staff reported that the outdoor temperature had to be at least 40 to 60 degrees 12 Page 12 of 34

for them to take children outside for PA. Overall, staff suggested that more time should be allotted for PA and/or girls-only PA time, but felt that when they were confined to being indoors during inclement weather (i.e., during winter) they did not have the space to accommodate

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additional PA time.

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When discussing staff’s ability to promote PA during organized group PA time, staff identified long-term staff (employed by ASP more than a year) as those who typically led PA.

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Staff who had been employed by the ASP less than one year did not appear confident in their

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ability to lead organized PA. Several staff mentioned that they had no knowledge of how to lead or promote PA with girls. One staff member stated “I don’t know how to play most of the group

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games that they play” (female, site 2). Additionally, several male staff (n=3) who mentioned not knowing how to facilitate girls PA, stated they were comfortable playing games with boys, but

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were not sure how to best interact with girls. When one male staff member was asked about his

Monitor: implementing consistent evaluation of children’s PA

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3.4.

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confidence in leading girls’ PA he stated, “In girls, being a guy probably not” (male, site 1).

None of the staff said they were currently monitoring the amount of PA that children accumulated at their ASP and few thought this was important. Interestingly, staff had varied opinions on whether girls accumulated adequate amounts of PA during ASP time. Approximately half of staff thought that girls did obtain adequate PA (e.g., 30 minutes of MVPA). The other half thought girls did not obtain adequate PA. Of those who believed girls did not receive adequate PA at their ASP, some mentioned that PA was dependent on the individual girl or age group. As one staff member stated, “It depends on the girl but I think most of them do group game at least for a little bit but maybe not 30 minutes…(maybe) 15, 20.” The only method

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staff discussed for keeping track of PA was monitoring the amount of time children were offered PA. Only a few staff mentioned that they had monitored children’s PA accumulation in the past and this was done with short-term programs run by outside organizations (e.g., walking

Discussion

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challenge).

The purpose of the present study was to explore staff perceptions of the use of evidence-

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based PA promotion strategies (based on 5 Ms) for promoting PA in girls. Overall, a majority of

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staff appeared to have some knowledge of PA promotion strategies (e.g., engaging in PA, offering age-appropriate scheduled PA). However, few staff reported consistently offering the

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PA promotion strategies they were aware of and a majority of staff felt several strategies were unnecessary (i.e., having a PA policy, monitoring PA). Given the lack of PA experience and

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training of staff, these findings provide further evidence for the need to train ASP staff to

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promote girls’ PA (Ajja, et al., 2012; Huberty, et al., 2012; Weaver, et al., 2012). Specific

4.1.

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recommendations are discussed below guided by the 5 Ms framework. 1. Mission

A majority of staff believed PA policies were not needed and even though two of the three ASPs had a PA policy, most staff were unaware of these policies. It should be noted that the primary focus of many ASPs is not PA but academics (Durlak, Weissberg, & Pachan, 2010). However PA has numerous benefits and by explaining the positive impact that PA can have on academics, this may help ASPs to better understand the need to offer PA. ASP policies are a key component to PA promotion efforts and represent the values of an organization (Beets, Webster, Saunders, & Huberty, 2012; Huberty, Beets, Beighle, & Balluff, 2010; Weaver, et al., 2012). Thus if PA is not included in ASP policy documents, new and existing staff may not believe 14 Page 14 of 34

promoting PA is important at the ASP. Although policies do not ensure implementation, there has been evidence of improved PA with strong environmental standards (PA policies) even with high staff turnover and limited staff training (Huberty, et al., 2013; Gortmaker, et al., 2012). In

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order to ensure ASPs are able to convert their PA policy into daily practice, strategies related to adoption of PA policies are needed. For example, identifying change agents (e.g., staff who may

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impact other staff opinions and/or staff employed by the organization longer than one year) and

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gaining their support can improve the dissemination and support of ongoing PA policies (Beets, et al., 2012). Results suggest that PA professionals (e.g., pedagogist, PA promotion specialist

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outside of ASP) need to ensure that ASPs have PA policies and work with key change agents to ensure that all staff perceive that these policies are important.

