Wellness-Promoting Practices Through Girl Scouts: A Pragmatic Superiority Randomized Controlled Trial With Additional Dissemination

Abstract

Purpose:

To evaluate the effectiveness of in-person versus online Girl Scout leader wellness training for implementation of wellness-promoting practices during troop meetings (phase I) and to assess training adoption and current practices across the council (phase II).

Design:

Pragmatic superiority trial (phase 1) followed by serial cross-sectional study (phase II).

Setting:

Girl Scout troop meetings in Northeast Kansas.

Participants:

Eighteen troop leaders from 3 counties (phase 1); 113 troop leaders from 7 counties (phase II).

Intervention:

Phase I: Troop leaders attended 2 wellness training sessions (first in groups, second individually), wherein leaders set wellness-promoting practice implementation goals, self-monitored progress, and received guidance and resources for implementation. Leaders received the intervention in person or online.

Measures:

Phase I: At baseline and postintervention, leaders completed a wellness-promoting practice implementation questionnaire assessing practices during troop meetings (max score = 11). Phase II: Leaders completed a survey about typical troop practices and interest in further training.

Analysis:

Phase I: Generalized linear mixed modeling.

Results:

Phase I: In-person training increased wellness-promoting practice implementation more than online training (in person = 2.1 ± 1.8; online = 0.2 ± 1.2; P = .022). Phase II: Fifty-six percent of leaders adopted the training. For 8 of 11 wellness categories, greater than 50% of leaders employed wellness-promoting practices.

Conclusion:

In-person training was superior to online training for improvements in wellness-promoting practices. Wellness training was adopted by the majority of leaders across the council.

Keywords

wellness policy physical activity nutrition child obesity health promotion

Purpose

Youth are consistently reported to have deficits in the areas of fruit and vegetable (FV) consumption and physical activity (PA) participation. It has been estimated that 96% of girls aged 9 to 13 years fail to consume the recommended amounts of FV.¹ Additionally, many children do not meet the recommendation for PA,^2
–4 which is 60 minutes or more of moderate-to-vigorous PA (MVPA) per day.⁵ Lifestyle behaviors have been shown to track from childhood into adulthood,^6,7 so intervening in youth is especially important to help young people develop healthful behaviors that may be carried with them for years into the future.

Girl Scouts as a Wellness Promotion Setting

Girl Scouts may represent an ideal intervention setting to promote healthy behaviors in young girls. The Girl Scouts of the United States is a not-for-profit national organization and represents the largest member of the World Association of Girl Guides and Girls Scouts (WAGGGS). There is the potential for a large public health reach when working with this organization, as WAGGGS reports a membership of 10 million girls and adults in 145 countries.⁸ The organization recognizes that promoting healthy choices and healthy living are necessary for the foundation girls need to become strong leaders. Since there are a variety of options and a high level of leader autonomy in meeting activities, and many troops offer snacks, there is the potential for the meeting to provide regular opportunities for MVPA and healthy eating.

Several studies have utilized Girl Scouts settings to facilitate health behavior change,^9

–13 and interventions delivered through scouting programs have effectively boosted children’s FV consumption.^14
–16 An observational study examined Girl Scouts troop meetings and found that girls were achieving only 2 minutes of MVPA and were sedentary for over 90 minutes of their troop meetings.¹⁷ Furthermore, troop leaders were found to frequently discourage PA. Previous research shows room for improvement in Girl Scouts for opportunities related to FV consumption and PA, and evidence has suggested that leader-targeted interventions can be effective for changing these behaviors in this setting.¹⁶

Rationale for the Present Study

Due to the presence of modifiable factors within troop meetings, and the potential to improve them with leader-targeted intervention, there appears to be an intervention opportunity focused on how to train leaders most effectively to implement wellness-promoting practices within their troop meetings. The way in which Girl Scouts leader training is delivered may impact the effectiveness and potential for larger-scale dissemination. Both an in-person delivery and online platform have their respective strengths and limitations as a format to provide wellness training. Online delivery may reach a wider audience, allow for a larger public health impact,¹⁸ and reduce the gap between research and practice.¹⁹ Evidence shows that online learning is comparable^20,21 or more effective than face-to-face instructional models²² for a variety of learning outcomes and skills. While the question of online versus in-person learning has been assessed in different settings, there is no published literature examining the differential impacts on volunteer Girl Scouts leaders.

