PPT on incentivizing physical activity at practicum site. PUBH-6640.

1. z Incentivizing
Physical Activity at
Mooseheart Child
City & School
Hannah LaCroix
Walden University

2. z
Overview Justification of Intervention
Proposed Intervention
Implementation Plan for Intervention
Major Goals of Intervention
Objectives of Intervention

3. z
Practicum Agency Project Alignment
Provides a safe, nurturing, caring environment for children to live, grow, & develop in
(Mooseheart, 2016)
Community setting creates a stable, healthy environment that promotes social skill development
(Mooseheart, 2016)
Residential
childcare facility
Not limited to being free of disease (Nemours Health & Prevention Services [NHPS], 2009
Physically, mentally, & socially well (NHPS, 2009)
Health
Delicate balance between physical, mental, & social well-being (NHPS, 2009)
Optimal physical health requires regular exercise
Child Health

4. z
Sociological Factors
Affecting Physical
Activity (PA)
 Availability of resources
(Healthy People, 2020a)
 Social norms & attitudes
(Healthy People, 2020a)
 Social support (Healthy
People, 2020a)
 Physical determinants
(Healthy People, 2020a)
Figure 1. Social determinants of health. From
“Healthy People 2020 Approach to Social
Determinants of Health,” Healthy People,
2020b

5. z
Program
Background
 Prevalence of overweight and obese
children in region is increasing & higher
than national levels (Kane County
Health Department [KCHD], 2018)
 In Kane County
 24.5% of children between
5– 17 years old have a
body mass index (BMI) in
the 95th percentile
 Indicating obesity
 36.9% of children have a
BMI in the 85th percentile
 Reflects overweight
children
 Variable levels of physical activity
(PA) at Mooseheart

6. z
Literature Review
 Incentives can be successful encourage PA levels
 Non-financial incentives & contingent reinforcement increased
MVPA among pre-schoolers (Patel et al., 2019)
 Social incentives and gamification can increase PA levels and
resulted in higher levels of daily steps during and after
intervention (Patel et al., 2017)
 Financial incentives can increase short-term increased PA levels
(Short et al., 2018)
 Not effective for maintenance of higher levels of PA among
adolescents

7. z
Literature Review Continued
 Natural environment can impact effectiveness of incentives (Cohen et al.,
2017)
 Increased PA levels were achieved using non-financial incentives and
community park programs among children & adolescents (Fair et al., 2017)
 Non-financial incentives combined with gamification decreased sedentary
behaviors and increased PA levels among adults (Ball et al., 2017)
 Financial incentives successfully increase PA levels among all age groups
(Strohacker et al., 2014)
 Concerns about undermining true motivation to encourage PA due to money
 Apple Watches successfully increase PA levels among high-risk, obese
participants (Hafner et al., 2018)
 Long-term maintenance of increased PA to pay off the Apple Watch

8. z
Consensus on
Incentives &
Physical
Activity
 Uniformity on effectiveness across all literature reviewed
 10 out of 12 studies reported success using incentives to increase
PA levels
 Among different age groups, using different reinforcers
and programs
 One study had high variability (Cohen et al., 2017)
 Attributed to high-poverty areas and crime rates
 One study found no association between the use of a PA
tracking device + PA resources and increased PA levels (Evans et
al., 2017)
 Daily steps among intervention group increased; not
linked with use of PA tracking device

9. z
Gaps in Research
1. Individual preference assessments
1. Lack of evidence on the effects on PA levels among children & adolescents (Patel et
al., 2019)
2. Can potentially increase motivation to engage in PA based on reinforcer unique to
the individual (Patel et al., 2019; Brazendale et al., 2017; Corepal et al., 2018)
2. Use of gamification combined with highly individualized incentives
1. Individually, these tactics can increase PA levels, less evidence on the combined
effects on PA levels (Patel et al., 2017; Corepal et al., 2018)
3. Systematically fading out the incentive
1. As opposed to abruptly ending research
2. Negative punishment occurs when a preferred stimulus is removed to reduce a
specific behavior (Lumen Learning, n.d.)
1. Providing reinforcer for desired behavior (increased PA) followed by
immediate removal due to research ending is potentially aversive and could
decrease PA motivation

