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Bachouri-Muniesa H, Lhuisset L, Aibar A, Fabre N, Asún-Dieste S, Bois JE, Verloigne M, Clemente JAJ, Dubertrand L, Ribeiro JC, García Bengoechea E, Ibor-Bernalte E, Zaragoza J. Dissemination, Implementation, and Evaluation of an Effective School-Based Intervention to Promote Physical Activity in Adolescents: A Study Protocol. Behav Sci (Basel) 2023; 13:bs13040290. [PMID: 37102804 PMCID: PMC10135457 DOI: 10.3390/bs13040290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023] Open
Abstract
Adolescents around the world do not engage in sufficient physical activity and the Spanish context is no exception. Understanding the educational context as a complex system, school-based multi-level and multi-component interventions seem to be an effective strategy to reverse this trend. Moreover, a co-creational approach seems to facilitate the mobilization of community partnerships and the engagement of stakeholders in the intervention process. This study aims to describe the dissemination, implementation, and evaluation process of an effective school-based intervention program in another setting using the replicating effective programs framework and a co-participatory approach. This study will be conducted in two Spanish secondary schools located in the region of Aragon (experimental vs. control school) in a sample of adolescents in the second grade (13–14 years old). To evaluate the effectiveness, different health behaviors such as physical activity, sleep, sedentary time with screens, nutrition, and psychosocial variables will be quantitatively measured at baseline and after the implementation of the intervention. Qualitative methods will also be used to better understand the implementation process and the co-creation approach, as well as to provide insights into the sustainability of the intervention program. The current study has the potential to provide strong information about the dissemination, implementation, and evaluation process of school-based programs to promote healthy behaviors among adolescents.
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Smit MS, Boelens M, Mölenberg FJM, Raat H, Jansen W. The long-term effects of primary school-based obesity prevention interventions in children: A systematic review and meta-analysis. Pediatr Obes 2023; 18:e12997. [PMID: 36545748 PMCID: PMC10078512 DOI: 10.1111/ijpo.12997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 11/07/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION This systematic review and meta-analysis investigate the long-term effects of primary school-based obesity prevention interventions on body-mass index (and z-scores), waist circumference (and z-scores) and weight status. METHODS Four databases were searched for studies from date of inception until June 8th, 2021. We included randomized controlled trials (RCT) and non-RCTs investigating effects ≥12 months post-intervention of primary school-based interventions with intervention duration ≥6 months and containing a diet and/or physical activity component on outcomes of interest. Articles were assessed on risk of bias and methodological quality by RoB2 and ROBINS-I. Meta-analysis was performed and results were narratively summarized. Evidence quality was assessed with GRADE. RESULTS Nineteen studies were included, 9 were pooled in a meta-analysis. No long-term effects were found on body-mass index (+0.06 kg/m2 ; CI95% = -0.38, 0.50; I2 = 66%), body-mass index z-scores (-0.08; CI95% = -0.20, 0.04; I2 = 36%), and waist circumference (+0.57 cm; CI95% = -0.62, 1.75; I2 = 13%). Non-pooled studies reported mixed findings regarding long-term effects on body-mass index, body-mass index z-scores and weight status, and no effects on waist circumference and waist circumference z-scores. Evidence certainty was moderate to very low. DISCUSSION No clear evidence regarding long-term effects of primary school-based interventions on obesity-related outcomes was found. Recommendations for further research and policy are discussed. Prospero registration ID: CRD42021240446.
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Affiliation(s)
- Michel S Smit
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Mirte Boelens
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Famke J M Mölenberg
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wilma Jansen
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.,Department of Social Development, City of Rotterdam, Rotterdam, the Netherlands
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Helme ZE, Morris JL, Nichols J, Chalkley AE, Bingham DD, McLoughlin GM, Bartholomew JB, Daly-Smith A. Assessing the Impacts of Creating Active Schools on Organisational Culture for Physical Activity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16950. [PMID: 36554831 PMCID: PMC9778943 DOI: 10.3390/ijerph192416950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND National and international guidance recommends whole-school approaches to physical activity, but there are few studies assessing their effectiveness, especially at an organisational level. This study assesses the impact of the Creating Active School's (CAS) programme on organisational changes to physical activity provision. METHODS In-school CAS leads completed a 77-item questionnaire assessing school-level organisational change. The questionnaire comprised 19 domains aligned with the CAS framework and COM-B model of behaviour change. Wilcoxon Signed Rank Tests assessed the pre-to-nine-month change. RESULTS >70% of schools (n = 53) pre-CAS had inadequate whole-school physical activity provision. After nine months (n = 32), CAS had a significant positive effect on organisational physical activity. The positive change was observed for: whole-school culture and ethos, teachers and wider school staff, academic lessons, physical education (PE) lessons, commute to/from school and stakeholder behaviour. CONCLUSIONS This study provides preliminary evidence that CAS is a viable model to facilitate system-level change for physical activity in schools located within deprived areas of a multi-ethnic city. To confirm the results, future studies are required which adopt controlled designs combined with a holistic understanding of implementation determinants and underlying mechanisms.
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Affiliation(s)
- Zoe E. Helme
- Faculties of Life Sciences and Health Studies, University of Bradford, Richmond Road, Bradford BD7 IDP, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford BD9 6TP, UK
| | - Jade L. Morris
- Faculties of Life Sciences and Health Studies, University of Bradford, Richmond Road, Bradford BD7 IDP, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford BD9 6TP, UK
| | - Joanna Nichols
- Faculties of Life Sciences and Health Studies, University of Bradford, Richmond Road, Bradford BD7 IDP, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford BD9 6TP, UK
| | - Anna E. Chalkley
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford BD9 6TP, UK
- Centre for Physically Active Learning, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, 5063 Bergen, Norway
| | - Daniel D. Bingham
- Faculties of Life Sciences and Health Studies, University of Bradford, Richmond Road, Bradford BD7 IDP, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford BD9 6TP, UK
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford BD9 6RJ, UK
| | - Gabriella M. McLoughlin
- College of Public Health, Temple University, Philadelphia, PA 19140, USA
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University, St. Louis, MO 63130, USA
| | - John B. Bartholomew
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX 78712, USA
| | - Andrew Daly-Smith
- Faculties of Life Sciences and Health Studies, University of Bradford, Richmond Road, Bradford BD7 IDP, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford BD9 6TP, UK
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Physical Activity Patterns Among Adolescents in Latin America and the Caribbean Region. J Phys Act Health 2022; 19:607-614. [PMID: 35981714 PMCID: PMC7613474 DOI: 10.1123/jpah.2022-0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/28/2022] [Accepted: 07/20/2022] [Indexed: 11/18/2022]
Abstract
Background Physical activity implies different patterns, but studies focused on physical inactivity and sedentary behaviors. This study aimed to estimate the prevalence of different physical activity patterns among adolescents in Latin America and the Caribbean region (LAC). Methods Pooled analysis of the most updated data of the Global School-based Student Health surveys. Age-standardized prevalence of four outcomes was estimated using information of last 7 days: physical inactivity (0 days of at least 60min/day), insufficient physical activity (<5 days of at least 60min/day), commuting physical activity (≥5 days of walking or biking to school), and sedentary behavior (≥3 hours/day of sitting time). Results A total of 132,071 records (33 countries) was analyzed, mean age 14.6 years, 51.2% girls. Pooled age-standardized prevalence of physical inactivity was 22.3%, greater among females (25.4%) than males (19.1%); insufficient physical activity was present in 67.7%, greater in females (73.6%) than males (61.5%); commuting physical activity was seen in 43.7%, similar between females (43.3%) and males (44.1%); and sedentary behavior was present in 43.4%, greater among females (45.4%) than males (41.3%). Conclusions In LAC, almost two thirds of adolescents are insufficiently physically active, ≥40% are sedentary, and ≥20% are physically inactive, more frequent among girls than boys.
