Supporting Healthy Lifestyles among Adolescent Girls: Mentors’ Perceptions of the ‘Go Girls!’ Program Delivered by Publishing Technology to: Purdue University Libraries IP: 200.59.54.134 on: Wed, 24 Feb 2016 14:34:04 Copyright (c) PNG Publications. All rights reserved.

A. Justine Dowd, PhD; Samantha M. Harden, PhD; Mark R. Beauchamp, PhD Objective: The aim of this study was to investigate perceptions of a healthy lifestyle program for adolescent girls, entitled Go Girls!, from the perspective of program mentors. Mentors were queried with regard to program processes and attributes as well as changes in the adolescent girls’ behaviors and cognitions as a result of participation in the program. Methods: Data were collected through semi-structured interviews with 9 Go Girls! mentors. Results: Seven themes inductively emerged from the data with descriptive categories that related to positive appraisals of the program, perceptions of the program man-

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entoring programs for youth are widely disseminated in developed nations globally.1 Such programs target a range of outcomes including improving academic performance and reducing drug and alcohol use and are generally found to produce small to moderate positive effects on these outcomes.2,3 Whereas many programs focus on targeting academic achievement and reducing health-compromising behaviors (eg, drug and alcohol use), there is a growing impetus for programs to target health-enhancing behaviors (eg, diet and physical activity). It is especially important to target these areas in mentoring programs designed for adolescent girls because this population typically displays poor dietary behaviors and low levels of physical activity.4-6 For example, compared to current evidence-based guidelines, onethird of adolescent girls do not consume the recommended number of servings of fruits and vegetables.7 Furthermore, the majority of adolescent A. Justine Dowd, Post-doctoral Fellow, University of Calgary, Department of Kinesiology, Calgary, AB. Samantha M. Harden, Assistant Professor, Virginia Tech University, Department of Human Nutrition, Foods and Exercise, Department of Health Sciences, Blacksburg, VA. Mark R. Beauchamp, Professor, University of British Columbia, School of Kinesiology, Vancouver, BC. Correspondence Dr Dowd; [email protected]

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date, experience with the program, suggested program adaptations, challenges in program delivery, characteristics of mentorship, and changes in attitudes and behaviors. Conclusions: Findings from this study provide preliminary support for the feasibility and enjoyment of delivering the Go Girls! group-based mentoring program as well as observations related to program effectiveness and potential areas for improvement. Key words: mentors; adolescent girls; behavior change intervention Am J Health Behav. 2015;39(5):698-708 DOI: http://dx.doi.org/10.5993/AJHB.39.5.11

girls do not engage in the recommended amount of health-enhancing (ie, moderate-to-vigorous) daily physical activity.5 In spite of the potential utility of mentoring programs to support adolescents’ uptake and adoption of health-enhancing behaviors, the results of various intervention programs have demonstrated mixed effects with regard to effectiveness and sustainability.2,3,8,9 Although there are a range of contextual (moderator) variables that may impinge upon the successful adoption of, and fidelity to, a given intervention,10,11 one important (but often overlooked) consideration corresponds to qualities, motives, and attitudes of the delivery agent, which in the context of mentoring programs relates to the program mentor. Previous research has identified that health educators’ activity behaviors12 and dietary perceptions13 influence the degree to which they promote or adopt physical activity and dietary interventions, respectively. In a mentoring program context, mentors are responsible for acting as a role model for mentees by demonstrating healthful behaviors.14 Role modeling is a particularly important facet of mentoring programs because it can have a strong influence on the behavior of others.15 In the context of delivering healthy lifestyle programs framed around mentoring, mentors represent a type of lay health educator. The use of lay health educators (eg, peer-mentors, pro-

