Engaging diverse midlife and older adults in a multilevel participatory physical activity intervention: evaluating impacts using Ripple Effects Mapping

Lay Summary Improving lifestyle behaviors is a complex task. Interventions to support such change often have multiple components, making their evaluation difficult. Within the context of an intervention trial delivered at senior public housing sites and designed to increase physical activity among ethno-racially diverse aging adults, we assessed the utility of a novel method, called Ripple Effects Mapping (REM), in identifying useful information for additional refinement of the interventions being studied. We facilitated REM sessions across 6 study sites. Using this method, we were able to uncover useful information, including expected and unexpected outcomes of the interventions from the perspective of the participants themselves. We also learned about participants' own challenges and solutions to problems they encountered during the intervention period, and how these kinds of interventions can be further revised to be most helpful in other settings and with similar populations. Thus, these types of participant-centered methods are feasible and can complement more traditional, investigator-driven evaluation efforts, particularly for complex interventions or those with multiple components. They can also inform scientists about the outcomes most valued by participants, how those outcomes came about, and how future interventions can enhance and sustain healthy behavior change over time. This first-generation study explored the feasibility and value of applying a novel participatory evaluation method, called Ripple Effects Mapping, within a behavioral lifestyle intervention trial to assess participant-centered outcomes, inform future intervention optimization and implementation, and complement more traditional researcher-driven evaluation measures. Multilevel interventions are increasingly recommended to increase physical activity (PA) but can present evaluation challenges. Participatory qualitative evaluation methods can complement standard quantitative methods by identifying participant-centered outcomes and potential mechanisms of individual and community-level change. We assessed the feasibility and utility of Ripple Effects Mapping (REM), a novel qualitative method, within the context of a multi-level cluster randomized trial, Steps for Change. Housing sites with ethnically diverse, low-income aging adults were randomized to a PA behavioral intervention alone or in combination with a citizen science-based intervention (Our Voice) for promoting PA-supportive neighborhoods. Four REM sessions were conducted after 12 months of intervention and involved six housing sites (n = 35 participants) stratified by intervention arm. Interviews (n = 5) were also conducted with housing site staff. Sessions leaders engaged participants in visually mapping intended and unintended outcomes of intervention participation and participant-driven solutions to reported challenges. Maps were analyzed using Excel and Xmind 8 Pro and data were classified according to the socio-ecological model. Eight themes were identified for outcomes, challenges, and solutions. Most themes (6/8) were similar across intervention arms, including increasing PA and PA tracking, improving health outcomes, and increasing social connectedness. Groups (n = 2) engaged in Our Voice additionally identified increased community knowledge and activities directly impacting local environmental change (e.g., pedestrian infrastructure changes). Housing staff interviews revealed additional information to enhance future intervention recruitment, sustainability, and implementation. Such qualitative methodologies can aid in evaluating multi-level, multi-component interventions and inform future intervention optimization, implementation, and dissemination.

Automated summary

It has been found that participant-centered methods can complement traditional researcher-driven evaluation methods, especially for complex interventions or those with multiple components. Using a new method called Ripple Effects Mapping (REM), expected and unexpected outcomes of interventions can be identified from the participants' perspective, along with their challenges and solutions. This method is feasible and provides valuable information for future intervention optimization and implementation.