Kohl’s Bull City Fit Program Evaluation Proposal

HEA 625
Krishnaveni Balakrishnan, Christopher Jacobs & Shemeka Thorpe
Section 1: Conceptualization of Evaluation
The purpose of the proposed evaluation is to determine the efficacy of Kohl’s Bull City
Fit (BCF) program and ascertain if it is improving the health and quality of life of participating
children and parents. The goal is to learn if the program is accomplishing its goals of increasing
health knowledge, addressing weight related illnesses, preventing chronic disease and improving
self-esteem. Specifically, we will focus on how the program is measuring BCF’s long term goals,
and if and through what methods familial support is increased throughout the duration of the
program. Lastly, the evaluation will determine how BCF is measuring its outcomes. The
proposed evaluation is interested in learning about the process of program implementation as
well as a learn more about the potential impacts of BCF on participants and their families.
The key stakeholders are first, the parents. They are most invested in the success of the
program because it will improve the health of their children. Next, is the school system. Durham
County Public Schools want their children to be healthier. This makes the school system shine
brighter and increases the likelihood of its student's scholastic success. BCF has an entire list of
partners that are invested in its success. The success of BCF allows programs like Durham Parks
and Rec and Y.O.G.A for Youth to continue working with the community through Bull City Fit.
This provides these programs an outlet to advertise their individual services. The Edison Johnson
Recreation Center allows BCF to use its space for its programs. They rent their space out to
Duke Health, the parent organization of Bull City Fit. BCF’s success maintains their agreement
of renting their space to them. As previously mentioned, Duke Health is the parent organization.
They have stake in BCF because they are investing people, time, resources, and money into it.
Finally, the Duke Endowment has granted money to BCF. It has stake in BCF because they have
deemed it an organization worthy of financial assistance. Other community partners can be found
in the table below.
Durham County Department of Public Duke Service Learning Lincoln Community Health Center
Health

Durham City Government Duke Dance Expressions Community Nutrition Partnership

East Durham Children’s Initiative Partnership for a Healthy Durham Blue Pointe Yoga

Farmer Foodshare Duke Family Medicine Duke Division of Community Health

Duke Children’s Hospital UNC School of Social Work Duke Center for Childhood Obesity
Research