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Dowd et al motoras, para-professionals) reduces the expertise required for program delivery and may accelerate the translation of evidence-based programs into practice. This pragmatic approach16 to health promotion program leadership has worked in a variety of initiatives and venues including fall prevention,17 faith-based organizations,18 and community settings.19 Understanding health educators’ perceptions of, and attitudes toward particular programs has the potential to inform a greater understanding of setting-level sustainability.20 Qualitative methods allow for the exploration of detailed insight into health educators’ perceptions, valued program features, and experiences. As such, the overall purpose of this study was to examine mentors’ experiences in a widely disseminated group-based health promotion program entitled Go Girls! Healthy Bodies, Healthy Minds, or Go Girls! for short. The current study builds on the findings from: (1) an outcome evaluation of the Go Girls! Program;21 and (2) a process evaluation of the participants’ (adolescent girls) experiences in the program.22 The results of the outcome evaluation provide evidence for the effectiveness of this program at changing adolescent girls’ health-enhancing behaviors (diet and physical activity) and cognitions (intentions and self-efficacy).21 Furthermore, findings from interviews with participants revealed that the adolescent girls enjoyed the program, felt that they experienced improvements in health-enhancing cognitions and behaviors, and created meaningful relationships with the other program participants and mentors.22 Building on these previous studies, we sought to understand: (1) the mentors’ overall experiences in the program; (2) mentors’ interpretation of their role as a mentor for the program; (3) perceptions of changes (cognitive and/or behavioral) in program participants; (4) components of the program that mentors felt worked well; and (5) components that the mentors thought should be improved. These questions were chosen for 2 primary reasons. First, mentors’ perceptions of their experience with the program may offer information on the extent that mentors bought into and delivered the program in the spirit for which it was intended, factors that can influence the degree to which participants benefit from the program.12 Second, these questions enabled mentors to share their perceptions of components of the program that worked well and those that needed to be improved based on their first-hand experiences in delivering the program. Using mentors’ responses, the program can be revised to address both program mentors’ and adolescent girls’ needs better as well as improve long-term program commitment, effectiveness and sustainability. METHODS Design The interviews conducted in this study were part

of a larger evaluation of the Go Girls! program. The outcome evaluation and results from interviews with the participants are published elsewhere.18,19 The authors aligned the reporting of this study with the Consolidated Criteria for Reporting Qualitative Research (COREQ).23 Go Girls! program. The Go Girls! program is run by member agencies of Big Brothers Big Sisters Canada (BBBS) in schools across Canada, with over 5000 adolescent girls participating in the program annually. Each program is run by 2 mentors (female volunteers aged 18-25) on a weekly basis for 7 weeks, with sessions lasting approximately 2 hours (14 hours total), addressing various topics related to being physically active, eating healthy, and seeking overall well-being. The Go Girls! groups range in size from 4 to 15 (Mgroup size = 8.54, SD = 3.11) adolescent girls and meet after school hours in a classroom provided by their respective schools. This program is offered without cost to all adolescent girls in participating schools, although some girls also may be asked to enroll in the program by teachers or BBBS staff school liaisons. The Go Girls! program was created based on social cognitive theory24 and aims to provide social learning experiences to teach adolescent girls about healthy living and encourage them to make healthy behavior changes in their lives. During each session, the girls learn about healthy living in terms of healthy eating behaviors, being physically active and engaging in activities designed to help them feel better about themselves (ie, improve their body image). The program targets these outcomes through activities that promote key social cognitions (ie, instrumental and affective attitudes, self-efficacy and social belonging) and behaviors (ie, healthy eating and physical activity) through social learning.15 Healthy eating and active living are promoted through the weekly sessions when mentors bring healthy snacks for the girls and engage in physical activities through which the mentors teach participants learn: (1) why and how to eat a healthy diet and be physically active (ie, instrumental attitudes); (2) that healthy eating and physical activity can be enjoyable (ie, affective attitudes), and (3) that they can eat a healthy diet and be physically active (ie, self-efficacy). The girls also engage in activities that involve learning to problem solve and to give each other compliments to improve how the girls feel about themselves. Through these group-based activities, the girls learn to work together, develop connections with each other, and learn more about one another (for a detailed overview of the program see http:// www.bigbrothersbigsisters.ca/en/home/mentoringprograms/gogirls.aspx).24 Go Girls! mentors. Go Girls! mentors are recruited and screened by BBBS agencies and trained by agency staff.25 Interested individuals are eligible to be a Go Girls! mentor if they are a woman between the ages of 18-25, are interested in providing positive guidance for healthy living for adolescent

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Supporting Healthy Lifestyles among Adolescent Girls: Mentors’ Perceptions of the Go Girls! Program

Table 1 Participant Demographics Age

24 ± 2.34 years

Ethnicity

N

White

7

South Asian

2

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girls, and can commit to running at least 2 nonconcurrent 7-week Go Girls! sessions. After interested individuals are screened, they participate in a mandatory full day training session (6-7 hours) with other mentors. All mentors are given a comprehensive resource manual that contains detailed curriculum for the entire 7-week program and tips on how to deal with difficult situations. Participants We conducted semi-structured, one-on-one interviews with 9 purposively sampled Go Girls! program mentors (M ± SD age 24 ± 2.35 years; Whites 77%, South Asians 23%). To maximize variability across the participants selected, we purposefully selected 9 mentors from 9 different schools in 3 separate geographical locations across Southern Ontario, Canada. Data reported in this study were collected as part of a larger evaluation of the Go Girls! program, which served participants (N = 344, age range 11–14 years, Mage = 11.68 years, SD = 0.80; most commonly reported ethnic groups were Whites 39.2%, Japanese 20.8%, Blacks 17.5% and South Asians 9.6%) within schools in Southern Ontario, Canada. Mentor participants for this study were recruited from 3 school districts in this region (N = 3 from Toronto, N = 3 from Peel, and N = 3 from Thames Valley). Purposively sampling mentors ensured that an equal number of women were drawn from each of 3 sites in which the study took place, and on the basis that they were willing to share their experiences of delivering the Go Girls! program. We followed procedures used by Statistics Canada in the 2011 Census and asked participants (ie, mentors) to identify all ethnic/cultural groups with which they self-identified (ie, participants could identify with more than one ethnic group). The ethnic groups involved in the mentor interview component of the program evaluation were Whites (78%), and South Asians (22%). Table 1 presents a summary of demographic characteristics of study participants. School board and institutional review board approval were obtained for all parts of this study before data were collected. Procedures Three research assistants, all of whom had previous experience in qualitative data collection, conducted the interviews. Interviewers explained that