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Tay GWN, Chan MJ, Kembhavi G, Lim J, Rebello SA, Ng H, Lin C, Shek LP, Lança C, Müller-Riemenschneider F, Chong MFF. Children's perceptions of factors influencing their physical activity: a focus group study on primary school children. Int J Qual Stud Health Well-being 2021; 16:1980279. [PMID: 34661503 PMCID: PMC8525992 DOI: 10.1080/17482631.2021.1980279] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose Establishing healthy lifestyle behaviours in primary school children is important, as these behaviours are likely to track into adulthood. This study aimed to explore the factors influencing physical activity (PA) in primary school children through their perspectives. Approach Eleven focus group discussions and one interview were conducted with 52 children (n = 29 girls) aged 9–12 years from two primary schools in Singapore. Data analyses were conducted using thematic analysis, deductively following the socio-ecological model (SEM) and inductively for themes at each SEM level. Results At individual level, children’s perceived enjoyment, health benefits and expectation of rewards motivated them to engage in PA, while time constraints and their apathy towards PA hindered PA engagement. Children’s PA occasions at home were reported to be influenced by parental permission, priorities and availability, and the availability of preferred peers. Physical environmental factors such as opportunities for PA in school, access to facilities for PA and weather influenced children’s time spent on PA and the types of activities they engaged in. Conclusion This study summarized some factors that children have reported to influence their PA behaviour. These findings could help inform future interventions aimed at promoting PA among primary school children in Singapore.
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Affiliation(s)
| | - Mei Jun Chan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Jubilee Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Salome A Rebello
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Hazyl Ng
- Health Promotion Board, Singapore
| | | | - Lynette P Shek
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | | | | | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
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Smit MS, Raat H, Mölenberg F, Wolfers MEG, Bannink R, Jansen W. Study protocol for the evaluation of long-term effects of the school-based obesity prevention program Lekker Fit! ('enjoy being fit'): a retrospective, controlled design. BMJ Open 2021; 11:e046940. [PMID: 34389567 PMCID: PMC8365823 DOI: 10.1136/bmjopen-2020-046940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Preventive interventions to reduce overweight and obesity in childhood and adolescence are studied on their effectiveness worldwide. A number with positive results. However, long-term effects of these interventions and their potentially wider influence on well-being and health have been less studied. This study aims to evaluate the long-term effects of a multicomponent intervention in elementary school children targeting individual behaviour as well as environment (Lekker Fit!). The primary outcomeis body mass index and the secondary outcomes are waist circumference, weight status, physical fitness, lifestyle, psychosocial health and academic performance. METHODS AND ANALYSIS In a naturalistic effect evaluation with a retrospective, controlled design adolescents in secondary schools, from intervention and non-intervention elementary schools, will be compared on a wide set of outcome variables. Data will be collected by questionnaires and through anthropometric and fitness measurements by trained physical education teachers and research assistants. Baseline data consist of measurements from the adolescents at the age of 5 years old and are gathered from preventive youth healthcare records, from before the intervention took place. Multilevel regression models will be used and adjusted for baseline measurements and potential confounding variables on the individual and environmental level. Furthermore, propensity scores will be applied. ETHICS AND DISSEMINATION The study has been approved by the Medical Research Ethics Committee of the Erasmus Medical Centre, Rotterdam, The Netherlands (permission ID: MEC-2020-0644). Study findings will be disseminated in peer-reviewed journals and by conference presentations. TRIAL REGISTRATION NUMBER NL8799. Pre-results.
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Affiliation(s)
| | - Hein Raat
- Public Health, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Rienke Bannink
- Policy and Research, CJG Rijnmond, Rotterdam, The Netherlands
| | - Wilma Jansen
- Public Health, Erasmus MC, Rotterdam, The Netherlands
- Social Development, Gemeente Rotterdam, Rotterdam, The Netherlands
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Considerations for Individual-Level Versus Whole-School Physical Activity Interventions: Stakeholder Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147628. [PMID: 34300080 PMCID: PMC8304121 DOI: 10.3390/ijerph18147628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 01/15/2023]
Abstract
Strategies to address declining physical activity levels among children and adolescents have focused on ‘individual-level’ approaches which often fail to demonstrate impact. Recent attention has been on an alternative ‘whole-school’ approach to increasing physical activity that involves promoting physical activity throughout all aspects of the school environment. There is, however, a lack of evidence on how whole-school physical activity approaches could be implemented in the UK. This qualitative study explored perspectives of key stakeholders on potential reasons for the lack of impact of individual-level school-based interventions on children’s physical activity, and key considerations for adopting a whole-school approach. Nineteen semi-structured interviews were conducted with a range of stakeholders involved in the implementation of physical activity programmes in UK schools. Data were analysed using an inductive approach. Respondents suggested that individual-level school-based interventions to increase physical activity often failed to consult end users in the design and were typically implemented in environments unsupportive of long-term change. They subsequently outlined specific barriers and key facilitators for the adoption and implementation of whole-school approaches in UK settings and recommended a shift in research foci towards building an evidence base around educational outcomes and whole-school implementation insights.
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Mooses K, Taveter K. Agent-Oriented Goal Models in Developing Information Systems Supporting Physical Activity Among Adolescents: Literature Review and Expert Interviews. J Med Internet Res 2021; 23:e24810. [PMID: 34009127 PMCID: PMC8173397 DOI: 10.2196/24810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/28/2020] [Accepted: 04/02/2021] [Indexed: 01/18/2023] Open
Abstract
Background Information and communication technologies (ICTs) are becoming increasingly popular in supporting the fight against low physical activity (PA) levels among adolescents. However, several ICT solutions lack evidence-based content. Therefore, there is a need to identify important features that have the potential to efficiently and consistently support the PA of adolescents using ICT solutions. Objective This study aims to create evidence-based models of requirements for ICT solutions supporting PA by combining scientific evidence from literature and health experts. In addition, we test the suitability of agent-oriented goal models in this type of modeling process. Methods A literature search of PubMed, Web of Science, and Scopus databases was conducted to identify evidence-based functional, quality, and emotional goals that have previously been proven to be relevant in supporting PAs among youth using ICT solutions. The identified goals were presented in the form of goal models. These models were used to collaborate with health experts to receive their input on the topic and suggestions for improvement. The initial goal models were improved based on the feedback from the experts. Results The results indicated that agent-oriented goal modeling is a suitable method for merging information from the literature and experts. One strength of agent-oriented goal models is that they present emotional requirements together with quality and functional requirements. Another strength is the possibility of presenting results from a literature review in a systematic manner and using them thereafter in the communication process with stakeholders. Agent-oriented goal models that were created were easy to understand for health experts without previous experience in requirements engineering, which facilitates and supports collaboration with nontechnical stakeholders. Conclusions The proposed agent-oriented goal models effectively merged information from scientific literature and experts in the field and presented early functional, quality, and emotional requirements in a holistic and coherent manner. We believe that the created models have high potential to help requirements engineers and developers to provide more efficient ICT solutions that support PA among adolescents in the future.
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Affiliation(s)
- Kerli Mooses
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Kuldar Taveter
- Institute of Computer Science, University of Tartu, Tartu, Estonia
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Corder KL, Brown HE, Croxson CHD, Jong ST, Sharp SJ, Vignoles A, Wilkinson PO, Wilson ECF, van Sluijs EMF. A school-based, peer-led programme to increase physical activity among 13- to 14-year-old adolescents: the GoActive cluster RCT. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Adolescent physical activity levels are low and are associated with rising disease risk and social disadvantage. The Get Others Active (GoActive) intervention was co-designed with adolescents and teachers to increase physical activity in adolescents.
Objective
To assess the effectiveness and cost-effectiveness of the school-based GoActive programme in increasing adolescents’ moderate-to-vigorous physical activity.
Design
A cluster randomised controlled trial with an embedded mixed-methods process evaluation.
Setting
Non-fee-paying schools in Cambridgeshire and Essex, UK (n = 16). Schools were computer randomised and stratified by socioeconomic position and county.
Participants
A total of 2862 Year 9 students (aged 13–14 years; 84% of eligible students).
Intervention
The iteratively developed feasibility-tested refined 12-week intervention trained older adolescents (mentors) and in-class peer leaders to encourage classes to undertake two new weekly activities. Mentors met with classes weekly. Students and classes gained points and rewards for activity in and out of school.
Main outcome measures
The primary outcome was average daily minutes of accelerometer-assessed moderate-to-vigorous physical activity at 10 months post intervention. Secondary outcomes included accelerometer-assessed activity during school, after school and at weekends; self-reported physical activity and psychosocial outcomes; cost-effectiveness; well-being and a mixed-methods process evaluation. Measurement staff were blinded to allocation.
