Developing an Academic–Community Partnership to Promote ...€¦ · WORK-IN-PROGRESS & LESSONS LEARNED Developing an Academic–Community Partnership to Promote Soccer-Based Physical

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pchp.press.jhu.edu © 2015 The Johns Hopkins University Press

Work-In-Progress & Lessons Learned

Developing an Academic–Community Partnership to Promote Soccer-Based Physical Activity Among Latino Youth

Daniel J. Schober1, Jose Zarate2, and Stephen B. Fawcett3

(1) Gretchen Swanson Center for Nutrition; (2) Kansas City Kansas Soccer Association; (3) University of Kansas Work Group for Community Health and Development

Submitted 25 February 2014, Revised 1 September 2014, accepted 12 October 2014.

Latinos represent a growing segment of the population, estimated at more than 53 million or 16.9% of the population in the United States.1 Compared with non-

Hispanic Whites, Latinos face a higher prevalence of chronic disease as well as poorer health outcomes with chronic disease. For example, Mexican American adults are 1.7 times more likely than non-Hispanic White adults to be diagnosed with diabetes and 1.5 times as likely to die from diabetes.2 These types of disparities pose a threat to population-wide health and they require health promotion efforts across multiple sec-tors of the community. This includes making healthier foods accessible, creating more opportunities for physical activity, and ensuring access to preventative health services.3–5

Abstract

Background. The Latino Health for All (LHFA) Coalition used a community-based participatory approach to develop an action plan for addressing chronic disease among Latinos in Kansas City.

Objectives. This study examines the development and imple-mentation of community-based soccer sessions for youth (ages 6–15) by an academic partner from the coalition and a community partner from a nonprofit youth soccer organization.

Methods. The academic and community partners spoke four times over 3 months to plan for these soccer sessions. These conversations ranged from sharing goals to planning logis-tics. The coalition helped to promote these opportunities through a variety of channels.

Results. Eight weekly soccer sessions were implemented, attracting Latino youth who were overweight or obese. These soccer sessions were perceived as enjoyable by youth and were appreciated by their parents.

Conclusions. Successful health promotion efforts require strong relationships between academic and community partners that involve shared goals and complementary skills/expertise.

Keywords

Community-based participatory research, community health partnerships, public health, health promotion, primary prevention

In 2008, The University of Kansas Work Group for Community Health and Development (KUWG) received a grant from the National Center on Minority Health and Health Disparities to implement the “Health for All Model” which involved action planning to guide the facilitation of community and system changes to prevent chronic disease.6 This grant focused on the Latino community in Wyandotte County, Kansas, a county that has a population of approxi-mately 157,000 residents, 26.4% of whom are Latino.7 Before this project, the Kansas Health Foundation had conducted a statewide assessment of health, and found that Wyandotte County was the least healthy county in Kansas.8

The KUWG partnered with members of the University of

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Kansas Medical Center’s Department of Preventive Medicine and Public Health as well as El Centro, a community-based organization that provides economic, educational, and social services to the Hispanic community in Kansas City, to assemble the LHFA Coalition.9–11 These partners reached out to community leaders and personal contacts who had a stake in the health of the Latino community. These individuals were invited to participate in the coalition’s first meeting to develop an action plan using a community-based participa-tory approach that aimed to be cooperative, empowering, and action oriented.12 Approximately 45 individuals from organizations in Kansas City participated in the development of the action plan and became members of the coalition. These individuals represented safety net clinics, youth organizations, translation service organizations, churches, members of the local Hispanic media, and community residents. The action planning process also involved developing a mission. In its final form, the LHFA Coalition’s mission read, “to reduce diabetes and cardiovascular disease among Latinos in Kansas City/Wyandotte County through a collaborative partnership to promote healthy nutrition, physical activity, and access to health services.”13

The LHFA Coalition was organized into three main action committees: 1) healthy nutrition, 2) physical activity, and 3) access to health services. Each action committee consisted of approximately 8 to 15 individuals, a chair (a key stakeholder from the community), and a liaison (an academic partner from the KUWG) to support coalition members, and to co-lead implementation of the action plan. A full-time community mobilizer also helped the action committees to implement their action plans. The physical activity action committee identified priority strategies for the LHFA Coalition’s action plan and voted on the most important strategies, which helped the committee to determine seven to pursue, including “Implement soccer tournaments that will promote physical activity.” The present study examines an academic–commu-nity partnership between the physical activity liaison (the first author of this study) and the President of the Kansas City, Kansas Soccer Association (the second author of this study).14 This partnership involved advancing this priority strategy by planning for and implementing opportunities for youth (aged 6–15 years) to be physically active through community-based soccer, as a form of primary prevention of chronic disease.