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the purpose of the interview was to understand the experiences of mentors in the Go Girls! program. Informed consent was subsequently obtained from mentors. Before the interview began the interviewers developed rapport with the participants through informal conversations. With the use of a semi-structured interview guide (including the use of key prompts) the research assistants queried mentors with regard to the following topics: (1) their overall experiences in the program; (2) interpretation of their role as a mentor for the program; (3) perceptions of changes (cognitive and/or behavioral) in program participants; (4) components of the program that mentors felt worked well; and (5) components that the mentors thought should be improved. (The interview guide is available from the first author upon request). Interviewers were encouraged to ask probing questions to get more detailed information from the mentors. Interviews were audio-recorded and conducted in private, at the school in which the Go Girls! program was delivered. Shortly after the interviews were conducted they were transcribed verbatim by the research assistants.26 All interviews were conducted within one month of completing the Go Girls! program. Data Analysis Following a conventional content analysis approach, the first 2 authors independently reduced the mentors’ responses to open-ended questions into meaning units. Meaning units were identified as words, phrases, or complete statements that represent a singular thought or concept.27 Meaning units were then independently coded into categories, which were then placed into higher-ordered themes. Themes were created when a category was represented across more than 2 participants. This was done to provide an overall representation of the most salient themes. This approach mirrors the recommendation by Miles and Huberman28 that researchers identify recurrent themes and “lay aside the more tenuous ones until other informants and observations give them better empirical grounding” (p. 70). An iterative process was used to understand the accounts expressed across the 9 transcripts. Trustworthiness was enhanced via the use of an audit trail throughout the process and the use of 2 data analysts. To avoid potential bias, the 2 authors who conducted the analyses were not involved in conducting the interviews. The lead author was a 4th year doctoral candidate who was hired to conduct the program evaluation. The second author was a postdoctoral fellow and behavioral scientist with previous experience conducting and evaluating qualitative data. The authors coded the first 3 transcripts (521 meaning units), met to resolve discrepancies, and discussed strategies to ensure clarity and parsimony throughout the rest of the coding process. Inter-rater reliability was determined to be 94% across the remaining 748 meaning units, with the first 2 authors again meeting to resolve any discrepancies with the re-

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maining meaning units. The third author served as a ‘critical friend’ to provide potential alternative interpretations of the data when necessary. The method for analyzing the mentor data was similar to the approach and analysis of the adolescent participants’ experiences of the program.22

General Components of the Program (N = 423 Meaning Units) Positive appraisal of the program (N = 197 meaning units). All of the mentors provided numerous positive comments about the Go Girls! program such as: “I love the way it focuses and uhh, like each week has a different theme,” “I feel that the whole program, the way it’s structured, is really good,” and “I see an extreme, extreme need for this program for girls for self-esteem building.” Five of the 9 mentors spoke about the program manual and reported that it was clear, thorough, and helpful in preparing them to run the sessions with comments including: “I love the way the book is detailed...and it’s always there for your reference,” and “it’s [the manual] very good the way it guides you through discussions like what can you expect from the girls.” In addition to general positive appraisals of the program of the program, 5 of the 9 mentors specifically spoke about enjoying the activities in the program, with comments such as: “all the activities that we do are very hands-on and there’s lots of laughter,” and the positive environment created in the program is “…the strongest aspect of Go Girls! (pause), it’s great that it’s implemented within the school.” All of the mentors