Furthermore, while the evidence suggests that improvements can be made in Girl Scouts meetings through wellness-promoting interventions, additional work is needed in the areas of dissemination and implementation science to better connect evidence-based practices with a public health impact in real-world settings. The RE-AIM framework²³ can be used to evaluate the reach, efficacy/effectiveness, adoption, implementation, and maintenance of a wellness promotion intervention, which are important elements to consider in the translation of research to a standard practice.

Therefore, phase I of the present study sought to evaluate the effectiveness of 2 Girl Scouts leader wellness training delivery formats (in person or online) for implementation of evidence-based wellness practices during troop meetings. Phase II assessed the feasibility of delivering the wellness training across a larger region, as well as the adoption and implementation of wellness-promoting practices by troop leaders across a larger region.

Hypotheses

Phase I: We hypothesized that both in-person and online leader wellness training would lead to improvements in implementation of wellness-promoting practices during troop meetings.

Phase II: We hypothesized that leader wellness training would be well accepted and feasible and that adoption and implementation of wellness-promoting practices would occur in greater than 50% of leaders’ troops. We also hypothesized that counties involved in phase I would have higher implementation rates when they were reassessed during phase II, as compared to those who did not participate in phase I. Thus, we expected to see an increase in implementation rates for the counties involved in both phase I and phase II.

Methods

This study was conducted in 2 phases, over the course of 2 years. Phase I was a pragmatic superiority randomized controlled trial, comparing in-person and online leader wellness training. Phase II was a serial cross-sectional study assessing the feasibility of wellness training, as well as the adoption and implementation of wellness-promoting practices across the wider geographical region. This study was approved by the university’s institutional review board (IRB #7387).

Phase I: Design

A pragmatic superiority randomized control trial was conducted where a cohort of Girl Scouts troop leaders (n = 18) were assessed at baseline, matched and randomized to one of the wellness training conditions (in-person or online training), and reassessed at 3 months postintervention. The randomization process was carried out by the primary investigator, and SPSS was used for the computer-generated randomization process.

Phase I: Sample

Participants were Girl Scouts leaders from 2 low-income counties in northeast Kansas. Each county has 1 to 2 service unit groups, defined as leaders within a specified region or area. Three service units were included within these 2 counties. Inclusion criteria required that the troop had at least an average of 5 girls who regularly attended troop meetings, meetings were held at least twice per month, and the troop met within 120 miles of the university.

Initial contact and recruitment of troop leaders occurred at the monthly service unit meetings. Research assistants attended these meetings in the 2 preselected counties (3 total meetings) to present the project overview and recruit potential leaders for participation. At the baseline service unit meetings, a leader from each troop reported their troop demographics and typical characteristics of their meetings. At the end of the questionnaire, leaders indicated whether or not they were interested in participating in further research. Interested troop leaders provided consent, and their troop was then matched with a similar troop within their county. Figure 1 shows the flow of participants in phase I of the study.

Figure 1.

Phase I: Flow of participants.

Phase I: Wellness Training Intervention

The wellness training intervention was developed, in part, by using components of Self-Determination Theory.²⁴ This theory posits that motivation is a key component of human behavior and that this motivation is influenced by one’s autonomy, competence, and relatedness. A goal of the wellness training intervention was to promote growth in each of these areas through a continuous quality improvement process, with the target outcome being an increase in wellness-promoting opportunities for girls during troop meetings. Throughout the training intervention, leaders developed skills and received resources necessary to develop and implement a wellness policy tailored to their troop. The training materials were adapted from our team’s previous work with afterschool programs²⁵ and schools,²⁶ in which skills and efficacy for healthy PA and dietary behaviors were targeted in adults and youth.