METHODSA case study design was used for the present study.15 It

focuses on describing the collaborative planning process, the promotion of the soccer sessions, the delivery of the soccer sessions, and the results of these efforts including a descrip-tive analysis of the youth who elected to participate in these soccer sessions.

Collaborative Planning

The LHFA Coalition’s community mobilizer introduced the Physical Activity Liaison (PA Liaison) to the Kansas City, Kansas Soccer Association President (KCKSA President); the KCKSA President was not initially a member of the LHFA Coalition. The PA Liaison and KCKSA President spoke four times to plan for these community-based soccer sessions. Each conversation was held by phone and the four conversations occurred over approximately 3 months. During the first call, the PA Liaison shared the LHFA Coalition’s mission, goals, and action plan. The KCKSA President shared KCKSA’s background, accomplishments, and community impact over its 10-year history. The PA Liaison also communicated the importance of targeting youth at risk for chronic disease, specifically, youth who were overweight or obese. This initial call enabled the PA Liaison and the KCKSA President to get to know each other. At the end of the meeting, both individuals felt comfortable moving forward to plan these community-based soccer sessions.

During the second conference call, the PA Liaison and the KCKSA President discussed the logistics required to facilitate these soccer sessions. This included selecting a field, decid-ing to hold eight weekly sessions, determining participant age groups, and considering training for volunteer coaches (the KCKSA President recommended that volunteer coaches become “certified” as youth soccer coaches). The third call involved more discussion about what each soccer session would involve (i.e., instruction, drills, and games). The sign-up process, insurance coverage, and a contingency plan in case of poor weather were also discussed. The PA Liaison and KCKSA President worked together to develop an informational flyer targeting youth who were interested in learning soccer skills. The PA Liaison also shared data collection needs with the KCKSA President; both parties agreed that a few items could be added to KCKSA’s sign-up form, and other items such

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Schober, Zarate, & Fawcett Soccer-Based Physical Activity Among Latino Youth

as program satisfaction questions, could be assessed with a separate survey at the end of the program. Although the PA Liaison was interested in collecting data each session, he and the KCKSA President agreed to limit data collection to the sign-up form and satisfaction survey. During the fourth conference call final details were discussed, particularly tasks for the first session, including how many volunteers should be present to collect signup forms, the equipment needed, and how the academic partner could help with setup for the first session.

Instrument Development

Part of the planning effort between the PA Liaison and KCKSA President involved the modification and development of two measurement instruments. The PA Liaison worked with the KCKSA President to add two questions to KCKSA’s sign-up form. One question asked parents to report how many days their child was physically active for 60 minutes or more during the past seven days. This question came from the Centers for Disease Control and Prevention’s (CDC) Youth Risk Behavioral Surveillance System.16 The second question asked parents to indicate whether their child was of Hispanic or Latino origin. This question came from the U.S. Census.17 KCKSA’s standard sign-up form asked parents to report the height, weight, and birthday of their child. The PA Liaison used this information to estimate the body mass index (BMI) of participants using the CDC’s BMI calculator.18 The PA Liaison also obtained Institutional Review Board approval from the University of Kansas along with an informed consent form for parents to review and sign so that data on the sign-up form could be used for this study. After the first session, the PA Liaison generated a participant list, which was used at each session to track participant attendance.

The second instrument that emerged from this collabora-tion was a paper-and-pencil satisfaction survey. Four items assessed child satisfaction. These four items consisted of affir-mative statements (e.g., “I learned soccer skills”). The child provided his or her level of agreement with each statement on a scale of 1 (a little) to 5 (a lot) with the assistance of his or her parent(s). These items assessed a) child perception of soccer skills learned, b) confidence in soccer skills, c) enjoyment of these soccer sessions, and d) desire to keep playing soccer. The satisfaction survey also consisted of three items to assess

parent satisfaction. The first item asked parents to indicate their level of agreement (1 [disagree] to 5 [agree]) with the statement, “Latino Health for All Youth Soccer was good exercise for my child(ren).” The second item asked parents how likely they would be to have their child participate in these types of structured soccer sessions in the future. The third item asked parents about their overall level of satisfaction with the soccer sessions. The sign-up form and survey were made available in English and Spanish.

Promotion

Members of the LHFA Coalition promoted these com-munity-based soccer sessions through a grassroots campaign, using a paper version of flyer, available in English and Spanish. The flyer provided key information about these soccer ses-sions, including session location, age groups, and session start times. Printed copies of the flyer were provided to LHFA Coalition members for distribution. The flyer was also printed in two local newspapers that targeted the Latino community in Kansas City. The members of the LHFA Coalition received an electronic copy of the flyer to disseminate to their local contacts, via email or website posting. Finally, the KCKSA President provided the flyer and a sign-up form on the KSKSA Website.

RESulTS

Session Delivery

Nine adult volunteers (seven males, two females) were certified by the Kansas Youth Soccer Association and assisted at weekly sessions.19 Seven of the nine adult volunteer coaches reported a Hispanic or Latino origin. Four of the nine reported previous experience coaching. Four coaches were parents of a child participating in the soccer sessions. Eight soccer sessions were delivered on consecutive weeks from early June through late July. Sessions one through seven occurred at a public park in Kansas City, Kansas, on a weekday evening. The final session occurred indoors at a local community center on a weekday evening. The hour-long soccer sessions were divided by age group: 6 to 9 years old, 10 to 12 years old, and 13 to 15 years old. Boys and girls participated together, by age group. Sessions began with brief verbal instruction of a key soccer skill (e.g., passing) and included demonstration of the skill.

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Then, youth participants practiced the skill in small groups (typically three to seven) with a volunteer adult coach. After practicing the skill, youth were divided into teams for practice games. These games involved five to ten participants on each team and used a small, nonregulation playing field. Both the KCKSA President and the volunteer coaches provided verbal encouragement throughout each session. Sessions ended with a group huddle and a review of the skill(s) learned. The program emphasized having fun with the game of soccer, and this was verbally re-iterated during the closing huddle. During the final session, parents received a list of additional local opportunities for their child to be involved in structured physical activities, such as youth sports teams. Parents also received information (in English or Spanish) on physical activity, including physical activity guidelines for adults and children, a pamphlet on diabetes prevention, and information about LHFA Coalition events.

Participant Engagement

Eighty-two youth participated in one or more soccer ses-sions. Parents of 74 of the 82 youth (90.2%) provided informed consent at their first soccer session. These 74 youth came from 53 households. Thirty-two of these 53 households (60.4%) were in Wyandotte County (the target county). Table 1 dis-plays detailed demographic data for participants. Fifty-two boys (70.3%) and 22 girls (29.7%) participated. Thirty-nine participants (52.7%) were 6 to 9 years old at their first session. Twenty-two participants (29.7%) were 10 to 12 year old and 8 participants (10.8%) were 13 to 15 years old at their first ses-sion. Three participants were either under the age of 6 or older than 15 at their first session; they participated with the group that they were closest to in age. Across sessions, participation ranged from 42.2% (session 6) to 67.4% (session 2); 60.8% attended the final session (Table 1 provides a breakdown of the number of sessions attended among the 74 youth). More than 90% of parents reported a Hispanic or Latino origin. “Mexican, Mexican American, or Chicano” represented the most common Hispanic/Latino origin reported (79.7%). The majority of parents (71.6%) reported that their child was less physically active than recommended in the past seven days (i.e., < 60 minutes each day). Nearly one-half of the partici-pants (48.6%) had never played a season of organized soccer before. Among the 59 parents who reported a height, weight,

and birthday for their child, 14 (23.7%) were overweight and 18 (30.5%) were obese.

Twenty-six youth and parents completed a satisfaction survey, a 35.1% youth response rate across all 74 study partici-pants (a 71.7% youth response rate among the 46 youth who attended session 8). Both youth and parents expressed high levels of satisfaction with the sessions. On average, youth rated the four affirmative statements with a high level of agreement; average rating by item ranged from 4.5 (I learned soccer skills, I feel more confident in my soccer skills) to 4.8 (I want to keep playing soccer). Parents also expressed high levels of overall satisfaction at 4.9. Table 2 provides the results of the satisfac-tion survey by question. The final item on the satisfaction survey asked for general comments. Among the 12 surveys with parent comments provided, 6 participants expressed gratitude, 5 expressed interest in continuing participation, and 1 mentioned that this helped their child become more active.

lESSONS lEARNEDThe PA Liaison and the KCKSA President learned a variety

of lessons throughout this partnership. While writing this article, both were reminded of the importance of a shared vision and mission. Although both individuals wanted the same thing—more youth to be physically active—they took different approaches to pursuing this before their partner-ship. The KCKSA President’s approach was through coaching, organizing, and running community soccer leagues, whereas the PA Liaison’s approach was through implementing a community-wide intervention to address minority health and health disparities.

For the PA Liaison, this working partnership enabled engagement of a hard-to-reach group, namely, Latino families and youth in Kansas City. Early in the collaborative process, the PA Liaison became aware of the complexities of youth soccer in Kansas City, especially among the Latino community. This included a landscape of numerous soccer leagues, with varying levels of competitive focus, requiring a range of fees to participate. The KCKSA President served as a key informant, advising the academic partner throughout this project.19 His decade of experience with the youth soccer community as well as his knowledge on how to carry out these soccer sessions allowed the PA Liaison to surpass a variety of barriers, including the lack of soccer fields and the need for

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table 1. demographics of participants from the soccer sessions (N = 74)

demographic frequency percentCumulative percent

(for ratio data)

Gender Male 52 70.3 Female 22 29.7Age at registration (y) < 6 2 2.7 2.7 6–9 39 52.7 55.4 10–12 22 29.7 85.1 13–15 8 10.8 95.9 > 15 1 1.4 97.3 Not reported or missing 2 2.7 100.0Origin Mexican, Mexican American, Chicano 59 79.7 Another Hispanic, Latino, or Spanish origin 7 9.5 Not of Hispanic, Latino or Spanish origin 6 8.1 Multiple Hispanic, Latino or Spanish origin 1 1.4 Not reported or missing 1 1.4BMI category Obese (BMI: 19.0 – 36.1) 18 24.3 Overweight (BMI: 17.3 – 25.7) 14 18.9 Healthy weight (BMI: 14.2 – 21.5) 20 27.0 Underweight (BMI: 11.2 – 13.8) 7 9.5 Not reported, missing, or undetermineda 15 20.3Reported number of days meeting PA requirement (d) 0 10 13.5 13.5 1 8 10.8 24.3 2 5 6.8 31.1 3 10 13.5 44.6 4 6 8.1 52.7 5 12 16.2 68.9 6 2 2.7 71.6 7 17 23.0 94.6 Not reported or missing 4 5.4 100.0Previous seasons of soccer (n)b 0 36 48.6 48.6 1 9 12.2 60.8 2 11 14.9 75.5 3 5 6.8 82.5 4 1 1.4 83.9 5 2 2.7 86.6 6 2 2.7 89.3 7 1 1.4 90.7 8 1 1.4 92.1 Not reported or missing 6 8.1 100.2Sessions attended (n) 1 7 9.5 9.5 2 13 17.6 27.0 3 8 10.8 37.8 4 14 18.9 56.8 5 10 13.5 70.3 6 11 14.9 85.1 7 9 12.2 97.3 8 2 2.7 100.0

Note. Percent and cumulative percent may not total 100 due to rounding.a “Undetermined” BMI categories are those in which the parent-reported height and weight of the child did not fit the Centers for Disease Control and

Prevention growth curve.b If parents reported their child’s prior seasons of soccer played in years, 1 year = 1 season.

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liability insurance—both resources that the KCKSA President had established for his own youth soccer leagues. The other resources that the KCKSA President provided were soccer equipment and his time. Volunteer coaches and he LHFA Coalition provided all other resources necessary for these soccer sessions.

The KCKSA President also learned a variety of lessons throughout this process. He had an interest in health and social issues, including addressing obesity and engaging more girls in soccer. Working with an academic partner on this effort allowed the KCKSA President address both interests. During the implementation of these soccer sessions, one adaptation the KSKSA President had to make was in working with children who were less experienced and skilled in soccer. This required patience and the need to make adjustments during the soccer sessions, such as extending instruction on certain soccer skills. The KCKSA President also found the level of parent engagement to be greater than usual. The parents of these youth stayed to watch sessions rather than just dropping their child(ren) off. The KCKSA President saw this as great opportunity to speak with parents and share additional opportunities for their child(ren) to play soccer and improve their skill and interest in the game. Because a large portion of the participants had never participated in a season of soccer before (48.6%), parents may have been more interested in watching their children participate. Thirteen of the 22 female participants (59.1%) had a male family member that also participated in these soccer sessions. Allowing both sexes to play together may have enabled parents to involve

their daughters in soccer (along with their sons) without the having to commit to additional time or effort for both sexes to participate in separate soccer sessions.

Our most significant challenge in implementing these sessions involved data collection, which affected our ability to evaluate this initiative. These sessions occurred in nonstruc-tured settings (i.e., a park); the logistics involved in collecting data presented a challenge because we were not able to have all participants seated at one time, or wait in a line. This was complicated by the fact that many parents had limited literacy skills and were unfamiliar with the informed consent process. Initially, we attempted to have interested families pre-register for the sessions online or by contacting the LHFA Coalition community mobilizer by phone. However, no participants pre-registered. Although we had three individuals to help par-ents complete the registration process, we often encountered missing data and ambiguous responses on sign-up forms.

To address this issue, we followed up with parents each session until we were certain all items on sign-up forms were understood and as complete as possible. During future soccer session, we will need additional staff or volunteers (preferably bilingual) who can help to facilitate the sign up process. This could have also helped us address the low overall response rate of the satisfaction survey (35.1%), which presented a limitation to understanding satisfaction with these soccer sessions, as parents who did not attend the final session may have held markedly different perceptions of these soccer ses-sions. Further, we will do a better job in communicating to parents that this data (e.g., data for BMI calculations, data on

table 2. Community-Based soccer session satisfaction ratings

survey item frequency mean

Child items (A little) (A lot)

1. I learned soccer skills. 1 0 3 2 20 4.5

2. I feel more confident in my soccer skills. 1 0 1 6 18 4.5

3. I had fun at soccer. 1 0 0 3 22 4.7

4. I want to keep playing soccer. 1 0 0 0 25 4.8

Parent items

5. I felt Latino Health for All Youth Soccer was good exercise for my child(ren).

(Disagree)0 0 0 1

(Agree)25 4.9

6. How likely are you to sign your child up for Latino Health for All Youth Soccer next year?

(Not Likely)0 0 1 1

(Very Likely)24 4.8

7. Overall, how satisfied are you with Latino Health for All Youth Soccer? (Dissatisfied)0 0 0 1

(Very Satisfied)25 4.9

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physical activity) is important, and that it can help to justify the provision of future soccer sessions (something that many parents asked for on the satisfaction survey).

DISCuSSIONThis article described a partnership between a member

of an academic institution and a community leader to carry out part of a community-determined action plan, across approximately 6 months. Data from the sign-up forms sug-gest that this effort was successful in attracting the prioritized population—Latino youth who were overweight (23.7%) and a disproportionate percentage who were obese (30.5%); a 2009–2010 national probability sample of Hispanic boys and girls aged 2 to 19 found 39.1% to be overweight and 21.2% to be obese.20 Further, data from the satisfaction survey suggested that these soccer sessions were enjoyable to child participants and appreciated by their parents.

The approach to this partnership that enabled this success-ful health promotion effort should be considered. Stoecker21 described three types of roles that academic researchers tend to adopt with community-based participatory research efforts, which he terms as the “initiator,” the “consultant,” and the “collaborator.” In the collaborator approach, “it is recognized that the researcher may have certain technical expertise and the community leader may have knowledge of community needs and perspectives,” which describes the approach the PA Liaison and KCKSA President took (p. 110). Since the conclusion of these community-based soccer sessions, the KCKSA President has led additional efforts that involved working with the LHFA Coalition to promote physical activ-ity though soccer. One example of the KCKSA President’s effort was his leadership to organize what he called “Soccer Day”—a day-long clinic that teaches youth about soccer. The KSKSA President worked with the LHFA Coalition to attract children who were overweight or obese and at risk for chronic disease. The next steps for this academic–community partner-ship involve determining ways for these types of activities to become institutionalized in the community.

This study offers an example of a community health partnership to promote physical activity among Latino youth. Other community organizations have used soccer among Latino communities to promote physical activity.22–24 However, none of these organizations provide in-depth docu-mentation of the partnership development process. Further, this study provides detailed sociodemographic, racial/ethnic, and BMI data to examine the success of this type of health promotion effort (in terms of the families and youth who elected to participate). The present study may inform future efforts to promote soccer-based physical activity, specifically those that involve academic–community partnerships.

Soccer-based physical activity is only one example of an effort that can contribute to the prevention of chronic disease (it was only one of seven action steps on the LHFA Coalition’s physical activity action plan). The LHFA Coalition and other community health organizations must facilitate a variety of efforts across community sectors to affect physical activity on a broader, population level and prevent chronic disease. Community health coalitions may play an important role in promoting opportunities for physical activity. Successful health promotion efforts require strong working partnerships between key stakeholders in the community who bring experi-ence, specific cultural knowledge, and passion for engaging the community. The formation of these partnerships is essential for promoting physical activity and other health behaviors among Latino youth and for preventing chronic disease throughout communities.

ACKNOWlEDGMENTSThis article was supported by grant number R24MD002780

from the National Center on Minority Health and Health Disparities (NCMHD) at the National Institutes of Health. The first author (the PA Liaison) was a doctoral candidate at the University of Kansas when he conducted this study. The authors thank the Latino Health for All Coalition, El Centro, Inc., and Kansas Youth Soccer.

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Developing an Academic–Community Partnership to Promote ...€¦ · WORK-IN-PROGRESS & LESSONS LEARNED Developing an Academic–Community Partnership to Promote Soccer-Based Physical