A toolkit to promote fidelity to health promotion interventions in afterschool programs.

Community-based obesity prevention efforts are an essential component of a public health approach to obesity and chronic disease risk reduction. Afterschool programs can participate by providing healthy snacks and regular physical activity. Although efficacious obesity prevention strategies have been identified, they have not been widely implemented. The authors describe the development of A+, a quality improvement (QI) toolkit designed to help YMCA afterschool programs implement healthy eating and physical activity guidelines. YMCA of the USA Health Promotion Standards for afterschool sites specify eliminating sugar-sweetened beverages and trans fats; providing fruits, vegetables, and water; and ensuring at least 30 minutes of physical activity daily. Field tests of A+ indicated that a QI toolkit for community-based afterschool programs can be implemented by a program director across multiple program sites, responds to programmatic needs, appropriately identifies barriers to improvement, and permits development of locally appropriate improvement plans. The QI approach holds promise for public health efforts and for field research to evaluate promising interventions by helping ensure full implementation of health promotion strategies.