Rolling with Resistance: Expand, Connect, Thrive Acceptability and Feasibility and Participant Perspectives on how to Impact Change

*Ruth Bernstein
Bariatric And Weight Management Center, Wake Forest Baptist Medical Center, North Carolina, United States

*Corresponding Author:
Ruth Bernstein
Bariatric And Weight Management Center, Wake Forest Baptist Medical Center, North Carolina, United States

Published on: 2021-08-07


Introduction: Effective interventions to increase positive health behaviors (PHB; e.g., healthy eating, exercise, stress management) in adolescence are vital; yet, PHB-promoting interventions have been less effective in minority populations. We aimed to evaluate the feasibility, acceptability, and preliminary outcomes of the Expand, Connect, Thrive (ECT) program, a PHB intervention for minority, low-SES adolescents.
Methods: Forty-eight adolescents (56% female, ages 10-14 years; 17% Hispanic, 56% Haitian/Creole) participated in the pilot ECT program at a school-based health clinic. Half of the sample was randomly assigned to receive motivational interviewing (MI) sessions. Adolescents were assessed at baseline, post-intervention, and 3- and 6-months follow-up regarding their self-reported eating behaviors, physical activity, and coping skills. Focus groups were conducted to determine next steps.
Results: The ECT program demonstrated strong attendance and retention. Adolescents’ reported satisfaction with the program; 75% rated the quality as “Excellent” or “Good” and about 73% indicated they would recommend the ECT program to a friend. Repeated measures MANOVA revealed that participants reported significantly less sedentary behaviors at post-intervention, compared to pre-intervention. No other main effects were seen and no differences emerged between those who did and did not receive MI. Focus groups indicated that the intervention could be more individually tailored, foster more adolescent ownership, integrate real-world applications, and facilitate more environmental support following the intervention.
Discussion: The ECT program provides a strong foundation on which future interventions within this at-risk population can build. Future interventions and studies can utilize focus group data as a guide for development of effective interventions.


Healthy Behaviors; Adolescents; Intervention; Minority; Prevention


Positive health behaviors (PHBs), or habits related to physical activity, sedentary behavior, dietary choices, and stress management, can prevent obesity and chronic disease [1]. They may be particularly important for adolescents, who have demonstrated increased rates of obesity over time (from 9.1% in 1991 to 17.0% in 2004, and somewhat stable since [2], and low-income and minority youth who have a higher risk of obesity [3,4]. While the consequences of poor PHBs include increased long-term morbidity and earlier mortality, they also extend beyond a child’s health, disrupting school attendance, academic performance, and social relationships [1]. This may compound already at-risk children of low socioeconomic status (SES), who experience poor nutrition, and have lower math scores, poorer school attendance, more behavior problems, and lower test scores overall [5-7]. Given these direct and indirect impacts of PHBs, preventive interventions that aim to increase the use of PHBs are particularly critical for low income and minority youth. Yet, to date no research has identified an intervention that effectively increases PHBs in low-income, minority youth. This could be due to a lack of inclusive change strategies (e.g., providing education that cannot be applied due to financial barriers or cultural restrictions/sensitivities) and/or lack of diversity in the study sample.
A recent meta-analysis indicated that of the 57 existing interventions aimed at increasing PHBs in adolescents, only four demonstrated statistically significant effects [8]. Of those four, three studied elementary-age children and one studied high-school-age youth. Furthermore, most interventions in this meta-analysis focused on one specific domain (e.g., increase physical activity, decrease sedentary activity, increase consumption of fruits and vegetables). Contrasting this, the American Dietetic Association (ADA) recommends that interventions to promote PHBs in adolescents include three domains:
Nutrition education,
Regular physical activity, and
Behavioral counseling [9].
Additionally, interventions have typically only demonstrated effectiveness for White, middle- to high-income participants. It is thus vital to determine if an intervention including all three ADA recommended domains to promote PHBs is feasible and acceptable with minority, low-SES adolescents.

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