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Rivera E, Hesketh KD, Orellana L, Taylor R, Carson V, Nicholson JM, Barnett LM, Löf M, Koorts H, Becker D, Galland B, Salmon J, Downing KL. Prevalence of toddlers meeting 24-hour movement guidelines and associations with parental perceptions and practices. J Sci Med Sport 2024; 27:250-256. [PMID: 38216403 DOI: 10.1016/j.jsams.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/29/2023] [Accepted: 12/14/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVES Whether toddlers (1-2 years) meet 24-hour Movement Guidelines and how parental practices and perceptions are related to compliance are uncertain. This study: a) estimated the proportion of toddlers meeting individual and combined movement guidelines; and b) examined associations between parental perceptions/practices and toddlers' compliance with movement guidelines. DESIGN Cross-sectional study. METHODS Australian parents self-reported their parenting practices/perceptions (routines, co-participation, restrictions, concerns, knowledge) and toddlers' movement behaviours in the baseline assessment of Let's Grow (n=1145), a randomised controlled trial. The World Health Organization's Guidelines on Physical Activity, Sedentary Behaviour, and Sleep for children under 5 years were used to estimate the prevalence of compliance with individual and combined movement guidelines. Logistic models assessed cross-sectional associations. RESULTS The prevalence of meeting guidelines was 30.9% for screen time, 82.3% for sleep, 81.6% for physical activity, 20.1% for combined, and 2.1% meeting none. Parents' knowledge of the guidelines, fewer concerns and more favourable restrictions concerning movement behaviours were associated with greater compliance with individual and combined movement guidelines. Routines for screen time and for combined behaviours were associated with adherence to their respective guidelines. Less co-participation in screen time and more co-participation in physical activity were associated with greater compliance with the relevant guidelines. CONCLUSIONS Given only 20% of toddlers met all guidelines, strategies early in life to establish healthy movement behaviours, especially screen time, are needed. Future studies could target the parental practices/perceptions identified in this study to support toddlers with optimal sleep and physical activity and reduced screen time.
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Affiliation(s)
- Elise Rivera
- Deakin University, Institute for Physical Activity and Nutrition, Locked Bag 20001, Geelong, Victoria 3220, Australia.
| | - Kylie D Hesketh
- Deakin University, Institute for Physical Activity and Nutrition, Locked Bag 20001, Geelong, Victoria 3220, Australia
| | - Liliana Orellana
- Deakin University, Biostatistics Unit, Faculty of Health, Locked Bag 20001, Geelong, Victoria 3220, Australia
| | - Rachael Taylor
- University of Otago, Department of Medicine, New Zealand
| | - Valerie Carson
- University of Alberta, Faculty of Kinesiology, Sport, and Recreation, Edmonton, 8840 114st, Edmonton, AB T6G 2H9, Canada
| | | | - Lisa M Barnett
- Deakin University, Institute for Physical Activity and Nutrition, Locked Bag 20001, Geelong, Victoria 3220, Australia; Deakin University, School of Health and Social Development, Locked Bag 20001, Geelong, Victoria 3220, Australia
| | - Marie Löf
- Deakin University, Institute for Physical Activity and Nutrition, Locked Bag 20001, Geelong, Victoria 3220, Australia; Karolinska Institutet, Department of Biosciences and Nutrition, Sweden
| | - Harriet Koorts
- Deakin University, Institute for Physical Activity and Nutrition, Locked Bag 20001, Geelong, Victoria 3220, Australia
| | - Denise Becker
- Deakin University, Biostatistics Unit, Faculty of Health, Locked Bag 20001, Geelong, Victoria 3220, Australia
| | - Barbara Galland
- University of Otago, Department of Women's & Children's Health, New Zealand
| | - Jo Salmon
- Deakin University, Institute for Physical Activity and Nutrition, Locked Bag 20001, Geelong, Victoria 3220, Australia
| | - Katherine L Downing
- Deakin University, Institute for Physical Activity and Nutrition, Locked Bag 20001, Geelong, Victoria 3220, Australia
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Teychenne M, Apostolopoulos M, France-Ratcliffe M, Chua E, Hall S, Opie RS, Blunden S, Duncan MJ, Olander EK, Koorts H. Factors relating to sustainability and scalability of the 'Food, Move, Sleep (FOMOS) for Postnatal Mental Health' program: Qualitative perspectives from key stakeholders across Australia. Health Promot J Austr 2024; 35:393-409. [PMID: 37384432 DOI: 10.1002/hpja.767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023] Open
Abstract
ISSUE ADDRESSED Supporting healthy behaviours (quality diet, physical activity, sleep) through home-based interventions is feasible to improve postnatal mental health. Involving stakeholders in developing interventions is essential for maximising accessibility, implementation and scale-up. This study aimed to identify factors affecting the sustainable implementation and scalability of the Food, Move, Sleep (FOMOS) for Postnatal Mental Health program, including strategies to enhance research-practice translation. METHODS Stakeholders (n = 13) involved in promoting physical activity, healthy eating, postnatal and mental health, public health and/or policy participated in semi-structured interviews. Interviews, based on PRACTIS Guide recommendations for implementation and scale-up, explored perceptions of program design, implementation and scalability. Reflexive thematic analysis was undertaken. Identified implementation and scale-up strategies were mapped against the Expert Recommendations for Implementing Change compendium and PRACTIS Guide. RESULTS Individual-level: Targeting multiple systems (primary, tertiary, community-based care) and entry points (early, mid-postpartum) for uptake was important. For equity, screening women in public hospitals, engaging with community agencies and targeting most at-risk women, was suggested. Provider-level: Stakeholders identified strategies to enhance future roll-out (organisations assisting with recruitment). Factors impacting sustainability included high demand for the FOMOS program, and governance around screening and funding; online delivery, connecting with partners and providers and integration into existing services may enhance sustainability. Systems-level: Political support and community champions were perceived important for program dissemination. Nine strategies addressing program uptake, reach, implementation, potential scalability and sustainability were identified. CONCLUSIONS For sustainable implementation and potential scalability of a home-based multi-behaviour postnatal intervention, multi-level implementation and scale-up strategies, aligned with existing health systems, policies and initiatives to support postnatal mental health should be considered. SO WHAT?: This paper provides a comprehensive list of strategies that can be used to enhance sustainable implementation and scalability of healthy behaviour programs targeting postnatal mental health. Further, the interview schedule, systematically developed and aligned with the PRACTIS Guide, may serve as a useful resource for researchers conducting similar studies in future.