Results
Of 2862 recruited participants, 2167 (76%) attended 10-month follow-up measurements and we analysed the primary outcome for 1874 (65.5%) participants. At 10 months, there was a mean decrease in moderate-to-vigorous physical activity of 8.3 (standard deviation 19.3) minutes in control participants and 10.4 (standard deviation 22.7) minutes in intervention participants (baseline-adjusted difference –1.91 minutes, 95% confidence interval –5.53 to 1.70 minutes; p = 0.316). The programme cost £13 per student compared with control. Therefore, it was not cost-effective. Non-significant indications of differential impacts suggested detrimental effects among boys (boys –3.44, 95% confidence interval –7.42 to 0.54; girls –0.20, 95% confidence interval –3.56 to 3.16), but favoured adolescents from lower socioeconomic backgrounds (medium/low 4.25, 95% confidence interval –0.66 to 9.16; high –2.72, 95% confidence interval –6.33 to 0.89). Mediation analysis did not support the use of any included intervention components to increase physical activity. Some may have potential for improving well-being. Students, teachers and mentors mostly reported enjoying the GoActive intervention (56%, 87% and 50%, respectively), but struggled to conceptualise their roles. Facilitators of implementation included school support, embedding a routine, and mentor and tutor support. Challenges to implementation included having limited school space for activities, time, and uncertainty of teacher and mentor roles.
Limitations
Retention on the primary outcome at 10-month follow-up was low (65.5%), but we achieved our intended sample size, with retention comparable to similar trials.
Conclusions
A rigorously developed school-based intervention (i.e. GoActive) was not effective in countering the age-related decline in adolescent physical activity. Overall, this mixed-methods evaluation provides transferable insights for future intervention development, implementation and evaluation.
Future work
Interdisciplinary research is required to understand educational setting-specific implementation challenges. School leaders and authorities should be realistic about expectations of the effect of school-based physical activity promotion strategies implemented at scale.
Trial registration
Current Controlled Trials ISRCTN31583496.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 6. See the NIHR Journals Library website for further project information. This work was additionally supported by the Medical Research Council (London, UK) (Unit Programme number MC_UU_12015/7) and undertaken under the auspices of the Centre for Diet and Activity Research (Cambridge, UK), a UK Clinical Research Collaboration Public Health Research Centre of Excellence. Funding from the British Heart Foundation (London, UK), Cancer Research UK (London, UK), Economic and Social Research Council (Swindon, UK), Medical Research Council, the National Institute for Health Research (Southampton, UK) and the Wellcome Trust (London, UK), under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged (087636/Z/08/Z; ES/G007462/1; MR/K023187/1). GoActive facilitator costs were borne by Essex and Cambridgeshire County Councils.
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Affiliation(s)
- Kirsten L Corder
- Centre for Diet and Activity Research and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Helen E Brown
- Centre for Diet and Activity Research and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Caroline HD Croxson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stephanie T Jong
- Centre for Diet and Activity Research and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Stephen J Sharp
- Centre for Diet and Activity Research and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Anna Vignoles
- Faculty of Education, University of Cambridge, Cambridge, UK
| | - Paul O Wilkinson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Edward CF Wilson
- Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Esther MF van Sluijs
- Centre for Diet and Activity Research and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Reach, Recruitment, Dose, and Intervention Fidelity of the GoActive School-Based Physical Activity Intervention in the UK: A Mixed-Methods Process Evaluation. CHILDREN-BASEL 2020; 7:children7110231. [PMID: 33212854 PMCID: PMC7698468 DOI: 10.3390/children7110231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 11/16/2022]
Abstract
School-based multi-component physical activity (PA) promotion is advocated; however, research has indicated that a multi-component approach may not always be effective at increasing adolescent PA. Evaluation of the GoActive 12-week multi-component school-based intervention showed no effect on adolescent PA. A mixed-methods process evaluation was embedded to facilitate greater understanding of the results, to elicit subgroup perceptions, and to provide insight into contextual factors influencing intervention implementation. This paper presents the reach, recruitment, dose, and fidelity of GoActive, and identifies challenges to implementation. The process evaluation employed questionnaires (1543 Year 9s), individual interviews (16 Year 9s; 7 facilitators; 9 contact teachers), focus groups (48 Year 9s; 58 mentors), alongside GoActive website analytics and researcher observations. GoActive sessions reached 39.4% of Year 9s. Intervention satisfaction was relatively high for mentors (87.3%) and facilitators (85.7%), but lower for Year 9s (59.5%) and teachers (50%). Intervention fidelity was mixed within and between schools. Mentorship was the most implemented component. Factors potentially contributing to low implementation included ambiguity of the roles subgroups played within intervention delivery, Year 9 engagement, institutional support, and further school-level constraints. Multiple challenges and varying contextual considerations hindered the implementation of GoActive in multiple school sites. Methods to overcome contextual challenges to implementation warrant in-depth consideration and innovative approaches.
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Corder K, Sharp SJ, Jong ST, Foubister C, Brown HE, Wells EK, Armitage SM, Croxson CHD, Vignoles A, Wilkinson PO, Wilson ECF, van Sluijs EMF. Effectiveness and cost-effectiveness of the GoActive intervention to increase physical activity among UK adolescents: A cluster randomised controlled trial. PLoS Med 2020; 17:e1003210. [PMID: 32701954 PMCID: PMC7377379 DOI: 10.1371/journal.pmed.1003210] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/01/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Less than 20% of adolescents globally meet recommended levels of physical activity, and not meeting these recommended levels is associated with social disadvantage and rising disease risk. The determinants of physical activity in adolescents are multilevel and poorly understood, but the school's social environment likely plays an important role. We conducted a cluster randomised controlled trial to assess the effectiveness of a school-based programme (GoActive) to increase moderate-to-vigorous physical activity (MVPA) among adolescents. METHODS AND FINDINGS Non-fee-paying, co-educational schools including Year 9 students in the UK counties of Cambridgeshire and Essex were eligible for inclusion. Within participating schools (n = 16), all Year 9 students were eligible and invited to participate. Participants were 2,862 13- to 14-year-olds (84% of eligible students). After baseline assessment, schools were computer-randomised, stratified by school-level pupil premium funding (below/above county-specific median) and county (control: 8 schools, 1,319 participants, mean [SD] participants per school n = 165 [62]; intervention: 8 schools, 1,543 participants, n = 193 [43]). Measurement staff were blinded to allocation. The iteratively developed, feasibility-tested 12-week intervention, aligned with self-determination theory, trained older adolescent mentors and in-class peer-leaders to encourage classes to conduct 2 new weekly activities. Students and classes gained points and rewards for engaging in any activity in or out of school. The primary outcome was average daily minutes of accelerometer-assessed MVPA at 10-month follow-up; a mixed-methods process evaluation evaluated implementation. Of 2,862 recruited participants (52.1% male), 2,167 (76%) attended 10-month follow-up measurements; we analysed the primary outcome for 1,874 participants (65.5%). At 10 months, there was a mean (SD) decrease in MVPA of 8.3 (19.3) minutes in the control group and 10.4 (22.7) minutes in the intervention group (baseline-adjusted difference [95% confidence interval] -1.91 minutes [-5.53 to 1.70], p = 0.316). The programme cost £13 per student compared with control; it was not cost-effective. Overall, 62.9% of students and 87.3% of mentors reported that GoActive was fun. Teachers and mentors commented that their roles in programme delivery were unclear. Implementation fidelity was low. The main methodological limitation of this study was the relatively affluent and ethnically homogeneous sample. CONCLUSIONS In this study, we observed that a rigorously developed school-based intervention was no more effective than standard school practice at preventing declines in adolescent physical activity. Interdisciplinary research is required to understand educational-setting-specific implementation challenges. School leaders and authorities should be realistic about expectations of the effect of school-based physical activity promotion strategies implemented at scale. TRIAL REGISTRATION ISRCTN Registry ISRCTN31583496.
