Chapter 18: Group Level Intervention Strategies. Coming together is a beginning, staying together is progress, working together is success. Henry Ford

Chapter 18: Chapter 18: Group Level Intervention Group Level Intervention StrategiesStrategies

Coming together is a beginning, staying Coming together is a beginning, staying together is progress, working together together is progress, working together

is success.is success. Henry Ford Henry Ford

People do come together and engage in People do come together and engage in physical activity programs in group physical activity programs in group settings in private fitness clubs, settings in private fitness clubs, community centers, universities, and so community centers, universities, and so on. on.

Some maintain their involvementSome maintain their involvement

But, what about working together—what But, what about working together—what Ford called success? Ford called success?

Group Level Intervention StrategiesGroup Level Intervention Strategies

Zander (1982) suggested that a collection of Zander (1982) suggested that a collection of individuals can be classified as a group when they: individuals can be classified as a group when they: • ________________________________• Identify the __________________ and other collectives Identify the __________________ and other collectives

as ________ as ________ • __________ and _____________ in group functions__________ and _____________ in group functions• Are primarily interested in _______, not _________ Are primarily interested in _______, not _________

accomplishmentsaccomplishments• Are interested in the ________________________ Are interested in the ________________________

Group Level Intervention StrategiesGroup Level Intervention Strategies

The Dyersville ExperienceThe Dyersville Experience

The BeginningThe Beginning

• The first step in the project was to bring people The first step in the project was to bring people together. together.

• Advertised a program for community members Advertised a program for community members interested in losing weight within a supportive interested in losing weight within a supportive social environment. social environment.

• Over 450 participants in a town of 3,800! Over 450 participants in a town of 3,800! Ford’s beginning had been realized—Ford’s beginning had been realized—

participants had come together. participants had come together.

The Dyersville ExperienceThe Dyersville Experience The Progress The Progress

Strategies to assist the participants in their efforts Strategies to assist the participants in their efforts to maintain involvement in the weekly diet, to maintain involvement in the weekly diet, physical activity, and motivational sessionsphysical activity, and motivational sessions

Participants were assigned to teamsParticipants were assigned to teams Teams decided a name and T-shirts Teams decided a name and T-shirts Participants enjoyed the weekly meetings and were Participants enjoyed the weekly meetings and were

rarely absent rarely absent

Progress also had been realized—participants Progress also had been realized—participants stayed togetherstayed together

The Dyersville ExperienceThe Dyersville Experience

THE SUCCESS!!THE SUCCESS!! Based on weight lossBased on weight loss Entire teams stepped onto a giant truck scale Entire teams stepped onto a giant truck scale

to monitor their progress to monitor their progress The winning teams were those that had lost The winning teams were those that had lost

the most collective weight. the most collective weight. How successful was the Dyersville campaign? How successful was the Dyersville campaign? The 450 plus participants lost a combined The 450 plus participants lost a combined

7,500 pounds!7,500 pounds!

The Dyersville project was not a scientific The Dyersville project was not a scientific study study

Why did the project work? Why did the project work? What were the group processes that facilitated What were the group processes that facilitated

behavior change? behavior change? What components were necessary to ensure What components were necessary to ensure

sustained participation? sustained participation? Will such a program ensure long-term Will such a program ensure long-term

adherence to healthy eating and/or physical adherence to healthy eating and/or physical activity?activity?

Theoretical Foundation for Group Level Theoretical Foundation for Group Level Physical Activity InterventionsPhysical Activity Interventions

Carron and Spink (1993) proposed a Carron and Spink (1993) proposed a conceptual framework for the application of conceptual framework for the application of group dynamics’ principles in physical group dynamics’ principles in physical activity classesactivity classes

Based on the assumption that various Based on the assumption that various __________________________ can lead to __________________________ can lead to ____________________________________________________________

Based upon the tenet that ____________ is Based upon the tenet that ____________ is

______________________________________________________________________


Group Group CohesionCohesion

Attractions toAttractions tothe group-Taskthe group-Task

Group Group Integration-TaskIntegration-Task

Group Group Integration-SocialIntegration-Social

Attractions toAttractions tothe group-Socialthe group-Social

TASKTASK SOCIALSOCIAL

GROUPGROUP

INDIVIDUALINDIVIDUAL

Group Cohesion Model Review(Carron, Widmeyer, Brawley, 1985)

The inputs = the group environment and structure The inputs = the group environment and structure • ______________________• __________________________________________• __________________________________________

The throughputs = group processesThe throughputs = group processes• ____________________________• ____________________________• __________________________________________________________

The output = __________________________The output = __________________________


GROUP ENVIRONMENT

----------------------

Distinctiveness

GROUP STRUCTURE

---------------------

Group Norms

Group Positions

GROUP PROCESSES

-------------------

Interaction & Communication

Sacrifices

Conceptual Framework for the Application of Group Dynamics’ principles in Physical Activity Classes (Carron &

Spink, 1993)

