Acceptability and perceived feasibility of the KaziKidz health promotion intervention among educators and caregivers in schools from South Africa: a qualitative descriptive study

BACKGROUND

Despite the uncontested benefits of physical activity, its promotion lags behind in the public health agenda of low- and middle-income countries (LMICs). School-based interventions are promising strategies to foster health during childhood, but evidence of their effectiveness is limited and inconclusive for LMICs. Thus, further investigation is needed on contextual factors associated with intervention implementation in low-resource settings. We studied the acceptability and feasibility of the KaziKidz health promotion intervention and its implementation and make recommendations to improve future adoption and sustainability.

METHODS

KaziKidz was implemented in four primary schools from low-income communities in South Africa in 2019. Semi-structured interviews with four school principals, three focus group interviews with 16 educators, and another three with 16 caregivers were conducted between October and November 2021. Participants were purposively recruited. Interview transcripts were analyzed via thematic analysis using a deductive and reflexive approach.

RESULTS

Three main themes influencing intervention implementation and adoption were identified: (1) prioritizing teachers' needs (2), integrating the program into the school structure, and (3) creating opportunities in the community. Supporting recommendations included: (theme 1) adopting intervention approaches that are inclusive of educators' health and providing them with capacity development and external support; (theme 2) fostering a feeling of ownership and belonging among school stakeholders to adapt interventions to specific resources and needs; and (theme 3) raising community awareness to encourage individuals to claim power over and actively engage with the program.

CONCLUSIONS

Comprehensive interventions comprising health support, adequate training, and ongoing assistance for educators combined with school-wide and community outreach actions seeking to strengthen program ownership, accountability, and engagement can enhance uptake of school-based interventions and long-term maintenance.

TRIAL REGISTRATION

ISRCTN15648510, registered on 17/04/2020.

The beautiful game bringing families together: children's and parents' experiences of a family football programme

Children are consistently not achieving recommended levels of physical activity (PA) despite it being a compulsory requirement of the national curriculum in England. Fruit and vegetable consumption also falls below recommended levels for both adults and children. With school PA increasingly being outsourced, football foundations (linked to professional football clubs) are now prominent providers of children's PA. However, research exploring coach-led interventions in schools is limited with a particular gap in knowledge surrounding the qualitative experiences of children and parents/carers. The current study therefore aimed to explore the experiences of children and parents engaged in a 6-week family football programme. Family football is a free after-school programme engaging parents/carers and their children, to enhance their engagement in PA and healthy nutritional habits. A purposive sample of parents/carers and their children (N = 36) took part in qualitative focus groups to discuss their experiences of participating in family football. Reflexive thematic analysis revealed two themes: (i) healthy lifestyle facilitators and challenges and (ii) added value of programme participation. Children discussed programme content around nutritional practices and parents/carers discussed examples of where nutritional practices had improved at home, though some parents/carers and children highlighted persistent barriers to health improvement. Both parents/carers and children reflected on how the programme had enabled them to spend dedicated time with one another. The findings emphasize the significance of direct parent/carer involvement in school-based health interventions as well as the value of coach-led interventions in the enhancement of PA enjoyment, nutritional knowledge and connectedness of families within schools.

Barriers and Facilitators to Physical Activity and FMS in Children Living in Deprived Areas in the UK: Qualitative Study

Using the socio-ecological model, this qualitative study aimed to explore teachers’ perspectives on the barriers and facilitators to Fundamental Movement Skills (FMS) and physical activity engagement in children living in deprived areas in the UK. A purposive sample of 14 primary school teachers participated in semi-structured focus groups drawn from schools situated in lower SES wards and ethnically diverse areas in Central England. Thematic analysis of transcripts identified multiple and interrelated factors across all levels of the socio-ecological model for barriers to FMS and PA (i.e., intrapersonal, interpersonal, organisational, community and policy). Facilitators at three levels of influence were found (i.e., intrapersonal, interpersonal and organisational). We conclude, barriers and enablers to the PA and FMS in children from ethnically diverse backgrounds living in deprived areas are multifactorial and interrelated. At a school level, initiatives to increase PA and develop the FMS needed to be active are likely to be ineffective unless the barriers are addressed at all levels and considered more holistically with their complexity. Multi-disciplinary solutions are needed across sectors given the range of complex and interrelated factors.

Implementation of physical education policies in elementary and middle schools in Mexico

School-based physical education (PE) is part of a whole-of-school approach to promote physical activity and its benefits for health. However, there are important gaps between the design and implementation of PE policies. This study aimed to describe the implementation fidelity and feasibility of school-based PE policies in Mexico. Data on implementation fidelity and feasibility was collected using semi-structured interviews (n = 17) and focus groups (n = 11) with high- (n = 7) and local-level (n = 122) stakeholders. We conducted a qualitative and triangulation content analysis. Feedback sessions were carried out with some participants. Barriers for implementation fidelity and feasibility of PE policies included inconsistencies in the time allocated to PE across schools and regions in the country; inconsistencies between teachers' planning of PE classes and the actual class; a wide diversity of professional profiles among PE teachers; a limited number of PE professors, materials and facilities. To address these situations, some PE teachers were able to modify lesson plans and to design PE materials made from recycled materials. In conclusion, the current way in which school-based PE policies are being implemented in Mexico hinder PE from playing a major role in promoting physical activity among children and adolescents.

Using a multi-stakeholder experience-based design process to co-develop the Creating Active Schools Framework

BACKGROUND

UK and global policies recommend whole-school approaches to improve childrens' inadequate physical activity (PA) levels. Yet, recent meta-analyses establish current interventions as ineffective due to suboptimal implementation rates and poor sustainability. To create effective interventions, which recognise schools as complex adaptive sub-systems, multi-stakeholder input is necessary. Further, to ensure 'systems' change, a framework is required that identifies all components of a whole-school PA approach. The study's aim was to co-develop a whole-school PA framework using the double diamond design approach (DDDA).

METHODOLOGY

Fifty stakeholders engaged in a six-phase DDDA workshop undertaking tasks within same stakeholder (n = 9; UK researchers, public health specialists, active schools coordinators, headteachers, teachers, active partner schools specialists, national organisations, Sport England local delivery pilot representatives and international researchers) and mixed (n = 6) stakeholder groupings. Six draft frameworks were created before stakeholders voted for one 'initial' framework. Next, stakeholders reviewed the 'initial' framework, proposing modifications. Following the workshop, stakeholders voted on eight modifications using an online questionnaire.

RESULTS

Following voting, the Creating Active Schools Framework (CAS) was designed. At the centre, ethos and practice drive school policy and vision, creating the physical and social environments in which five key stakeholder groups operate to deliver PA through seven opportunities both within and beyond school. At the top of the model, initial and in-service teacher training foster teachers' capability, opportunity and motivation (COM-B) to deliver whole-school PA. National policy and organisations drive top-down initiatives that support or hinder whole-school PA. To the authors' knowledge, this is the first time practitioners, policymakers and researchers have co-designed a whole-school PA framework from initial conception. The novelty of CAS resides in identifying the multitude of interconnecting components of a whole-school adaptive sub-system; exposing the complexity required to create systems change. The framework can be used to shape future policy, research and practice to embed sustainable PA interventions within schools. To enact such change, CAS presents a potential paradigm shift, providing a map and method to guide future co-production by multiple experts of PA initiatives 'with' schools, while abandoning outdated traditional approaches of implementing interventions 'on' schools.