(N = 9) also spoke about the bonding relationships they developed with the girls through the program structure with comments such as: “[it became about] developing trust between us and the girls” and that the participants felt like family “so there was little bit of that, where they would say ‘oh you’re kind of like my older sister I never had’.” Another component of positive appraisals of the program involved comments from a few of the mentors (N = 4) about the mentor training and that they felt that the training helped them to know what to expect. One mentor stated: “yeah, I could tell that it [the training] was helpful for a lot of the other people who didn’t have as much experience. They were asking a lot of questions … I could hear them talking amongst themselves about you know, what they would do, you know in a situation and stuff.” Finally, a few mentors (N = 3) felt that they had excellent support from reliable school champions, as illustrated by the following comment: “my champions have always been really fantastic they email back right away they’re really involved with the program.” Thus, mentors perceived the Go Girls! program to be useful and necessary for adolescent girls, positively evaluated the environment created by the structure of the program, developed meaningful relationships with the participants, and felt well-prepared to mentor the program. Program mandate (N = 118 meaning units). Almost all of the mentors (N = 8) described the general program objectives (eg, “The mandate is about promoting healthy living, healthy mind, and active living”). Many of the mentors (N = 7) provided examples of how the program specifically targeted behavior change through social cognitive theorybased strategies including mastery experiences (eg, “they learn first hand with our activities how easy it is to get exercise), role modeling (eg, “even if they weren’t so into it, like they, a couple of girls, like they didn’t like skipping, they didn’t really know how to skip, but once we kinda showed them how to do it…” and “it just helps them like be able to see that there are other girls out there that feel the exact same way as them”), and verbal support (eg, “you would give them that feedback, like ‘oh you’re doing great’”). The majority of the mentors (N = 7) also provided descriptions of the activities in the program such as: “in terms of health, we do something called the Wheel of Life, where we help girls brainstorm ideas; you know, ‘What’s the problem with being an overeater? What would happen if I eat a little too much sugar?” Overall, mentors’ perceptions of the program mandate were in line with those outlined by the program manual, they reported using theory-based strategies to improve the participants’ health behaviors, and were able to relate to the activities they delivered in the program. Experiences in the program (N = 52 meaning units). When asked about their experiences with the program, the majority of mentors (N = 6) spoke about the ease of the general recruitment process,

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RESULTS Each interview lasted approximately 31 minutes (± 13.33), and produced 96 pages of single-spaced transcribed text. Three higher order themes emerged from the data (general components of the program, being a mentor, and mentors’ perceptions of changes in participants), with 7 lower-order themes nested within the 3 higher-order themes (Figure 1) that reflected the mentors’ experiences in the Go Girls! program. Thirty-one categories aligned with the higher-order themes (Table 2). As Figure 1 illustrates, the first higher-order theme that emerged from the data was general comments about the program, which included participants’ positive appraisal of the program, program mandate, experiences in the program, and suggested program adaptations. The second higher-order theme that emerged from the data involved comments about being a mentor, which included challenges in program delivery and characteristics of mentorship. Finally, the third higher-order theme that emerged from the data pertained to mentors’ perceptions of changes in participants, namely mentors’ perceptions of the girls, which included observations of the girls’ at the start of the program, during the program, and at the end of the program, general changes and no changes in their thoughts and behaviors.

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Supporting Healthy Lifestyles among Adolescent Girls: Mentors’ Perceptions of the Go Girls! Program

Table 2 Qualitative Results for Mentor Interviews from Go Girls! Program Evaluation during the 2012-2013 School Year

Positive Appraisal of the Program Program Mandate Experiences in the Program Suggested Program Adaptations Challenges in Program Delivery

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Category Name

P (N)

MU (N)

General praise/enjoyment

9

99

Example MU “I loved just the way the whole program is organized.”

Program manual

5

21

“It’s very good the way it guides you through discussions like what can you expect from potentially the girls.”

Enjoy activities

5

33

“We enjoyed all the activities and everything we had to do.”

Environment

5

12

“I found more kids were better than just one.”

Bonding relationships developed through program structure

5

12

“When you get to about the 5th , 6th and 7th session those become more intense and more personal where I start to learn more things about the girls.”

Good training

4

13

“It was a bit of an overview for me but it was great because they really highlighted what their expectation for the mentors were in the program what specifically you need to make sure you do with the girls and stuff like that so that was great [the training].”

School champion/support

3

7

“My champions have always been really fantastic they email back right away they’re really involved with the program.”

General

8

53

“The mandate is about promoting healthy living, healthy mind, active living.”

Social Cognitive Theory Subcategories Mastery experiences

7

35

Mastery experiences: “And they were all like I don’t want to do it I can’t do it, it’s so hard and then by the end they were all doing it and they all mastered it.” Role modeling: “…but we suggest that they join the group once they saw that all the girls were having fun, they ended up just joining the whole time.”

Role modeling

Similar others

Similar others: “…it just helps them like be able to see that there are other girls out there that feel the exact same way as them.”

Verbal support

Verbal support: “And you would give them that feedback, ‘oh you’re doing great’.”

Description of activities

7

30

“We talk about peer pressure, and a lot of the girls bring up the models they see in the magazines.”

