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Porter A, Walker R, House D, Salway R, Dawson S, Ijaz S, de Vocht F, Jago R. Physical activity interventions in European primary schools: a scoping review to create a framework for the design of tailored interventions in European countries. Front Public Health 2024; 12:1321167. [PMID: 38389941 PMCID: PMC10883314 DOI: 10.3389/fpubh.2024.1321167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction Schools provide a unique environment to facilitate physical activity for children. However, many school-based physical activity interventions have not been effective. We propose a new approach, which allows schools to tailor interventions to their specific context. This scoping review aimed to identify intervention components from previous school-based physical activity interventions to form the basis of a tailored approach in a European setting. Methods Joanna Briggs Institute guidelines for conducting scoping reviews were followed. European school-based intervention studies aimed at increasing physical activity in children aged 7-11 years published in English since 2015 were included. Databases searched were Ovid Medline, Embase, PsycINFO, Web of Science Social Sciences Citation Index, ERIC and British Education Index. Data was extracted on intervention components, context-related factors (geographical location, school size, child socioeconomic status and ethnicity), feasibility, acceptability and cost-effectiveness. A data-driven framework was developed to summarize the identified intervention components. Results 79 articles were included, constituting 45 intervention studies. We identified 177 intervention components, which were synthesized into a framework of 60 intervention component types across 11 activity opportunities: six within the school day, three within the extended school day and two within the wider school environment. Interventions most frequently targeted physical education (21%), active and outdoor learning (16%), active breaks (15%), and school-level environmewnt (12%). Of the intervention components, 41% were delivered by school staff, 31% by the research team, and 24% by external organizations. Only 19% of intervention studies reported geographical location and only 10% reported school size. Participant ethnicity and socioeconomic information was reported by 15% and 25%, respectively. Intervention acceptability was reported in 51% of studies, feasibility in 49%, and cost effectiveness in 2%. Discussion This review offers a first step in developing a future framework to help schools to develop context-specific, tailored interventions. However, there was a lack of reporting of contextual factors within the included studies, making it difficult to understand the role of context. Future research should seek to measure and report contextual factors, and to better understand the important aspects of context within school-based physical activity.
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Affiliation(s)
- Alice Porter
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - Robert Walker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Danielle House
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Ruth Salway
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- The National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - Sharea Ijaz
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- The National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- The National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
| | - Russell Jago
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
- The National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, United Kingdom
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Pearson AL, Tribby C, Brown CD, Yang JA, Pfeiffer K, Jankowska MM. Systematic review of best practices for GPS data usage, processing, and linkage in health, exposure science and environmental context research. BMJ Open 2024; 14:e077036. [PMID: 38307539 PMCID: PMC10836389 DOI: 10.1136/bmjopen-2023-077036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/16/2024] [Indexed: 02/04/2024] Open
Abstract
Global Positioning System (GPS) technology is increasingly used in health research to capture individual mobility and contextual and environmental exposures. However, the tools, techniques and decisions for using GPS data vary from study to study, making comparisons and reproducibility challenging. OBJECTIVES The objectives of this systematic review were to (1) identify best practices for GPS data collection and processing; (2) quantify reporting of best practices in published studies; and (3) discuss examples found in reviewed manuscripts that future researchers may employ for reporting GPS data usage, processing and linkage of GPS data in health studies. DESIGN A systematic review. DATA SOURCES Electronic databases searched (24 October 2023) were PubMed, Scopus and Web of Science (PROSPERO ID: CRD42022322166). ELIGIBILITY CRITERIA Included peer-reviewed studies published in English met at least one of the criteria: (1) protocols involving GPS for exposure/context and human health research purposes and containing empirical data; (2) linkage of GPS data to other data intended for research on contextual influences on health; (3) associations between GPS-measured mobility or exposures and health; (4) derived variable methods using GPS data in health research; or (5) comparison of GPS tracking with other methods (eg, travel diary). DATA EXTRACTION AND SYNTHESIS We examined 157 manuscripts for reporting of best practices including wear time, sampling frequency, data validity, noise/signal loss and data linkage to assess risk of bias. RESULTS We found that 6% of the studies did not disclose the GPS device model used, only 12.1% reported the per cent of GPS data lost by signal loss, only 15.7% reported the per cent of GPS data considered to be noise and only 68.2% reported the inclusion criteria for their data. CONCLUSIONS Our recommendations for reporting on GPS usage, processing and linkage may be transferrable to other geospatial devices, with the hope of promoting transparency and reproducibility in this research. PROSPERO REGISTRATION NUMBER CRD42022322166.