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Affiliation(s)
- Megan Teychenne
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Maria Apostolopoulos
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Madeleine France-Ratcliffe
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Elysha Chua
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Sanae Hall
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Rachelle S Opie
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Sarah Blunden
- Appleton Institute of Behavioural Science, Central Queensland University, Adelaide, South Australia, Australia
| | - Mitch J Duncan
- School of Medicine & Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Ellinor K Olander
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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Koorts H, Ma J, Swain CTV, Rutter H, Salmon J, Bolton KA. Systems approaches to scaling up: a systematic review and narrative synthesis of evidence for physical activity and other behavioural non-communicable disease risk factors. Int J Behav Nutr Phys Act 2024; 21:32. [PMID: 38515118 PMCID: PMC10958859 DOI: 10.1186/s12966-024-01579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 02/24/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are the leading causes of death worldwide. Systems approaches have potential for creating sustainable outcomes at scale but have rarely been used to support scale up in physical activity/nutrition promotion or NCD prevention more generally. This review aimed to: (i) synthesise evidence on the use of systems approaches in scaling up interventions targeting four behavioural risk factors for NCDs; and (ii) to explore how systems approaches have been conceptualised and used in intervention implementation and scale up. METHOD Seven electronic databases were searched for studies published 2016-2021. Eligible studies targeted at least one of four NCD behavioural risk factors (physical inactivity, tobacco use, alcohol consumption, diet), or described evaluation of an intervention planned for or scaled up. Studies were categorised as having a (i) high, (ii) moderate, or (iii) no use of a systems approach. A narrative synthesis of how systems approaches had been operationalised in scale up, following PRISMA guidelines. RESULTS Twenty-one intervention studies were included. Only 19% (n = 4) of interventions explicitly used systems thinking to inform intervention design, implementation and scale up (targeting all four risk factors n = 2, diet n = 1, tobacco use n = 1). Five studies ('high use') planned and implemented scale up with an explicit focus on relations between system elements and used system changes to drive impact at scale. Seven studies ('moderate use') considered systems elements impacting scale-up processes or outcomes but did not require achieving system-level changes from the outset. Nine studies ('no use') were designed to work at multiple levels among multiple agencies in an intervention setting, but the complexity of the system and relations between system elements was not articulated. We synthesised reported barriers and facilitators to scaling up, and how studies within each group conceptualised and used systems approaches, and methods, frameworks and principles for scaling up. CONCLUSION In physical activity research, and NCD prevention more broadly, the use of systems approaches in scale up remains in its infancy. For researchers, practitioners and policymakers wishing to adopt systems approaches to intervention implementation at scale, guidance is needed on how to communicate and operationalise systems approaches in research and in practice. TRIAL REGISTRATION PROSPERO (CRD42021287265).
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Affiliation(s)
- Harriet Koorts
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition (IPAN), 221 Burwood Highway, Burwood Geelong, VIC, 3125, Australia.
| | - Jiani Ma
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition (IPAN), 221 Burwood Highway, Burwood Geelong, VIC, 3125, Australia
| | - Christopher T V Swain
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Department of Physiotherapy, Faculty of Medicine Dentistry and Health Sciences, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, UK
| | - Jo Salmon
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition (IPAN), 221 Burwood Highway, Burwood Geelong, VIC, 3125, Australia
| | - Kristy A Bolton
- School of Exercise and Nutrition Sciences, Deakin University, Institute for Physical Activity and Nutrition (IPAN), 221 Burwood Highway, Burwood Geelong, VIC, 3125, Australia
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Contardo Ayala AM, Parker K, Mazzoli E, Lander N, Ridgers ND, Timperio A, Lubans DR, Abbott G, Koorts H, Salmon J. Effectiveness of Intervention Strategies to Increase Adolescents' Physical Activity and Reduce Sedentary Time in Secondary School Settings, Including Factors Related to Implementation: A Systematic Review and Meta-Analysis. Sports Med Open 2024; 10:25. [PMID: 38472550 DOI: 10.1186/s40798-024-00688-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/21/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Globally, just one in five adolescents meet physical activity guidelines and three-quarters of the school day is spent sitting. It is unclear which types of school-based interventions strategies increase physical activity and reduce sedentary time among adolescents, or how these interventions are implemented influences their effectiveness. OBJECTIVE The three aims of our systematic review were to (a) identify intervention strategies used within secondary school settings to improve students' movement behaviours throughout school-based initiatives, delivered at or by the school; (b) determine the overall effect of the interventions (meta-analysis) on physical activity (all intensities), sedentary time, cognitive/academic, physical health and/or psychological outcomes; and (c) describe factors related to intervention implementation. METHODS Searches were conducted in MEDLINE complete, EMBASE, CINAHL, SPORTDiscus, APA PsycINFO, and ERIC in January 2023 for studies that (a) included high school-aged adolescents; (b) involved a school-based intervention to increase physical activity and/or decrease sedentary time; and (c) were published in English. Reported effects were pooled in meta-analyses where sufficient data were obtained. RESULTS Eighty-five articles, representing 61 interventions, met the inclusion criteria, with 23 unique intervention strategies used. Interventions that involved whole-school approaches (i.e., physical activity sessions, environmental modifications, teacher training, peer support and/or educational resources) were favourably associated with most of the outcomes. The meta-analyses showed: (a) non-significant effects for sedentary time (Standardized mean difference [SMD] = -0.02; 95%CI, -0.14, 0.11), physical activity at all intensities (light: SMD= -0.01; 95%CI, -0.08, 0.05; moderate: SMD = 0.06; 95%CI, -0.09, 0.22; vigorous: SMD = 0.08; 95%CI, -0.02, 0.18; moderate-to-vigorous: SMD = 0.05; 95%CI, -0.01, 0.12) and waist circumference (SMD = 0.09; 95%CI, -0.03, 0.21), and (b) a small statistically significant decrease in body mass index (SMD= -0.09, 95%CI -0.16, -0.0). Factors related to intervention implementation were reported in 51% of the articles. CONCLUSION While some intervention approaches demonstrated promise, small or null effects were found in meta-analyses. Future school-based interventions should utilize a whole-school approach designed to increase adolescents' activity across the day. Consistent reporting of implementation will increase understanding of how interventions are adopted, implemented and sustained. REGISTRATION PROSPERO (CRD42020169988).