Troop leaders in both intervention groups attended 2 wellness training sessions (approximately 30-45 minutes each), which included 1 group training followed by an individual training. For the group training session, leaders in the in-person delivery group troop attended the training session that was held in their county. The online group did not physically attend these sessions but received the same information and training materials through a website and online learning platform (Qualtrics system).

Group training

During the group training, leaders developed tailored wellness policies and set goals for their troop meetings in 5 key wellness areas: (1) PA opportunities, (2) limiting sedentary time, (3) offering FV as snack choices, (4) making water available as the beverage choice, and (5) opportunities for building social, nondigital connections among their girls. For each of the 5 key wellness areas, leaders could choose a “gold,” “silver,” or “bronze” level goal or they had the option to create their own goal within each category. Table 1 provides further information about the training sessions, as well as behavior change techniques employed.²⁷

Table 1.

Training Session Information.

Training Session Content	Delivery Format	How Behavior Change Was Targeted
Overview of recommendations for youth and existing gaps	In-person group: Face to face; received handout with PowerPoint slides during in-person presentation	Standards for physical activity and fruit and vegetable consumption were identified; leaders gained awareness about the current gaps for youth in meeting recommendations
Overview of recommendations for youth and existing gaps	Online group: PowerPoint presentation uploaded to Canvas website	Michie’s Behavior Change Techniques²⁷: Provide information about behavior in general (technique #1) and to the individual (technique #2) Provide normative information about others’ behavior (technique #4)
Troop report card/printed feedback	In-person group: Received report card in hard copy	Leaders were able to compare their troops to others and identify areas where they could improve their troop meeting wellness opportunities
	Online group: Received an e-mail with the attachment of their report card	Michie’s Behavior Change Techniques: Provide feedback on performance (technique #19) Facilitate social comparison (technique #28)
Development of troop wellness policy	In-person group: Set goals during the in-person training	Leaders increased competence and maintained autonomy through the goal-setting practices. The policies were self-tailored to their troop and dynamics, and realistic goals were set. Leaders were encouraged to set small goals at first and progress to larger goals over time
	Online group: Asked to set goals during their online training	Michie’s Behavior Change Techniques: Goal setting (behavior) (technique #5) Action planning (technique #7) Set graded tasks (technique #9)
Resources and tips for implementation	In-person group: Discussion happened in a face-to-face format	Leaders gained barriers self-efficacy, as they worked through solutions to problems that they expected to face with policy implementation. Relatedness was fostered as leaders discussed strategies and ideas with one another and made connections regarding their shared experiences
	Online group: Discussion boards were set up with threads created by research staff to mirror the content discussed during the in-person training	Michie’s Behavior Change Techniques: Barrier identification/problem solving (technique #8) Focus on past success (technique #18) Plan social support (technique #29) Identification as a role model (technique #30)

Individual training

Approximately 1 month after the group wellness training session, the leaders had an individual leader training session. For those in the in-person group, a research assistant attended a troop meeting and met with the leader to identify areas where they had made progress and where they could still improve to meet their troop’s goals. Online group leaders provided information about their meeting activities and leader practices through e-mail, and research staff worked with them individually on these same issues. Leaders were asked to self-monitor their progress, with the goal being an increase in self-regulation skills and competence for making positive changes as they worked through barriers and identified solutions to use in future meetings. Both groups of leaders were provided specific feedback and were given additional resources and suggestions about activities to incorporate into their meetings.