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Affiliation(s)
- Amber L Pearson
- CS Mott Department of Public Health, Michigan State University, Flint, MI, USA
| | - Calvin Tribby
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, California, USA
| | - Catherine D Brown
- Department of Geography, Environment and Spatial Sciences, Michigan State University, East Lansing, Michigan, USA
| | - Jiue-An Yang
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, California, USA
| | - Karin Pfeiffer
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Marta M Jankowska
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, California, USA
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Neil-Sztramko SE, Caldwell H, Dobbins M. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev 2021; 9:CD007651. [PMID: 34555181 PMCID: PMC8459921 DOI: 10.1002/14651858.cd007651.pub3] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physical activity among children and adolescents is associated with lower adiposity, improved cardio-metabolic health, and improved fitness. Worldwide, fewer than 30% of children and adolescents meet global physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day. Schools may be ideal sites for interventions given that children and adolescents in most parts of the world spend a substantial amount of time in transit to and from school or attending school. OBJECTIVES The purpose of this review update is to summarise the evidence on effectiveness of school-based interventions in increasing moderate to vigorous physical activity and improving fitness among children and adolescents 6 to 18 years of age. Specific objectives are: • to evaluate the effects of school-based interventions on increasing physical activity and improving fitness among children and adolescents; • to evaluate the effects of school-based interventions on improving body composition; and • to determine whether certain combinations or components (or both) of school-based interventions are more effective than others in promoting physical activity and fitness in this target population. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, BIOSIS, SPORTDiscus, and Sociological Abstracts to 1 June 2020, without language restrictions. We screened reference lists of included articles and relevant systematic reviews. We contacted primary authors of studies to ask for additional information. SELECTION CRITERIA Eligible interventions were relevant to public health practice (i.e. were not delivered by a clinician), were implemented in the school setting, and aimed to increase physical activity among all school-attending children and adolescents (aged 6 to 18) for at least 12 weeks. The review was limited to randomised controlled trials. For this update, we have added two new criteria: the primary aim of the study was to increase physical activity or fitness, and the study used an objective measure of physical activity or fitness. Primary outcomes included proportion of participants meeting physical activity guidelines and duration of moderate to vigorous physical activity and sedentary time (new to this update). Secondary outcomes included measured body mass index (BMI), physical fitness, health-related quality of life (new to this update), and adverse events (new to this update). Television viewing time, blood cholesterol, and blood pressure have been removed from this update. DATA COLLECTION AND ANALYSIS: Two independent review authors used standardised forms to assess each study for relevance, to extract data, and to assess risk of bias. When discrepancies existed, discussion occurred until consensus was reached. Certainty of evidence was assessed according to GRADE. A random-effects meta-analysis based on the inverse variance method was conducted with participants stratified by age (children versus adolescents) when sufficient data were reported. Subgroup analyses explored effects by intervention type. MAIN RESULTS Based on the three new inclusion criteria, we excluded 16 of the 44 studies included in the previous version of this review. We screened an additional 9968 titles (search October 2011 to June 2020), of which 978 unique studies were potentially relevant and 61 met all criteria for this update. We included a total of 89 studies representing complete data for 66,752 study participants. Most studies included children only (n = 56), followed by adolescents only (n = 22), and both (n = 10); one study did not report student age. Multi-component interventions were most common (n = 40), followed by schooltime physical activity (n = 19), enhanced physical education (n = 15), and before and after school programmes (n = 14); one study explored both enhanced physical education and an after school programme. Lack of blinding of participants, personnel, and outcome assessors and loss to follow-up were the most common sources of bias. Results show that school-based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity (mean difference (MD) 0.73 minutes/d, 95% confidence interval (CI) 0.16 to 1.30; 33 studies; moderate-certainty evidence) and may lead to little to no decrease in sedentary time (MD -3.78 minutes/d, 95% CI -7.80 to 0.24; 16 studies; low-certainty evidence). School-based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (VO₂max) (MD 1.19 mL/kg/min, 95% CI 0.57 to 1.82; 13 studies; low-certainty evidence). School-based physical activity interventions may result in a very small decrease in BMI z-scores (MD -0.06, 95% CI -0.09 to -0.02; 21 studies; low-certainty evidence) and may not impact BMI expressed as kg/m² (MD -0.07, 95% CI -0.15 to 0.01; 50 studies; low-certainty evidence). We are very uncertain whether school-based physical activity interventions impact health-related quality of life or adverse events. AUTHORS' CONCLUSIONS Given the variability of results and the overall small effects, school staff and public health professionals must give the matter considerable thought before implementing school-based physical activity interventions. Given the heterogeneity of effects, the risk of bias, and findings that the magnitude of effect is generally small, results should be interpreted cautiously.
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Affiliation(s)
| | - Hilary Caldwell
- Department of Kinesiology, Child Health & Exercise Medicine Program, McMaster University, Hamilton, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
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Gerards SMPL, Van Kann DHH, Kremers SPJ, Jansen MWJ, Gubbels JS. Do parenting practices moderate the association between the physical neighbourhood environment and changes in children's time spent at various physical activity levels? An exploratory longitudinal study. BMC Public Health 2021; 21:168. [PMID: 33468096 PMCID: PMC7816369 DOI: 10.1186/s12889-021-10224-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As many children do not meet the recommended daily physical activity (PA) levels, more research is needed towards environmental determinants of children's PA levels. The aims of this longitudinal study were to investigate whether the physical environment and parenting practices have an impact on changes in children's weekday time spent at various PA levels and whether associations between physical neighbourhood environment and changes in children's PA are moderated by parenting practices. METHODS We performed a secondary data analysis of longitudinal data collected at three timepoints (baseline, 6, and 18 months) from 10 control schools of the Active Living study, a quasi-experimental study, which took place in South Limburg, the Netherlands. In total, 240 children aged 8-12 years were included in the analyses. PA levels were measured using accelerometry (ActiGraph GT3X+). The physical environment was assessed at baseline through neighbourhood audits of the school environment, and PA parenting practices were measured at baseline via validated parental questionnaires. Multivariate multilevel regression analyses were conducted to determine the main effects of the physical environment and parenting practices on changes in children's time spent in sedentary behaviour (SB), light PA and moderate-to-vigorous PA (MVPA) over 18 months. Additionally, moderation of the association between the physical environment and children's PA levels by parenting practices was examined by adding interacting terms to the regression equations. RESULTS Walkability of the physical environmental was associated with a decrease in SB at 18 months (B = -5.45, p < .05). In addition, the parenting practice logistic support was associated with an increase in MVPA (at all time points, B = .68, B = .73 and B = 1.02, respectively, all p < .05) and a decrease in SB (at 18 months, B = -1.71, p < .05). Stratified analyses (based on significant interaction terms) showed that the effect of specific physical environmental features (e.g., sports facilities) on children's improvements in PA levels were strengthened by favourable parenting practices. DISCUSSION Besides the main effects of walkability and logistic support, there were indications that several parenting practices moderate the association between the physical environment and changes in children's time in various PA levels. The current findings are exploratory, and need to be confirmed in further research.