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Affiliation(s)
- Kirsten Corder
- UKCRC Centre for Diet and Activity Research, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Stephen J. Sharp
- UKCRC Centre for Diet and Activity Research, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Stephanie T. Jong
- UKCRC Centre for Diet and Activity Research, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Campbell Foubister
- UKCRC Centre for Diet and Activity Research, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Helen Elizabeth Brown
- UKCRC Centre for Diet and Activity Research, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Emma K. Wells
- UKCRC Centre for Diet and Activity Research, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Sofie M. Armitage
- UKCRC Centre for Diet and Activity Research, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Caroline H. D. Croxson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Anna Vignoles
- Faculty of Education, University of Cambridge, Cambridge, United Kingdom
| | - Paul O. Wilkinson
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Edward C. F. Wilson
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Esther M. F. van Sluijs
- UKCRC Centre for Diet and Activity Research, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
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Duncan E, O'Cathain A, Rousseau N, Croot L, Sworn K, Turner KM, Yardley L, Hoddinott P. Guidance for reporting intervention development studies in health research (GUIDED): an evidence-based consensus study. BMJ Open 2020; 10:e033516. [PMID: 32273313 PMCID: PMC7245409 DOI: 10.1136/bmjopen-2019-033516] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/10/2020] [Accepted: 02/19/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To improve the quality and consistency of intervention development reporting in health research. DESIGN This was a consensus exercise consisting of two simultaneous and identical three-round e-Delphi studies (one with experts in intervention development and one with wider stakeholders including funders, journal editors and public involvement members), followed by a consensus workshop. Delphi items were systematically derived from two preceding systematic reviews and a qualitative interview study. PARTICIPANTS Intervention developers (n=26) and wider stakeholders (n=18) from the UK, North America and Europe participated in separate e-Delphi studies. Intervention developers (n=13) and wider stakeholders (n=13) participated in a 1-day consensus workshop. RESULTS e-Delphi participants achieved consensus on 15 reporting items. Following feedback from the consensus meeting, the final inclusion and wording of 14 items with description and explanations for each item were agreed. Items focus on context, purpose, target population, approaches, evidence, theory, guiding principles, stakeholder contribution, changes in content or format during the development process, required changes for subgroups, continuing uncertainties, and open access publication. They form the GUIDED (GUIDance for the rEporting of intervention Development) checklist, which contains a description and explanation of each item, alongside examples of good reporting. CONCLUSIONS Consensus-based reporting guidance for intervention development in health research is now available for publishers and researchers to use. GUIDED has the potential to lead to greater transparency, and enhance quality and improve learning about intervention development research and practice.
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Affiliation(s)
- Edward Duncan
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
| | - Alicia O'Cathain
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Nikki Rousseau
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
- Leeds Institute of Clinical Trials, School of Medicine, University of Leeds, Leeds, UK
| | - Liz Croot
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Katie Sworn
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Lucy Yardley
- Psychology, University of Southampton, Southampton, UK
- School of Health Sciences, University of Bristol, Bristol, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professional Research Unit, University of Stirling, Stirling, UK
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Pathways to Increasing Adolescent Physical Activity and Wellbeing: A Mediation Analysis of Intervention Components Designed Using a Participatory Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020390. [PMID: 31936074 PMCID: PMC7014090 DOI: 10.3390/ijerph17020390] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 11/28/2022]
Abstract
We assessed which intervention components were associated with change in moderate-to-vigorous physical activity (MVPA) and wellbeing through proposed psychosocial mediators. Eight schools (n = 1319; 13–14 years) ran GoActive, where older mentors and in-class-peer-leaders encouraged classes to conduct two new activities/week; students gained points and rewards for activity. We assessed exposures: participant-perceived engagement with components (post-intervention): older mentorship, peer leadership, class sessions, competition, rewards, points entered online; potential mediators (change from baseline): social support, self-efficacy, group cohesion, friendship quality, self-esteem; and outcomes (change from baseline): accelerometer-assessed MVPA (min/day), wellbeing (Warwick-Edinburgh). Mediation was assessed using linear regression models stratified by gender (adjusted for age, ethnicity, language, school, BMI z-score, baseline values), assessing associations between (1) exposures and mediators, (2) exposures and outcomes (without mediators) and (3) exposure and mediator with outcome using bootstrap resampling. No evidence was found to support the use of these components to increase physical activity. Among boys, higher perceived teacher and mentor support were associated with improved wellbeing via various mediators. Among girls, higher perceived mentor support and perception of competition and rewards were positively associated with wellbeing via self-efficacy, self-esteem and social support. If implemented well, mentorship could increase wellbeing among adolescents. Teacher support and class-based activity sessions may be important for boys’ wellbeing, whereas rewards and competition warrant consideration among girls.
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Jong ST, Croxson CH, Guell C, Lawlor ER, Foubister C, Brown HE, Wells EK, Wilkinson P, Vignoles A, van Sluijs EM, Corder K. Adolescents' perspectives on a school-based physical activity intervention: A mixed method study. JOURNAL OF SPORT AND HEALTH SCIENCE 2020; 9:28-40. [PMID: 31921478 PMCID: PMC6943775 DOI: 10.1016/j.jshs.2019.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 05/23/2019] [Accepted: 05/27/2019] [Indexed: 06/10/2023]
Abstract
Purpose To examine adolescent experiences and perspectives of the GoActive intervention (ISRCTN31583496) using mixed methods process evaluation to determine satisfaction with intervention components and interpret adolescents' experiences of the intervention process in order to provide insights for future intervention design. Methods Participants (n = 1542; 13.2 ± 0.4 years, mean ± SD) provided questionnaire data at baseline (shyness, activity level) and post-intervention (intervention acceptability, satisfaction with components). Between-group differences (boys vs. girls and shy/inactive vs. others) were tested with linear regression models, accounting for school clustering. Data from 16 individual interviews (shy/inactive) and 11 focus groups with 48 participants (mean = 4; range 2-7) were thematically coded. Qualitative and quantitative data were merged in an integrative mixed methods convergence matrix, which denoted convergence and dissonance across datasets. Results Effect sizes for quantitative results were small and may not represent substantial between-group differences. Boys (vs. girls) preferred class-based sessions (β = 0.2, 95% confidence interval (CI): 0.1-0.3); qualitative data suggested that this was because boys preferred competition, which was supported quantitatively (β = 0.2, 95%CI: 0.1-0.3). Shy/inactive students did not enjoy the competition (β = -0.3, 95%CI: -0.5 to -0.1). Boys enjoyed trying new activities more (β = 0.1, 95%CI: 0.1-0.2); qualitative data indicated a desire to try new activities across all subgroups but identified barriers to choosing unfamiliar activities with self-imposed choice restriction leading to boredom. Qualitative data highlighted critique of mentorship; adolescents liked the idea, but older mentors did not meet expectations. Conclusion We interpreted adolescent perspectives of intervention components and implementation to provide insights into future complex interventions aimed at increasing young people's physical activity in school-based settings. The intervention component mentorship was liked in principle, but implementation issues undesirably impacted satisfaction; competition was disliked by girls and shy/inactive students. The results highlight the importance of considering gender differences in preference of competition and extensive mentorship training.
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Affiliation(s)
- Stephanie T. Jong
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, UK
| | - Caroline H.D. Croxson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Cornelia Guell
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, TR1 3HD, UK
| | - Emma R. Lawlor
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, UK
| | - Campbell Foubister
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, UK
| | - Helen E. Brown
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, UK
| | - Emma K. Wells
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, UK
| | - Paul Wilkinson
- Department of Psychiatry, University of Cambridge and Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
| | - Anna Vignoles
- Faculty of Education, University of Cambridge, Cambridge, CB2 8PQ, UK
| | - Esther M.F. van Sluijs
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, UK
| | - Kirsten Corder
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, UK
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15
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Program Reach and Implementation Feasibility of a Physical Activity School Health Program: A Qualitative Study of Teachers' Perception. J Phys Act Health 2019; 16:843-850. [PMID: 31357258 DOI: 10.1123/jpah.2018-0583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 04/12/2019] [Accepted: 06/03/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The reasons for the mixed evidence of the effectiveness of school-based physical activity programs can be many, including implementation challenges. Studying program implementation can potentially contribute to enhancing effectiveness, the design of future interventions, improved implementation, and the interpretation of outcomes. METHODS For this process evaluation, individual interviews were conducted with 16 teachers who had implemented the program "Active All Year Round" in a fifth-grade school class (students aged 9-11 y) in 2017. Through systematic text condensation feasibility and barriers of program implementation, perceived program reach and the programs' influence on social cohesion were identified and discussed. RESULTS Teachers described the program as very feasible to implement and identified very few implementation barriers, the most prominent being time constrains. Perceived program reach was very high, and teachers reported that those students who are less confident when it comes to physical activity did not have differential participation than those feeling more confident about physical activity. Finally, the program was perceived to positively affect social cohesion in class. CONCLUSIONS Active All Year Round is a standardized, flexible, and easily implemented program in Danish schools. Future studies are needed to study implementation from a student's perspective and/or students' role in and experiences with competition-based health programs.