One assumption being made is that high confidence and self-esteem are directly linked to good
health/lower body weight. BCF is assuming that children will increase their physical activity and
become healthier, lose weight, and consequently feel better about themselves. BCF is assuming
that by improving children’s physical health, their emotional well-being, self-confidence, and
esteem will also improve. There is an assumption that the program will have a long-lasting
impact. Many of the goals presented are long-term (e.g., improved quality of life). Quality of life
encompasses physical, emotional and mental health. Nutrition, physical activity and self-esteem
are predictors of quality of life that are addressed through BCF. However, children would have
to take the principles learned and carry them with them for several years afterwards for it to have
this impact. Research has shown that parents self-efficacy level is a key factor in children
developing healthy lifestyles, therefore we are also assuming that by empowering parents their
self-efficacy will increase.1,5 Also, BCF focuses on keeping the family at the center of its
program, therefore suggesting that the family of the participants are open to change and
supportive in improving their child’s health. Lastly, we’re assuming that knowledge and
increased education equates to changed behavior. A large portion of the program is contingent on
education to spur behavior change.
The first contextual factor that needs to be considered is the socioeconomic status of the
families being served. Their level of income impacts many aspects of their lives. Low-income
families may only have one form of transportation or rely on public transits. BCF needs to keep
that in consideration when servicing this population. It may be beneficial to work the program
around the city bus schedule. Doing so will eliminate barriers preventing the families from
participating. Transportation barriers could also influence access to healthy food.
Low-income families may not have consistent access to healthy foods or exercise
facilities. This needs to be considered when planning the program; the families may learn from
it, but may not have the means to put their education into practice. Without access to exercise
facilities, they may be limited in the quality and duration of strenuous physical activity. Many
exercises, such as walking/running, can be done without weights or machines. However, some
neighborhoods are unsafe to walk or run in or do not have sidewalks, which is another factor
making exercise unsafe.
Section 2: Program Description
The mission of BCF is to build a life-long commitment to wellness through an
encouraging, inclusive and active environment. The BCF hopes to foster friendships, encourage
peer support, endorse individual accountability, instill self-confidence and demonstrate that
anyone can achieve a healthy lifestyle. BCF targets children who are overweight or obese. Being
a community-based program, BCF is highly family oriented. BCF is implemented in Durham,
NC at the Durham’s Edison Johnson Recreation Center (500 W Murray Avenue). BCF has not
been previously evaluated.
The four goals of BCF are: 1) to increase knowledge and levels of physical activity, and
to promote healthy eating. 2) to address current weight-related illnesses and prevent chronic
disease through increased levels of physical activity 3) improve quality of life through health
eating 4) increase confidence and support positive change by building a lifelong commitment to
a healthy lifestyle.
There are four program-related goals that are presented to families at the new participant
orientation: 1. Have fun 2. Be active as a family 3. Work towards wellness and health and 4.
Make sustainable and realistic healthy lifestyle changes. The first goal encourages participants to
have fun while being physically active. BCF’s goal is that participants will grow to enjoy
exercise, without it feeling like a chore. The second goal is encouraging members of BCF to be
active with their families. Parents of participating children are required to be present for the
duration of their child’s session. The third goal raises awareness of the importance of being
physically active and the overall health and wellness of participants. The fourth and final goal is
for participants to take the knowledge that they gained from BCF and implement these skill in
their daily lives.
Logic Model: After contacting the BCF program coordinator a logic model was
developed that best represents their current program inputs, activities, outputs and program goals
(see below). Currently, BCF does not have a logic or conceptual model for their program, so this
was an opportunity for us to learn about the program and for the program coordinator to learn
about logic models.
The program is implemented with the help of a nutritionist; grant funding from Kohl’s;
Duke University students, Duke Children’s Healthy Lifestyles staff, medical providers, and a
partnership with Durham Parks and Recreation. To achieve their goals, BCF has a new
participant orientation for families to meet the staff and learn about the activities offered.
Participants must receive a physical and written permission from their medical provider to
participate in the program. Once a participant is enrolled, they can participate in community
gardening, cooking and nutrition classes, weekend and evening physically active classes such as
running, swimming, hip hop dance, spin class, etc.
There are several challenges that presented themselves when addressing the program’s
outputs. BCF is currently in between grants and projects. This makes it difficult to evaluate
because they do not have any projected outputs. BCF does not have a set number of sessions that
they would like for children and parents to participate in. There is also no set number of students
they are aiming to enroll during the fiscal year. Finally, BCF does not have a specific percentage
of its participants they want to have achieved weight-loss. This makes it challenging to evaluate
because there is ambiguity surrounding the hard number goals of BCF
Section 3: Evaluation Plan
The evaluation questions were derived from the gaps in the logic model and the formal and
informal program goals. Based on the contextual factors mentioned previously and BCF’s
understanding that each family has a different background, the socioecological model was used
to inform this evaluation. The socioecological model consists of five domains: individual,
interpersonal, community, environmental and policy. Research has suggested that when two or
more domains are targeted in an intervention they will have a greater impact on behavioral
change. Specifically interventions that have targeted individual, interpersonal (family, peers,
etc.), and community levels have reported the best results.
Evaluation Questions
● To what extent does the program lead to greater familial impacts (e.g., greater family
support and participation)?
● To what extent does the program lead to lifelong commitment to a healthier lifestyle
(e.g., healthier eating, increase in physical activity, and positive self-esteem and self-
efficacy)?
○ Are there any factors (mediators) that effect the relationship between participation
and achieving this goal this lifelong commitment? (e.g., transportation, SES,
access to fresh fruits and vegetables, age, gender, etc.)
Experimental Design
The evaluation will utilize a quasi-experimental design, complete with control groups and
pre-test/post-test design. We will select 25 students who only participate in Duke Healthy
Lifestyles nutritional and medical programs as the control group. Since the students are
overweight we believe that it is important that the control group receive some type of service.
Students who are referred to Duke Healthy Lifestyles are usually referred to BCF, so we only
select from the youth who opt out of BCF. The intervention group will consist of 25 students
who are currently enrolled in the BCF program. Using a control group will increase the internal
validity of the evaluation. All parents referred to BCF in the month of August will be asked to
participate. We will over sample due to attrition in hopes of reaching the sample goal. The
intervention and control group will be recruited through the BCF program coordinator, Duke
student volunteers, and Duke Healthy Lifestyles program.

Data Collection and Instrumentation

Surveys and Surveys and

Surveys Surveys Focus Groups
Focus Groups
(August 2018) (August 2019) (August 2020)
(February 2019)
Surveys: Surveys will be given to the intervention and control group (N=50 students and up to
100 parents/guardians if it is a dual-parent household) four times during the evaluation at pre-
test, 6, 12 months, and 24 months. The parents in the intervention and control groups will
receive a pre-test survey at the beginning of the school year (August 2018) to measure
their physical activity, healthy eating, and participant’s self-esteem and parent’s self-efficacy
towards adopting healthy behaviors. The parents in the intervention group will receive these
surveys during the new participant orientation and at the BCF sessions. Questionnaires will be
collected from the control group during their Duke Healthy Lifestyles visits at pre-test, 6 months
(February 2019) 12 months (August 2019) and 24 months (August 2020). Participants contact
information will also be collected to keep in contact with them after 12 and 24-months to reduce
attrition. Demographic information for both the parents and participants will also be collected,
including race, ethnicity, access to transportation and environment.