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Affiliation(s)
- Sanne M P L Gerards
- Department of Health Promotion, Nutrition and Translational Research Institute Maastricht (NUTRIM), Maastricht University, P.O. Box 616, Maastricht, MD, 6200, The Netherlands.
| | - Dave H H Van Kann
- Department of Health Promotion, Nutrition and Translational Research Institute Maastricht (NUTRIM), Maastricht University, P.O. Box 616, Maastricht, MD, 6200, The Netherlands.,School of Sport Studies, Fontys University of Applied Sciences, P.O. Box 347, Eindhoven, AH, 5600, The Netherlands
| | - Stef P J Kremers
- Department of Health Promotion, Nutrition and Translational Research Institute Maastricht (NUTRIM), Maastricht University, P.O. Box 616, Maastricht, MD, 6200, The Netherlands
| | - Maria W J Jansen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, Maastricht, MD, 6200, The Netherlands.,Academic Collaborative Centre for Public Health, Public Health Service South Limburg, P.O. Box 33, Heerlen, AA, 6400, The Netherlands
| | - Jessica S Gubbels
- Department of Health Promotion, Nutrition and Translational Research Institute Maastricht (NUTRIM), Maastricht University, P.O. Box 616, Maastricht, MD, 6200, The Netherlands
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Rodríguez-Rodríguez F, Cristi-Montero C, Castro-Piñero J. Physical Activity Levels of Chilean Children in a National School Intervention Programme. A Quasi-Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124529. [PMID: 32586063 PMCID: PMC7345723 DOI: 10.3390/ijerph17124529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 12/02/2022]
Abstract
Background. Recess is a great opportunity to interrupt sedentary behaviour and increase moderate-to-vigorous physical activity (MVPA) in schoolchildren. This quasi-experimental study aimed to compare the levels of physical activity (PA) during the school day of children in a school intervention programme vs. those in a control group, and to determine compliance with MVPA recommendations. Methods. A sample of 154 schoolchildren (6–12 years old) was obtained from several schools (70 with the intervention and 84 controls). This programme was structured with a duration of 90 min/session and performed three times/week. PA levels were recorded with triaxial accelerometers during the school day: during recess, during a PA session or physical education session (PE), and during lunchtime. No pre-intervention evaluation was performed. Results. The MVPA of the control group was higher than that of the intervention group during the first recess (p < 0.001). None of the groups complied with the recommendations for steps during the PA or PE sessions. During the PA session, sedentary time was lower and MVPA was higher, in the intervention group than in the control group. Fifty percent of the children from the intervention group complied with the MVPA recommendations, vs. 22.7% of those in the control group. Conclusions. The schoolchildren in the intervention group performed more MVPA than those in the control group. Future interventions could include other periods, such as recess and lunchtime, which are opportunities for improving the MVPA levels of schoolchildren.
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Affiliation(s)
- Fernando Rodríguez-Rodríguez
- IRyS Group, School of Physical Education, Pontificia Universidad Católica de Valparaíso, Valparaíso 2340025, Chile;
- Correspondence:
| | - Carlos Cristi-Montero
- IRyS Group, School of Physical Education, Pontificia Universidad Católica de Valparaíso, Valparaíso 2340025, Chile;
| | - José Castro-Piñero
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, 11003 Cadiz, Spain;
- Biomedical Research and Innovation Institute of CaÅLdiz (INiBICA) Research Unit, 11009 Cadiz, Spain
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Implementation of KEIGAAF in Primary Schools: A Mutual Adaptation Physical Activity and Nutrition Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030751. [PMID: 31991622 PMCID: PMC7037055 DOI: 10.3390/ijerph17030751] [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: 11/28/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 01/19/2023]
Abstract
School health promotion is advocated. Implementation studies on school health promotion are less often conducted as effectiveness studies and are mainly conducted conventionally by assessing fidelity of "one size fits all" interventions. However, interventions that allow for local adaptation are more appropriate and require a different evaluation approach. We evaluated a mutual adaptation physical activity and nutrition intervention implemented in eight primary schools located in low socioeconomic neighborhoods in the Netherlands, namely the KEIGAAF intervention. A qualitative, multiple-case study design was used to evaluate implementation and contextual factors affecting implementation. We used several qualitative data collection tools and applied inductive content analysis for coding the transcribed data. Codes were linked to the domains of the Consolidated Framework for Implementation Research. NVivo was used to support data analysis. The implementation process varied greatly across schools. This was due to the high level of bottom-up design of the intervention and differing contextual factors influencing implementation, such as differing starting situations. The mutual adaptation between top-down and bottom-up influences was a key element of the intervention. Feedback loops and the health promotion advisors played a crucial role by navigating between top-down and bottom-up. Implementing a mutual adaptation intervention is time-consuming but feasible.
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Bartelink NHM, van Assema P, Jansen MWJ, Savelberg HHCM, Moore GF, Hawkins J, Kremers SPJ. Process evaluation of the healthy primary School of the Future: the key learning points. BMC Public Health 2019; 19:698. [PMID: 31170941 PMCID: PMC6554901 DOI: 10.1186/s12889-019-6947-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/07/2019] [Indexed: 11/23/2022] Open
Abstract
Background While schools have potential to contribute to children’s health and healthy behaviour, embedding health promotion within complex school systems is challenging. The ‘Healthy Primary School of the Future’ (HPSF) is an initiative that aims to integrate health and well-being into school systems. Central to HPSF are two top-down changes that are hypothesized as being positively disruptive to the Dutch school system: daily free healthy lunches and structured physical activity sessions. These changes are expected to create momentum for bottom-up processes leading to additional health-promoting changes. Using a programme theory, this paper explores the processes through which HPSF and the school context adapt to one another. The aim is to generate and share knowledge and experiences on how to implement changes in the complex school system to integrate school health promotion. Methods The current study involved a mixed methods process evaluation with a contextual action-oriented research approach. The processes of change were investigated in four Dutch primary schools during the development year (2014–2015) and the first two years of implementation (2015–2017) of HPSF. The schools (each with 15–26 teachers and 233–389 children) were in low socio-economic status areas. Measurements included interviews, questionnaires, observations, and analysis of minutes of meetings. Results Top-down advice, combined with bottom-up involvement and external practical support were key facilitators in embedding HPSF within the schools’ contexts. Sufficient coordination and communication at the school level, team cohesion, and feedback loops enhanced implementation of the changes. Implementation of the healthy lunch appeared to be disruptive and create momentum for additional health-promoting changes. Conclusions Initiating highly visible positive disruptions to improve school health can act as a catalyst for wider school health promotion efforts. Conditions to create a positive disruption are enough time, and sufficient bottom-up involvement, external support, team cohesion and coordination. The focus should be on each specific school, as each school has their own starting point and process of change. Trial registration The study was retrospectively registered in the ClinicalTrials.gov database on 14 June 2016 (NCT02800616). Electronic supplementary material The online version of this article (10.1186/s12889-019-6947-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N H M Bartelink
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. .,Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands. .,Public Health Services, Academic Collaborative Centre for Public Health Limburg, P.O. Box 33, 6400, AA, Heerlen, The Netherlands.