10. z
Rationale for Proposed Intervention
 Bibliographies offer evidence on incentives increasing PA
participation among children, adolescents, and adults
 Specifically, non-financial incentives
 Non-financial incentives combined with gamification
 Fill gaps in research identified through literature review
 Preference assessments
 Help fill gaps in research
 Help inform future research aiming to decrease the number of
overweight children and levels of childhood obesity
 Local, state, and national levels

11. z
Proposed Intervention
 Select two residential homes
 One female home
 One male home
 Preference assessments for all participants
 Identify list of non-financial motivators and reinforcers to encourage PA
 Reinforcers will be ranked on a scale of most preferred to least preferred
 Will be distributed over the 12 week intervention based on the number of days goal is met
 PA Tracking
 Wrist worn PA monitoring devices will be used to track daily steps “points” earned by students (Evans et al.,
2017)
 Live-in caregivers will record daily points earned via Google Forms

12. z
Proposed Intervention Continued
 Gamification
 Use of points in a non-game context
 Steps will be referred to as points to reduce non-compliance or reduced participation (Short et al., 2018)
 Leaderboards will be used in both homes to generate social incentives and competition among participants
(Patel et al., 2017)
 Breakdown of steps/points
 Based on age and appropriate moderate-to-vigorous PA (MVPA) (Tudor-Locke et al., 2011)
 4 – 6 year old's must reach between 10,000 – 14,000 steps (points) per day
 Equivalent to 60-100 minutes of MVPA
 7 – 9 year old’s must reach between 13,000 - 15,000 steps (points) per day
 Equivalent to 60 minutes of MVPA
 10– 18 year old’s must reach between 10,000 - 11,700 steps (points) per day
 Equivalent to 60 minutes of MVPA

13. z
Proposed Intervention Cont.
 Incentive rewarded
 Based on individual preference assessments, reinforcers will be
provided on the seventh day of the week
 Participants must reach the step/point goal for their age group for
3 out of 5 days in the week
 End of incentives
 Reinforcers for reaching step/point goals daily will be discontinued
at week 13
 Daily steps will continue to be monitored for 2 weeks

14. z
Data Collection
Daily steps
Will be used for baseline and outcome
evaluation
Wrist worn pedometers will track
daily steps
Height & Weight
Will be used for baseline and outcome
evaluation
Collected at baseline
Used to calculate BMI
Used pre- and post-intervention to
assess health status and any changes

15. z
Evaluation
• Process & Impact Evaluation
• Semi-structured
• Evaluate the attitudes, beliefs, and overall feedback
on the effectiveness of incentives among child and
adolescent participants
• Offers depth and insight on issues related to the
intervention (Community Toolbox, n.d.-a)
Focus groups
• Process & Impact Evaluation
• Semi-structured
• Evaluate and gain insight on attitudes, beliefs, and
collect feedback from live-in family teachers on the
effectiveness of incentives
• Useful form of evaluation to obtain specific
information that cannot be obtained easily through
questionnaires or written surveys (Community
Toolbox, n.d.-b)
Interviews

16. z
Project
Timeline
Collect baseline height & weight measurements
between 8/2/20 – 8/7/20
• Calculate baseline body mass index scores for all male & female
participants
Establish reinforcers for participants between
8/17/20 – 8/25/20
• Conduct one-on-one interviews among 24 participants to
identify reinforcers
• Share individualized preference lists with live-in teachers
Develop criteria document for awarding incentives
between 8/26/20– 9/7/20
• Create chat for daily points per age group & minimum weekly
goal
• Create gamification leaderboard chart & materials
Baseline daily steps data collection between 9/8/20
– 9/25/20
• Distribute daily step log to live-in teachers
• Analyze daily steps taken by all participants

