Maternal self-care, behaviors facilitating healthy eating, physical activity (PA), and stress management, are targets for child obesity prevention efforts and there is a need for optimized interventions to enhance these efforts. Plan, Do, Study, Act (PDSA) Cycling, a quality improvement process using rapid cycle testing to develop and refine interventions within healthcare settings, is less often used in maternal health and nutrition studies.
PDSA Cycles were applied during the development of the Healthy EnviROnments (HEROs) Self-care intervention to refine and verify intervention components including content, delivery methods, and digital strategies.
Study Design, Setting, Participants
HEROs Self-care was designed for low-income mothers of preschoolers in rural Colorado to improve healthy eating, PA, and stress management. Three sequential PDSA cycles were conducted via group or individual interviews with: 1) an expert panel (n = 8), 2) a convenience sample (n = 5), and 3) target audience (n = 6).
Outcomes, Measures and Analysis
Three cycles of group and/or individual interviews provided insights into intervention components: Cycle 1 provided input on program content: flow, activities, and materials; Cycle 2 provided feedback on delivery methods: in-person and videoconferencing meeting strategies, duration, and use of electronic binders; and Cycle 3 gathered information about the feasibility of digital strategies: website, iPad, and an activity tracker. Interviews were transcribed, data were compiled from group discussion notes, and data from each cycle was analyzed for emergent themes around intervention components.
In Cycle 1, areas for refinement included the addition of mindfulness activities, revision of handouts for literacy level, and additional time for group discussion. Cycle 2 verified that content was acceptable to the target audience and delivery methods functioned in rural areas. Cycle 3 verified that digital strategies were feasible.
PDSA cycles allow for the optimization of intervention components prior to full-scale implementation, potentially saving resources and resulting in more efficacious interventions.