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Affiliation(s)
- Ana María Contardo Ayala
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia.
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia.
| | - Kate Parker
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Emiliano Mazzoli
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Natalie Lander
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Nicola D Ridgers
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, , Australia
| | - Anna Timperio
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - David R Lubans
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Newcastle, NSW, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Hunter Medical Research institute, New Lambton Heights, NSW, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Victoria, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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Koorts H, Timperio A, Lonsdale C, Ridgers ND, Lubans DR, Della Gatta J, Bauman A, Telford A, Barnett L, Lamb KE, Lander N, Lai SK, Sanders T, Arundell L, Brown H, Wilhite K, Salmon J. Scaling up a school-based intervention to increase physical activity and reduce sedentary behaviour in children: protocol for the TransformUs hybrid effectiveness-implementation trial. BMJ Open 2023; 13:e078410. [PMID: 37907301 PMCID: PMC10618986 DOI: 10.1136/bmjopen-2023-078410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/06/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Efficacious programmes require implementation at scale to maximise their public health impact. TransformUs is an efficacious behavioural and environmental intervention for increasing primary (elementary) school children's (5-12 years) physical activity and reducing their sedentary behaviour within school and home settings. This paper describes the study protocol of a 5-year effectiveness-implementation trial to assess the scalability and effectiveness of the TransformUs programme. METHODS AND ANALYSIS A type II hybrid implementation-effectiveness trial, TransformUs is being disseminated to all primary schools in the state of Victoria, Australia (n=1786). Data are being collected using mixed methods at the system (state government, partner organisations), organisation (school) and individual (teacher, parent and child) levels. Evaluation is based on programme Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. RE-AIM domains are being measured using a quasi-experimental, pre/post, non-equivalent group design, at baseline, 12 and 24 months. Effectiveness will be determined in a subsample of 20 intervention schools (in Victoria) and 20 control schools (in New South Wales (NSW), Australia), at baseline, 12 and 24 months. Primary outcomes include TransformUs Reach, Adoption, Implementation and organisational Maintenance (implementation trial), and children's physical activity and sedentary time assessed using accelerometers (effectiveness trial). Secondary outcomes include average sedentary time and moderate to vigorous-intensity physical activity on weekdays and during school hours, body mass index z-scores and waist circumference (effectiveness trial). Linear mixed-effects models will be fitted to compare outcomes between intervention and control participants accounting for clustering of children within schools, confounding and random effects. ETHICS AND DISSEMINATION The trial was approved by the Deakin University Human Research Ethics Committee (HEAG-H 28_2017), Victorian Department of Education, the NSW Department of Education, Australian Catholic University (2017-145R), Melbourne Archdiocese Catholic Schools and Catholic Schools NSW. Partners, schools/teachers and parents will provide an informed signed consent form prior to participating. Parents will provide consent for their child to participate in the effectiveness trial. Findings will be disseminated via peer-reviewed publications, scientific conferences, summary reports to schools and our partner organisations, and will inform education policy and practice on effective and sustainable ways to promote physical activity and reduce sedentary behaviours population-wide. TRIAL REGISTRATION NUMBER Australian Clinical Trials Registration Registry (ACTRN12617000204347).