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Similar to other research few staff had received PA trainings and those that did had

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difficulty remembering the specifics of the training (Ajja, et al., 2012). Staff suggested that

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trainings needed to be interactive, fun, “hands on” and “not be boring” in order to make them want to attend the trainings. Additionally, all sites had access to PA curriculum, but these

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resources were not utilized because games were too complicated, the book was too big to take the time to look through, and/or staff reported they already knew what games worked with the children. Given that long-term staff desire new trainings, PA staff trainings may be an amenable change to the usual staff trainings they do attend. Furthermore, having long-term staff lead these trainings may improve engagement of long-term staff. 4.1.2. Motivate Overall, staff mentioned that girls were much more difficult to motivate compared to boys and perceived that some girls were not motivated to participate in PA. Staff perceptions of girls’ lack of desire/motivation to participate in PA may decrease staff’s desire to try to motivate 15 Page 15 of 34

girls to be more active (Taylor & Ntoumanis, 2007). This may have been evident when staff discussed using only one motivational strategy to encourage girls who did not want to be active. While several of the strategies staff used were evidence-based (i.e., engaging in PA, making PA

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fun), staff also reported not consistently using these strategies. ASP research in girls has

suggested that when numerous motivational strategies are in place (i.e., staff promoting PA, staff

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organizing an activity, equipment present) more girls are active (Huberty, et al., 2012). These

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results suggest that there is a need to address staff’s perceptions of girls desire to participate in PA and to teach staff how to consistently employ multiple PA promotion strategies to help

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motivate girls to be active as well as continuing to try new strategies even if a child initially declines participation in PA. Future research could also explore utilizing older girls at ASP sites

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to lead and role model PA for younger girls.

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Staff also reported that the reasons girls were difficult to motivate varied by age. PA

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opportunities may need to be re-structured to imitate activities girls enjoy. For example, staff

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reported that younger girls especially were more interested in playing sedentary games such as Barbies and other imagination games (Davies, 2011). PA professionals could explore teaching staff how to use “pretend” play to promote PA to young girls (e.g., when girls are playing “house” encourage them to take their dog for a walk). If this technique is unsuccessful, staff could also monitor the time girls spend in sedentary activities and encourage girls to participate in PA after girls have been sitting for more than 30 minutes. Furthermore, staff mentioned that they did not want to challenge sedentary behaviors of children because they did not want the child to leave the ASP. Running an ASP can be an expensive endeavor with the typical ASP costing an average of $4,320 for 3.7 hours of operation (Baldwin Grossman, Lind, Hayes, McMaken, & Gersick, 2009). A reduction in children 16 Page 16 of 34

attending means decreased income for the ASP and thus a decreased ability to have quality staff and programming. In addition to cost, as children grow older, they have more of a choice as to whether they will attend an ASP or not and thus it is extremely important to retain children for

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their future academic and health outcomes. Future research should explore utilizing the input from sedentary youth to better engage these youth in PA promotion efforts to ensure these youth

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are interested in the PA opportunities provided.

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4.1.3. Manage

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There were several findings related to staff’s management and planning of PA time that may negatively impact girls PA. First, PA was only an option at two sites. Given that staff

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reported young girls preferred sedentary activities, girls at these sites may have been less likely to choose to participate in PA. Second, consistent with other research staff reported girls’

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favorite games were various forms of tag but the games implemented were competitive games

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that boys preferred (Beets, et al., 2012; Davison, et al., 2010; Knowles, et al., 2011). If only