Inputs

Throughputs

GROUP COHESION

-------------------

ATG-Task

ATG-Social

GI-Task

GI-Social

Outputs

In DyersvilleIn Dyersville Weight-loss teams also were encouraged to Weight-loss teams also were encouraged to

select a catchy name and have t-shirts made = select a catchy name and have t-shirts made = feelings of distinctivenessfeelings of distinctiveness

Members developed common expectations Members developed common expectations around collective goals = group normsaround collective goals = group norms

The length of the program provided ample The length of the program provided ample time for the development of group interaction time for the development of group interaction and communication = group processes and communication = group processes


Carron and Spink (1993) first applied their Carron and Spink (1993) first applied their framework to female participants in 17 framework to female participants in 17 university aerobic fitness classesuniversity aerobic fitness classes

Classes met 3 times/week for 13 weeksClasses met 3 times/week for 13 weeks

Randomly assigned to either a team-Randomly assigned to either a team-building or control conditionbuilding or control condition

A four-stage process consisting of an A four-stage process consisting of an introductory, a conceptual, a practical, and introductory, a conceptual, a practical, and an intervention stage an intervention stage

Team Building in Physical Activity SettingsTeam Building in Physical Activity Settings

_________________ stage--20-minute _________________ stage--20-minute presentation to class instructorspresentation to class instructors

________________ stage--provided the class ________________ stage--provided the class instructors with an understanding of the instructors with an understanding of the conceptual framework conceptual framework

________________stage--the class instructors ________________stage--the class instructors become active agents in the development of become active agents in the development of specific strategies specific strategies

________________stage--specific intervention ________________stage--specific intervention strategies were introduced and maintained strategies were introduced and maintained throughout the program throughout the program



Specific strategies developed in practical stage and implemented in intervention stage: (See Table 18-1 in Textbook)

• Group Environment/Distinctiveness:– _______________________________

– __________________________

• Group Structure/Individual Positions:– _______________________________depending on fitness level

• Group Structure/Group norms– __________________________________

– _________________ to lose weight together


• Group Processes/Individual Sacrifices:– Ask two or three people for a goal for the day

– _______________________________

• Group Processes/Interaction & Communication:– Use ______________ and have them ________________

– _______________________________________________

The intervention was successful: team-building The intervention was successful: team-building increased perceptions of cohesionincreased perceptions of cohesion

Individuals in the team-building and control Individuals in the team-building and control conditions did not differ on______________conditions did not differ on______________

But Fewer _____________ from classes that But Fewer _____________ from classes that had experienced the team-building intervention had experienced the team-building intervention and participants were and participants were ______________________________________________________________


How do these findings generalize?How do these findings generalize? Previous research has shown that exercise Previous research has shown that exercise

class cohesion can be improved through class cohesion can be improved through team-building techniques team-building techniques

As cohesion is a predictor of exercise As cohesion is a predictor of exercise participation in older exercisers, a similar participation in older exercisers, a similar intervention should improve adherence to intervention should improve adherence to an exercise class developed for older adultsan exercise class developed for older adults


Estabrooks & Carron (1999) examined the Estabrooks & Carron (1999) examined the effect of a team-building intervention on effect of a team-building intervention on exercise attendance and program return rate exercise attendance and program return rate of older adult exercisersof older adult exercisers

Participants were first time registrants in a Participants were first time registrants in a fitness program for seniors.fitness program for seniors.

Physical activity classes met for 1 hour 2 Physical activity classes met for 1 hour 2 times per week for 6 weeks.times per week for 6 weeks.


Participants were randomly assigned to the team-building, attention-placebo, or control condition.Participants were randomly assigned to the team-building, attention-placebo, or control condition. The control condition received a standard-care physical activity class.The control condition received a standard-care physical activity class. The attention-placebo condition received a standard-care physical activity class plus a weekly visit The attention-placebo condition received a standard-care physical activity class plus a weekly visit

from a research assistant.from a research assistant.


The team-building intervention was based upon strategies from group dynamics:The team-building intervention was based upon strategies from group dynamics: Promote distinctivenessPromote distinctiveness Introduce roles within the groupIntroduce roles within the group Set group goalsSet group goals Foster increased interaction and communication among group membersFoster increased interaction and communication among group members

Carron & Spink, 1993Carron & Spink, 1993


0102030405060708090

100

TB Placebo Control

Attendance


0102030405060708090

100

TB Placebo Control

Return Rate


Annesi (1999) -- changes in participation Annesi (1999) -- changes in participation rates might be the result of leader attention rates might be the result of leader attention

Examined the effectiveness of a group Examined the effectiveness of a group cohesion based intervention when there is cohesion based intervention when there is minimal leader contact minimal leader contact

New members of the facility participatedNew members of the facility participated All given the standard orientation and All given the standard orientation and

prescribed a 3-time weekly exercise program prescribed a 3-time weekly exercise program lasting 15 weeks lasting 15 weeks


The participants in the intervention The participants in the intervention arm attended more sessions (65% vs arm attended more sessions (65% vs 48%) and had less drop-out (29% vs 48%) and had less drop-out (29% vs 50%) 50%)

