Process Evaluation Plan

The Environmental Component

Choose to Lose can be implemented in any gym or wellness center type setting. Since the program is designed to be primarily individualized, limited participation (around 10-15 clients) is encouraged in order to ensure maximum success. Thus, aside from the program planner, the Choose to Lose team requires only two to three instructors, ideally one per five participants. This is to ensure that attention to detail, focus on individualized approaches, and client-centered care are prioritized to enhance program effectiveness. Space required will be a private room for one-on-one sessions and a larger room with tables, chairs, and at least one outlet for cooking demonstrations.

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The Curriculum Component

Choose to Lose curriculum is designed to be delivered over a 12-week period with weekly hour-long one-on-one sessions spent directly on curriculum content with supplemental resources available online, including a platform for group discussions between participants. In addition, instructors will be readily available through e-mail or text messaging if participants are struggling or have any questions.

An initial individual assessment will be made to determine the participant’s psychological state, such as readiness for change, environmental factors, such as family support, lifestyle factors, such as work status, and specific health goals. Anthropomorphic measurements will also be obtained using smart scale technology or a skinfold caliper in order for comparison at the end of the program.

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The first half of the program will focus on why-to take action and explore motivational determinants of change. An individualized approach will determine if the participant is struggling with change related to perceived barriers, perceived susceptibility, perceived severity, or other motivational determinants. Once participant and instructor feel they have thoroughly explored motivational determinants, appropriate nutrition education strategies will be used. For instance, if a participant is struggling with perceived barriers, instructor and participant will identify them and correct misconceptions. If another participant is struggling with perceived susceptibility, providing scientific data for a health condition based off their family history would be appropriate.

In the second half of the program, focus will shift to how-to take action, which will look the same for all participants. Facilitating determinants that will be addressed are, behavioral capability, self-efficacy, positive and negative outcome expectations (physical, and self-evaluative), and self-regulation.

Curriculum topics to include:

  • Negative outcomes of current behavior and positive outcomes of taking action.
  • Encourage participants to start becoming aware of how the body feels after eating certain foods.
  • Recommendations for daily fruit and vegetable consumption.
  • Daily physical activity recommendations.
  • How to embrace all foods in a healthy diet. This will include having them set intentions to stop labeling food as “good” or “bad.”
  • How to incorporate healthy foods into their busy schedules.
  • How to set SMART goals.
  • Maintaining behavior change through mindfulness eating techniques and linking their goals to their self-identity.

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Self-efficacy will be enhanced through group two-hour cooking demonstrations offered every fourth week. Recipes will be simple and involve little to no cooking. Instructors will come to class prepared with ingredients as well as a portable electric stove for anything that does need to be cooked. The first half of class will lay out quick and healthy meal options, including ideas on how to meal prep for the week, and a demonstration of the kitchen utensils being used. The second half will allow participants hands-on experience by putting the meals together.

The Training Component

Choose to Lose program developers will prepare instructors through a mandatory one-week (Mon-Fri) training seminar to take place directly before program implementation. Program materials will be handed out during training. Biweekly meetings will take place during program implementation to address any questions or concerns. Additional support in the form of program developer contact details will be offered for instructors throughout program.

The training will be categorized by:

  • Instructors’ roles and job requirements
  • Providing in-depth knowledge of curriculum content
  • Developing MI techniques through role-playing
  • Instructions and demonstrations on how to use the program’s online forum
  • Group discussions to build team environment
  • Safety protocols for cooking demonstration

Complete and Acceptable Delivery

High-quality delivery of curriculum will involve instructors utilizing motivational interviewing (MI) strategies to elicit behavior change in one-on-one sessions with participants. Since this is primarily an individualized intervention program, timing of curriculum will differ between participants and should not be an indicator of high-quality delivery, so long as all curriculum is utilized. Supplemental take home material explaining food and nutrition related information discussed in sessions and mindfulness eating techniques will be given to participants. During the first half of the program, participants should be encouraged to log a three-day food intake along with how they felt after each meal. From this self-assessment, during the second half of the program, participants should create SMART goals to address their issues.

In Summary

The final list of process evaluation questions will relate to Saunders’ et al. (2005) fidelity, reach, dose delivered, and dose received. They will include:

  1. Were program components implemented as planned? – fidelity
  2. What percentage of participants attended every session? What percentage attended at least half? – reach
  3. What percentage of participants attended every cooking class? What percentage attended at least half? – reach
  4. What percentage of participants engaged in the online forum? – reach
  5. Was all curriculum content covered? – dose delivered
  6. To what degree did participants engage in program activities? – dose received
  7. Did participants enjoy program activities? (i.e. what was their reactions?) – dose received
  8. Did participants’ body measurements improve by the end of the program? – dose received
  9. Did participants report having a better relationship with food by the end of the program? – dose received

The questions above will most accurately reveal the quality and effectiveness of the program. A huge part of this program is the content delivered during one-on-one sessions. Deciphering whether all the content was covered as well as if all components were implemented as planned will have a huge impact on the outcome of the program. Audience participation can also have substantial impacts on results. For instance, if it is found that only 20% of participants attend each session, it may be necessary to ask if the program should be moved to a more easily accessible location.

Moreover, the methods of assessment and resources required for these evaluation questions are not extensive and would only require modest funds. Combined, these questions will evaluate whether or not the program achieved it’s intended goals. It will be particularly interesting to receive participant feedback from the pilot run of Choose to Lose. It is this developer’s hope that this process evaluation plan will accurately locate Choose to Lose’s successes and failures as only then can improvements be made to create an even more effective program.

References

Saunders, R.P., Evans, M.H., & Joshi, P. (2005). Developing a process-evaluation plan for assessing health promotion program implementation: A how-to guide. Health Promotion Practice, 6(2), 134-147. Retrieved August 4, 2020, from https://pubmed.ncbi.nlm.nih.gov/15855283/