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competitive games that girls did not enjoy were offered during organized PA time, this may decrease girls PA (Rosenkranzb, Welk, Hastmann, & Dzewaltowski, 2011). Third, staff mentioned that older boys dominated games and there were often more boys than girls participating. Other research suggests that when more boys are in a play area girls tend to segregate themselves because they dislike the aggressive play of boys during high energy physical games (Beets, et al., 2012; Pellegrini & Smith, 1998; Saint-Maurice, et al., 2011). Fourth, staff may have been providing minimal outdoor PA time during winter months as staff mentioned the temperature had to be 40 to 60 degrees to take children outside. This is in spite of the fact that at these same locations, outdoor recess was being implemented during the school day at much lower temperatures (e.g., wind chill factor above zero). Research has found that 17 Page 17 of 34

children accumulate more PA at ASPs when PA is provided outdoors compared to indoors (Rosenkranza, et al., 2011).

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To address these barriers to girls’ PA, PA professionals should ensure that site directors or other PA champions have the skill and motivation to structure the ASP schedule to promote

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girls’ PA (Nigg, et al., 2012). One method of ensuring PA champions have the motivation to structure PA opportunities mentioned earlier is to align PA with the overall mission of the ASP

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(e.g., academics). Specifically, the site director or PA champions should schedule daily girls-

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only PA time in which several PA choices are offered simultaneously and attempt to offer outdoor PA when possible (Ajja, et al., 2012; Knowles, et al., 2011; Roemmich, et al., 2012;

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Rosenkranzb, et al., 2011; Vu, et al., 2006; Weaver, et al., 2012). Providing girls-only PA time and offering age-appropriate PA that girls prefer may eliminate the barrier of intimidation and

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ensure that activities girls enjoy are implemented, thus increasing girls’ PA.

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Several staff did mention that they would like to implement girls-only PA time, but did

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not believe they had the space to do so when constrained to indoor activity. To overcome this barrier, site directors should explore partnering with school personnel to maximize available indoor space (Sangster, et al., 2008). For example, hallways could be used to create a walking path or larger classrooms (e.g., music rooms) could be used to provide an area for girls to participate in Wii dancing. To increase outdoor PA opportunities during extreme weather months (e.g., winter, summer), upper level staff (i.e., ASP organizational directors, site directors) may need to mandate ASP staff take children outside for PA in low or high temperatures (as long as there is no risk to health). Teaching staff how to utilize strategies (e.g., requiring children and staff to bring gloves and hats to play outside) to increase outdoor PA time during winter months

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may mitigate the decrease in PA that typically occurs when children are confined to indoor PA areas.

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Another key finding was that new staff may lack confidence in their ability to lead PA and three of five male staff reported that they were less confident in leading PA with girls than

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with boys. Demographic information revealed approximately 62.5% of staff reported they were not consistently active (participating in PA less than five days/week) and only 37.5% were

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participating in regular PA. The lack of participation in regular PA by a majority of the staff may

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indicate a lack of interest in PA and/or lack of skills a barrier reported in the successful implementation of another ASP PA program (Kelder, et al. 2005). Also, research has found that

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young girls are more likely to identify with their female teachers as compared to boys and look to female teachers to model behavior (Davies, 2011, p. 330) thus the behaviors of female staff

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may be key indicators to the PA levels of girls. Staff trainings need to emphasize the importance

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of all staff engaging in PA when possible. Also, there is a need to ensure that staff members are

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confident in their own ability to participate in PA. This could be accomplished by helping staff to incorporate PA into their work day. For example, sites could start or end each day with a group PA activity (i.e., trying a new game for the children, walking meetings). 4.1.4. Monitor

Staff reported that they did not currently monitor children’s PA (tracking the amount of PA children accumulate at the ASP) and few thought that monitoring PA was important. This may have been influenced by some staff’s belief that girls acquired adequate PA while at the ASP. Not only can objectively monitoring PA (e.g., pedometer, direct observation) be used as a PA promotion strategy with children but monitoring PA may also ensure that staff have an

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objective assessment of children’s PA levels and thus a method to identify those children who need more encouragement to participate in PA (Schoefield, Mummary, & Schoefield, 2005; Weaver, et al., 2012). Objective measurements such as pedometers offer a realistic and

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affordable option for ASPs to monitor PA. Furthermore, if PA is not monitored, the effectiveness

tool for PA promotion for children and as a policy evaluation tool. Limitations and Strengths

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4.2.