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Farič N, Yorke E, Varnes L, Newby K, Potts HW, Smith L, Hon A, Steptoe A, Fisher A. Younger Adolescents' Perceptions of Physical Activity, Exergaming, and Virtual Reality: Qualitative Intervention Development Study. JMIR Serious Games 2019; 7:e11960. [PMID: 31210135 PMCID: PMC6601253 DOI: 10.2196/11960] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 01/12/2019] [Accepted: 02/17/2019] [Indexed: 12/13/2022] Open
Abstract
Background Novel strategies to promote physical activity (PA) in adolescence are required. The vEngage study aims to test whether a virtual reality (VR) exergaming intervention can engage younger adolescents (aged 13 to 15 years) with PA. Objective This study aimed to gather adolescents’ views of using VR to encourage PA and identify the key features they would like to see in a VR exergaming intervention via interviews. Methods Participants were recruited through 2 schools in London, United Kingdom. Semistructured interviews were conducted with adolescents about their views on PA and what might work to increase PA, technology, knowledge and experience of VR, and desired features in a VR exergaming intervention. Data were analyzed using Framework Analysis. Results A total of 31 participants aged between 13 and 15 years (58% female, 62% from nonwhite ethnicities) participated in this interview study. The vast majority had no awareness of government PA recommendations but felt they should be more thoroughly informed. All participants were positive about the use of VR in PA promotion. Rewards, increasing challenges, and a social or multiplayer aspect were identified by participants as crucial aspects to include in a VR exercise game. Barriers were related to cost of high-end systems. Being able to exercise at home was very appealing. VR exergaming was viewed as a way to overcome multiple perceived social and cultural barriers to PA, particularly for girls. Conclusions Key elements that should be incorporated into a VR game for health intervention were identified and described. These also included the use of rewards, novelty and enjoyment in immersive game play, multiplayer options, and real-world elements, as well as continual updates and new challenge levels. The use of VR to promote PA in adolescents is promising, but some barriers were raised.
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Affiliation(s)
- Nuša Farič
- Department of Behavioural Science & Health, University College London, London, United Kingdom
| | - Eleanor Yorke
- Department of Behavioural Science & Health, University College London, London, United Kingdom
| | - Laura Varnes
- Department of Behavioural Science & Health, University College London, London, United Kingdom
| | - Katie Newby
- Faculty Research Centre for Advances in Behavioural Science, Coventry University, Coventry, United Kingdom
| | - Henry Ww Potts
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | | | - Andrew Steptoe
- Department of Behavioural Science & Health, University College London, London, United Kingdom
| | - Abigail Fisher
- Department of Behavioural Science & Health, University College London, London, United Kingdom
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van den Berg V, Vos EE, de Groot RHM, Singh AS, Chinapaw MJM. Untapped Resources: 10- to 13-Year-Old Primary Schoolchildren's Views on Additional Physical Activity in the School Setting: A Focus Group Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122713. [PMID: 30513783 PMCID: PMC6313416 DOI: 10.3390/ijerph15122713] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/24/2018] [Accepted: 11/28/2018] [Indexed: 11/16/2022]
Abstract
Schools are considered ideal venues to promote physical activity (PA) in children. However, a knowledge gap exists on how to adequately integrate PA into the school day and in particular, on the preferences of children regarding additional PA in school. Therefore, the aim of our qualitative study was to gain comprehensive insight into 10⁻13-year-old primary schoolchildren's perspectives on how to increase PA in the school setting. We conducted nine focus groups (32 girls and 20 boys) with children attending the final two grades of primary school in the Netherlands. We used inductive thematic analysis to analyze the data. The results showed that children were enthusiastic about additional PA in school. Children suggested various ways to increase PA, including more time for PA in the existing curriculum, e.g., physical education (PE), recess, and occasional activities, such as field trips or sports days; school playground adaptation; improving the content of PE; and implementing short PA breaks and physically active academic lessons. Children emphasized variation and being given a voice in their PA participation as a prerequisite to keep PA enjoyable and interesting in the long term. Finally, children mentioned the role of the teacher and making efforts to accommodate all children and their different preferences as important. Children have concrete ideas, acknowledging the challenges that accompany integrating additional PA in school. We therefore recommend actively involving children in efforts to increase school-based PA and to make "additional PA in school" a shared project of teachers and students.
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Affiliation(s)
- Vera van den Berg
- Amsterdam UMC, Amsterdam Public Health, Department of Public and Occupational Health, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands.
| | - Eline E Vos
- Amsterdam UMC, Amsterdam Public Health, Department of Public and Occupational Health, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands.
| | - Renate H M de Groot
- Welten Institute-Research Centre for Learning, Teaching and Technology, Open University of the Netherlands, 6419 AT, Heerlen, The Netherlands.
- Department of Complex Genetics, School for Nutrition, Toxicology and Metabolism/Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD, Maastricht, The Netherlands.
| | - Amika S Singh
- Amsterdam UMC, Amsterdam Public Health, Department of Public and Occupational Health, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands.
| | - Mai J M Chinapaw
- Amsterdam UMC, Amsterdam Public Health, Department of Public and Occupational Health, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands.
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Owen MB, Kerner C, Taylor SL, Noonan RJ, Newson L, Kosteli MC, Curry WB, Fairclough SJ. The Feasibility and Acceptability of The Girls Peer Activity (G-PACT) Peer-led Mentoring Intervention. CHILDREN-BASEL 2018; 5:children5090128. [PMID: 30235896 PMCID: PMC6162561 DOI: 10.3390/children5090128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/11/2018] [Accepted: 09/18/2018] [Indexed: 11/30/2022]
Abstract
Enjoyment of physical activity (PA) is positively correlated with PA engagement. The inclusion of peers has been found to increase the likelihood of PA enjoyment in youth. Peer-led strategies, incorporating peer networks in the intervention delivery, is relatively underused and consequently understudied in school-based PA interventions. The purpose of this investigation was to evaluate the feasibility and acceptability of the novel Girls Peer Activity (G-PACT) peer-led mentoring intervention. Two-hundred and forty-nine Year 9 adolescent girls (13–14 years old) from three mixed-sex secondary schools located in West Lancashire, North-West England were invited to participate in the G-PACT project. The study employed a novel approach by using a three-tier model, including (Tier 1) Mentors (undergraduate students), (Tier 2) Leaders (Year 9 girls selected by teachers), and (Tier 3) Peers (whole Year 9 cohort). Mentors delivered a series of educational and leadership training to the Leaders in each respective school who then disseminated this information to their Peers and encouraged them to engage in more physical activities. Eight focus groups were conducted with Leaders (n = 40), 28 focus groups with Peers (n = 185), two focus groups with Mentors (n = 6), and three interviews with teachers (n = 4). Thematic analysis was used to analyze the pooled data and identify the key themes. The study found that the G-PACT intervention was feasible and acceptable for adolescent PA Leaders and their Mentors. The relationship between Leaders and their Peers required refinement to improve the communication processes to increase Peer engagement in the G-PACT project.
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Affiliation(s)
- Michael B Owen
- Movement Behaviours, Health and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, St Helens Road, Ormskirk, Lancashire L39 4QP, UK.
| | - Charlotte Kerner
- Movement Behaviours, Health and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, St Helens Road, Ormskirk, Lancashire L39 4QP, UK.
- Department of Life Sciences, Brunel University, London UB8 3PH, UK.
| | - Sarah L Taylor
- Movement Behaviours, Health and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, St Helens Road, Ormskirk, Lancashire L39 4QP, UK.
| | - Robert J Noonan
- Movement Behaviours, Health and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, St Helens Road, Ormskirk, Lancashire L39 4QP, UK.
| | - Lisa Newson
- Natural Sciences and Psychology, Research Centre for Brain and Behaviour, Liverpool John Moores University, Liverpool L3 5AF, UK.
| | - Maria-Christina Kosteli
- Movement Behaviours, Health and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, St Helens Road, Ormskirk, Lancashire L39 4QP, UK.
| | - Whitney B Curry
- Wellbeing and Public Health, Cornwall Council, Truro TR1 3AY, UK.
| | - Stuart J Fairclough
- Movement Behaviours, Health and Wellbeing Research Group, Department of Sport and Physical Activity, Edge Hill University, St Helens Road, Ormskirk, Lancashire L39 4QP, UK.