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Affiliation(s)
- Harriet Koorts
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC 3216, Australia
| | - Anna Timperio
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC 3216, Australia
| | - Chris Lonsdale
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW 2060, Australia
| | - Nicola D Ridgers
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC 3216, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, South Australia 5001, Australia
| | - David R Lubans
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jacqueline Della Gatta
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC 3216, Australia
| | - Adrian Bauman
- School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Amanda Telford
- Australian Catholic University, National School of Education, Melbourne, VIC 3065, Australia
| | - Lisa Barnett
- Deakin University, Institute for Physical Activity and Nutrition, School of Health and Social Development, Geelong, VIC 3125, Australia
| | - Karen E Lamb
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3053, Australia
| | - Natalie Lander
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC 3216, Australia
| | - Samuel K Lai
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC 3216, Australia
| | - Taren Sanders
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW 2060, Australia
| | - Lauren Arundell
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC 3216, Australia
| | - Helen Brown
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC 3216, Australia
| | - Katrina Wilhite
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW 2060, Australia
| | - Jo Salmon
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC 3216, Australia
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Koorts H, Bauman A, Edwards N, Bellew W, Brown WJ, Duncan MJ, Lubans DR, Milat AJ, Morgan PJ, Nathan N, Searles A, Lee K, Plotnikoff RC. Tensions and Paradoxes of Scaling Up: A Critical Reflection on Physical Activity Promotion. Int J Environ Res Public Health 2022; 19:ijerph192114284. [PMID: 36361159 PMCID: PMC9657872 DOI: 10.3390/ijerph192114284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 05/21/2023]
Abstract
Achieving system-level, sustainable 'scale-up' of interventions is the epitome of successful translation of evidence-based approaches in population health. In physical activity promotion, few evidence-based interventions reach implementation at scale or become embedded within systems for sustainable health impact. This is despite the vast published literature describing efficacy studies of small-scale physical activity interventions. Research into physical activity scale-up (through case-study analysis; evaluations of scale-up processes in implementation trials; and mapping the processes, strategies, and principles for scale-up) has identified barriers and facilitators to intervention expansion. Many interventions are implemented at scale by governments but have not been evaluated or have unpublished evaluation information. Further, few public health interventions have evaluations that reveal the costs and benefits of scaled-up implementation. This lack of economic information introduces an additional element of risk for decision makers when deciding which physical activity interventions should be supported with scarce funding resources. Decision-makers face many other challenges when scaling interventions which do not relate to formal research trials of scale-up; Methods: To explore these issues, a multidisciplinary two-day workshop involving experts in physical activity scale-up was convened by the University of Newcastle, Australia, and the University of Ottawa, Canada (February 2019); Results: In this paper we discuss some of the scale-up tensions (challenges and conflicts) and paradoxes (things that are contrary to expectations) that emerged from this workshop in the context of the current literature and our own experiences in this field. We frame scale-up tensions according to epistemology, methodology, time, and partnerships; and paradoxes as 'reach without scale', 'planned serendipity' and 'simple complexity'. We reflect on the implications of these scale-up tensions and paradoxes, providing considerations for future scale-up research and practice moving forward; Conclusions: In this paper, we delve deeper into stakeholders' assumptions, processes and expectations of scaling up, and challenge in what ways as stakeholders, we all contribute to desired or undesired outcomes. Through a lens of 'tensions' and 'paradoxes', we make an original contribution to the scale-up literature that might influence current perspectives of scaling-up, provide future approaches for physical activity promotion, and contribute to understanding of dynamic of research-practice partnerships.
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Affiliation(s)
- Harriet Koorts
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
| | - Adrian Bauman
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, NSW 2037, Australia
| | - Nancy Edwards
- School of Nursing, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - William Bellew
- Sydney Medical School & Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Wendy J. Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, QLD 4072, Australia
| | - Mitch J. Duncan
- School of Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - David R. Lubans
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyvaskyla, Finland
| | - Andrew J. Milat
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
- Centre for Epidemiology and Evidence, NSW Ministry of Health, 1 Reserve Rd., St Leonards, NSW 2065, Australia
| | - Philip J. Morgan
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Nicole Nathan
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW 2287, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Karen Lee
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, NSW 2037, Australia
| | - Ronald C. Plotnikoff
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Correspondence: ; Tel.: +61-(02)-49854465
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Koorts H, Timperio A, Abbott G, Arundell L, Ridgers ND, Cerin E, Brown H, Daly RM, Dunstan DW, Hume C, Chinapaw MJM, Moodie M, Hesketh KD, Salmon J. Is level of implementation linked with intervention outcomes? Process evaluation of the TransformUs intervention to increase children’s physical activity and reduce sedentary behaviour. Int J Behav Nutr Phys Act 2022; 19:122. [PMID: 36115963 PMCID: PMC9482275 DOI: 10.1186/s12966-022-01354-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/23/2022] [Indexed: 01/16/2023] Open
Abstract
Background TransformUs was a four-arm school-based intervention to increase physical activity and reduce sedentary behaviour among primary school children. Pedagogical and environmental strategies targeted the classroom, school grounds and family setting. The aims of this study were to evaluate program fidelity, dose, appropriateness, satisfaction and sustainability, and associations between implementation level and outcomes among the three intervention arms. Methods At baseline, 18-months (mid-intervention) and 30-months (post-intervention), teachers, parents and children completed surveys, and children wore GT3X ActiGraph accelerometers for 8 days at each time point to determine physical activity and sedentary time. Implementation data were pooled across the three intervention groups and teachers were categorised by level of implementation: (i) ‘Low’ (< 33% delivered); (ii) ‘Moderate’ (33–67% delivered); and (iii) ‘High’ (> 67% delivered). Linear and logistic mixed models examined between group differences in implementation, and the association with children’s physical activity and sedentary time outcomes. Qualitative survey data were analysed thematically. Results Among intervention recipients, 52% (n = 85) of teachers, 29% (n = 331) of parents and 92% (n = 407) of children completed baseline evaluation surveys. At 18-months, teachers delivered on average 70% of the key messages, 65% set active/standing homework, 30% reported delivering > 1 standing lesson/day, and 56% delivered active breaks per day. The majority of teachers (96%) made activity/sports equipment available during recess and lunch, and also used this equipment in class (81%). Fidelity and dose of key messages and active homework reduced over time, whilst fidelity of standing lessons, active breaks and equipment use increased. TransformUs was deemed appropriate for the school setting and positively received. Implementation level and child behavioural outcomes were not associated. Integration of TransformUs into existing practices, children’s enjoyment, and teachers’ awareness of program benefits all facilitated delivery and sustainability. Conclusions This study demonstrated that intervention dose and fidelity increased over time, and that children’s enjoyment, senior school leadership and effective integration of interventions into school practices facilitated improved intervention delivery and sustainability. Teacher implementation level and child behavioural outcomes were unrelated, suggesting intervention efficacy was achieved irrespective of implementation variability. The potential translatability of TransformUs into practice contexts may therefore be increased. Findings have informed scale-up of TransformUs across Victoria, Australia. Trial registration International Standard Randomized Controlled Trial Number ISRCTN83725066; Australian New Zealand Clinical Trials Registry Number ACTRN12609000715279. Registered 19 August 2009. Available at: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=308387&isReview=true Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01354-5.