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of PA policies is unknown. There is a need to emphasize the importance of monitoring PA as a

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There were several limitations to this study. First, data may have suffered from interview bias and staff may have shared what the researchers wanted to hear. Second, there were issues

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with recruitment and only staff from three of the nine ASPs who were initially recruited participated in the study. However, authors reached a point of saturation during the data analysis

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and believe that the addition of other interviews would not have changed the findings. The

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strength of this study was that it was the first to qualitatively explore staff’s perceptions of PA

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promotion strategies and how they promote PA to girls. Another strength is that this study provides information on the training needs of afterschool staff and these findings will be utilized to modify the existing training to better emphasize increasing girls’ PA. 4.3. Lessons Learned

These findings lead to several recommendations for the enhancement of the 5 Ms staff training framework to promote girls’ PA in ASPs. First, there is a need to address staff’s perceptions that PA policies are not needed. PA professionals need to work with key change agents to ensure that all staff perceive that these policies are important. Second, staff need to be trained on how to employ multiple PA promotion strategies to increase girls’ PA and how this 20 Page 20 of 34

can impact girls’ desire to participate in PA. Third, PA staff need to ensure that girls-only PA time is scheduled daily to allow girls the opportunity to participate in PA without interference from boys. Staff need to be trained about how to manage schedules and work with school

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personnel to allot for this. Fourth, PA opportunities need to be re-structured to imitate activities that girls enjoy. Staff need training about the specific activities that girls enjoy and/or how to

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tailor already existing activities to be more attractive to girls. Fifth, engagement by staff

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(especially female staff) could positively impact girls’ PA and staff need to be trained on the importance of consistently engaging in PA with girls. Finally, staff trainings need to emphasize

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the importance of monitoring PA as a tool for PA promotion for children and as a policy

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evaluation tool. Additional details on the modifications are provided in Table 3. This formative evaluation provided invaluable information regarding the perceptions of

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staff which can help to inform the enhancement of the 5 Ms targeting girls’ PA. While several of

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these findings are confirmed by existing literature (e.g., girls enjoy non-competitive tag games),

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there were many key findings (e.g., reliance on long-term staff to lead PA, lack of staff confidence to lead PA) that were relatively new to the field. Formative evaluation is needed to better increase the success of interventions targeting increases in girls’ PA. -Insert Table 3 Here-

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Table 1 Semi-Structured Interview Questions Ms Interview Question Construct 1. Tell me how you started working for this organization. 2. Please describe a typical day at your afterschool program. a. What type of physical activities do the children usually participate in? b. Who typically makes the decisions on the type of activities offered? c. What resources do you have for encouraging children to be active (equipment, CATCH, etc.)? d. Please describe the activity levels of girls at your site. 3. Please tell me about the most memorable staff training you attended. 4. Please describe your relationship with girls in your program. Mission 5. What (if any) policies does your organization have regarding PA? Mission 6. How do you work towards meeting these policies? a. How successful do you think your site is at meeting these policies? Motivate 7. What strategies do you currently use to motivate girls to be more active? Motivate 8. What would you like to learn about in terms of motivating girls to be active? Motivate 9. How do you handle children who do not want to participate in PA? Manage 10. When you have disciplinary issues during an activity, what strategies have worked best to manage girls during PA time? Monitor 11. How do you currently keep track of the amount of PA girls in your program attain? 12. What do you think is needed in your ASP to help girls to be more active?

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n 16 27.4 18

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13 5 18

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3 14 1

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18 16

7 2 9

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4 6 6

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Table 2 Staff Demographics Variable Age Mean Gender Female Male Race African American/Black Caucasian/White Other Student Yes No PA ≤ 2 days 3-4 days ≥ 5 days Employment