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Larsson I, Staland-Nyman C, Svedberg P, Nygren JM, Carlsson IM. Children and young people's participation in developing interventions in health and well-being: a scoping review. BMC Health Serv Res 2018; 18:507. [PMID: 29954392 PMCID: PMC6027768 DOI: 10.1186/s12913-018-3219-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 05/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Greater interest is being shown in participatory approaches, especially in research on interventions that concern children and young people's health and well-being. Although participatory approaches have user involvement in common, they differ in terms of the explicit guidance on how to actually involve and engage children and young people in health research. The aim of this scoping review was to systematically map recent research involving children and young people in the development of interventions targeting issues of health and well-being. METHODS An interpretative scoping literature review based on: a scientific literature search in (health and social science) databases, reference lists, a manual search in key journals and contact with existing networks was conducted. A total of 4458 references were identified through the literature search, of which 41 studies published between 2000 and 2017 were included in the review. The target population was children and young people under 25 years old. Level of participation was categorized according to Shier's Pathways to Participation Model. RESULTS The review showed that participatory approaches were most often used in the development of interventions in school settings and in community and healthcare settings and on issues concerning support in lifestyle or in managing illness or disease. The level of participation varied from children and young people taking part just as active informants, through stages of greater participation both in quantitative and qualitative terms, to children and young people becoming an active agent involved as a co-researcher where the research process was shaped by views of a higher level of mutuality. Most of the studies were categorised at a medium level and only three studies were judged to involve the children and young people at the highest level. CONCLUSIONS This scoping review showed that work remains in enabling children and young people to influence the development of interventions targeting health and well-being. In relation to level of sustainability in the interventions, it is relevant that goals, strategies and processes are formulated by those who can gain from the interventions. Participatory approaches aiming for a higher level of participation where children and young people work together with the researchers in partnerships are thus warranted.
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Affiliation(s)
- Ingrid Larsson
- School of Health and Welfare, Halmstad University, Box 823, S-30118, Halmstad, Sweden.
| | - Carin Staland-Nyman
- School of Health and Welfare, Halmstad University, Box 823, S-30118, Halmstad, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Box 823, S-30118, Halmstad, Sweden
| | - Jens M Nygren
- School of Health and Welfare, Halmstad University, Box 823, S-30118, Halmstad, Sweden
| | - Ing-Marie Carlsson
- School of Health and Welfare, Halmstad University, Box 823, S-30118, Halmstad, Sweden
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Saez L, Legrand K, Alleyrat C, Ramisasoa S, Langlois J, Muller L, Omorou AY, De Lavenne R, Kivits J, Lecomte E, Briançon S. Using facilitator-receiver peer dyads matched according to socioeconomic status to promote behaviour change in overweight adolescents: a feasibility study. BMJ Open 2018; 8:e019731. [PMID: 29934380 PMCID: PMC6020946 DOI: 10.1136/bmjopen-2017-019731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of an innovative peer intervention promoting healthy eating and physical activity, which purposefully selected peer facilitators according to socioeconomic status to target less-advantaged overweight receivers. SETTING Nine high schools, two middle schools. PARTICIPANTS One hundred and fifty-six adolescents were approached to become facilitators, of whom 18 were trained. Thirty-two of 56 potential receivers agreed to participate. INTERVENTION The peer intervention was carried out in 2013-2014 and embedded in a larger trial: PRALIMAP-INÈS (Promotion de l'ALIMentation et l'Activité Physique-INEgalité de Santé). Facilitanoators were selected and trained to organise weight-control activities with specific peer receivers participating in the programme. PRIMARY AND SECONDARY OUTCOME MEASURES Different types of data were collected to assess demand, acceptability, implementation and practicality of the intervention. For the facilitators, this included 6 training sessions, 11 mid-programme interviews, 4 end-of-programme sessions, telephone notes and text message exchanges. All six potential receivers in one school were also interviewed. Sociodemographic and health characteristics were also analysed. RESULTS Agreeing to participate was more likely when asked by a peer compared with a professional (51.2% discordant pairs; p<0.02). Twelve activities, mostly based on physical activity and implemented during weekends or holidays, were carried out. The mean age of active receivers was 16 and their body mass index was higher than other participants. For both facilitators and active receivers, there were more participating girls. Qualitative analysis reveals key implementation challenges for facilitators. Interviews with the receivers highlight social difficulties, with most feeling bad about their appearance and wanting to lose weight. Those who participated in peer activities were very positive about the experience especially social support. CONCLUSIONS The present study suggests the peer intervention is feasible provided organisational difficulties are addressed. Good practice recommendations are formulated, including a longer training session, organising a joint meeting with the facilitators and receivers, matching dyads on place of residence and multiplying modes of contact. TRIAL REGISTRATION NUMBER NCT01688453.
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Affiliation(s)
- Laura Saez
- University of Lorraine, APEMAC EA 4360, Nancy, France
| | - Karine Legrand
- University of Lorraine, APEMAC EA 4360, Nancy, France
- INSERM, CIC-1433, CHRU Nancy, F-54 000, Nancy, France
| | | | | | - Johanne Langlois
- University of Lorraine, APEMAC EA 4360, Nancy, France
- National Conservatory of Arts and Crafts (CNAM), Nancy, France
| | | | - Abdou Yacoubou Omorou
- University of Lorraine, APEMAC EA 4360, Nancy, France
- INSERM, CIC-1433, CHRU Nancy, F-54 000, Nancy, France
| | | | - Joëlle Kivits
- University of Lorraine, APEMAC EA 4360, Nancy, France
| | - Edith Lecomte
- National Conservatory of Arts and Crafts (CNAM), Nancy, France
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Guldager JD, Andersen PT, von Seelen J, Leppin A. Physical activity school intervention: context matters. HEALTH EDUCATION RESEARCH 2018; 33:232-242. [PMID: 29741620 DOI: 10.1093/her/cyy012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 04/19/2018] [Indexed: 06/08/2023]
Abstract
School-based interventions for increasing physical activity among children are widespread, however there is still a lack of knowledge about how school context factors are linked to implementation quality and effectiveness of programmes. The aim of this paper is to examine teacher-perceived effectiveness of a Danish national classroom-based health programme 'Active Around Denmark' and in particular, to investigate whether perceptions vary as a function of school social context factors. After completion of the programme all teachers (N = 5.892) received an electronic questionnaire. 2.097 completed the questionnaire (response rate 36%) and 1.781 datasets could be used for analysis. The teachers were asked about their perceptions of changes in children's attitudes towards and levels of physical activity after the competition. Our results indicated that certain contextual factors, such as schools' prioritization of health promotion, teachers' support by their school principal in implementation as well as teacher's satisfaction with the school' physical environment made a significant difference in teacher-perceived effectiveness. To conclude, teacher-perceived effectiveness of the health programme does vary as a function of school social context factors.
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Affiliation(s)
- J D Guldager
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark
| | - P T Andersen
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark
| | - J von Seelen
- Department for Research and Development-Research Program for Health Promotion and Learning, University College of Southern Denmark, Lembckesvej 3-7, 6100 Haderslev, Denmark
| | - A Leppin
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Niels Bohrs Vej 9-10, 6700 Esbjerg, Denmark
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The Feasibility of a Novel School Peer-Led Mentoring Model to Improve the Physical Activity Levels and Sedentary Time of Adolescent Girls: The Girls Peer Activity (G-PACT) Project. CHILDREN-BASEL 2018; 5:children5060067. [PMID: 29857554 PMCID: PMC6028908 DOI: 10.3390/children5060067] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 05/27/2018] [Accepted: 05/30/2018] [Indexed: 11/16/2022]
Abstract
Regular physical activity (PA) is associated with numerous physical and psychological health benefits. Adolescents, specifically girls, are at risk of physical inactivity. To date, there is limited research on PA interventions involving peers, which could encourage more adolescent girls to engage in PA. The investigation aimed to evaluate the feasibility of a novel school three-tier peer-led mentoring model designed to improve PA levels and reduce sedentary time (ST) of adolescent girls. Two-hundred and forty-nine Year 9 adolescent girls (13⁻15 years old) from three UK secondary schools were invited to participate in a peer-led mentoring intervention (Girls Peer Activity (G-PACT) project). The peer-led mentoring model was delivered in all three schools. Two of the schools received an additional after-school PA component. PA and ST were assessed through wrist-worn accelerometry. Girls who received an exercise class after-school component significantly increased their whole day moderate-to-vigorous PA (MVPA) (3.2 min, p = 0.009, d = 0.33). Girls who received no after-school component significantly decreased their MVPA (3.5 min, p = 0.016, d = 0.36) and increased their ST (17.2 min, p = 0.006, d = 0.43). The G-PACT intervention demonstrated feasibility of recruitment and data collection procedures for adolescent girls. The peer-led mentoring model shows promise for impacting girls' MVPA levels when combined with an after-school club PA opportunity.