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Koorts H, Salmon PM, Swain CTV, Cassar S, Strickland D, Salmon J. A systems thinking approach to understanding youth active recreation. Int J Behav Nutr Phys Act 2022; 19:53. [PMID: 35549726 PMCID: PMC9097093 DOI: 10.1186/s12966-022-01292-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Active recreation contributes to child and adolescent physical activity, however, factors affecting uptake are poorly understood at the systems level. The aims of this study were: (1) to use systems analysis methods to understand youth active recreation in Victoria, Australia, (ii) identify potential system leverage points to enhance active recreation, and (iii) explore stakeholder views of systems analysis methods for informing practice and policy decision-making. Methods Phase 1: Umbrella review of systematic reviews (2013–2018), synthesising evidence for correlates, determinants and intervention evidence for promoting active recreation. Phase 2: Development of three systems models (ActorMap and two ActivMaps), depicting active recreation actors/organisations, correlates, determinants and intervention evidence. Phase 3: Development of causal loop diagrams (CLDs) and identification of leverage points based on the Action Scales Model. Phase 4: Model feedback via stakeholder interviews (n = 23; 16 organisations). Results From the literature, 93 correlates and determinants, and 49 intervention strategies were associated with child and adolescent active recreation; the majority located at a social or individual level. Ten potential system leverage points were identified in the CLDs, which differed for pre-schoolers versus children and adolescents. Only time outdoors (an event leverage point) emerged for all age groups. Changes to the built and natural environment (i.e., land use planning, urban design) as a complete domain was a key structural leverage point for influencing active recreation in children and adolescents. Subject matter experts and stakeholder interviews identified 125 actors operating across seven hierarchical active recreation system levels in Victoria. Stakeholder interviews identified 12 areas for future consideration and recommendations for practice/policy influence. Conclusions Our findings underscore the need for dynamic models of system behaviour in active recreation, and to capture stakeholder influence as more than a transactional role in evidence generation and use. Effective responses to youth inactivity require a network of interventions that target specific leverage points across the system. Our models illustrate areas that may have the greatest system-level impact, such as changes to the built and natural environment, and they provide a tool for policy, appraisal, advocacy, and decision-making within and outside of government. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01292-2.
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Affiliation(s)
- Harriet Koorts
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, 221 Burwood Highway, Burwood, Geelong, VIC, 3125, Australia.
| | - Paul M Salmon
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Christopher T V Swain
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, 221 Burwood Highway, Burwood, Geelong, VIC, 3125, Australia.,Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
| | - Samuel Cassar
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, 221 Burwood Highway, Burwood, Geelong, VIC, 3125, Australia
| | - David Strickland
- Sport and Recreation Victoria, Department of Jobs Precincts and Regions, Melbourne, Victoria, Australia
| | - Jo Salmon
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, 221 Burwood Highway, Burwood, Geelong, VIC, 3125, Australia
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Koorts H, Maple JL, Eakin E, Lawrence M, Salmon J. Complexities and Context of Scaling Up: A Qualitative Study of Stakeholder Perspectives of Scaling Physical Activity and Nutrition Interventions in Australia. Front Public Health 2022; 10:771235. [PMID: 35419340 PMCID: PMC8995799 DOI: 10.3389/fpubh.2022.771235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/03/2022] [Indexed: 01/07/2023] Open
Abstract
Background Scaling up population health interventions is a context-orientated, dynamic and multi-stakeholder process; understanding its influences is essential to enhance future scaling efforts. Using physical activity and nutrition interventions in Australia as case examples, the aim of this paper is to identify core influences involved in scaling up physical activity and nutrition interventions, and how these may differ by context and stakeholder. Methods A qualitative study involving semi-structured telephone interviews with individuals representing academic, government and non-government organizations with involvement in scaling up state and national physical activity and nutrition interventions. Interview questions were derived from the WHO report “20 Questions for Developing a Scaling up Case Study”, and mapped against four key principles and five core areas in the WHO ExpandNet framework for scaling up: (1) The innovation; (2) User organization; (3) Environment; (4) Resource team and; (5) Scale up strategy. Data were analyzed thematically. Results Nineteen interviews were conducted (government = 3; non-government = 5; and academic = 11 sectors) involving eight scaled up interventions, targeting nutrition (n = 2), physical activity (n = 1) or a combination (n = 5). Most themes aligned to the “Environment”, including: (i) political (e.g., personal agendas); (ii) social (e.g., lack of urgency); and (iii) sector/workforce (e.g., scale up accountability) factors. Themes relating to “Scale up strategy” (e.g., flexibility and evaluation transparency) were next most commonly occurring. Whilst themes were broadly consistent across participants, government participants had a more policy-oriented perspective on the scale up process. Academics discussed a tension between the generation and use of evidence, and the influence of political climates/interest on scale up decisions. Conclusion Attributes of the “Environment” and “Scale up strategy” consistently featured as major influences on successful outcomes, while the role of evidence differed greatly between participant groups. A multisector scale up strategy for future interventions may enable the complexities of environmental and political contexts to be incorporated into scale up planning.