Variable Instrument
Physical Activity Parent: Adult Food & Physical Activity Questionnaire 2

Child: Modified Youth Physical Activity Survey

Healthy Eating Parent: Adult Food & Physical Activity Questionnaire 2

Child: 3rd to 5th Grade Nutrition Education Survey3

Emotional Health Parent: Parental Self-Efficacy to Enact Healthy
Lifestyles Questionnaire4

Child: Self-Perception Profile for Children6

Focus Group: At 6 months (February 2019) and 24 months (August 2020) focus groups will be
conducted to see how effective BCF is in fostering family support and engagement. Questions
about barriers to attending BCF sessions will also be asked. Only parents of participants in the
intervention group can participate. These focus groups will allow parents the opportunity to
suggest ways to improve the program so BCF can meet their goals.

Incentives: Participants will be given a $15 Visa gift card for after they complete the surveys for
each time point. The participants will be given 20 BCF participation points which can be used at
the BCF store to purchase swag and gear. Parents will receive a $20 Visa Gift Card and free
dinner for each focus group they participate in.

Variables: The variables are levels of family support, participant self-esteem, parent’s self-
efficacy to adopt healthy behaviors, healthy eating and physical activity, and program
components that foster family support and parental engagement. Measurements of physical,
mental and emotional health when combined create a measure of quality of life.
Evaluation Crosswalk
Child and Child and Parent Self- Parents’ Family Demographic
Parent Parent Physical Efficacy account of Engagement, Information
Nutrition Activity Survey Child’s Self Support and
Survey Survey (Treatment) Esteem Barriers Focus
Focus Group
(Intervention (Intervention Group (Treatment)
and Control and Control
Group) Group) (Treatment)
To what extent does X X X X
the program lead to
greater familial
impacts
To what extent does X X X X X
the program lead to a
lifelong commitment
to a healthier
lifestyle?
Are there any factors X X
(mediators) that effect
the relationship
between participation
and achieving this goal
this lifelong
commitment?
Section 4: Reporting Plan
As mentioned in the timeline the data will be compiled and presented to both BCF staff and
participants. Participants will receive newsletters with results from the evaluation, healthy meals
recipe and any program events/updates and future data collection dates. These newsletters will
allow us to stay in contact with participants over the duration of two years and will allow them to
see why their participation is so important. The data collected will be analyzed and then
condensed into a summary for the BCF staff and stakeholders. They summary including the
process and outcome of the program based on the data will be presented in a PowerPoint at the
BCF quarterly board meeting in December 2019 after the first year of data collection and again
in December 2020. Small take home infographics will be developed for the participants and their
families. BCF staff will also receive a copy of the evaluation instruments, proposal and executive
summary electronically. The summary will contain sections that focus on both the process
evaluation and outcome evaluation. Testimonials from parents and participants will also be used
by the BCF staff on promotional materials such as pamphlets, handouts and advertisements.
There are no plans at this time to publish the results into an academic journal, but the staff and
physicians of Duke Healthy Lifestyles may decide to publish the findings later. This information
may be presented in the Duke Health Magazine.
Section 5: Detailed Budget
Section 6: Detailed Timeline

August 2019 September January February March May August September

2019 2019 2019 2019 2019 2019 2019
Attend BCF BCF Starts Contact parents Collect parent and Research Newsletter Parent and Research
New Participant to recruit for child surveys at assistants sent to child assistants
Orientation Research focus groups two BCF sessions compile, parents surveys compile, input
assistants to capture most of input, code collected and analyze
Parent and Child compile, the participants and analyze (control and baseline data
Surveys input and baseline intervention
Collected analyze Collect parent and data group)
(Intervention and baseline data child surveys at
Control Group) Duke Healthy Update
Lifestyles for participant’s
First round of control group contact
incentives information
distributed ($15) Focus groups with
BCF parents

December 2020 July 2020 August 2020 September & December 2020
October 2020
Data presented at Newsletter sent to Contact parents to confirm Research Present final
BCF annual parents focus group attendance assistants evaluation results at
meeting compile, input, BCF annual
Attend BCF sessions to Conduct focus groups with code and analyze meeting
recruit parents who BCF parents baseline data
participated last year Send electronic
Collect parent and child documents to the
Contact parents to surveys from intervention and BCF coordinator
recruit for focus group control group
References
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6. Harter, S. 1985. The Self-Perception Profile for Children: Revision of the Perceived Competence Scale for Children, Denver,
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