| | - P van Assema
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.,Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - M W J Jansen
- Public Health Services, Academic Collaborative Centre for Public Health Limburg, P.O. Box 33, 6400, AA, Heerlen, The Netherlands.,Department of Health Services Research, CAPHRI, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - H H C M Savelberg
- Department of Nutrition and Movement Sciences, NUTRIM, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - G F Moore
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, Wales
| | - J Hawkins
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, Wales
| | - S P J Kremers
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
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Boudewijns EA, Pepels JJS, van Kann D, Konings K, van Schayck CP, Willeboordse M. Non-response and external validity in a school-based quasi-experimental study 'The Healthy Primary School of the Future': A cross-sectional assessment. Prev Med Rep 2019; 14:100874. [PMID: 31061783 PMCID: PMC6488530 DOI: 10.1016/j.pmedr.2019.100874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/06/2019] [Accepted: 04/16/2019] [Indexed: 11/26/2022] Open
Abstract
Limited evidence is available about (non)-representativeness of participants in health-promoting interventions. The Dutch Healthy Primary School of the Future (HPSF)-study is a school-based study aiming to improve health through altering physical activity and dietary behaviour, that started in 2015 (registered in ClinicalTrials.gov on 14-06-2016, NCT02800616). The study has a response rate of 60%. A comprehensive non-responder analysis was carried out, and responders were compared with schoolchildren from the region and the Netherlands using a cross-sectional design. External sources were consulted to collect non-responder, regional, and national data regarding relevant characteristics including sex, demographics, health, and lifestyle. The Chi-square test, Mann-Whitney U test, or Student's t-test were used to analyse differences. The analyses showed that responders (n = 494) were comparable with non-responders (n = 348) and regional data (n = 6172) with regard to sex and health. Responders did not significantly differ from regional data with regard to lifestyle. Responders had significantly higher educated parents compared to non-responders and were more often of autochthonous ethnicity compared to regional data. Major differences were observed between responders and schoolchildren in the Netherlands, regarding, among others sex, ethnicity, and parental employment rates. We conclude that a potential healthy-volunteer effect in the HPSF-sample is limited. External validity is high when compared to the regional population but low when compared to the national sample. For future intervention studies, we advise to evaluate outcome measures according to regional/national standards and to cooperate with external parties in early stages of research to be able to assess and enhance generalisability.
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Key Words
- BMI, Body Mass Index
- CBS, Statistics Netherlands (Centraal Bureau voor de Statistiek)
- DUO, Dutch Education Executive Agency (Dienst Uitvoering Onderwijs)
- External validity
- GDPR, General Data Protection Regulation
- GGD, Regional Public Health Services (Gemeentelijke Gezondheids Dienst Zuid Limburg)
- HPSF, Healthy Primary School of the Future
- IOTF, International Obesity Task Force
- JGZ, Youth Healthcare (Jeugd Gezondheidszorg)
- Lifestyle
- Non-response bias
- OML, Educational Monitor Limburg (OnderwijsMonitor Limburg)
- Representativeness
- SDQ, Strength and Difficulties Questionnaire
- SES, Socio-economic status
- School-based study
- Selection bias
- VCP, Dutch National Food Consumption Survey (Voedsel Consumptie Peiling)
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Affiliation(s)
- E A Boudewijns
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - J J S Pepels
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - D van Kann
- School of Sport Studies, Fontys University of Applied Sciences, Theo Koomenlaan 3, 5644 HZ Eindhoven, the Netherlands
| | - K Konings
- Public Health Service Southern Limburg, Het Overloon 2, 6411 TE Heerlen, the Netherlands (GGD Zuid Limburg)
| | - C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - M Willeboordse
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
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Böhm B, Karwiese SD, Böhm H, Oberhoffer R. Effects of Mobile Health Including Wearable Activity Trackers to Increase Physical Activity Outcomes Among Healthy Children and Adolescents: Systematic Review. JMIR Mhealth Uhealth 2019; 7:e8298. [PMID: 31038460 PMCID: PMC6658241 DOI: 10.2196/mhealth.8298] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 06/18/2018] [Accepted: 02/07/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Children and adolescents do not meet the current recommendations on physical activity (PA), and as such, the health-related benefits of regular PA are not achieved. Nowadays, technology-based programs represent an appealing and promising option for children and adolescents to promote PA. OBJECTIVE The aim of this review was to systematically evaluate the effects of mobile health (mHealth) and wearable activity trackers on PA-related outcomes in this target group. METHODS Electronic databases such as the Cochrane Central Register of Controlled Trials, PubMed, Scopus, SPORTDiscus, and Web of Science were searched to retrieve English language articles published in peer-reviewed journals from January 2012 to June 2018. Those included were articles that contained descriptions of interventions designed to increase PA among children (aged 6 to 12 years) only, or adolescents (aged 13 to 18 years) only, or articles that include both populations, and also, articles that measured at least 1 PA-related cognitive, psychosocial, or behavioral outcome. The interventions had to be based on mHealth tools (mobile phones, smartphones, tablets, or mobile apps) or wearable activity trackers. Randomized controlled trials (RCTs) and non-RCTs, cohort studies, before-and-after studies, and cross-sectional studies were considered, but only controlled studies with a PA comparison between groups were assessed for methodological quality. RESULTS In total, 857 articles were identified. Finally, 7 studies (5 with tools of mHealth and 2 with wearable activity trackers) met the inclusion criteria. All studies with tools of mHealth used an RCT design, and 3 were of high methodological quality. Intervention delivery ranged from 4 weeks to 12 months, whereby mainly smartphone apps were used as a tool. Intervention delivery in studies with wearable activity trackers covered a period from 22 sessions during school recess and 8 weeks. Trackers were used as an intervention and evaluation tool. No evidence was found for the effect of mHealth tools, respectively wearable activity trackers, on PA-related outcomes. CONCLUSIONS Given the small number of studies, poor compliance with accelerometers as a measuring instrument for PA, risk of bias, missing RCTs in relation to wearable activity trackers, and the heterogeneity of intervention programs, caution is warranted regarding the comparability of the studies and their effects. There is a clear need for future studies to develop PA interventions grounded on intervention mapping with a high methodological study design for specific target groups to achieve meaningful evidence.