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Affiliation(s)
- Harriet Koorts
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Jaimie-Lee Maple
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Elizabeth Eakin
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Mark Lawrence
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Jo Salmon
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
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10
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Hesketh KD, Downing KL, Galland BC, Nicholson JM, Taylor R, Orellana L, Abdelrazek M, Koorts H, Brown V, Haines J, Campbell KJ, Barnett LM, Löf M, Moodie M, Carson V, Salmon J. Protocol for the Let's Grow randomised controlled trial: examining efficacy, cost-effectiveness and scalability of a m-Health intervention for movement behaviours in toddlers. BMJ Open 2022; 12:e057521. [PMID: 35351726 PMCID: PMC8961153 DOI: 10.1136/bmjopen-2021-057521] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Despite being an important period for the development of movement behaviours (physical activity, sedentary behaviour and sleep), few interventions commencing prior to preschool have been trialled. The primary aim of this trial is to assess the 12-month efficacy of the Let's Grow mHealth intervention, designed to improve the composition of movement behaviours in children from 2 years of age. Let's Grow is novel in considering composition of movement behaviours as the primary outcome, using non-linear dynamical approaches for intervention delivery, and incorporating planning for real-world implementation and scale-up from its inception. METHODS AND ANALYSIS A randomised controlled trial will test the effects of the 12-month parental support mHealth intervention, Let's Grow, compared with a control group that will receive usual care plus electronic newsletters on unrelated topics for cohort retention. Let's Grow will be delivered via a purpose-designed mobile web application with linked SMS notifications. Intervention content includes general and movement-behaviour specific parenting advice and incorporates established behaviour change techniques. Intervention adherence will be monitored by app usage data. Data will be collected from participants using 24-hour monitoring of movement behaviours and parent report at baseline (T0), mid-intervention (T1; 6 months post baseline), at intervention conclusion (T2; 12 months post baseline) and 1-year post intervention (T3; 2 years post baseline). The trial aims to recruit 1100 families from across Australia during 2021. In addition to assessment of efficacy, an economic evaluation and prospective scalability evaluation will be conducted. ETHICS AND DISSEMINATION The study was approved by the Deakin University Human Ethics Committee (2020-077). Study findings will be disseminated through publication in peer-reviewed journals, presentation at scientific and professional conferences, and via social and traditional media. TRIAL REGISTRATION NUMBER ACTRN12620001280998; U1111-1252-0599.
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Affiliation(s)
- Kylie D Hesketh
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Katherine L Downing
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Barbara C Galland
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Jan M Nicholson
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Rachael Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Liliana Orellana
- Faculty of Health Biostatistics Unit, Deakin University, Geelong, Victoria, Australia
| | - Mohamed Abdelrazek
- School of Information Technology, Deakin University, Burwood, Victoria, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Victoria Brown
- Deakin Health Economics, Institute for Health Transformation, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Lisa M Barnett
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
- School of Health & Social Development, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Marie Löf
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Deakin University Faculty of Health, Geelong, Victoria, Australia
| | - Valerie Carson
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Jo Salmon
- Institute for Physical Activity and Nutrition, Deakin University Faculty of Health, Geelong, Victoria, Australia
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11
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Wong S, Hassett L, Koorts H, Grunseit A, Tong A, Tiedemann A, Greaves CJ, Haynes A, Milat A, Harvey LA, Taylor NF, Hinman RS, Pinherio MDB, Jennings M, Treacy D, O'Rourke S, West C, Ramsay E, Kirkham C, Morris C, Sherrington C. Planning implementation and scale-up of physical activity interventions for people with walking difficulties: study protocol for the process evaluation of the ComeBACK trial. Trials 2022; 23:40. [PMID: 35033165 PMCID: PMC8760869 DOI: 10.1186/s13063-021-05990-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background There is currently little evidence of planning for real-world implementation of physical activity interventions. We are undertaking the ComeBACK (Coaching and Exercise for Better Walking) study, a 3-arm hybrid Type 1 randomised controlled trial evaluating a health coaching intervention and a text messaging intervention. We used an implementation planning framework, the PRACTical planning for Implementation and Scale-up (PRACTIS), to guide the process evaluation for the trial. The aim of this paper is to describe the protocol for the process evaluation of the ComeBACK trial using the framework of the PRACTIS guide. Methods A mixed methods process evaluation protocol was developed informed by the Medical Research Council (MRC) guidance on process evaluations for complex interventions and the PRACTIS guide. Quantitative data, including participant questionnaires, health coach and administrative logbooks, and website and text message usage data, is being collected over the trial period. Semi-structured interviews and focus groups with trial participants, health coaches and health service stakeholders will explore expectations, factors influencing the delivery of the ComeBACK interventions and potential scalability within existing health services. These data will be mapped against the steps of the PRACTIS guide, with reporting at the level of the individual, provider, organisational and community/systems. Quantitative and qualitative data will elicit potential contextual barriers and facilitators to implementation and scale-up. Quantitative data will be reported descriptively, and qualitative data analysed thematically. Discussion This process evaluation integrates an evaluation of prospective implementation and scale-up. It is envisaged this will inform barriers and enablers to future delivery, implementation and scale-up of physical activity interventions. To our knowledge, this is the first paper to describe the application of PRACTIS to guide the process evaluation of physical activity interventions. Trial registration Australian and New Zealand Clinical Trials Registry (ANZCTR) Registration date: 10/12/2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05990-3.
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Affiliation(s)
- Siobhan Wong
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.
