Collaborative planning for formative assessment and cultural appropriateness in the Girls health Enrichment Multi-site Studies (GEMS): a retrospection.

OBJECTIVE: The Girls health Enrichment Multi-site Studies (GEMS), Phase 1, developed and pilot-tested interventions to prevent obesity in African-American preadolescent girls. This article describes the collaborative planning process undertaken to take full advantage of formative assessment activities for improving contextual relevance and cultural appropriateness. DESIGN: Working group activities were designed to stimulate awareness and reflection among group members and, through them, among other field center investigators and staff about developmental, cultural, and contextual issues for formative assessment. SETTING: Telephone, Internet, and face-to-face interactions across GEMS field centers in Houston, Texas; Memphis, Tennessee; Minneapolis, Minnesota; and Palo Alto, California. PARTICIPANTS: Investigators and staff involved in intervention development. MAIN OUTCOME MEASURES: The utility of the process was judged from feedback by participants and field center principal investigators about the contribution of the collaborative effort to improving the perceived relevance and cultural appropriateness of formative assessment data collection and interpretation. RESULTS: A working bibliography was compiled. A detailed matrix of programmatic, child, family, and contextual issues related to ethnicity, socioeconomic status, general health and lifestyle, food, physical activity, and body image/weight control was completed. Additional guidance was derived from a workshop that involved scholars with expertise in aspects of African-American culture, child development, and family processes. CONCLUSIONS: This process improved the breadth and depth of GEMS formative assessment activities by increasing the appreciation of the complex structural, contextual, and personal forces at play. A similar process may be useful to other investigators when attempting to develop culturally appropriate interventions.

Dance and reducing television viewing to prevent weight gain in African-American girls: the Stanford GEMS pilot study.

OBJECTIVE: To test the feasibility, acceptability, and potential efficacy of after-school dance classes and a family-based intervention to reduce television viewing, thereby reducing weight gain, among African-American girls. DESIGN: Twelve-week, 2-arm parallel group, randomized controlled trial. SETTING: Low-income neighborhoods. PARTICIPANTS: Sixty-one 8-10-year-old African-American girls and their parents/guardians. INTERVENTIONS: The treatment intervention consisted of after-school dance classes at 3 community centers, and a 5-lesson intervention, delivered in participants' homes, and designed to reduce television, videotape, and video game use. The active control intervention consisted of disseminating newsletters and delivering health education lectures. MAIN OUTCOME MEASURES: Implementation and process measures, body mass index, waist circumference, physical activity measured by accelerometry, self-reported media use, and meals eaten with TV. RESULTS: Recruitment and retention goals were exceeded. High rates of participation were achieved for assessments and intervention activities, except where transportation was lacking. All interventions received high satisfaction ratings. At follow up, girls in the treatment group, as compared to the control group, exhibited trends toward lower body mass index (adjusted difference = -.32 kg/m2, 95% confidence interval [CI] -.77, .12; Cohen's d = .38 standard deviation units) and waist circumference (adjusted difference = -.63 cm, 95% CI -1.92, .67; d = .25); increased after-school physical activity (adjusted difference = 55.1 counts/minute, 95% CI -115.6, 225.8; d = .21); and reduced television, videotape, and video game use (adjusted difference = -4.96 hours/week, 95% CI -11.41, 1.49; d = .40). The treatment group reported significantly reduced household television viewing (d = .73, P = .007) and fewer dinners eaten while watching TV (adjusted difference = -1.60 meals/week, 95% CI -2.99, -.21; d = .59; P = .03). Treatment group girls also reported less concern about weight (d = .60; P = .03), and a trend toward improved school grades (d = .51; P = .07). CONCLUSIONS: This study confirmed the feasibility, acceptability, and potential efficacy of using dance classes and a family-based intervention to reduce television viewing, thereby reducing weight gain, in African-American girls.

Recruitment of African-American pre-adolescent girls into an obesity prevention trial: the GEMS pilot studies.

OBJECTIVE: The objective of this report is to describe the methods used to recruit 8- to 10-year-old African-American girls into four 12-week randomized controlled pilot studies on obesity prevention. DESIGN: The Girls health Enrichment Multi-site Study (GEMS) involved 4 field centers which independently developed and tested interventions designed to prevent excess weight gain in African-American girls. Each field center developed its own recruitment plan, but used a standardized recruitment reporting form. The goal was to recruit 40-60 girls, depending on the center. MEASURES: Recruitment yields were computed at each site. Socio-demographic data and weight status were collected for 210 African-American girls who were randomized into the study, as well as for their parents/caregivers. Data were collected on the sources from which participants heard about the study, and the reasons for their interest in the project. RESULTS: The 4 field centers used multiple, but different, recruitment strategies. The most commonly used approaches were mailings, flyers, radio announcements, and group presentations. Caregivers were most likely to hear about the program from the radio (29%), a flyer from the school (23%), or from their child (18%). Among caregivers, the most common reasons for participating were: interest in health (56%), interest in diet/health (51%), and believing the program would be fun for their child (46%). The most frequent reason given by girls was that the program sounded like fun (70%). Three of the 4 field centers met their recruitment target goals. CONCLUSIONS: The GEMS experience demonstrates the feasibility of recruiting and enrolling African-American girls in short-term intervention studies of behavior change. The multiple recruitment strategies, which included developing trusting relationships in the respective communities, were considered critical to the success of recruitment.

Primary care interventions to reduce television viewing in African-American children.

BACKGROUND: Data are lacking on primary care interventions to reduce children's television viewing. Low-income African-American children watch greater amounts of television than their peers. DESIGN/METHODS: A randomized controlled pilot and feasibility trial was conducted. Twenty-eight families with 7- to 12-year-old African-American children receiving primary care at an urban community clinic serving a low-income population were randomized to receive counseling alone or counseling plus a behavioral intervention that included an electronic television time manager. The main outcome was hours of children's television, videotape, and video game use. Parents/guardians and children completed baseline and 4-week follow-up self-report surveys. Additional outcomes included overall household television use, time spent in organized physical activity and playing outside, and meals eaten by the child while watching television. RESULTS: Both intervention groups reported similar decreases in children's television, videotape, and video game use (mean changes of -13.7, SD=26.1 and -14.1, SD=16.8 hours per week). The behavioral intervention group reported significantly greater increases in organized physical activity (changes of +2.5, SD=5.9 and -3.6, SD=4.7 hours per week; p =0.004) and nearly significant greater increases in playing outside (changes of 1.0, SD=5.9 and -4.7, SD=9.4 hours per week; p <0.06). Changes in overall household television use and meals eaten while watching television also appeared to favor the behavioral intervention, with small to medium effect sizes, but differences were not statistically significant. CONCLUSIONS: This small pilot and feasibility study evaluated two promising primary care-based interventions to reduce television, videotape, and video game use among low-income African-American children. The effects on physical activity suggest that the behavioral intervention may be more effective.