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Affiliation(s)
- Birgit Böhm
- Institute of Preventive Pediatrics, Technical University of Munich, Munich, Germany
| | - Svenja D Karwiese
- Institute of Preventive Pediatrics, Technical University of Munich, Munich, Germany
| | - Harald Böhm
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Aschau im Chiemgau, Germany
| | - Renate Oberhoffer
- Institute of Preventive Pediatrics, Technical University of Munich, Munich, Germany
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Prevo L, Stessen K, Kremers S, Wassenberg M, Jansen M. Shining light inside the tunnel: using photovoice as a strategy to define the needs for health promotion among families of low socioeconomic status. Int J Qual Stud Health Well-being 2018; 13:1542909. [PMID: 30452338 PMCID: PMC6249552 DOI: 10.1080/17482631.2018.1542909] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE This study aimed to identify opportunities to improve the current health and social situation of low socioeconomic status (SES) families and to gain a better understanding of the main needs regarding health promotion. Low-SES families were approached to participate in a photovoice study. METHOD The study took place in the municipality of Vaals, which is located in the southernmost part of the Netherlands. A diverse group of ten people from eight different families took about 150 photographs within their community on topics they considered important for their health and quality of life. This was followed by individual interviews and a focus group interview. RESULTS Four main needs were identified: meeting each other, helping each other, feeling safe and being mobile. The photographs showed that health-related themes had low priority for these families. CONCLUSION The low-SES families focused on upstream factors relating to independence, self-resilience and a sense of belonging, to help them cope with their current situation. This study represents a first step towards the development of a community approach to health promotion in low-SES families.
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Affiliation(s)
- Lotte Prevo
- NUTRIM, Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Kelly Stessen
- NUTRIM, Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Stef Kremers
- NUTRIM, Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Marjolein Wassenberg
- Department of Society, Municipal Government of Vaals, Vaals, The Netherlands
- Department of Knowledge and Innovation, Public Health Service Southern Limburg, Heerlen, The Netherlands
| | - Maria Jansen
- CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Academic Collaborative Center for Public Health, Public Health Service Southern Limburg, Heerlen, The Netherlands
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11
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Pedersen NH, Koch S, Larsen KT, Kristensen PL, Troelsen J, Møller NC, Brønd JC, Hjelmborg JVB, Brage S, Grøntved A. Protocol for evaluating the impact of a national school policy on physical activity levels in Danish children and adolescents: the PHASAR study - a natural experiment. BMC Public Health 2018; 18:1245. [PMID: 30409171 PMCID: PMC6225578 DOI: 10.1186/s12889-018-6144-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/23/2018] [Indexed: 12/17/2022] Open
Abstract
Background In 2014 the Danish Government introduced a wide-ranging school reform that applies to all public schools in Denmark. The reform involves changes in several aspects of the school structure and content. In a physical activity promotion perspective, a distinctive feature of the school reform is that it has become mandatory to integrate an average of 45 min of daily physical activity in the regular school day. The overarching objective of the PHASAR study is to evaluate the implementation and effect of this ambitious policy-driven physical activity promotion initiative on physical activity and overweight. This paper describes in detail the study protocol. Methods The evaluation is divided into a quantitative effect evaluation and a combined quantitative and qualitative process evaluation. A total of 31 schools are enrolled in the PHASAR study including more than 2,000 school-aged children. Objectively measured physical activity data are obtained in the PHASAR study in 2017/18 and compared to repeated cross sectional data collected in four historical school-based studies from 1998 to 2012. Body mass index data from 2012 to 2018 will be collected from The Child Database, which includes repeated cross-sectional assessments on approximately 100,000 children annually. In the absence of a control group, interrupted time-series analysis will be used to evaluate pre- and post-reform physical activity and body mass index levels and trends. A characterization of the school environment for physical activity promotion on a political, environmental, organizational and individual level and school implementation processes will be conducted to evaluate the implementation process. Data will be collected using interviews, surveys, document analyses and observations. Discussion The PHASAR study is a rare opportunity to evaluate the effectiveness of a nation-wide policy-driven school-based physical activity promotion initiative. The use of objectively measured pre- and post-reform physical activity and body mass index data combined with a characterization of the school implementation processes for physical activity promotion will provide a comprehensive source to evaluate the school reform. The study findings have the potential to influence national and international policy makers, health professionals and school staff.
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Affiliation(s)
- Natascha Holbæk Pedersen
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Sofie Koch
- Research unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Kristian Traberg Larsen
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Peter Lund Kristensen
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Jens Troelsen
- Research unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Niels Christian Møller
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Jan Christian Brønd
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Jacob von Bornemann Hjelmborg
- The Danish Twin Registry, Epidemiology, Biostatistics and Biodemography, SDU eScience Centre, J. B. Winsløws Vej 9, 5000, Odense C, Denmark
| | - Søren Brage
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,MRC Epidemiology Unit, Cambridge School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Anders Grøntved
- Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
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12
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The Healthy Primary School of the Future: A Contextual Action-Oriented Research Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102243. [PMID: 30720796 PMCID: PMC6209969 DOI: 10.3390/ijerph15102243] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 09/28/2018] [Accepted: 10/10/2018] [Indexed: 01/04/2023]
Abstract
Background: Schools can play an important role in promoting children’s health behaviours. A Dutch initiative, ‘The Healthy Primary School of the Future’, aims to integrate health and well-being into the school system. We use a contextual action-oriented research approach (CARA) to study the implementation process. Properties of CARA are its focus on contextual differences and the use of monitoring and feedback to support and evaluate the process of change. The aim of this article is to describe the use of the approach. Methods: Four schools (each with 200–300 children, aged 4–12 years) were included; all located in low socio-economic status areas in the south of the Netherlands. Data collection methods include interviews, observations, questionnaires, and health and behavioural measurements. Research contributions include giving feedback and providing schools with a range of possibilities for additional changes. The contextual data we examine include schools’ health promoting elements, practices of teachers and parents, dominating organisational issues, and characteristics of the student population; process data include the presence of potential barriers to changes. Discussion: CARA is an adaptive research approach that generates knowledge and experiences on how to deal with health promotion in complex systems. We think this approach can set an example for research efforts in comparable initiatives.