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Jong ST, Brown HE, Croxson CHD, Wilkinson P, Corder KL, van Sluijs EMF. GoActive: a protocol for the mixed methods process evaluation of a school-based physical activity promotion programme for 13-14year old adolescents. Trials 2018; 19:282. [PMID: 29784016 PMCID: PMC5963130 DOI: 10.1186/s13063-018-2661-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Process evaluations are critical for interpreting and understanding outcome trial results. By understanding how interventions function across different settings, process evaluations have the capacity to inform future dissemination of interventions. The complexity of Get others Active (GoActive), a 12-week, school-based physical activity intervention implemented in eight schools, highlights the need to investigate how implementation is achieved across a variety of school settings. This paper describes the mixed methods GoActive process evaluation protocol that is embedded within the outcome evaluation. In this detailed process evaluation protocol, we describe the flexible and pragmatic methods that will be used for capturing the process evaluation data. METHODS A mixed methods design will be used for the process evaluation, including quantitative data collected in both the control and intervention arms of the GoActive trial, and qualitative data collected in the intervention arm. Data collection methods will include purposively sampled, semi-structured interviews and focus group interviews, direct observation, and participant questionnaires (completed by students, teachers, older adolescent mentors, and local authority-funded facilitators). Data will be analysed thematically within and across datasets. Overall synthesis of findings will address the process of GoActive implementation, and through which this process affects outcomes, with careful attention to the context of the school environment. DISCUSSION This process evaluation will explore the experience of participating in GoActive from the perspectives of key groups, providing a greater understanding of the acceptability and process of implementation of the intervention across the eight intervention schools. This will allow for appraisal of the intervention's conceptual base, inform potential dissemination, and help optimise post-trial sustainability. The process evaluation will also assist in contextualising the trial effectiveness results with respect to how the intervention may or may not have worked and, if it was found to be effective, what might be required for it to be sustained in the 'real world'. Furthermore, it will offer suggestions for the development and implementation of future initiatives to promote physical activity within schools. TRIAL REGISTRATION ISRCTN, ISRCTN31583496 . Registered on 18 February 2014.
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Affiliation(s)
- Stephanie T. Jong
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Helen Elizabeth Brown
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Caroline H. D. Croxson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG UK
| | - Paul Wilkinson
- Department of Psychiatry, University of Cambridge and Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Kirsten L. Corder
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Esther M. F. van Sluijs
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
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Holmberg C, Larsson C, Korp P, Lindgren EC, Jonsson L, Fröberg A, Chaplin JE, Berg C. Empowering aspects for healthy food and physical activity habits: adolescents' experiences of a school-based intervention in a disadvantaged urban community. Int J Qual Stud Health Well-being 2018; 13:1487759. [PMID: 29972679 PMCID: PMC6032021 DOI: 10.1080/17482631.2018.1487759] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE This study aimed to describe adolescents' experiences of participating in a health-promoting school-based intervention regarding food and physical activity, with a focus on empowering aspects. Method: The school was located in a urban disadvantaged community in Sweden, characterized by poorer self-reported health and lower life expectancy than the municipality average. Focus group interviews with adolescents (29 girls, 20 boys, 14-15 years) and their teachers (n = 4) were conducted two years after intervention. Data were categorized using qualitative content analysis. RESULTS A theme was generated, intersecting with all the categories: Gaining control over one's health: deciding, trying, and practicing together, in new ways, using reflective tools. The adolescents appreciated influencing the components of the intervention and collaborating with peers in active learning activities such as practicing sports and preparing meals. They also reported acquiring new health information, that trying new activities was inspiring, and the use of pedometers and photo-food diaries helped them reflect on their health behaviours. The adolescents' experiences were also echoed by their teachers. Conclusions: To facilitate empowerment and stimulate learning, health-promotion interventions targeting adolescents could enable active learning activities in groups, by using visualizing tools to facilitate self-reflection, and allowing adolescents to influence intervention activities.
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Affiliation(s)
- Christopher Holmberg
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Christel Larsson
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Peter Korp
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Eva-Carin Lindgren
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Linus Jonsson
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Fröberg
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - John E Chaplin
- Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christina Berg
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
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Brown HE, Whittle F, Jong ST, Croxson C, Sharp SJ, Wilkinson P, Wilson EC, van Sluijs EM, Vignoles A, Corder K. A cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of the GoActive intervention to increase physical activity among adolescents aged 13-14 years. BMJ Open 2017; 7:e014419. [PMID: 28963278 PMCID: PMC5623411 DOI: 10.1136/bmjopen-2016-014419] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Adolescent physical activity promotion is rarely effective, despite adolescence being critical for preventing physical activity decline. Low adolescent physical activity is likely to last into adulthood, increasing health risks. The Get Others Active (GoActive) intervention is evidence-based and was developed iteratively with adolescents and teachers. This intervention aims to increase physical activity through increased peer support, self-efficacy, group cohesion, self-esteem and friendship quality, and is implemented using a tiered-leadership system. We previously established feasibility in one school and conducted a pilot randomised controlled trial (RCT) in three schools. METHODS AND ANALYSIS We will conduct a school-based cluster RCT (CRCT) in 16 secondary schools targeting all year 9 students (n=2400). In eight schools, GoActive will run for two terms: weekly facilitation support from a council-funded intervention facilitator will be offered in term 1, with more distant support in term 2. Tutor groups choose two weekly activities, encouraged by older adolescent mentors and weekly peer leaders. Students gain points for trying new activities; points are entered into a between-class competition. Outcomes will be assessed at baseline, interim (week 6), postintervention (week 14-16) and 10-month follow-up (main outcome). The primary outcome will be change from baseline in daily accelerometer-assessed moderate-to-vigorous physical activity. Secondary outcomes include accelerometer-assessed activity intensities on weekdays/weekends; self-reported physical activity and psychosocial outcomes; cost-effectiveness and cost-utility analyses; mixed-methods process evaluation integrating information from focus groups and participation logs/questionnaires. ETHICS AND DISSEMINATION Ethical approval for the conduct of the study was gained from the University of Cambridge Psychology Research Ethics Committee. Given the lack of rigorously evaluated interventions, and the inclusion of objective measurement of physical activity, long-term follow-up and testing of causal pathways, the results of a CRCT of the effectiveness and cost-effectiveness of GoActive are expected to add substantially to the limited evidence on adolescent physical activity promotion. Workshops will be held with key stakeholders including students, parents, teachers, school governors and government representatives to discuss plans for wider dissemination of the intervention. TRIAL REGISTRATION NUMBER ISRCTN31583496.
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Affiliation(s)
- Helen Elizabeth Brown
- UKCRC Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Fiona Whittle
- UKCRC Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Stephanie T Jong
- UKCRC Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Caroline Croxson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stephen J Sharp
- UKCRC Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Paul Wilkinson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Edward Cf Wilson
- Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK
| | - Esther Mf van Sluijs
- UKCRC Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Anna Vignoles
- Faculty of Education, University of Cambridge, Cambridge, UK
| | - Kirsten Corder
- UKCRC Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Using a Co-Creational Approach to Develop, Implement and Evaluate an Intervention to Promote Physical Activity in Adolescent Girls from Vocational and Technical Schools: A Case Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14080862. [PMID: 28763041 PMCID: PMC5580566 DOI: 10.3390/ijerph14080862] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 11/26/2022]
Abstract
Background: As physical inactivity is particularly prevalent amongst lower-educated adolescent girls, interventions are needed. Using a co-creational approach increases their engagement and might be effective. This study aimed to: (1) describe the co-creation process, (2) evaluate how girls experienced co-creation, and (3) evaluate the effect of the co-creational interventions on physical activity, individual, sociocultural and school-based factors. Methods: Three intervention schools (n = 91) and three control schools (n = 105) across Flanders participated. A questionnaire was completed pre (September–October 2014) and post (April–May 2015). In between, sessions with a co-creation group were organised to develop and implement the intervention in each intervention school. Focus groups were conducted to evaluate the co-creational process. Results: School 1 organised sport sessions for girls, school 2 organised a fitness activity and set up a Facebook page, school 3 organised a lunch walk. Girls were positive about having a voice in developing an intervention. No significant effects were found, except for small effects on extracurricular sports participation and self-efficacy. Conclusions: Using a co-creational approach amongst adolescent girls might be a feasible approach. However, as interventions were minimal, effects were limited or undetectable. Future co-creation projects could consider the most optimal co-creation process, evaluation design and intensively test this approach.