17. z
Project
Timeline
Initiate intervention from 9/28/20 – 12/21/20
• Send daily step logs at the end of each day at 7:00 PM
• Live-in teachers deliver incentives every Sunday based on criteria
• Live-in teachers discontinue delivering incentives on 12/21/20
Evaluation of interviews & focus groups
• Semi-structured interviews among live-in teachers between 10/12/20 – 10/13/20 & 1/4/21 –
1/5/21
• Thematic analysis of semi-structured interviews from 10/13/20 – 1/25/21 & 1/11/21 –
4/26/21
• Implement changes recommended
• Semi-structured focus groups among children & adolescents between 10/14/20 - 10/16/20 &
1/6/21 – 1/8/21
• Thematic analysis of semi-structured focus groups between 10/16/20 – 1/29/21 & 1/11/21 –
4/26/21
• Implement recommended changes
Collect follow-up height & weight measurements between 1/29/21 – 2/12/21
• Calculate BMI scores for all male & female participants
Data analysis between 2/15/21 – 8/2/21
• Analyze qualitative data
• Analyze pre- & post- height, weight, & BMI data
• Analyze daily steps from baseline period to follow-up period
• Compare qualitative data findings to incentive delivery timeline
• Develop report of major findings
• Present findings to Mooseheart administrators & community stakeholders
• Proposal for intervention: Next steps

18. z
Goals of Intervention
Goal 1:
• Increase PA
through
incentivizing
participation
using
individualized
reinforcing
activities/items
amount children
& adolescents
living at
Mooseheart Child
City & School
Goal 2:
• Reduce overall
BMI scores
and/or numerical
weight among
the 24 child &
adolescent
participants
living at
Mooseheart
through
incentivizing PA
& gamification
Goal 3:
• Obtain insight
into the attitudes,
beliefs, & collect
feedback on
incentivizing PA
among children
& adolescents
from live-in
family teachers
Goal 4:
• Obtain insight
into the attitudes,
beliefs, & collect
feedback on the
health
intervention from
child &
adolescent
participants

19. z
SMART Objectives of Intervention
Goal 1
SMART
Objective:
By week 14 (post-intervention), increase the baseline daily steps
taken among participants between 4 & 6 years old to 10,000 –
14,000 steps per day; increase the baseline daily steps taken by
participants between 7 & 9 years old to 13,000 – 15,000 steps per
day by week 14 follow-up; & increase the baseline daily steps taken
by participants between 10 & 19 years old to 10,000 – 11,700
Goal 2
SMART
Objective:
By week 14 (post-intervention), reduce the weight of children at
Mooseheart with BMI scores in the 85th & 95th percentile range by
0.5 pounds or more in comparison to baseline weight, & reduce the
weight of adolescents at Mooseheart with BMI scores in the 85th &
95th percentile range by 2 pounds or more in comparison to baseline
weight

20. z
SMART Objectives of Intervention
Goal 3
SMART
Objective:
By week 2 of the incentivizing PA & gamification
intervention, the practicality & beliefs about the
program will be evaluated through two semi-
structured interviews among four live-in family
teachers at Mooseheart
Goal 4
SMART
Objective:
By week 2 of the incentivizing PA combined with
gamification intervention, one semi-structured
focus group will be conducted among 24 students
about the attitudes, beliefs, & opinions on barriers
related to PA engagement/intervention

21. z
References
 Centers for Disease Control and Prevention (CDC). (n.d.). Types of evaluation.
https://www.cdc.gov/std/Program/pupestd/Types%20of%20Evaluation.pdf
 Cohen, D., Han, B., Derose, K. P., Williamson, S., Marsh, T., Raaen, L., & McKenzie, T. L. (2017). Promoting physical activity in
high-poverty neighborhood parks. Social Science & Medicine, 186, 130-138. https://doi.org/10.1016/j.socscimed.2017.06.001
 Community Toolbox. (n.d.-a). Section 6. Conducting focus groups. Center for Community Health and Development at the
University of Kansas. https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/conduct-
focus-groups/main
 Community Toolbox. (n.d.-b). Section 12. Conducting interviews. Center for Community Health and Development at the
University of Kansas. https://ctb.ku.edu/en/table-of-contents/assessment/assessing-community-needs-and-resources/conduct-
interviews/main
 Corepal, R., Best, P., O'Neil, R., Tully, M. A., Edwards, M., Jago, R., Miller, S. J., Kee, F., & Hunter, R. (2018). Exploring the use
of a gamified intervention for encouraging physical activity in adolescents: A qualitative longitudinal study in Northern Ireland.
BMJ Journals, 8(4), Article e019663. doi:10.1136/bmjopen-2017-019663
 Evans, E. W., Abrantes, A. M., Chen, E., & Jelalian, E. (2017). Using novel technology within a school-based setting to increase
physical activity: A pilot study in school-age children from a low-income, urban community. BioMed Research International,
2017, 1-7. https://doi.org/10.1155/2017/4271483
 Fair, M. L., Kaczynski, A. T., Hughey, S. M., Besenyi, G. M., & Powers, A. R. (2017). An initiative to facilitate park usage,
discovery, and physical activity among children and adolescents in Greenville County, South Carolina, 2014. Preventing Chronic
Disease, 14, Article 160043. http://dx.doi.org/10.5888/pcd14.160043