Recruitment

6

11

“It was pretty straightforward and it was just umm I had to go in to do a little interview and then I had to provide some references, personal references.”

Reasons for volunteering

5

25

“Well I signed up for the Go Girls! program to get a bit more experience working with youth.”

General

4

8

“It’s been very much, umm, kinda front line, hands on social work experience with youth.”

Own personal growth

3

8

“Before I would sort of give in to what they would say, but now we, I’m far better at sticking to the rules.”

Specific examples

7

32

“I think after school may help right it’s good for parents cause it gives them like you know the kids can stay yeah and I think it would fit people’s hours better.”

Increase duration of sessions

4

24

“I think it [the sessions] should be longer.”

Difficult situations

7

37

“But I just find that one [session 6] is always like a toss-up, depending on the school location and stuff, because we’re not given the proper equipment.”

Range of girls’ needs

6

40

“Right so it’s like they’re not acknowledging that maybe this is a specific group of girls that have specific needs that need to be met but they are sort of ignoring them.”

Short duration

6

34

“I especially think that since the sessions are so short I definitely think that [the girls] are not getting everything out there that they should be getting.”

Juvenile/awkward activities

3

9

“…some of them are great for grade 6s but when you apply them the grade 8 girls they’re a little lame sort of…”

School champions/lack of support

3

7

“It was pretty good, umm the first school we were at was a bit difficult only because our school champion wasn’t umm at the school when we were there so there was once or twice where we had a scheduling conflict where we had an assembly taking place that ran into our session time but nothing major.” (continued on next page)

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Table 2 (continued) Qualitative Results for Mentor Interviews from Go Girls! Program Evaluation during the 2012-2013 School Year

Characteristics of Mentorship Changes in Attitudes and Behaviors

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Category Name Roles Subcategories Leader/mentor

P (N)

MU (N)

9

98

Example MU Leader/mentor: “…but I definitely took charge when it came to um doing a lot of the activities or starting the discussions.”

Listener

Listener: “You are there to listen.”

Provide knowledge

Provide knowledge: “In one group, the second group I really tried to focus on a lot of discussions on diet and what can happen if you continue to eat this way, or if you don’t eat, what can happen.”

Responsibilities

9

49

“You are responsible for contacting or your co-mentor is responsible for contacting the school umm and asking, umm introducing yourselves.”

Personal Style

8

66

“…and then I think that’s why being a fun, crazy goofy mentor helps.”

Problem solving strategies

7

34

“Like I’ve turned off lights when the people weren’t paying attention.”

Co-mentor

5

43

“I’m usually a little bit of the louder one between the 2 of us [co-mentors].”

End of Program Changes Attitudes

9

118

Attitudes: “…you can tell attitudes change about themselves.”

Behaviors

Behaviors: “…and I think that what I’ve seen is as it moves forward, they become, they find more creative ways to engage in exercise.”

Friendships/bonding

Friendships: “At the end, everyone was like friends, and they were like ‘we’re gonna go to the movies together!’” General: “There’s more to these kids that everyone says are bad.”

General Changes During Attitudes

9

91

Attitudes: “We did a body mapping activity. Like I said they were more positive about the language they were using.”

Behaviors

Behaviors: “I would bring a juice and they would take like 5, like these kids don’t eat or something it.”

Friendships/bonding

Friendships/bonding: “They are quite friendly with each other.”

General

General: “But overall, the girls have been very enthusiastic…”

Start of Program

8

49

“For instance, I had a couple girls who just, at first were just so shy and timid, and didn’t want to really discuss anything.”

General

8

62

“They follow, they follow and just jump on it because they need to feel umm wanted.”

No changes

7

34

“Like I never had any girl that at the beginning was super upset about how she looked and at the end was super happy about the way she looked.”

Note. P = number of participants who spoke about the category. MU = number of meaning units that pertained to that category.

(eg, “Yeah it was easy, I got an email last winter, I think around Christmas 2011 from the school saying that they needed mentors and explaining what it was all about and so I just emailed the school and they responded right away and said you know if you give us your address and availability then we can locate you in a school in your area”). Five of the 9 mentors also spoke about their motivation for volunteering with many of them wanting to spend more time with at-risk youth with comments including: “I just wanted to give back” and “I just feel like the girls nowadays don’t have enough like positive role models.” Four of the mentors also spoke about their general experiences in the program (eg, “it’s been very much, umm, kinda front

line, hands on social work experience with youth”). A few of the mentors (N = 3) spoke about their own personal growth as a result of being a mentor for the program (“and even though I try to be as sympathetic and empathetic as possible, I think that there is more of a confidence in the way that, in the way that I lead the activities”). Mentors found it was generally easy to sign up to be a mentor for the program; they wanted to be a positive influence for adolescent girls and felt that they were able to have rewarding experiences with the youth which often resulted in opportunities for their own personal growth. Suggested program adaptations (N = 56 meaning units). Most of the mentors (N = 7) pro-