| | - Leanne Hassett
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.,Sydney School of Health Sciences, Faculty of Medicine & Health, University of Sydney, Sydney, Australia
| | - Harriet Koorts
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Anne Grunseit
- Prevention Research Collaboration, Sydney Medical School, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital, Westmead, Sydney, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Colin J Greaves
- Psychology Applied to Health, School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Abby Haynes
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Andrew Milat
- Sydney Medical School, School of Public Health, The University of Sydney, Sydney, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Northern Clinical School, The University of Sydney, Sydney, Australia
| | - Nicholas F Taylor
- Centre for Sport and Exercise Medicine Research, La Trobe University, Melbourne, Australia.,Eastern Health, Alfred Health, Box Hill, Victoria, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Marina De Barros Pinherio
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | | | - Daniel Treacy
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.,South Eastern Sydney Local Health District, Sydney, Australia
| | - Sandra O'Rourke
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Courtney West
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Elizabeth Ramsay
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Catherine Kirkham
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | | | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
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12
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Koorts H, Cassar S, Salmon J, Lawrence M, Salmon P, Dorling H. Mechanisms of scaling up: combining a realist perspective and systems analysis to understand successfully scaled interventions. Int J Behav Nutr Phys Act 2021; 18:42. [PMID: 33752681 PMCID: PMC7986035 DOI: 10.1186/s12966-021-01103-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 02/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Sustainable shifts in population behaviours require system-level implementation and embeddedness of large-scale health interventions. This paper aims to understand how different contexts of scaling up interventions affect mechanisms to produce intended and unintended scale up outcomes. Methods A mixed method study combining a realist perspective and systems analysis (causal loop diagrams) of scaled-up physical activity and/or nutrition interventions implemented at a state/national level in Australia (2010–18). The study involved four distinct phases: Phase 1 expert consultation, database and grey literature searches to identify scaled-up interventions; Phase 2 generating initial Context-Mechanism-Outcome configurations (CMOs) from the WHO ExpandNet framework for scaling up; Phase 3 testing and refining CMOs via online surveys and realist interviews with academics, government and non-government organisations (NGOs) involved in scale up of selected interventions (Phase 1); and Phase 4 generating cross-case mid-range theories represented in systems models of scaling up; validated by member checking. Descriptive statistics were reported for online survey data and realist analysis for interview data. Results Seven interventions were analysed, targeting nutrition (n = 1), physical activity (n = 1), or a combination (n = 5). Twenty-six participants completed surveys; 19 completed interviews. Sixty-three CMO pathways underpinned successful scale up, reflecting 36 scale up contexts, 8 key outcomes; linked via 53 commonly occurring mechanisms. All five WHO framework domains were represented in the systems models. Most CMO pathways included ‘intervention attributes’ and led to outcomes ‘community sustainability/embeddedness’ and ‘stakeholder buy-in/perceived value’. Irrespective of interventions being scaled in similar contexts (e.g., having political favourability); mechanisms still led to both intended and unintended scale up outcomes (e.g., increased or reduced sustainability). Conclusion This paper provides the first evidence for mechanisms underpinning outcomes required for successful scale up of state or nationally delivered interventions. Our findings challenge current prerequisites for effective scaling suggesting other conditions may be necessary. Future scale up approaches that plan for complexity and encourage iterative adaptation throughout, may enhance scale up outcomes. Current linear, context-to-outcome depictions of scale up oversimplify what is a clearly a complex interaction between perceptions, worldviews and goals of those involved. Mechanisms identified in this study could potentially be leveraged during future scale up efforts, to positively influence intervention scalability and sustainability. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01103-0.
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Affiliation(s)
- Harriet Koorts
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, VIC, Australia.
| | - Samuel Cassar
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, VIC, Australia
| | - Jo Salmon
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, VIC, Australia
| | - Mark Lawrence
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, VIC, Australia
| | - Paul Salmon
- Centre for Human Factors and Sociotechnical Systems, Faculty of Arts, Business and Law, University of the Sunshine Coast, Queensland, Australia
| | - Henry Dorling
- Solent University, School of Sport, Health and Social Science, Southampton, Hampshire, UK
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Abstract
Despite a number of important global public health successes, for many health behaviours there is a continued lack of interventions that have been sufficiently scaled up to achieve system-wide integration. This has limited sustainable and equitable population health improvement. Systems change plays a major role in the relation between implementation processes and at-scale institutionalisation of public health interventions. However, in research, systems approaches remain underutilised in scaling up. Public health scale-up models have typically centred on intervention replication through linear expansion. In this paper, we discuss current conceptualisations and approaches used when scaling up in public health, and propose a new perspective on scaling that shifts attention away from the intervention to focus instead on achieving the desired population-level health outcomes. In our view, 'scaling up' exists on a continuum. At one end, effective scaling can involve a linear, intervention-orientated expansive approach that prioritises the spread of evidence-based interventions into existing systems in order to drive expansion in the application of that intervention. At the other end, we contend that scale-up can sit within a complex systems paradigm in which interventions are conceptualised as events in systems. In this case, implementation and scale-up activities should focus on generating changes within the system itself to achieve the desired outcome. This we refer to as 'systems-orientated scale-up' to achieving population health improvement, which can complement traditional approaches in relevant situations. We argue that for some health behaviours, our proposed approach towards scaling up could enhance intervention implementation, sustainability and population health impact.
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Affiliation(s)
- Harriet Koorts
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Claverton Down, Bath, United Kingdom
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14
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Laws R, Love P, Hesketh KD, Koorts H, Denney-Wilson E, Moodie M, Brown V, Ong KL, Browne J, Marshall S, Lioret S, Orellana L, Campbell KJ. Protocol for an Effectiveness-Implementation Hybrid Trial to Evaluate Scale up of an Evidence-Based Intervention Addressing Lifestyle Behaviours From the Start of Life: INFANT. Front Endocrinol (Lausanne) 2021; 12:717468. [PMID: 34975744 PMCID: PMC8715861 DOI: 10.3389/fendo.2021.717468] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/21/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Promoting healthy eating and active play in early life is critical, however few interventions have been delivered or sustained at scale. The evaluation of interventions at scale is a crucial, yet under-researched aspect of modifying population-level health behaviours. INFANT is an evidence-based early childhood healthy lifestyle intervention that aims to improve parents' knowledge and skills around promoting optimal energy balance-related behaviours that, in turn, influence children's diet, activity and adiposity. It consists of: 1) Four group sessions delivered via first time parent groups across the first 12 months of life; 2) access to the My Baby Now app from birth to 18 months of age. This research aims to assess real-world implementation, effectiveness and cost-effectiveness of INFANT when delivered at scale across Victoria, Australia. METHODS AND ANALYSIS A hybrid type II implementation-effectiveness trial applying a mixed methods design will be conducted. INFANT will be implemented in collaboration with practice and policy partners including maternal and child health services, population health and Aboriginal health, targeting all local government areas (n=79) in Victoria, Australia. Evaluation is based on criteria from the 'Outcomes for Implementation Research' and 'RE-AIM' frameworks. Implementation outcomes will be assessed using descriptive quantitative surveys and qualitative interviews with those involved in implementation, and include intervention reach, organisational acceptability, adoption, appropriateness, cost, feasibility, penetration and sustainability. Process measures include organizational readiness, fidelity, and adaptation. Effectiveness outcomes will be assessed using a sample of INFANT participants and a non-randomized comparison group receiving usual care (1,500 infants in each group), recruited within the same communities. Eligible participants will be first time primary caregivers of an infant aged 0-3 months, owning a personal mobile phone and able to communicate in English. Effectiveness outcomes include infant lifestyle behaviours and BMIz at 12 and 18 months of age. IMPACT This is the first known study to evaluate the scale up of an evidence based early childhood obesity prevention intervention under real world conditions. This study has the potential to provide generalisable implementation, effectiveness and cost-effectiveness evidence to inform the future scale up of public health interventions both in Australia and internationally. CLINICAL TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry https://www.anzctr.org.au/, identifier ACTRN12620000670976.
