Process Evaluation to Monitor and Guide a Multi‐Level, Multi‐Component Obesity Prevention Program for Low‐Income, African American Youth

Multilevel, multicomponent (MLMC) interventions are needed to address the complex, multifactorial obesity epidemic. Such interventions work in several settings simultaneously, including schools, food stores, restaurants and households. However, limited work has been done to use MLMC program implementation data to guide program delivery. In July 2014, implementation of B'More Healthy Communities for Kids MLMC trial began. It's goal is to reduce obesity among low income African American youth (10‐14 years) by partnering with policymakers, wholesalers, small food stores, carryouts, recreation centers, and families through environmental change, education, structural incentives, and social media. Detailed process evaluation is conducted by regularly assessing 88 implementation standards for reach, dose delivered and fidelity. Every two months, the latest process data is reviewed to improve the program. For example, during the first review, reach to children during corner store intervention delivery periods did not meet the standard of 10 interactions/session (mean: 6.7, range: 0‐20). The # of new items stocked per food store was low. In a second review, reach to children during store interactive sessions increased (mean: 8.7). Additionally, recreation center session reach decreased from 15.7 to 7.6 interactions/session. These findings led to rescheduling intervention delivery times to when more youth were present, and increasing the duration of sessions. Detailed process evaluations using defined standards are essential for continuous improvement of MLMC intervention trials.