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13
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Hanssen-Doose A, Albrecht C, Schmidt SCE, Woll A, Worth A. Quantitative und qualitative Merkmale des Schulsports in Deutschland im Zusammenhang mit der Gesundheit der Schülerinnen und Schüler. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2018. [DOI: 10.1007/s12662-018-0542-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Measuring implementation fidelity of school-based obesity prevention programmes: a systematic review. Int J Behav Nutr Phys Act 2018; 15:75. [PMID: 30103764 PMCID: PMC6088402 DOI: 10.1186/s12966-018-0709-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/26/2018] [Indexed: 02/01/2023] Open
Abstract
Background Until now, there is no clear overview of how fidelity is assessed in school-based obesity prevention programmes. In order to move the field of obesity prevention programmes forward, the current review aimed to 1) identify which fidelity components have been measured in school-based obesity prevention programmes; 2) identify how fidelity components have been measured; and 3) score the quality of these methods. Methods Studies published between January 2001–October 2017 were selected from searches in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library and ERIC. We included studies examining the fidelity of obesity prevention programmes (nutrition and/or physical activity and/or sitting) at school (children aged 4–18 year) measuring at least one component of implementation fidelity. A data extraction was performed to identify which and how fidelity components were measured. Thereafter, a quality assessment was performed to score the quality of these methods. We scored each fidelity component on 7 quality criteria. Each fidelity component was rated high (> 75% positive), moderate (50–75%) or low (< 50%). Results Of the 26,294 retrieved articles, 73 articles reporting on 63 different studies were included in this review. In 17 studies a process evaluation was based on a theoretical framework. In total, 120 fidelity components were measured across studies: dose was measured most often (N = 50), followed by responsiveness (N = 36), adherence (N = 26) and quality of delivery (N = 8). There was substantial variability in how fidelity components were defined as well as how they were measured. Most common methods were observations, logbooks and questionnaires targeting teachers. The quality assessment scores ranged from 0 to 86%; most fidelity components scored low quality (n = 77). Conclusions There is no consensus on the operationalisation of concepts and methods used for assessing fidelity in school-based obesity prevention programmes and the quality of methods used is weak. As a result, we call for more consensus on the concepts and clear reporting on the methods employed for measurements of fidelity to increase the quality of fidelity measurements. Moreover, researchers should focus on the relation between fidelity and programme outcomes and determine to what extent adaptations to programmes have been made, whilst still being effective. Electronic supplementary material The online version of this article (10.1186/s12966-018-0709-x) contains supplementary material, which is available to authorized users.
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15
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Verjans-Janssen SRB, Van Kann DHH, Gerards SMPL, Vos SB, Jansen MWJ, Kremers SPJ. Study protocol of the quasi-experimental evaluation of "KEIGAAF": a context-based physical activity and nutrition intervention for primary school children. BMC Public Health 2018; 18:842. [PMID: 29980235 PMCID: PMC6035437 DOI: 10.1186/s12889-018-5764-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background The environment affects children’s energy balance-related behaviors to a considerable extent. A context-based physical activity and nutrition school- and family-based intervention, named KEIGAAF, is being implemented in low socio-economic neighborhoods in Eindhoven, The Netherlands. The aim of this study was to investigate: 1) the effectiveness of the KEIGAAF intervention on BMI z-score, waist circumference, physical activity, sedentary behavior, nutrition behavior, and physical fitness of primary school children, and 2) the process related to the implementation of the intervention. Methods A quasi-experimental, controlled study with eight intervention schools and three control schools was conducted. The KEIGAAF intervention consists of a combined top-down and bottom-up school intervention: a steering committee developed the general KEIGAAF principles (top-down), and in accordance with these principles, KEIGAAF working groups subsequently develop and implement the intervention in their local context (bottom-up). Parents are also invited to participate in a family-based parenting program, i.e., Triple P Lifestyle. Children aged 7 to 10 years old (grades 4 to 6 in the Netherlands) are included in the study. Effect evaluation data is collected at baseline, after one year, and after two years by using a child questionnaire, accelerometers, anthropometry, a physical fitness test, and a parent questionnaire. A mixed methods approach is applied for the process evaluation: quantitative (checklists, questionnaires) and qualitative methods (observations, interviews) are used. To analyze intervention effectiveness, multilevel regression analyses will be conducted. Content analyses will be conducted on the qualitative process data. Discussion Two important environmental settings, the school environment and the family environment, are simultaneously targeted in the KEIGAAF intervention. The combined top-down and bottom-up approach is expected to make the intervention an effective and sustainable version of the Health Promoting Schools framework. An elaborate process evaluation will be conducted alongside an effect evaluation in which multiple data collection sources (both qualitative and quantitative) are used. Trial registration Dutch Trial Register NTR6716 (registration date 27/06/2017, retrospectively registered), METC163027, NL58554.068.16, Fonds NutsOhra project number 101.253. Electronic supplementary material The online version of this article (10.1186/s12889-018-5764-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S R B Verjans-Janssen
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, Maastricht, The Netherlands.
| | - Dave H H Van Kann
- School of Sport Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Sanne M P L Gerards
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, Maastricht, The Netherlands
| | - Steven B Vos
- School of Sport Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Maria W J Jansen
- Academic Collaborative Center for Public Health, Public Health Service South-Limburg, Heerlen, The Netherlands.,Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Stef P J Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, Maastricht, The Netherlands
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16
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Accelerometry-Derived Physical Activity Correlations Between Parents and Their Fourth-Grade Child Are Specific to Time of Day and Activity Level. J Phys Act Health 2018; 15:440-447. [PMID: 29570002 DOI: 10.1123/jpah.2016-0645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this study was to employ high-frequency accelerometry to explore parent-child physical activity (PA) relationships across a free-living sample. METHODS We recorded 7 days of wrist-mounted accelerometry data from 168 dyads of elementary-aged children and their parents. Using a custom MATLAB program (Natick, MA), we summed child and parent accelerations over 1 and 60 seconds, respectively, and applied published cut points to determine the amount of time spent in moderate-vigorous PA (MVPA). Bivariate and partial correlations examined parent-child relationships between percentage of time spent in MVPA. RESULTS Weak to moderate positive correlations were observed before school (r = .326, P < .001), after school (r = .176, P = .023), during the evening (r = .213, P = .006), and on weekends (r = .231, P = .003). Partial correlations controlling for parent-child MVPA revealed significant relationships during the school day (r = .185, P = .017), before school (r = .315, P < .001), and on weekends (r = .266, P = .001). In addition, parents of more active children were significantly more active than parents of less active children during the evening. CONCLUSIONS These data suggest that there is some association between parent-child PA, especially before school and on weekends. Future interventions aiming to increase PA among adults and children must consider patterns of MVPA specific to children and parents and target them accordingly.