Am J Health Behav.™ 2015;39(5):698-708

DOI:

http://dx.doi.org/10.5993/AJHB.39.5.11

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Supporting Healthy Lifestyles among Adolescent Girls: Mentors’ Perceptions of the Go Girls! Program

Figure 1 Relationships among Emergent Categories, Lower and Higher Order Themes Categories

Lower-Order Themes

Higher-Order Themes

General Praise/Enjoyment Program Manual

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Enjoy Activities Environment Bonding Good Training School Champion General Social Cognitive Theory

Program Mandate

Description of Activities

General Components of the Program

Recruitment Reasons for Volunteering General

Experiences in the Program

Own Personal Growth Specific Examples Increase Duration

Suggested Program Adaptations

Difficult Situations Range of Girls’ Needs Short Duration Juvenile/Awkward Activity

Challenges in Program Delivery Being a Mentor

School Champion Roles Responsibilities Personal Style

Characteristics of Mentorship

Problem Solving Strategies Co-mentor End of Program Changes Changes During Program Start of Program General No changes

704

Positive Appraisal of the Program

Changes in Attitudes and Behaviors

Mentors’ Perceptions of Changes in Participants

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Being a Mentor (N = 417 Meaning Units) Challenges in program delivery (N = 127 meaning units). Many of the mentors (N = 7) for this program reported a number of challenges they incurred in program delivery including not having enough equipment (eg, “we’re not given the equipment so I find that every session that I’ve had, I don’t have the equipment to properly do all the exercises like we have been able to not really do, we haven’t been able to actually fully do the act properly, the exercises properly”) and challenges working with their co-mentor (eg, “the last session that I ran I found I had a bit more difficulty kind of working with my co-mentor and I don’t know if that was necessarily because she could be a bit young to take on the responsibility of being a mentor or what it was”). Some mentors (N = 6) also felt that it was challenging to try to meet a diverse range of girls’ needs based on age. For example, one mentor commented: “It [the range of ages] definitely did affect the way the program was facilitated, obviously we had to be that mentor for both [younger and older girls], without disregard of the other persons… So it [the range of ages] made it a bit more challenging to do that [facilitate the program well].” The short duration of the program also was highlighted as a challenge in program delivery with mentors feeling as though the girls were not getting everything they could out of the program. For example, one noted: “I would say that one of them the (sigh) flaws I would say is that Go Girls! is only 7 weeks,” whereas another stated: “but I often don’t do that [ask in depth questions during group discussions] because of time restraints.” Three of the mentors felt that some of the activities in the program were not age-appropriate for the older participants (eg, “some of them are great for grade 6s but when you

apply them to the grade 8 girls, they are a little lame sort of”). In contrast to the 3 mentors who felt that they had excellent support from the school champions, 3 of the mentors felt that they lacked support from the school champions, which made their job as a mentor difficult (eg, “I noticed that some of the schools say that the girls, the admin staff, or school staff or principal are not as receptive…they don’t want any interaction with you so that was quite surprising”). Overall, the mentors reflected on a variety of logistical concerns about their experiences in the program, such as not having the right equipment or enough time to run the sessions. Some of the mentors’ concerns pertained to interpersonal difficulties such as struggling to meet a diverse range of participants’ needs and getting along well with their co-mentor. Characteristics of mentorship (N = 290 meaning units). All 9 of the mentors spoke about a range of roles they felt that they fulfilled as a mentor for the program. They reported being a leader/mentor (eg, “I definitely took charge when it came to um doing a lot of the activities or starting the discussions”), being a listener (eg, “you are there to listen”), and a provider of knowledge (eg, “I explained to them, they knew the 4 food groups but they did not know, like, what iron was, or what protein was or what oh I can eat vegetables and this, like they, I’m like ‘you can’t just eat vegetables’ or you can’t just eat meat”). They also described their responsibilities as a mentor in the program which included thinking about how to deliver the program effectively (eg, “so my role as a mentor is to really look at these dynamics within the group and like make sure that we can relate the programming that Go Girls! lays out in a coherent enough fashion that is still relatable to their lives in the present moment”) and bringing healthy snacks for the girls (eg, “I always bring something very healthy so fruits or vegetables or like your cheeses”). While describing their roles and responsibilities, most of the mentors (N = 8) spoke about their own personal style that they had as a mentor, with some mentors reporting that they have a fun style as a mentor (eg, “like I’ll go and I’ll try and do these dances with them so to get them to, they’ll laugh at me. I rather they laugh at me because I’m doing something funny rather than them picking on the other girls”). Other mentors spoke about trying to be natural and real to be able to connect with the girls (eg, “especially I’ll go very like no makeup, like everyday not how I am now, like you have to be at their level… put my hair up so we dance around, we play”). Mentors reported often having to use their own problem solving strategies which included addressing issues as they arise (eg, “I’ll stop right there and be like, I don’t care if you like her or don’t like her. At this point you have to work together. I give them examples like you’re kind of working with people in your life you may not like but you still need to work with them right”) and adapting activities for their group (eg, “So we made it that umm, we wrote, we

