Long-Term Perspectives of a School-Based Intervention to Promote Active School Transportation

Applying the multiphase optimization strategy to evaluate the feasibility and effectiveness of an online road safety education intervention for children and parents: a pilot study

BACKGROUND

Reports of children's engagement in active transportation outline low participation rates in many countries despite many associated mental, physical, and social health benefits. One of the main contributors to this phenomenon is a cited lack of education and knowledge among children regarding active travel (AT), specifically road safety. To address this issue, the aim of this study was to evaluate the feasibility and effectiveness of an online road safety education intervention to promote AT among children and their parents.

METHODS

Applying the Multiphase Optimization Strategy (MOST) for intervention development, implementation, and evaluation, we designed and assessed a four-module online road safety education intervention with a sample of 57 parent-child dyads using a 23 factorial design featuring both qualitative and quantitative analyses.

RESULTS

Main intervention feasibility findings include positive and critical feedback on the program's content and design, and moderate participant engagement as reflected by program retention and completion rates. With respect to the preliminary intervention effectiveness on children, a significant improvement in road safety knowledge scores was observed for groups that feature the "wheeling safety and skills" module. Slight improvements in AT knowledge scores across all the intervention groups were observed, but were not of significance. Preliminary intervention effectiveness on select parental AT practices and perceptions saw significant improvements in some groups. Groups that featured the 'wheeling safety and skills' module exhibited significantly higher guided choice scores upon completion of the program than those who did not receive this component.

CONCLUSION

The MOST framework allowed us to design and evaluate the feasibility and preliminary effectiveness of an online road safety education intervention. The developed intervention has demonstrated that it has the potential to improve children's road safety knowledge and some areas of parental AT practices and perceptions, to which improvements may be attributed to the inclusion of the "wheeling safety and skills" module, suggesting that the targeted focus on cycling skills is a prioritized area. AT programming and practice implications are discussed. Future research is encouraged to refine modules to better reflect the priorities of children and parents and to test these refined components among larger samples.

WORD COUNT

9,391 (excludes abstract, tables, figures, abbreviations, and references).

The intervention design to promote active travel mode among children and adolescents: A systematic review

Background

Walking and cycling are examples of active travel modes or nonmotorized modes that rely on human physical power rather than fossil fuel consumption. In the context of short-distance journeys, active travel modes are advocated as feeder modes to reduce energy consumption and CO2 emissions. However, in Thailand and many other developing countries, these modes of transportation have not been widely adopted or effectively promoted. The absence of comprehensive campaigns and interventions to promote and facilitate the use of active travel modes has become a major barrier to their adoption, particularly among adolescents who will be future global citizens. Therefore, a campaign or intervention targeting adolescents is imperative to introduce and persuade them to adopt active travel modes. This study aims to provide guidelines for developing a robust intervention strategy to promote active travel modes among adolescents.

Methods

This study performed a systematic review to achieve the research goal using a particular search and selection approach. The search strategy has focused on published studies in the English language since 2014 to highlight the most recent trends. The selection process focused on articles relevant to promoting active travel mode among children and adolescents (up to 18 years old) through intervention.

Conclusions

A total of 16 studies were included. The findings reveal that successful interventions to promote active travel modes consist of an educational program and activities incorporating gamification to encourage their use. Furthermore, the intervention should last longer than one month to be effective.

Children's active school transportation: an international scoping review of psychosocial factors

BACKGROUND

Over the last decades, the prevalence of AST has decreased significantly. Barriers to active school transport (AST) have been extensively examined in the literature, while psychosocial factors that facilitate AST have received less attention. To our best knowledge, there are currently no reviews on this subject. Therefore, the objective of this review was to scope the literature and identify published research about psychosocial factors related to AST.

METHODS

Systematic searches conducted in PubMed, Web of Science, TRID, Scopus, and ERIC resulted in a total of 1933 publications, and 77 of them were considered eligible for this review.

RESULTS

The results of the included articles were categorised into four psychosocial factors: confidence in ability, attitudes, social support, and social norms, which were all generally positively related to AST, with a few exceptions.

CONCLUSION

The findings of this review indicate that these psychosocial factors may be important to consider when developing interventions and highlight that both children and parents should be involved in the process. This knowledge can serve as a valuable guide for developing interventions to promote AST. However, the evidence base supporting these psychosocial factors requires further investigation to fully understand how and when to incorporate them to maximise AST efficacy.