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17
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A Multicomponent Schoolyard Intervention Targeting Children's Recess Physical Activity and Sedentary Behavior: Effects After 1 Year. J Phys Act Health 2017; 14:866-875. [PMID: 28682695 DOI: 10.1123/jpah.2016-0656] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of the study was to test the 12-month effects of a multicomponent physical activity (PA) intervention at schoolyards on morning recess PA levels of sixth- and seventh-grade children in primary schools, using accelerometry and additional global positioning system data. METHODS A quasi-experimental study design was used with 20 paired intervention and control schools. Global positioning system confirmatory analyses were applied to validate attendance at schoolyards during recess. Accelerometer data from 376 children from 7 pairs of schools were included in the final analyses. Pooled intervention effectiveness was tested by multilevel linear regression analyses, whereas effectiveness of intervention components was tested by multivariate linear regression analyses. RESULTS Children exposed to the multicomponent intervention increased their time spent in light PA (+5.9%) during recess. No pooled effects on moderate to vigorous PA were found. In-depth analyses of intervention components showed that physical schoolyard interventions particularly predicted a decrease in time spent in sedentary behavior during recess at follow-up. Intervention intensity and the school's commitment to the project strengthened this effect. CONCLUSIONS The multicomponent schoolyard PA intervention was effective in making children spend a larger proportion of recess time in light PA, which was most likely the result of a shift from sedentary behavior to light PA.
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Tercedor P, Villa-González E, Ávila-García M, Díaz-Piedra C, Martínez-Baena A, Soriano-Maldonado A, Pérez-López IJ, García-Rodríguez I, Mandic S, Palomares-Cuadros J, Segura-Jiménez V, Huertas-Delgado FJ. A school-based physical activity promotion intervention in children: rationale and study protocol for the PREVIENE Project. BMC Public Health 2017; 17:748. [PMID: 28950837 PMCID: PMC5615806 DOI: 10.1186/s12889-017-4788-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/21/2017] [Indexed: 01/12/2023] Open
Abstract
Background The lack of physical activity and increasing time spent in sedentary behaviours during childhood place importance on developing low cost, easy-toimplement school-based interventions to increase physical activity among children. The PREVIENE Project will evaluate the effectiveness of five innovative, simple, and feasible interventions (active commuting to/from school, active Physical Education lessons, active school recess, sleep health promotion, and an integrated program incorporating all 4 interventions) to improve physical activity, fitness, anthropometry, sleep health, academic achievement, and health-related quality of life in primary school children. Methods A total of 300 children (grade 3; 8-9 years of age) from six schools in Granada (Spain) will be enrolled in one of the 8-week interventions (one intervention per school; 50 children per school) or a control group (no intervention school; 50 children). Outcomes will include physical activity (measured by accelerometry), physical fitness (assessed using the ALPHA fitness battery), and anthropometry (height, weight and waist circumference). Furthermore, they will include sleep health (measured by accelerometers, a sleep diary, and sleep health questionnaires), academic achievement (grades from the official school’s records), and health-related quality of life (child and parental questionnaires). To assess the effectiveness of the different interventions on objectively measured PA and the other outcomes, the generalized linear model will be used. Discussion The PREVIENE Project will provide the information about the effectiveness and implementation of different school-based interventions for physical activity promotion in primary school children.
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Affiliation(s)
- Pablo Tercedor
- PA-HELP "Physical Activity for HEalth Promotion" Research Group, Granada, Spain. .,Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.
| | - Emilio Villa-González
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.,PROFITH "PROmoting FITness and Health through physical activity" Research Group, Granada, Spain
| | - Manuel Ávila-García
- PA-HELP "Physical Activity for HEalth Promotion" Research Group, Granada, Spain.,Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Carolina Díaz-Piedra
- "Mind, Brain, and Behavior" Research Center, University of Granada, Granada, Spain
| | - Alejandro Martínez-Baena
- "Physical Activity and Pedagogy" Research Unit, Department of Physical Education and Sport, School of Sport Sciences, University of Valencia, Valencia, Spain
| | - Alberto Soriano-Maldonado
- "SPORT" Research Group, Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain
| | - Isaac José Pérez-López
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.,"Physical Education and Social Transformation" Research Group, Granada, Spain
| | - Inmaculada García-Rodríguez
- PA-HELP "Physical Activity for HEalth Promotion" Research Group, Granada, Spain.,Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Sandra Mandic
- Active Living Laboratory, School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Juan Palomares-Cuadros
- "Curricular Design, Development and Innovation in the Area of Physical Education Didactics" Research Group, Department of Physical Education and Sport, International University of La Rioja, La Rioja, Spain
| | - Víctor Segura-Jiménez
- PA-HELP "Physical Activity for HEalth Promotion" Research Group, Granada, Spain.,Department of Physical Education, School of Education Sciences, University of Cádiz, Cádiz, Spain
| | - Francisco Javier Huertas-Delgado
- PA-HELP "Physical Activity for HEalth Promotion" Research Group, Granada, Spain.,Teaching School La Inmaculada, University of Granada, Granada, Spain
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Bezold CP, Stark JH, Rundle A, Konty K, Day SE, Quinn J, Neckerman K, Roux AVD. Relationship between Recreational Resources in the School Neighborhood and Changes in Fitness in New York City Public School Students. J Urban Health 2017; 94:20-29. [PMID: 28116590 PMCID: PMC5359172 DOI: 10.1007/s11524-016-0114-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Physical fitness in children has many beneficial effects, including the maintenance of a healthy weight. The built environment may influence youths' physical fitness by encouraging physical activity. This paper assessed whether higher density of parks, playgrounds, and sports facilities around a school is related to improvements in fitness in middle school boys and girls. Fitness scores and other student covariates collected as part of NYC FITNESSGRAM between the 2006-2007 and 2010-2011 school years were linked with school neighborhood data on characteristics of the built environment for NYC public school students in grades 6-8. Data were analyzed in 2015. Medium, but not high, density of recreational resources in the area surrounding a school was associated with greater annual improvements in fitness for both boys and girls. This association appeared to be driven mainly by the presence of parks. Findings for sports facilities and playgrounds were inconsistent. Overall, few associations were observed between recreational resources near a school and changes in student fitness. Future studies of school influences on student fitness should consider the influence of school resources and the home neighborhood.