Phase I: Measures

The primary outcome for phase I was implementation of wellness-promoting practices, as assessed through the leader report of the troop meeting. This information was collected via the Wellness Practice Implementation Questionnaire (Supplemental Appendix 1) at the conclusion of a troop meeting that occurred at baseline and at postintervention. Leaders completed the questionnaire and 11 of the items pertained to the wellness promotion opportunities of the meeting. Each item was presented in a yes/no format, where a wellness-promoting response was scored as a 1 and a wellness-demoting response was scored as a 0. Thus, the maximum Wellness Practice Implementation score was 11. The 11 items pertained to the presence or absence of the following items during the meeting: PA opportunity, sedentary breaks, leader promotion of PA, leader promotion of healthy eating, availability of fruits, availability of vegetables, availability of water, use of electronic devices, availability of fruit juice, availability of sweets or salty snacks, and availability of sugar-sweetened beverages. In-person group troop leaders completed this questionnaire in paper form and gave it to the research assistant at their meeting, while those in the online group completed the questionnaire via Qualtrics (online survey site).

Phase I: Analysis

SPSS for Windows (version 23.0) and SAS software (Version 9.4) were used for statistical analyses. Intervention groups were compared at baseline using independent t tests. A generalized linear mixed model in SAS was used to analyze differential change between in person and online in wellness promotion opportunities over the course of the intervention. The model was used to test for an interaction between intervention group and time, as well as main effects, using leader socioeconomic status and troop grade level as covariates. An Analysis of Variance was used to test for condition by time differences in the 11 wellness categories, with subsequent paired t tests to check for differences in wellness promotion opportunities within the 11 wellness categories between the time points for each condition.

Phase II: Wellness Training Dissemination and Implementation

Phase II of the research project assessed the potential for wellness training dissemination, as well as adoption and implementation of wellness-promoting practices across the wider region. Research assistants attended a total of 7 service units, including the 3 that were visited during phase I. At this meeting, a group wellness training was delivered and leaders completed a questionnaire regarding their troop meeting practices.

Phase II: Design

Phase II was a serial cross-sectional study. Rates of training adoption were assessed for leaders in the 7 service units, and a serial, cross-sectional view of change in implementation rates was determined for the 3 service units visited during both phase I and phase II.

Phase II: Sample

Participants for phase II were troop leaders in the 7 service units that were visited. Of 180 registered troop leaders across the 7 counties, 113 attended the meetings in their area and received the wellness training. For the 3 service units visited during phase I and phase II, there were 52 leaders and 48 leaders during year 1 and year 2, respectively.

Phase II: Measures

Leaders in phase II completed the Typical Troop Practices Questionnaire (Supplemental Appendix 2) to assess troop demographics, wellness promotion opportunities, and an overview of the troop’s regular practices. It assessed PA opportunities, typical snack and beverage options, the use of electronic devices, opportunities for building social connections, and the leader’s perception of the importance of improving the wellness promotion opportunities of their troop meetings. The questions were asked on a 4-point Likert scale, with possible responses ranging from “rarely or never” offered during a typical meeting to offered “every meeting.” A positive response was indicated by a response of at least “some of the time” for PA, water as a beverage choice, fruit availability, vegetable availability, and promotion of healthy eating and PA. A response of “rarely or never” was considered a wellness-promoting response in the areas of prolonged sedentary time, sweet and salty snacks, sugar-sweetened beverages, and fruit juice. At the end of the questionnaire, leaders indicated whether or not they would be interested in participating further in wellness promotion training.

Adoption occurs when an organization or individual commits to incorporating the evidence-based practices into their setting,²⁸ and therefore, adoption was determined to have occurred in our study if the troop leader indicated that they were interested in receiving further wellness-promoting training via the Typical Troop Practices Questionnaire. Implementation occurs when evidence-based practices are integrated into particular setting,²⁸ and therefore, implementation was determined to have occurred in our study if the troop leader indicated a wellness-promoting response in the various wellness categories.

Phase II: Analysis

Chi-square analyses were used to test for differences in the characteristics of leaders who adopted the wellness training materials versus those who were not interested in adoption. Descriptive statistics were used to calculate troop means, as well as percentages of leaders reporting wellness-promoting responses. Additionally, chi-square tests were used to determine differences between years for percentages of leaders reporting implementation of wellness-promoting practices within the 3 service units visited at both time points. For all tests, significance was set at P < .05.