It was concluded that simply having It was concluded that simply having new exercisers warm-up and cool down new exercisers warm-up and cool down together should increase the probability together should increase the probability of program adherenceof program adherence


King and her associates (1998) questioned utility King and her associates (1998) questioned utility of group-based approachesof group-based approaches

May be effective __________________ but May be effective __________________ but counter productive _____________________counter productive _____________________

• Participants could become Participants could become ___________________ ___________________ environment for sustained participationenvironment for sustained participation

• Programs invariably end either for a summer or Programs invariably end either for a summer or winter break or because the program’s objectives winter break or because the program’s objectives have been met have been met

• Those individuals who depend upon the group’s Those individuals who depend upon the group’s support support ______________________________________________________ if/when the if/when the group group __________________________

Concerns About Group-based InterventionsConcerns About Group-based Interventions

Does the above concern have merit? Does the above concern have merit? Studies rarely, if ever, report physical activity Studies rarely, if ever, report physical activity

rates once the program ends rates once the program ends Estabrooks and Carron (1999) did not assess Estabrooks and Carron (1999) did not assess

physical activity between the completion of the physical activity between the completion of the 11stst program and the initiation of the 2 program and the initiation of the 2ndnd

Participants may have become relatively or Participants may have become relatively or completely inactive during the hiatus completely inactive during the hiatus

The participants might not have the The participants might not have the confidence or skills necessary to complete a confidence or skills necessary to complete a similar program at home similar program at home


The question that remains is—can The question that remains is—can group-based intervention continue to group-based intervention continue to exert an influence on independent exert an influence on independent individual behavior after the group individual behavior after the group ceases to exist? ceases to exist?


Brawley and his associates (2000) examined if Brawley and his associates (2000) examined if a group-based intervention could be effective a group-based intervention could be effective for increasing individual participation not for increasing individual participation not only during the life of the program but also only during the life of the program but also when the program was terminatedwhen the program was terminated

Healthy previously sedentary older adults (> Healthy previously sedentary older adults (> 65 years) were recruited and 65 years) were recruited and assigned to one assigned to one of three conditions—group-motivated of three conditions—group-motivated cognitive-behavioral, standard physical cognitive-behavioral, standard physical activity, or wait-list controlactivity, or wait-list control

Group-Based Interventions as Agents of Group-Based Interventions as Agents of ChangeChange

The study was carried out in three The study was carried out in three periods of 3 months eachperiods of 3 months each

Throughout those periods Throughout those periods questionnaires were administered to questionnaires were administered to assess levels of physical activity and assess levels of physical activity and perceptions about quality of life perceptions about quality of life


11stst 3-month period, the intervention was 3-month period, the intervention was introduced introduced

The group-motivated cognitive-behavioral The group-motivated cognitive-behavioral condition and the standard physical activity condition and the standard physical activity condition participated in a structured condition participated in a structured program that included physical activities at program that included physical activities at homehome

Individuals in these two conditions were Individuals in these two conditions were exposed to considerably different sets of exposed to considerably different sets of experiences experiences


The intervention used with the group-The intervention used with the group-motivated cognitive-behavioral condition motivated cognitive-behavioral condition included many components of Carron and included many components of Carron and Spink’s (1993) conceptual model Spink’s (1993) conceptual model


The participants selected and adopted a group name The participants selected and adopted a group name

Told that their group was “above average” in their Told that their group was “above average” in their members’ potential to change members’ potential to change

Facilitated interaction and communication Facilitated interaction and communication

Taught a number of self-regulatory skills and then asked Taught a number of self-regulatory skills and then asked to pair up for the purpose of practicing the new skills to pair up for the purpose of practicing the new skills

Discussed group-relevant goals for monitoring and Discussed group-relevant goals for monitoring and

behavior behavior


The group discussed individual and group goals, The group discussed individual and group goals, possible reasons for failure associated with the possible reasons for failure associated with the goalsgoals

The participants were also encouraged to begin The participants were also encouraged to begin discussing how to maintain individual physical discussing how to maintain individual physical activity and to identify and overcome cues to activity and to identify and overcome cues to relapsing into sedentary lifestyle.relapsing into sedentary lifestyle.

The group discussed the implications of decreasing The group discussed the implications of decreasing contact between the project staff and participants. contact between the project staff and participants.


In the final 3-month period, the program was In the final 3-month period, the program was terminatedterminated

The participants in the The participants in the group-mediated group-mediated cognitive-behavioralcognitive-behavioral condition condition

• Higher average frequency of physical activity Higher average frequency of physical activity • Greater total amount of physical activity during Greater total amount of physical activity during

the initial 6 months of the interventionthe initial 6 months of the intervention• ___________________________________ after the ___________________________________ after the

completion of the programcompletion of the program


ENDEND

Web Assignment: RE-AIM: Way to evaluation Health Behavior interventions

• Visit www.re-aim.org

• Under “Community Leaders” section– Take the RE-AIM Self-Rating Quiz – And click on and read the tips to help improve

in the various elements of interventions

Documents

Chapter 18: Group Level Intervention Strategies. Coming together is a beginning, staying together is progress, working together is success. Henry Ford