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Affiliation(s)
- Carla P Bezold
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 401 Park Drive, Boston, MA, 02115, USA.
| | - James H Stark
- Worldwide Safety and Regulatory, Pfizer Inc., New York, NY, USA
| | - Andrew Rundle
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | - Kevin Konty
- Office of School Health, NYC Department of Health and Mental Hygiene, New York, NY, USA
| | - Sophia E Day
- Office of School Health, NYC Department of Health and Mental Hygiene, New York, NY, USA
| | - James Quinn
- Department of Epidemiology, Mailman School of Public Health, New York, NY, USA
| | | | - Ana V Diez Roux
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA, USA
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Van Kann DHH, Kremers SPJ, de Vries NK, de Vries SI, Jansen MWJ. The effect of a school-centered multicomponent intervention on daily physical activity and sedentary behavior in primary school children: The Active Living study. Prev Med 2016; 89:64-69. [PMID: 27235606 DOI: 10.1016/j.ypmed.2016.05.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/24/2016] [Accepted: 05/21/2016] [Indexed: 11/18/2022]
Abstract
The aim of the current study was to examine the effectiveness of a school-centered multicomponent PA intervention, called 'Active Living', on children's daily PA levels. A quasi-experimental design was used including 9 intervention schools and 9 matched control schools located in the Netherlands. The baseline measurement took place between March-June 2013, and follow-up measurements were conducted 12months afterwards. Accelerometer (ActiGraph, GT3X+) data of 520 children aged 8-11years were collected and supplemented with demographics and weather conditions data. Implementation magnitude of the interventions was measured by keeping logbooks on the number of implemented physical environmental interventions (PEIs) and social environmental interventions (SEIs). Multilevel multivariate linear regression analyses were used to study changes in sedentary behavior (SB), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) between baseline and follow-up. Finally, effect sizes (ESs) were calculated using Cohen's d. No pooled effects on PA and SB were found between children exposed and not exposed to Active Living after 12months. However, children attending Active Living schools that implemented larger numbers of both PEIs and SEIs engaged in 15 more minutes of LPA per weekday at follow-up than children in the control condition (ES=0.41; p<.05). Moreover, children attending these schools spent less time in SB at follow-up (ES=0.33), although this effect was non-significant. No significant effects were found on MVPA. A school-centered multicomponent PA intervention holds the potential to activate children, but a comprehensive set of intervention elements with a sufficient magnitude is necessary to achieve at least moderate effect sizes.
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Affiliation(s)
- D H H Van Kann
- Department of Health Promotion, School of Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Academic Collaborative Center for Public Health Limburg, Public Health Services, P.O. Box 2022, 6160 HA Geleen, The Netherlands; School of Sports Studies, Fontys University of Applied Sciences, P.O. Box 347, 5600 AH Eindhoven, The Netherlands.
| | - S P J Kremers
- Department of Health Promotion, Nutrition and Translational Research Institute Maastricht (NUTRIM), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - N K de Vries
- Department of Health Promotion, School of Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Academic Collaborative Center for Public Health Limburg, Public Health Services, P.O. Box 2022, 6160 HA Geleen, The Netherlands.
| | - S I de Vries
- The Hague University of Applied Sciences, Research group Healthy Lifestyle in a Supporting Environment, P.O. Box 13336, 2501 EH The Hague, The Netherlands.
| | - M W J Jansen
- Academic Collaborative Center for Public Health Limburg, Public Health Services, P.O. Box 2022, 6160 HA Geleen, The Netherlands; Department of Health Services Research, School of Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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Remmers T, Van Kann D, Thijs C, de Vries S, Kremers S. Playability of school-environments and after-school physical activity among 8-11 year-old children: specificity of time and place. Int J Behav Nutr Phys Act 2016; 13:82. [PMID: 27421643 PMCID: PMC4946175 DOI: 10.1186/s12966-016-0407-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/28/2016] [Indexed: 11/12/2022] Open
Abstract
Background Physical Activity (PA) occurs in several behavioral domains (e.g., sports, active transport), and is affected by distinct environmental factors. By filtering objective PA using children’s school schedules, daily PA can be separated into more conceptually meaningful domains. We used an ecological design to investigate associations between “playability” of 21 school-environments and children’s objectively measured after-school PA. We also examined to what extent distinct time-periods after-school and the distance from children’s residence to their school influenced this association. Methods PA was measured in 587 8–11 year-old children by accelerometers, and separated in four two-hour time-periods after-school. For each school-environment, standardized playability-scores were calculated based on standardized audits within 800 m network buffers around each school. Schools and children’s residences were geocoded, and we classified each child to be residing in 400, 800, 1600, or >1600 m crow-fly buffers from their school. The influence of network-distance buffers was also examined using the same approach. Results Playability was associated with light PA and moderate-to-vigorous PA after-school, especially in the time-period directly after-school and among children who lived within 800 m from their school. Playability explained approximately 30 % of the after-school PA variance between schools. Greater distance from children’s residence to their school weakened the association between playability of the school-environments and after-school PA. Conclusions This study demonstrated that relationships between the conceptually matched physical environment and PA can be revealed and made plausible with increasing specificity in time and distance.
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Affiliation(s)
- Teun Remmers
- Department of Epidemiology, Maastricht University (Medical Center+), CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200MD, Maastricht, The Netherlands.
| | - Dave Van Kann
- Department of Health Promotion, Maastricht University (Medical Center+), CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
| | - Carel Thijs
- Department of Epidemiology, Maastricht University (Medical Center+), CAPHRI School for Public Health and Primary Care, P.O. Box 616, 6200MD, Maastricht, The Netherlands
| | - Sanne de Vries
- The Hague University of Applied Sciences, Research group Healthy Lifestyle in a Supporting Environment, The Hague, The Netherlands
| | - Stef Kremers
- Department of Health Promotion, Maastricht University (Medical Center+), NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
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