Results

Phase I: Wellness Training Intervention Findings

Phase I baseline troop characteristics are shown in Table 2. There were no differences in the number of girls, meeting length, cumulative Wellness Practice Implementation score, or other troop demographics or leader characteristics between the 2 intervention conditions at baseline.

Table 2.

Phase I: Baseline Troop Characteristics.

	In-Person Group, Mean (SD)	Online Group, Mean (SD)	P Value
Number of girls	11.8 (3.8)	10.5 (4.2)	.554
Meeting length (minutes)	80 (16.8)	80 (12.2)	1.00
Wellness Practice Implementation Score (Max score of 11)	6.1 (1.8)	6.3 (2.1)	.830
Troop level
Daisy (K-1st grade)	1	1	.949
Brownie (2nd-3rd grade)	5	3
Junior (4th-5th grade)	3	2
Leader socioeconomic status (based on free/reduced lunch status)
Low income	3	2	.690
Not low income	5	4
Unreported	1	0

Abbreviation: SD, standard deviation.

At each assessment period, the implementation of wellness practices during the troop meeting was analyzed. Table 3 shows the percentage of leaders who reported a wellness-promoting response in each of the 11 wellness categories at baseline, with no differences (P > .05) between groups. The highest implementation rates were in the categories of fruit juice availability (offered rarely or never) and water availability (offered at least some of the time). The lowest implementation rates were for vegetable availability (offered at least some of the time).

Table 3.

Phase I: Percentage of Leaders Reporting Wellness-Promoting Responses at Baseline.

Wellness Category	In-Person Group	Online Group	P Value
Use of electronic devices	77.8%	83.3%	.792
Fruit availability	33.3%	16.7%	.475
Vegetable availability	11.1%	0%	.398
Sweets or salty snack availability	33.3%	33.3%	1.00
SSB availability	66.7%	83.3%	.475
Fruit juice availability	100.0%	83.3%	.475
Water availability	66.7%	100%	.114
Promotion of healthy eating	44.4%	66.7%	.398
Physical activity opportunity	66.7%	66.7%	1.00
Sedentary breaks	55.6%	66.7%	.667
Promotion of physical activity	33.3%	33.3%	1.00

Abbreviation: SSB, Sugar-sweetened beverage.

Phase I: Primary Outcome

The primary outcome for phase I was implementation of wellness practices, specifically the changes that occurred in implementation over the course of the study. When using a generalized linear mixed model adjusted for troop grade level and free/reduced lunch status, there was a significant interaction between intervention group and time (P = .022). Figure 2 shows the change in Wellness Practice Implementation score from baseline to postintervention for both of the delivery method groups. The in-person delivery group exhibited a significant increase in Wellness Practice Implementation score from baseline to postintervention (2.1 ± 1.8; P = .019), while the change was not significant in the online group (0.2 ± 1.2; P = .741).

Figure 2.

Phase I: Change in Wellness Practice Implementation Score between intervention groups over time. There was a significant interaction between intervention condition and time (P = .022), whereby the in-person group exhibited an increase in Wellness Practice Implementation score, while the control group did not significantly change from baseline to postintervention (in person = 2.1 ± 1.8; online = 0.2 ± 1.2; P = .022). Error bars show 95% confidence intervals. Model is adjusted for troop (age) level and free/reduced lunch status.

Phase I: Secondary Outcomes

Secondary analyses were conducted to determine the categories in which improvement occurred following intervention. When analyzing each of the 11 wellness categories separately, there were no differences between groups in change over time (P > .05). When looking at only leaders in the in-person delivery group, there was a significant reduction in the availability of sweets or salty snacks (P = .03), with other categories showing nonsignificant changes. Figure 3 shows change in the percentage of leaders indicating a wellness-promoting response in each of the 11 categories for both the in-person and online delivery groups. The proportion of categories of Wellness Practice Implementation scores that increased in the in-person delivery group was 10 of 11, while the online group showed increases in 5 of 11 categories. Chi square analyses indicated that there were no significant differences (P = .06) between groups with regard to proportions of categories that changed in a positive direction.