Children's intervention participation is associated with more positive beliefs towards active school transportation among parents

Insufficient physical activity among children is a critical issue and health promoting initiatives are required to reverse this trend. In response to the current situation, a school-based intervention aiming to increase physical activity with the aid of active school transportation (AST) was implemented in one municipality in northern Sweden. By adopting the framework of the Theory of Planned Behavior, we aimed to analyse beliefs among parents whose children were or were not involved in the AST intervention. All municipality schools were included. There were 1024 responses from parents, comprising 610 who responded either 'yes' or 'no' to participating in the intervention. An adjusted linear regression analysis showed that children's intervention participation was significantly associated with more positive beliefs towards AST among parents. These results indicates that it is possible to influence beliefs that are important in the parental decision-making process by the use of an AST intervention. Therefore, to make children's active transport to school the more favorable choice for parents, it seems to be worthwhile to not only give children the opportunity to participate but also to involve parents and address their beliefs when designing interventions.

Changing Primary School Children's Engagement in Active School Travel Using Safe Routes to School Interventions: A Rapid Realist Review

Safe Routes to School (SR2S) interventions have been implemented in many economically developed countries to improve children's engagement in Active School Travel (AST). Evaluations have highlighted inconsistencies in SR2S intervention outcomes, raising questions as to how, why, and under what contextual conditions these interventions work. This review used a Rapid Realist Review (RRR) methodology to build, test, and refine an overarching program theory that unpicks the contextual factors and underlying mechanisms influencing children's engagement in AST. From the 45 included documents, 16 refined Context-Mechanism-Outcome Configurations (CMOCs) were developed and clustered into three partial program theories (i.e., implementor/implementation, child, and parent), with the associated mechanisms of: (1) School Reliance; (2) School Priority; (3) Fun; (4) Pride; (5) Perceived Safety; (6) Distrust; (7) Convenience; (8) Perceived Capabilities; and (9) Reassurance. The overarching program theory delineates the pathways between intervention implementation, children's motivation, parental decision-making, and children's engagement in AST. The findings suggest SR2S interventions can motivate children to engage in AST, but whether this motivation is translated into engagement is determined by parental decision-making. This review is novel for highlighting that many of the factors influencing parental decision-making are contextually driven and appear to be unaddressed by the current suite of SR2S intervention strategies. The review additionally highlights the complexity of parental perceptions of safety, with the traffic and the road environment shaping only part of this multidimensional mechanism. Practitioners and policymakers need to tailor SR2S interventions to local contexts to better influence parental decision-making for children's engagement in AST.

A Reusable Multiplayer Game for Promoting Active School Transport: Development Study

Background

Most children and adolescents in Sweden do not meet the recommended daily physical activity levels of the World Health Organization. Active school transport (AST) and gamification are potential methods for increasing children’s daily physical activity. We previously developed a game named Tic-Tac-Training for promoting active transport at workplaces; however, the game has not been applied to AST.

Objective

The objectives of this study are to investigate how Tic-Tac-Training functions to promote AST among schoolchildren in northern Sweden, improve the game to be more suitable for schoolchildren, and construct a road map for future development based on children’s ideas.

Methods

First, we developed Tic-Tac-Training using the Scrum agile software development method. Second, we conducted a questionnaire-based formative evaluation of the game with schoolchildren (n=16; 9/16, 56% male; 6/16, 38% female; and 1/16, 6% other aged 11-12 years) in Luleå, Sweden. Third, we conducted focus group interviews with 33 children (13/33, 39% male and 20/33, 61% female aged 12-13 years) to gather ideas for gamifying AST. We mapped the interview results to the Octalysis gamification framework and established a road map for future development.

Results

The formative evaluation revealed several issues, including a lack of interesting game features, lack of support for continuous engagement, disliked competitive features, and lack of incentives for discourse and participation. New features such as rewards, collectibles, and levels were implemented based on the results. The focus group interviews revealed additional ideas for gamifying AST, such as using avatars, in-game currency and trading, and context-sensitive tasks.

Conclusions

The results have several potential impacts on how reusable, gamified AST interventions can be developed and what kind of gamification elements schoolchildren in northern Sweden wish to see. These results can interest game researchers and teachers who wish to apply gamification in school contexts. Finally, we aim to continue developing the game based on the road map.

