“S.P.L.A.S.H. Into Fitness!” An Identity-Focused Behavioral Swim Camp and Family-Oriented eHealth Intervention for Girls

Abstract

Despite a recent plateau in the trend, childhood and adolescent overweight and obesity rates remain high in the United States. Furthermore, insufficient physical activity participation and poor dietary habits are common in girls throughout adolescence. Adolescent girls are disproportionately at risk for poor health behaviors and unhealthy weight gain as compared to their male counterparts. Research indicates that summer presents a heightened behavioral risk for girls, as poor dietary habits and physical inactivity increase in these months. A strategy to mitigate this seasonal risk may be to engage girls in summer camps which target healthy nutrition and exercise outcomes, albeit positive lifestyle changes associated with similar behavioral programs have been short-term in nature. Indeed, the behavioral intervention literature is fraught with mixed findings regarding long-term positive results, perhaps due to two factors: 1) previous studies targeting youth have not directly intervened upon identity, an important psychological mechanism which meaningfully influences longitudinal behavior, or 2) intervention designs did not consider the need for family-oriented programming to habituate healthy behaviors in the home environment. An individual strives to remain in behavioral congruence with their chosen identity standards. Thus, physical activity may be influenced by one’s exercise identity and dietary behaviors may be impacted a salient healthy eater identity. Notably, identity is best developed during the adolescent years and trends as stable across the lifespan. Therefore, the development of a girl’s exercise and healthy eater identity through participation in a family-oriented intervention is of interest. However, identity-focused and family-oriented interventions should initially be offered in the summer months as part of a multicomponent framework, to best address behavioral risks which are exacerbated during this time frame. This dissertation investigated the effectiveness of a multicomponent intervention, comprised of a 1-week behavioral camp and a 10-week family-oriented eHealth program, on a variety of health outcomes in pre-adolescent girls when results from the intervention group were compared to a control group. All study participants attended an identity-focused, behavioral swimming and healthy lifestyle camp for one week in the summer, prior to randomization to either access eHealth (intervention group) or to a usual care comparison (control group). Both the camp and eHealth program aimed to develop girls’ exercise identity and healthy eater identity, and subsequently enhance healthy behaviors. It was hypothesized that the camp-plus-eHealth condition (i.e., intervention) would report improved exercise identity, healthy eater identity, and physical activity and dietary behaviors as compared to the camp-only condition (i.e., control) due to the extended availability of intervention materials in the home environment via the eHealth program. This dissertation includes three study manuscripts, entitled as Chapters 4, 5, and 6. Chapter 4 describes the importance of key community stakeholders in the intervention design phase, and additionally offers lessons-learned for future intervention design teams. Chapter 5 provides findings from between- and within-group analytic comparisons of the intervention and control groups and addresses the study’s specific aims, attached hypotheses, and a question of interest concerning participants’ compliance with physical activity guidelines at baseline, post-camp, and follow-up measures. Additional questions of interest were posed, such as: 1) which psychological factor (i.e., exercise identity or healthy eater identity) would be most associated with follow-up physical activity and dietary behaviors, and 2) would eHealth compliance be associated with study outcomes? In-depth answers to these questions of interest are available in Chapter 6 of this dissertation. Chapter 6 also provides qualitative feedback regarding the perceived utility and usability of the intervention eHealth website. Collectively, this dissertation provides unique perspectives regarding a novel behavioral intervention strategy for pre-adolescent girls: target exercise and healthy eater identity development. Findings from the three dissertation manuscripts may be utilized by future public health researchers to provide identity-focused and family-oriented interventions for larger populations of at-risk girls.