Figure 3.

Phase I: Percentage of troop leaders reporting positive wellness-promoting responses.

Phase II: Wellness Training Dissemination and Adoption and Implementation Findings

A total of 113 Girl Scouts leaders from 7 service units were trained during phase II of the project. The smallest service unit had 4 leaders in attendance, while the largest included 35 leaders. There were a total of 180 registered leaders in the service units that were reached. Therefore, approximately 63% of potential leaders attended the wellness practice implementation training. Of the 113 leaders trained, 85 (75%) leaders completed the Typical Troop Practices Questionnaire, and 48 leaders (56% of leaders who completed the questionnaire) indicated that they would be interested in participating further in wellness promotion projects, thus adopting the wellness training intervention components, for their Girl Scouts troop. Troop leaders who were interested in further training differed in socioeconomic status (as assessed through eligibility for free/reduced lunch), when compared to the uninterested group (χ² = 6.99, P = .03).

An assessment of wellness-promoting practices was done during phase II in the 85 leaders who completed the Typical Troop Practices Questionnaire. Figure 4 shows the percentage of leaders reporting a wellness-promoting response in the 11 wellness categories. Greater than 50% of troop leaders reported implementation of wellness-promoting practices in 8 of the 11 categories during year 2.

Figure 4.

Phase II: Percentage of troops reporting implementation of wellness-promoting practices in 11 wellness categories.

Three of the service units were visited during both phase I and phase II of the project, thus providing a serial, cross-sectional view of the wellness environment. These 3 service units were analyzed to compare wellness practice implementation across the 2 years. Table 4 shows the percentage of troops that indicated implementation of a wellness-promoting response in each of the categories over the 2 years. A significantly greater percentage of leaders reported opportunities for fruit consumption (P = .039) and vegetable consumption (P = .036) during year 2, as compared to year 1.

Table 4.

Phase II: Percentage of Troops Reporting Wellness-Promoting Response Across 2 Years in 3 Service Units.

	Year 1 (N = 52)	Year 2 (N = 48)	P Value
Physical activity opportunities (at least sometimes)	86.5%	85.4%	0.871
Prolonged sedentary time (rarely or never)	19.2%	31.3%	0.166
Water as beverage choice (at least sometimes)	98.1%	89.6%	0.074
Use of electronic devices (rarely or never)	82.7%	87.2%	0.529
Fruit as snack choice (at least sometimes)	53.8%	73.9%	0.039
Vegetable as snack choice (at least sometimes)	36.5%	57.8%	0.036
Sweet/salty snacks (rarely or never)	31.3%	29.2%	0.811
Sugar-sweetened beverages (rarely or never)	50.0%	60.4%	0.296
Fruit juice (rarely or never)	45.1%	47.8%	0.788
Promotion of healthy eating (at least sometimes)	86.5%	78.7%	0.303
Promotion of physical activity (at least sometimes)	84.6%	87.5%	0.678

Discussion

Phase I

Our hypothesis for phase I was supported, in that in-person and online leader wellness training led to improvements in implementation of wellness practices during troop meetings. We found a significantly larger effect for leaders who were trained in person, when compared to those trained online, showing that in-person training was superior to online training for eliciting changes in health-promoting opportunities for girls.

