Background:
As part of its provincial-wide Communities in Action initiative, in April 2008 the Ontario Ministry of Health Promotion and the Public Health Agency of Canada provided funding to YMCA Ontario and the Boys and Girls Club of Ontario (BGC) to implement CATCH Kids Club (CKC), a physical activity and nutrition education program designed for elementary school aged children (grades K - 5), in 330 after-school sites across the province. The CKC program was developed from CATCH (Coordinated Approach To Child Health), a school-based health promotion program with demonstrated efficacy in increasing self-reported physical activity and observed physical activity during school-time physical education classes (Luepker et al., 1996).
While the after-school environment has been described as a “ready-made opportunity” for health and active living interventions (Kelder et al., 2005), to date the after-school initiatives that have been reported have been limited and implemented on a small scale (Pate & O’Neill, 2009). The Ontario implementation of CKC is the first large-scale attempt to promote health using the after-school environment as the vehicle. It is also an initiative that has been driven by community agencies instead of researchers.
Objectives:
The objective of the evaluation was to examine the effectiveness of the CKC program model within the after-school environment. Specifically, this study asked:
1) What was the impact of the CATCH Kids Club program on the quantity of physical activity delivered in the YMCA and BGC after-school programs?
2) What was the impact of CKC on the quality of physical activity observed at the YMCA and BGC after-school programs?
3) How was the process of implementing CKC for program leaders?
Methods:
This study used a pre-test/post-test quasi-experimental comparative research design. The CKC program was introduced in September 2008 and ran until the end of the school year in June 2009. Baseline data were collected in September 2008 and post-intervention data in May/June 2009. Data were collected at 40 sites (22 YMCA & 6 BGC CKC sites, 12 control sites). Three main measures were used: SOFIT (System for Observing Fitness Instruction Time), a program observation form, and post-intervention interviews with program leaders. SOFIT uses direct observations to obtain a measure of participants’ physical activity levels and lesson context.
Results:
Quantity of time spent in MVPA: Total time spent in moderate to vigorous physical activity (MVPA) increased from September to May at all CKC sites. CKC had a substantial and positive impact on BGC sites (35.2% to 70.8%) whereas at YMCA sites the increases (52.1% to 59.3%) were not substantial or significantly different from the control sites (54.0% to 64.2%). This finding supports Coleman et al.’s (2009) finding that children are more active in unstructured play than in adult-led play. However, CKC appears to be effective at raising programs to 50% MVPA if the starting point is lower.
Quality of PA time: When compared to control sites, both YMCA and BGC CKC sites spent considerably more time delivering instructional (‘General’ and ‘Knowledge’) content, a higher percentage of time in ‘Game Play’, and considerably less time in ‘Free Play.’ This suggests that CKC opens up opportunities for instructional development without reducing %MPVA. Observations also showed that a small number of activities accounted for a high proportion of the activities observed, which suggests that the activity resources were underutilized.
Implementing the CATCH Kids Club Program: The after-school sites varied dramatically in the resources and opportunities available to children to be active. Program leaders identified the main strengths of the CKC program were its resources and inclusive focus. Implementation challenges were that it “felt too much like school,” age and attendance variability, and the requirement of mandatory participation. Most leaders had made the program optional or alternated it with days of free play, as a way to increase choice and reduce participant resistance.
Conclusions:
Overall, the study found that health and active living initiatives can effectively be implemented by community agencies on a large scale. While program leader buy-in did vary, conformance to the agency requirements was generally upheld. However, because participants valued free choice and were also highly active without adult-led direction, the impact of highly prescriptive health and active living interventions in the after-school environment may be limited. A more appropriate role for after-school environments may be to focus on the development of physical literacy by providing opportunities for participants to expand their activity repertoire and explore their interests in a positive, fun, and autonomy-supportive setting.
Support:
Research funding was provided by the Ontario Ministry of Health Promotion and the Public Health Agency of Canada.