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vided a variety of specific examples regarding how to improve the program such as: “I think [offering the program] after school may help right, it’s good for parents ‘cause it gives them like you know the kids can stay yeah and I think it would fit people’s hours better.” Some mentors (N = 4) also felt that the program could be improved by making rules about attendance (eg, “so if it was like, a more umm, like mandatory attendance”). Of the mentors who spoke about the duration of the program (4 of 9), they all reported that they felt that the sessions should be longer, (eg, “make it longer or longer sessions because girls are late”), and that they would like to offer more sessions (“the program in weeks it should be longer…if that’s not going to happen, then it [each session] needs to be a full 2 or 2.5 hours”). Overall, the mentors provided logistical suggestions about how to improve the program with regard to timing in terms of when the program is offered and the length of the sessions. In line with the positive reports of the program, many mentors felt that the program should be longer which reflects their desire to spend more time with the girls.

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Supporting Healthy Lifestyles among Adolescent Girls: Mentors’ Perceptions of the Go Girls! Program

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gave each girl a piece of paper and we hung them up on the walls of the room and each girl wrote her name on them, and then we all went around and wrote compliments to each girl”). Many of the mentors (N = 5) discussed experiences working with their co-mentor. As one noted of her positive perceptions of her co-mentor: “I think it helps the girls because they see 2 different women umm and we’re going to bring our own things to the table our own strengths our own weaknesses to the table,” whereas another had more negative experiences of her co-mentor, as illustrated by the following comment: “I’ve had one co-mentor who was really to the book and the girls don’t like it as much.” When taken together, the mentors discussed a variety of ways in which their own personality affected the ways in which they mentored and created their own style as a mentor. The mentors interviewed in this study generally perceived they had similar roles and responsibilities to each other; however, their individual personalities affected how they ultimately chose to deliver the program and interacted with the participants. Mentors’ Perceptions of Changes in Participants (N = 354) Changes in attitudes and behaviors (N = 354 meaning units). All of the mentors spoke about the range of changes they observed in the girls at the end of program such that they felt the girls displayed positive changes in their attitudes (eg, “and they were more aware of themselves and how they feel”), behaviors (eg, “I would just say that they’re more willing to like eat fruits and vegetables,” and “I think that what I’ve seen is as it moves forward, they become, they find more creative ways to engage in exercise”), friendships/bonding (eg, “at the end, everyone was like friends, and they were like ‘we’re gonna go to the movies together!’”). In addition to changes observed at the end of the program, each mentor also described numerous changes they observed in the girls during the program such as changes in the girls’ attitudes, behaviors, friendships/bonding and general changes. Most mentors (N = 8) spoke about their perception of the girls at the start of the program and felt some girls were nervous and shy – “for instance, I had a couple girls who just, at first were just so shy and timid, and didn’t want to really discuss anything.” Most mentors (N = 8) also described their general perceptions of the girls being mature, (eg, “these kids are 10 years old and all of a sudden you feel like you are speaking to an adult right with the information they know”). Other general perceptions of the girls included mentors’ observations of the insecurities the girls can have (eg, “the grade 5s are a little bit, they have much more energy if you get to the point where they’re going to listen and I think they’re just developing those insecurities and unfortunately I think everybody has them until you learn them those insecurities”). Interestingly, many of the mentors (N = 7) mentioned that