Initial Design and Testing of Multiplayer Cooperative Game to Support Physical Activity in Schools

Recent studies have shown that children are not adequately physically active and there is a need to increase children’s physical activity. This study describes new opportunities and solutions for using existing games and gamification to increase physical activity among children in Sweden. We adopted the principles of Tic-Tac-Training to redesign, build, and test a classical multiplayer cooperative game, Battleship, to create a PA game that children experience as fun and engaging. The low fidelity prototype of the game was developed using an iterative game development life cycle and tested with 13 young male children aged 8–11 in a real-world informal setting. A mixed-method research approach was used to understand the users’ experiences and the impact of the Battleship-PA game on behavior change regarding physical activity. Research data were collected through audio recordings of interactions, direct observation, and a user experience questionnaire. The results of this study indicate both positive and negative feedback that can be used to improve the game and user experiences. The results from the unfiltered recordings revealed that both teams were competitive, cooperated within their team, and became excited whenever they destroyed opponent’s ships or were close to winning. However, the children felt bored and exhausted when many gamification tasks were repeated several times in a game session. Direct observation indicated that the children enjoyed the physical activities resulting from playing the game. However, participants who had not previously played the classical version of Battleship were confused about the objectives and concept of the game. The analysis of the user experience questionnaire indicated that most children found the game easy to play, motivating, engaging, interactive, fun, cooperative, competitive, and visually appealing. Furthermore, most children agreed that the game helped them to be physically active and strongly agreed that they enjoyed performing the physical activities in the game. Future work is needed to improve the game user interface, gamification elements, and prepare additional physical activity tasks for a rewarding experience.

Development and Initial Validation of the PILCAST Questionnaire: Understanding Parents' Intentions to Let Their Child Cycle or Walk to School

Children generally do not meet the recommendation of 60 min of daily physical activity (PA); therefore, active school transportation (AST) is an opportunity to increase PA. To promote AST, the involvement of parents seems essential. Using the theory of planned behavior (TPB), the aim was to develop and validate the PILCAST questionnaire to understand parents’ intentions to let their child cycle or walk to school. Cross-sectional sampling was performed, where 1024 responses were collected from parents. Confirmatory factor analysis indicated acceptable fit indices for the factorial structure according to the TPB, comprising 32 items grouped in 11 latent constructs. All constructs showed satisfying reliability. The regression analysis showed that the TPB explained 55.3% of parents’ intentions to let the child cycle to school and 20.6% regarding walking, increasing by a further 18.3% and 16.6%, respectively, when past behavior was added. The most influential factors regarding cycling were facilitating perceived behavioral control, positive attitudes, subjective and descriptive norms, and for walking, subjective and descriptive norms. The PILCAST questionnaire contributes to a better understanding of the psychological antecedents involving parents’ decisions to let their child cycle or walk to school, and may therefore provide guidance when designing, implementing and evaluating interventions aiming to promote AST.

Promotion of Healthy Lifestyles to Teenagers with Mobile Devices: A Case Study in Portugal

Educating teenagers about nutrition and promoting active lifestyles is essential in reducing the long-term health risks and one idea to achieve this is by using mobile applications. Previous studies showed that the existing mobile applications have similar functionalities, such as intervention with questionnaires, and the use of gamification techniques to improve interactiveness. However, unlike our study, some studies are not validated and verified by healthcare professionals. Additionally, this study intends to promote the interaction between the teenagers and the medical communities. In this study, we analyze the benefits of the proposed mobile application, which features monitoring of physical activity, daily tips and curiosities, questionnaires, and gamification through earning points. Most of the teenagers were satisfied with the physical activity monitoring and found the tips, curiosities, and weekly questionnaires useful. The study started with 26 teenagers from two schools in the center of Portugal that would use the mobile application for five weeks. Still, at the end of the study, only 7 teenagers finalized the study. The decreasing number of teenagers in the study was affected by the lack of social interaction caused by the pandemic situation. During the period, the mobile application would engage the users with notifications on nutrition and physical activity, challenges concerning the number of steps and calories they would have to spend, and questionnaires related to the curiosities and suggestions from the previous week. We used Fisher’s test to investigate the relationship between the assessment obtained in the responses to the questionnaires, and the adoption of healthier eating and sports practices. In summary, participants were satisfied with the mobile application and experienced some improvements in diet and habits.