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Corder K, Sharp SJ, Atkin AJ, Andersen LB, Cardon G, Page A, Davey R, Grøntved A, Hallal PC, Janz KF, Kordas K, Kriemler S, Puder JJ, Sardinha LB, Ekelund U, van Sluijs EM. Age-related patterns of vigorous-intensity physical activity in youth: The International Children's Accelerometry Database. Prev Med Rep 2016; 4:17-22. [PMID: 27413656 PMCID: PMC4929125 DOI: 10.1016/j.pmedr.2016.05.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/16/2016] [Indexed: 11/04/2022] Open
Abstract
Physical activity declines during youth but most evidence reports on combined moderate and vigorous-intensity physical activity. We investigated how vigorous-intensity activity varies with age. Cross-sectional data from 24,025 participants (5.0-18.0 y; from 20 studies in 10 countries obtained 2008-2010) providing ≥ 1 day accelerometer data (International Children's Accelerometry Database (ICAD)). Linear regression was used to investigate age-related patterns in vigorous-intensity activity; models included age (exposure), adjustments for monitor wear-time and study. Moderate-intensity activity was examined for comparison. Interactions were used to investigate whether the age/vigorous-activity association differed by sex, weight status, ethnicity, maternal education and region. A 6.9% (95% CI 6.2, 7.5) relative reduction in mean vigorous-intensity activity with every year of age was observed; for moderate activity the relative reduction was 6.0% (5.6%, 6.4%). The age-related decrease in vigorous-intensity activity remained after adjustment for moderate activity. A larger age-related decrease in vigorous activity was observed for girls (- 10.7%) versus boys (- 2.9%), non-white (- 12.9% to - 9.4%) versus white individuals (- 6.1%), lowest maternal education (high school (- 2.0%)) versus college/university (ns) and for overweight/obese (- 6.1%) versus healthy-weight participants (- 8.1%). In addition to larger annual decreases in vigorous-intensity activity, overweight/obese individuals, girls and North Americans had comparatively lower average vigorous-intensity activity at 5.0-5.9 y. Age-related declines in vigorous-intensity activity during youth appear relatively greater than those of moderate activity. However, due to a higher baseline, absolute moderate-intensity activity decreases more than vigorous. Overweight/obese individuals, girls, and North Americans appear especially in need of vigorous-intensity activity promotion due to low levels at 5.0-5.9 y and larger negative annual differences.
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Affiliation(s)
- Kirsten Corder
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom
| | - Stephen J. Sharp
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom
| | - Andrew J. Atkin
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom
| | - Lars B. Andersen
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Norwegian School of Sport Science, Oslo, Norway
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Angie Page
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - Rachel Davey
- Centre for Research and Action in Public Health, University of Canberra, Canberra, Australia
| | - Anders Grøntved
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Kathleen F. Janz
- Department of Health and Human Physiology, University of Iowa, Iowa City, US
| | - Katarzyna Kordas
- School of Social and Community Medicine, University of Bristol, UK
| | - Susi Kriemler
- Epidemiology, Biostatistics and Public Health Institute, University of Zürich, Switzerland
| | - Jardena J. Puder
- Service of Endocrinology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland
- Division of Pediatric Endocrinology, Diabetology and Obesity, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Luis B. Sardinha
- Exercise and Health Laboratory, Faculty of Human Movement, Technical University of Lisbon, Lisbon, Portugal
| | - Ulf Ekelund
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom
- Norwegian School of Sport Science, Oslo, Norway
| | - Esther M.F. van Sluijs
- MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom
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Joronen K, Aikasalo A, Suvitie A. Nonphysical effects of exergames on child and adolescent well-being: a comprehensive systematic review. Scand J Caring Sci 2016; 31:449-461. [PMID: 27862145 DOI: 10.1111/scs.12393] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 09/06/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Exergames have the potential to promote physical activity among children and adolescents. They also have other important benefits, but knowledge about other than the physical effects of exergaming remains thin. AIM To report the findings of a review of ten studies on the nonphysical effects of exergames on child and adolescent well-being. DATA SOURCES A broad search strategy was employed to identify relevant studies in CINAHL Ebsco Host, Ovid MEDLINE, Psycinfo ProQuest, Eric ProQuest, Scopus and Cochrane Library. The search timeframe was from January 2004 to April 2015. REVIEW METHODS A comprehensive systematic review without meta-analysis was conducted on 10 quantitative, qualitative and mixed-methods intervention studies. The quality of these studies was assessed following the guidelines of the Joanna Briggs Institute. The data were analysed using a narrative synthesis approach. RESULTS Exergaming was found to have some positive effects on self-concept, situational interest and motivation, enjoyment, psychological and social well-being, symptomatology and different learning experiences. However, two studies reported no effect on self-efficacy, and one study showed no intervention effect on self-esteem. The only follow-up study indicated that the enjoyment effect lasted for a few months. CONCLUSION Most of the studies reviewed found that exergaming had positive effects. However, more research evidence is still needed. In particular, there is a need for better-validated instruments and follow-up research.
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Affiliation(s)
- Katja Joronen
- School of Health Sciences (Nursing Science), University of Tampere, Tampere, Finland
| | - Anna Aikasalo
- School of Health Sciences (Nursing Science), University of Tampere, Tampere, Finland
| | - Anne Suvitie
- School of Health Sciences (Nursing Science), University of Tampere, Tampere, Finland
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Corder K, Brown HE, Schiff A, van Sluijs EMF. Feasibility study and pilot cluster-randomised controlled trial of the GoActive intervention aiming to promote physical activity among adolescents: outcomes and lessons learnt. BMJ Open 2016; 6:e012335. [PMID: 27836873 PMCID: PMC5129050 DOI: 10.1136/bmjopen-2016-012335] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Assess the feasibility of implementing the GoActive intervention in secondary schools, to identify improvements, test study procedures, determine preliminary effectiveness to increase moderate-to-vigorous physical activity (MVPA), and inform power calculations to establish programme effectiveness. SETTING Feasibility study (1 school) and pilot cluster-randomised controlled trial (CRCT; 2 intervention; 1 control school(s)). PARTICIPANTS 460 participants (46.6% female; 13.2 (0.4) years old). INTERVENTIONS 8-week intervention (2013) involved: classes choosing weekly activities encouraged by mentors (older adolescents) and in-class peer leaders. Students gain points for trying activities which are entered into an intramural competition. PRIMARY AND SECONDARY OUTCOME MEASURES Planned quantitative (questionnaire) and qualitative (focus groups) process evaluation addressed enjoyment, confidence, participation, suggested improvements. Outcomes were assessed at baseline and follow-up (week 8) in pilot CRCT and included accelerometer-assessed MVPA; adolescent-reported activity type, well-being, peer support, shyness, sociability. Analysis of covariance was used to assess preliminary effectiveness as change in MVPA adjusted for baseline. RESULTS All year 9 students in intervention schools were exposed to the intervention; over all schools 77% of eligible students were measured. 71% boys and 74% girls found GoActive 'fun'; 38% boys and 32% girls said it increased confidence, and 64% boys and 59% girls said they would continue with a GoActive activity. Suggested improvements included more mentorship; improved training; streamlined points recording. Pilot results indicated potential effectiveness ((adjusted mean difference (95% CI) p value; MVPA mins; 5.1 (1.1 to 9.2) p=0.014)) and suggest recruitment of 16 schools (2400 adolescents) for a full trial. Compared with control, intervention students reported greater peer support 0.5 (0.1 to 0.9) p=0.03, well-being 1.8 (0.1 to 3.4) p=0.04 but no difference in shyness/sociability. Participation in activity types approached significance (intervention group 2.3 (-0.2 to 4.7) p=0.07 more activity types). CONCLUSIONS Results suggest feasibility and indicate potential effectiveness of GoActive to increase MVPA and support a fully powered evaluation of effectiveness and cost-effectiveness. Process evaluation data were used to refine GoActive prior to a full trial. TRIAL REGISTRATION NUMBER ISRCTN31583496; pre-results.
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Affiliation(s)
- Kirsten Corder
- MRC Epidemiology Unit, UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Helen E Brown
- MRC Epidemiology Unit, UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Annie Schiff
- MRC Epidemiology Unit, UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Esther M F van Sluijs
- MRC Epidemiology Unit, UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
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