22. z
References
 Fang, Y., Ma, Y., Mo, D., Zhang, S., Xiang, M., & Zhang, Z. (2019). Methodology of an exercise intervention program using social
incentives and gamification for obese children. BMC Public Health, 19, Article 686. https://doi.org/10.1186/s12889-019-6992-x
 Hafner, M., Pollard, J., & van Stolk, C. (2018). Incentives and physical activity: An assessment of the association between vitality's
active rewards with Apple watch benefit and sustained physical activity improvements. Rand
Europe. https://doi.org/10.7249/RR2870
 Healthy People. (2020a). Determinants of health. https://www.healthypeople.gov/2020/about/foundation-health-
measures/Determinants-of-Health#:~:text=Social%20Factors,quality%2Dof%2Dlife%20outcomes.
 Healthy People. (2020b). Determinants of health [Image]. https://www.healthypeople.gov/2020/topics-objectives/topic/social-
determinants-of-health
 Kane County Health Department (KCHD). (2018). 2018 community health needs assessment report: Kane County, Illinois.
https://www.countyofkane.org/Documents/Quality%20of%20Kane/Community_Health_Needs_Assessment.PDF
 Mooseheart Child City and School. (2016, Feburary). Family teacher application packet. http://www.mooseheart.org/wp-
content/uploads/2016/02/Family-Teacher-Information.pdf
 Nemours Health & Prevention Services (NHPS). (2009). Promoting children’s emotional and behavioral health.
https://www.nemours.org/content/dam/nemours/www/filebox/service/preventive/nhps/publication/ebhchildhealth10.pdf

23. z
References
 Patel, M. S., Benjamin, E. J., Volpp, K. G., Fox, C. S, Small, D. S., Massaro, J. M., Lee, J. J., Hilbert, V., Valentino, M.,
Taylor, D. H., Manders, E. S., Mutalik, K., Zhu, J., Wang, W., Murabito, J. M. (2017). Effect of a game-based
intervention designed to enhance social incentives to increase physical activity among families: The BE FIT
randomized clinical trial. JAMA Internal Medicine, 177(11), 1586-1593.
https://doi.org/10.1001/jamainternmed.2017.3458
 Patel, R. R., Normand, M. P., & Kohn, C. S. (2019). Incentivizing physical activity using token reinforcement with
preschool children. Journal of Applied Behavior Analysis, 52(2), 499-515. https://doi-
org.ezp.waldenulibrary.org/10.1002/jaba.536
 Short, K. R., Chadwick, J. Q., Cannady, T. K., Branam, D. E., Wharton, D. F., Tullier, M. A., Thompson, D. M., &
Copeland, K. C. (2018). Using financial incentives to promote physical activity in American Indian adolescents: A
randomized controlled trial. PLoS One, 13(6), Article e0198390. https://doi.org/10.1371/journal.pone.0198390
 Strohacker, K., Galarraga, O., & Williams, D. M. (2014). The impact of incentives on exercise behavior: A systematic
review of randomized controlled trials. Annals of Behavioral Medicine, 48(1), 92-
99. https://doi.org/10.1007/s12160-013-9577-4
 Tudor-Locke, C., Craig, C. L., Beets, M. W., Belton, S., Cardon, G. M., Duncan, S., Hatano, Y., Lubans, D. R., Olds, T.
S., Raustorp, A., Rowe, D. A., Spence, J. C., Tanaja, S., & Blair, S. N. (2011). How many steps/day are enough? For
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https://doi.org/10.1186/1479-5868-8-78