Conmigo: a multi-level mother-daughter physical activity intervention for pre-adolescent girls

Fewer girls meet current physical activity (PA) guidelines, with lower rates observed among those from lower-income backgrounds and not socialized to engage in regular physical activity, contributing to widespread differences in health outcomes. PA interventions in the pre-pubertal phase (ages 8-11) can help mitigate the sharp decline in PA during adolescence. Multilevel interventions involving mothers and their preadolescent daughters hold great promise; however, prior studies have lacked objective outcomes and long-term follow-up. Our team recently completed an R21 pilot feasibility trial and additional formative research suggesting improvements among mother-daughter dyads following a 12-week multilevel intervention. Building on these findings, we will conduct a two-arm cluster RCT in 18 schools serving girls aged 8-11 to test our newly developed multi-level intervention compared to a similar attention control nutrition program, both delivered by YMCA staff. Using a Hybrid-Type 1 effectiveness implementation design, we will use mixed methods to evaluate both effectiveness and implementation outcomes. At the individual level, girls will attend PA classes and learn behavioral strategies to support daily PA habits. At the family level, mothers will be engaged in the intervention to support their daughters through PA parenting strategies and improved family communication around health behaviors. Multilevel implementation strategies aim to increase community organizations' capacity to implement the intervention and strengthen partnerships between 9 YMCAs and 18 schools. PA will be measured by accelerometry in the daughters and mothers (n=216 dyads) at baseline, 3, 9, and 15 months. Interviews will be conducted with participants, program staff, and school and YMCA leaders to identify benefits, barriers, and facilitators to future widespread adoption. Specific Aims are: To test the effectiveness of the intervention on daughters' MVPA over time (Aim 1); evaluate individual (e.g., mothers’ MVPA) and family level (e.g., mother-daughter communication) mechanisms of change and their bidirectional effects (Aim 2); and use qualitative and quantitative methods to evaluate implementation outcomes and barriers and facilitators of these outcomes (Aim 3). This study will improve the rigor of research on mother-daughter dyads where the influence of family may be strong. This study will advance implementation science by evaluating strategies to improve community coalitions by partnering in program implementation.