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they did not observe any changes in the girls (eg, “I’ve never seen a change, I don’t know I would see sort of that change in a session”); however, these comments were typically followed-up by comments about changes that they did observe in the girls (such as those changes described above, at the end and during the program). Overall, the mentors consistently reported numerous positive changes in the participants’ cognitions and behaviors as a result of participating in the program. DISCUSSION The purpose of this study was to gain an understanding of volunteer mentors’ experiences with the group-based Go Girls! healthy lifestyle program. Overall the mentors reported positive perceptions of the program and the participants, improvements in the participants’ thoughts about the program and healthy living behaviors, their perceived role as a mentor for the program, understanding of the program mandate, and experience in the program. They also provided information about challenges they experienced as a mentor for the program and suggested how the program could be improved. These findings are in line with the positive perceptions of the program reported by participants22 and as found in the outcome evaluation.21 From a health promotion perspective, these results are particularly important because mentors reported enjoying their volunteer position, improvements in adolescent girls’ health-enhancing cognitions and behaviors, and that overall, the program was feasible to deliver. Furthermore, these findings are consistent with the participants’ reports22 of improvements in their thoughts about living a healthy lifestyle and corresponding physical activity and dietary behaviors. From a program evaluation perspective, it is important to consider the mentors’ suggestions for program improvement. Most of the mentors provided specific examples about how to improve the program such as changing the timing (offering after school) or making attendance mandatory. Six of the 9 mentors discussed that the short duration was one of the challenging aspects of delivering the program. Accordingly, the most common suggestion provided by mentors was to make the program longer (suggested by 4 mentors) which is in line with the participants’ (ie, adolescent girls participating in the program) reports of also wanting the program to be longer.22 Rather than extending the program, a potential low-cost option could be to offer a booster session after the program finishes to bring the group back together.29 This session could involve addressing any issues girls are facing after completing the program and reminding participants about key lessons learned in the 7-week program. Another reported challenge in program delivery was not having enough support (staff), supplies, and equipment. One possible strategy to assist mentors would be to have a readiness assessment checklist developed for schools to com-

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Dowd et al plete before the program is delivered to ensure that the schools are ready, willing, and able to deliver the Go Girls! program. These mentors (ie, lay health educators) reported that in general, it was feasible to implement the program, the program was an enjoyable experience, and that they understood the program mandate, and wanted to promote it to program participants. As noted previously, the Go Girls! program is delivered across Canada, which means this program is primed for diffusion across numerous school systems and, ultimately, to reach more female youth. Observability, or the degree to which the effects and perceptions of the program are visible to others, is positively related to the rate of program adoption.30 One way to diffuse the results of observability presented here would be to integrate the feedback from previous mentors in the mentor training sessions. This could be accomplished through a train-the-trainer model,31,32 in which previous Go Girls! mentors would share feedback from their experiences with each new cohort of volunteer mentors. Although our findings provide detailed information about mentors’ experiences with a groupbased health promotion program for adolescent girls, several limitations should be noted. First, our ability to draw causal claims about the effects of the program is limited because of the qualitative methods and retrospective study design used in the current study. However, the results provide detailed information into understanding mentors’ perceptions of leading a healthy living program for adolescent girls. The mentors’ perceptions of the program are in line with the positive reports from participants22 and the quantitative outcome evaluation21 which provides assurance about the finding from the current study. In addition, we acknowledge that the sample size in the current study was small (N = 9), which may have implications for the generalizability or transferability of the findings to other programs. Nevertheless, to maximize participant variability, and thereby reduce sampling bias (as much as possible), we purposively collected data from 9 mentors from 9 different schools in 3 separate geographical areas in Southern Ontario, Canada. Future research could extend the transferability of the findings by increasing the variability of the participants by interviewing mentors from agencies across Canada. As a final consideration, it should be noted that mentors were sampled if they had completed mentoring with at least one Go Girls! Group. The use of this inclusion/exclusion criterion may have resulted in more positive perceptions of experiences in the program. It would have been beneficial to interview mentors who had stopped volunteering for BBBS. Data from such interviews could provide insight regarding how to improve mentor retention and support for this program. In conclusion, Go Girls! program mentors reported improvements in participants’ health behaviors and thoughts about these behaviors, positive per-

ceptions of the program, and provided suggestions for program improvement. Our findings provide preliminary support for the feasibility and enjoyment of delivering the Go Girls! program as well as observations of program effectiveness and potential areas of improvement.

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Human Subjects Approval Prior to commencing data collection, approval was obtained from the first author’s institution Behavioral Research Ethics Board (H11-01345). Conflict of Interest Statement The Ontario Ministry of Education provided the funding for this project and is an arms length organization to both the authors and Big Brothers Big Sisters of Canada. The authors have no competing interests to declare. Acknowledgments The findings from this study have been presented in a Program Evaluation Report presented to Big Brothers Big Sisters of Canada. Please contact the first author for a copy of this report. The authors thank the staff of Big Brothers Big Sisters of Canada’s member agencies in Toronto, Peel and Thames Valley for their assistance with facilitating this program evaluation. We also acknowledge all of the research assistants who conducted and transcribed the interviews, Aliyah Deane, Eva Pila, Tanya Scarapicchia, and Danielle Tobin. The Ontario Ministry of Education provided the funding for this project and is an arms length organization to both the authors and Big Brothers Big Sisters. AJD was funded by a Canadian Institute of Health Research Doctoral Research Award; SMH was funded by the Canadian Institute of Health Research; and MRB was supported by a career investigator award from the Michael Smith Foundation for Health Research. References

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