These findings are in contrast to the meta-analysis showing that students learning in an online environment performed better than those receiving the instruction in a face-to-face format for graduate and professional students.²² This same study found that learning effects were smaller when the content and organization of activities (ie, group work, independent work, discussion, etc) was identical between the conditions. In the present study, it is possible that negligible effects were found for the online group because they did not access and engage with the materials as fully as the in-person group. A review study examining online versus face-to-face learning in a variety of settings concluded that there are benefits and obstacles regarding an online instructional model.²⁹ Although there is the potential to reach a geographically diverse audience in a flexible and cost-effective way, there are certain technical skills required, and oftentimes users feel a lack of interpersonal interaction. These may have been conditions that led to the lack of change in wellness practice implementation for the online group. Additionally, it is possible that training sessions were less impactful when delivered online versus in person, the group context and relatedness were not fostered as well in the online group, and online leaders did not adopt the core principles and practices promoted in the training, among other possible reasons. The online training sessions may not have successfully targeted behavior change constructs in the way that the in-person training did, although these mediators of behavior change were not explicitly studied in this present project. Future research should assess engagement of the online troop leaders, since they are considered change agents and implementers of the training components.³⁰

Our findings are consistent with previous research showing improvements in the wellness environment of Girl Scouts troop meetings following leader-targeted intervention. Rosenkranz and colleagues¹⁶ implemented a wellness promotion curriculum and a set of wellness policies for offering PA and healthy snacks in intervention troops and found increases in both of these areas at the postintervention period. Our present study was similar in that our troops set wellness policies, but there was a greater deal of autonomy and leader choice in setting specific goals, when compared to the previous study. An overarching goal of the present study was to translate and extend our effective, evidence-based practices¹⁶ into the Girl Scouts organization to study implementation and dissemination as it would happen in a real-world setting, which was achieved.

Phase II

Phase II assessed the feasibility of our approach to further disseminate wellness training, as well as adoption and implementation of wellness practices across the wider region. The phase II hypotheses were also supported. As evidenced by strong attendance and completion of group leader trainings, the current model of wellness training was well accepted and feasible. Adoption of the wellness training and interest in applying the principles to troop meetings occurred in 56% of the troop leaders who went through the training during phase II of the project. Additionally, the majority (>50%) of troop leaders reported implementation of wellness-promoting practices in 8 of the 11 wellness categories. A meta-analysis³⁰ found that implementation rates are positively related to program success and that positive outcomes can be seen with implementation rates of greater than 60%, which were found in 6 of the 11 wellness categories during phase II.

The serial cross-sectional view of the service units over the 2 years showed relatively stable implementation rates of wellness practices for many of the areas, with exceptions for FV availability, which showed a higher percentage of wellness-promoting responses during the second year. Since there is relatively high turnover in Girl Scouts leaders, the same set of leaders may not have completed the surveys for both years and therefore should not be considered as change across years within leaders. The high leader turnover in Girl Scouts represents an important component to consider when striving to make organizational change. Lasting change will require more than changing individual leaders’ behaviors, since they may leave the organization, but a true change in the direction of wellness promotion will require the core concepts to become embedded into the training system and organizational structure of Girl Scouts. This notion is consistent with recommendations for wellness promotion in schools, which call for coordinated efforts between school policies, supportive classroom environments, health education curriculum, family involvement, and professional development.³¹ In this way, impacting the system requires investment at the institutional level and broad support across domains within the organization.

Data from phase II showed that leaders interested in further training were more likely to be from low-income households, compared with leaders who were not interested. It is possible that these leaders, due to staffing and budget constraints, were not receiving the same level of troop leader training as higher income areas. It is promising that low-income troop leaders were most interested in wellness promotion projects, as evidence shows that low-income individuals are more at risk for unhealthy behaviors, as compared to their higher income counterparts.³² The public health impact of this type of intervention could be increased by reaching those who are in most need of improvement.

Strengths and Limitations

A strength of our study was that the intervention-targeted theoretical constructs (autonomy, competence, relatedness) shown to be important for eliciting behavior change. Logistically, the group training session length seemed to be appropriate (30-45 minutes) and could be included as part of the service unit meeting activities in the future, should it become a part of the larger organization’s practices. An additional strength is the potential reach of this intervention. Within the United States, there are 1.6 million girls and adult volunteers within the Girl Scouts Organization. Integrating a wellness-training component into the leader training experience could have meaningful and impactful effects on the organization and wellness behaviors of participating girls.

