Whole-of-Community Systems Intervention for Youth Population Physical Activity

The underlying conditions where youth live are associated with population health outcomes,
with rural communities facing under-studied challenges. Youth physical activity (PA), a key
risk factor linked to later cancer occurrence, is an outcome of community conditions. The
proposed work will address a critical public health need by evaluating the impact of a
whole-of-community multi-level adaptive systems intervention on implementation of community
change and youth population PA. The intervention, Wellscapes, is based on a hierarchical
patch dynamics paradigm, given that communities are "wellness landscapes" of spatially
heterogeneous geographic areas, characterized by a patchwork of interacting organization and
activity settings. The intervention will establish a multi-level system infrastructure
(Community Hub, Organization Wellness Teams, Activity Setting/Leaders) and provide training
and support for population health quality improvement cycle processes targeting two
evidence-based practices (EBPs): (1) stacking time segments of PA episodes within an
organization's daily routine, and (2) improving the quality of PA episodes (% time in PA).
The omnibus hypothesis is that intervention communities (plus organizations and leaders
nested within) will have synergy and capacity to implement EBPs, adapting to continuously
changing local system drivers to create a whole-of-community ecosystem of diverse and
equitable youth PA opportunities. Building on local health department partnerships, the
investigators will conduct a two-wave staggered-start community randomized trial with four
volunteer rural communities (each having nested school, after-school, scouting/4-H club,
youth sport organizations) randomly assigned to intervention or standard public health
practice. For baseline and intervention years, one day per month in the fall (3 days) and
spring (3 days), organization activity settings (e.g., classrooms, teams) that house 480
children in 3rd through 6th grades will be assessed, resulting in observed community
condition data, PA accelerometer data, and setting reach data (children % attendance by
gender, ethnicity, free/reduced lunch status, and grade). The investigators will also obtain
estimates of population level PA with the use of the calibrated Youth Activity Profile, as
well as community system qualitative data. The specific aims are to: (1) Determine the impact
of the intervention on multi-level community system outcomes; and (2) Determine the
implementation system drivers of multi-level youth population PA. The investigators will use
"big data" multi- level modeling methods for this effectiveness-implementation hybrid design,
because there is a dual focus on testing an implementation strategy while simultaneously
evaluating youth population PA impact. The research is significant because it evaluates a
method for improving population health, theory-based systems, and behavior change processes
in low-resource rural communities. The proposed research is novel because the adaptive patch
dynamics approach builds capacity for both equitable collaboration and EBPs implementation
across multiple local systems that are individually and collectively, dynamic and
unpredictable.

Inclusion Criteria:

- Community located in rural micropolitan area

- Community is a one high school town

- Organization is a school district

- Organization is a after school program

- Organization is a youth club system

- Organization is a youth sport delivery system

- Leaders of settings in school, after-school, club, and youth sport

- 3rd through 6th grade settings and children within

Exclusion Criteria: