This study examines how the 8-week Hoosier Sport program impacts cardiovascular disease (CVD) risks by promoting physical activity (PA) among rural, low-income children. Using a human-centered participatory co-design approach, the program aimed to increase PA levels (e.g., total PA, daily steps) in at-risk children. The present study explored the feasibility of the intervention as well as physiological and psychological changes across the intervention using a hybrid type 2 design (a model that evaluates both the effectiveness of an intervention and its implementation in real-world settings). Favorable feasibility indicators like attendance, acceptability, and compliance, with a 23.3% recruitment rate and 94.3% retention rate, were observed. Moreover, participants attended over 80% of sessions across the 8 weeks. Accelerometers (AX3) tracked daily steps and total PA for 7 days before and after the intervention, revealing increased PA levels throughout. At post-intervention, notable improvements were observed in psychological factors such as autonomy, social competence, and global self-worth. This study highlights the importance of tailored PA interventions in schools, emphasizing their potential to improve PA levels among rural, low-income children.

Sport-based youth development programs, delivered through campus–community partnerships, can create impactful experiences for college students, meet university objectives, and improve the health of children in under-resourced rural communities. This study aimed to pilot test intervention mapping (IM), a systematic approach to intervention development and implementation, to refine the Hoosier Sport intervention, which is a local public health initiative that utilizes the Obesity-Related Behavioral Intervention Trials (ORBITs) model to improve physical activity in middle school children. The IM process, which included a diverse IM planning and advisory group of university representatives and local schools, was guided by self-determination theory (SDT) and social cognitive theory (SCT) and followed four steps: Logic Model of the Problem, Logic Model of Change, Program Design, and Program Production. Using SDT and SCT, we identified our personal determinants as autonomy, competence, and relatedness, while our environmental determinants were role-modeling and sports equipment access. We then created change methods and practical applications for refining and implementing our intervention and gathered pilot test data to assess the feasibility of the intervention. The IM process provided a more robust and evidence-based approach to intervention design and production, while involving stakeholders to foster meaningful collaboration and increase program success. By using IM in program development, public health interventions that promote youth development through sport will likely be more easily scaled up.

Cardiovascular disease remains the leading cause of death in the United States, with rural communities experiencing elevated risk. Youth in rural settings are particularly vulnerable, reporting worse health outcomes than their urban peers. The growing influence of social media has added complexity to adolescent health behaviors, particularly among youth experiencing challenges with physical and mental well-being. This qualitative study presents findings from a co-design initiative conducted with rural middle school students to examine adolescents’ views on body image, social media use, and engagement in physical activity, and to inform the development of the Hoosier Sport Re-Social intervention. Fourteen middle school students (grades 7–8) from a rural community participated in a structured co-design process spanning five sessions over nine weeks. A deductive thematic analysis was employed using Basic Psychological Needs Theory (BPNT) and Social Comparison Theory (SOCO) as guiding frameworks.

Many physical activity (PA) interventions have been designed, yet few are scaled up or sustained. Additional refinement of implementation strategies may improve adoption, implementation, and maintenance of PA interventions. One such intervention is Hoosier Sport, a sport-based program partnering with middle schools to increase youth PA engagement. The objective of the present study was to (1) retrospectively use an implementation mapping approach to identify determinants, compile methods of change, and evaluate outcomes and (2) to synthesize results of implementation mapping within the context of a pilot study of the Hoosier Sport implementation strategy. We conducted a retrospective study of Hoosier Sport using implementation mapping to iteratively develop a comprehensive implementation strategy. Implementation mapping occurred with a campus-community team composed of researchers, college students, and community partners. A pilot study of Hoosier Sport served as the input and exemplified retrospective use of implementation mapping in context. The process identified key strengths (e.g., high fidelity and program interest) and weaknesses (e.g., reproducibility of evaluation and training materials, limited theoretical rationale), and used them to pinpoint opportunities for refinement (e.g., integration of positive youth development into sport lessons, connecting theoretical constructs to performance objectives). Our findings demonstrate a pragmatic example of the utility of implementation mapping, while also contributing to the literature by providing a unique assessment of past research combined with future implementation planning.

Background: As demands grow for inclusivity and representation in the workplace, schools, and various other settings, an increased focus has been placed on the lack of diversity in health multimedia. Specifically, textbooks utilized in medical school curriculum often lack photos that depict diverse skin tones, body shapes, sexes, and genders. However, past studies did not analyze the most recent clinical textbooks or emerging clinical video databases. This research focuses on examining patient and clinician clinical diversity in two clinical education resources: Bates’ Guide to Physical Examination and History Taking 13th edition (2021 e-text) and Bates’ Visual Guide to Physical Examination (video series). Methods: We developed a coding scheme for photos and videos based on previous literature that analyzes age, gender, sex, health state, skin tone, hair texture, body composition, SES, and the presence of tattoos and/or piercings. The coding scheme underwent 2 rounds of testing and subsequent modifications with a smaller sample. The final validated scheme was used to assess 576 photos and videos. Results: Of the photos and videos, only 18% exhibited individuals with curly or wavy hair, 1% included individuals with a darker skin tone, and 0.3% of individuals had a larger body type. There were no intersex or nonbinary individuals included. None of the individuals had tattoos, and all the piercings displayed were earlobe piercings, with all but 1 of the individuals being female. Conclusions/Implications: These findings reflect conclusions from previous studies, demonstrating that diversity and representation in medical textbooks can still be improved. Although there was some diversity in the photos and videos, several of the same models were used throughout the sources, which limits the application of such images to a range of diverse individuals. By advancing the diversity of medical school curriculum materials, students can provide more competent and compassionate care.