The primary outcome of this study relied on the troop leaders’ self-reports of the meeting activities and leader behaviors. Additionally, only 1 troop meeting was assessed at each time point (baseline and postintervention). It is possible that leaders may have changed their behavior due to being assessed or may have given responses that do not accurately reflect their typical meeting practices. Since the project was conducted in low-income, Midwestern counties, we cannot generalize the results to higher income groups or those who reside in areas inherently different from our target geographical area.

Future Directions

Future work should assess how to disseminate leader wellness training most effectively, as well as ways to integrate the training successfully into the larger Girl Scouts organization. Research should specifically address ways to enhance the online wellness training delivery, possibly through a more tailored and individualized online approach, as this may represent a more cost-effective and larger reaching medium for large-scale dissemination within the organization.

In conclusion, a combination of group-based and individual-based Girl Scouts leader wellness training improved the implementation of wellness-promoting practices, with in-person training shown to be superior to online training in phase I. Additionally, leader wellness training appeared to be feasible, with implementation and adoption occurring in the majority of leaders participating in the wellness training during phase II. Additional research, including objective assessment of troop meeting practices, is needed to determine the most effective way to train Girl Scouts troop leaders on implementation of wellness-promoting practices and the potential impact on youth health behaviors. With a large reach potential within the Girl Scouts organization, focusing on wellness promotion within this setting creates an opportunity for change in behaviors and opportunities for a large and diverse population of girls.

So What?

What is already known on this topic?

Girl Scout troop meetings represent an opportunity for wellness-promoting activities, including healthy snacking and physical activity. Previous interventions have been effective for improving these opportunities through leader-targeted training and intervention. However, there is a need to elucidate how to most effectively train a large number of leaders across a wide region for a public health impact.

What does this article add?

This article adds evidence regarding effective training methods within the organization. Girl Scout leaders who were trained in person increased implementation of wellness-promoting practices more than leaders who received the training materials online. Wellness training appeared to be feasible, and the majority of leaders implemented and adopted the wellness training content.

What are the implications for health promotion practice or research?

These findings suggest that leader wellness training may be effective for improving the wellness-promoting environment of Girl Scouts. Determining the most cost-effective and feasible training delivery method is warranted. If Girl Scout leader wellness training were to be implemented with fidelity across the organization, there is the potential to reach a large and diverse group of girls for wellness promotion.

Supplemental Material

Supplemental Material, Typical_Troop_Practices_Questionnaire_(2) - Wellness-Promoting Practices Through Girl Scouts: A Pragmatic Superiority Randomized Controlled Trial With Additional Dissemination

Supplemental Material, Typical_Troop_Practices_Questionnaire_(2) for Wellness-Promoting Practices Through Girl Scouts: A Pragmatic Superiority Randomized Controlled Trial With Additional Dissemination by Brooke J. Cull, David A. Dzewaltowski, Justin M. Guagliano, Sara K. Rosenkranz, Cassandra K. Knutson, and Richard R. Rosenkranz in American Journal of Health Promotion

Supplemental Material

Supplemental Material, Wellness_Practice_Implementation_Questionnaire_(1) - Wellness-Promoting Practices Through Girl Scouts: A Pragmatic Superiority Randomized Controlled Trial With Additional Dissemination

Supplemental Material, Wellness_Practice_Implementation_Questionnaire_(1) for Wellness-Promoting Practices Through Girl Scouts: A Pragmatic Superiority Randomized Controlled Trial With Additional Dissemination by Brooke J. Cull, David A. Dzewaltowski, Justin M. Guagliano, Sara K. Rosenkranz, Cassandra K. Knutson, and Richard R. Rosenkranz in American Journal of Health Promotion

Footnotes

Acknowledgments

The authors would like to acknowledge their undergraduate research assistants for their help with data collection, as well as the Girl Scouts of Northeast Kansas and Northwest Missouri for their participation.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The project was funded by a grant from the Kansas Health Foundation.

Supplemental Material

Supplementary material for this article is available online.

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