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Affiliation(s)
- Rachel Laws
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
- *Correspondence: Rachel Laws,
| | - Penelope Love
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Kylie D. Hesketh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Elizabeth Denney-Wilson
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Kok-Leong Ong
- La Trobe Analytics Lab, La Trobe University, Melbourne, VIC, Australia
| | - Jennifer Browne
- Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Sarah Marshall
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | | | | | - Karen J. Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
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15
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Subedi N, Rawstorn JC, Gao L, Koorts H, Maddison R. Implementation of Telerehabilitation Interventions for the Self-Management of Cardiovascular Disease: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e17957. [PMID: 33245286 PMCID: PMC7732711 DOI: 10.2196/17957] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/02/2020] [Accepted: 07/15/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Coronary heart disease (CHD) is a leading cause of disability and deaths worldwide. Secondary prevention, including cardiac rehabilitation (CR), is crucial to improve risk factors and to reduce disease burden and disability. Accessibility barriers contribute to underutilization of traditional center-based CR programs; therefore, alternative delivery models, including cardiac telerehabilitation (ie, delivery via mobile, smartphone, and/or web-based apps), have been tested. Experimental studies have shown cardiac telerehabilitation to be effective and cost-effective, but there is inadequate evidence about how to translate this research into routine clinical practice. OBJECTIVE This systematic review aimed to synthesize research evaluating the effectiveness of implementing cardiac telerehabilitation interventions at scale in routine clinical practice, including factors underlying successful implementation processes, and experimental research evaluating implementation-related outcomes. METHODS MEDLINE, Embase, PsycINFO, and Global Health databases were searched from 1990 through November 9, 2018, for studies evaluating the implementation of telerehabilitation for the self-management of CHD. Reference lists of included studies and relevant systematic reviews were hand searched to identify additional studies. Implementation outcomes of interest included acceptability, appropriateness, adoption, feasibility, fidelity, implementation cost, penetration, and sustainability. A narrative synthesis of results was carried out. RESULTS No included studies evaluated the implementation of cardiac telerehabilitation in routine clinical practice. A total of 10 studies of 2250 participants evaluated implementation outcomes, including acceptability (8/10, 80%), appropriateness (9/10, 90%), adoption (6/10, 60%), feasibility (6/10, 60%), fidelity (7/10, 70%), and implementation cost (4/10, 40%), predominantly from the participant perspective. Cardiac telerehabilitation interventions had high acceptance among the majority of participants, but technical challenges such as reliable broadband internet connectivity can impact acceptability and feasibility. Many participants considered telerehabilitation to be an appropriate alternative CR delivery model, as it was convenient, flexible, and easy to access. Participants valued interactive intervention components, such as real-time exercise monitoring and feedback as well as individualized support. The penetration and sustainability of cardiac telerehabilitation, as well as the perspectives of CR practitioners and health care organizations, have received little attention in existing cardiac telerehabilitation research. CONCLUSIONS Experimental trials suggest that participants perceive cardiac telerehabilitation to be an acceptable and appropriate approach to improve the reach and utilization of CR, but pragmatic implementation studies are needed to understand how interventions can be sustainably translated from research into clinical practice. Addressing this gap could help realize the potential impact of telerehabilitation on CR accessibility and participation as well as person-centered, health, and economic outcomes. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42019124254; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=124254.
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Affiliation(s)
- Narayan Subedi
- School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Australia
| | - Jonathan C Rawstorn
- School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Australia
| | - Lan Gao
- School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, Australia
| | - Harriet Koorts
- School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Australia
| | - Ralph Maddison
- School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Australia
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Cassar S, Salmon J, Timperio A, Koch S, Koorts H. A qualitative study of school leader experiences adopting and implementing a whole of school physical activity and sedentary behaviour programme: Transform-Us! HE 2020. [DOI: 10.1108/he-05-2020-0031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Little is known about the experiences of school leaders adopting and implementing real-world, scaled-up physical activity interventions in the Australian educational system. Transform-Us! is a novel physical activity and sedentary behaviour intervention available to all primary schools in Victoria, Australia, since September 2018. This study explored barriers and facilitators experienced by school leaders during the adoption and early implementation phases of Transform-Us!.
Design/methodology/approach
Qualitative study involving seven semi-structured telephone interviews with school leaders implementing Transform-Us! in primary schools in Victoria, Australia. Interview schedules were developed based on the theoretical domains framework (TDF). Interviews were coded using a framework analysis approach.
Findings
Four key themes emerged relating to ten of the 14 TDF domains. Themes included: knowledge, goals, implementation factors and leadership. School leaders play a central role in creating a positive implementation environment including the delivery setting (classroom) and a supportive culture (knowledge sharing) in the school. The application of the TDF to the study bridges the gap between theory and practice and identifies potential future implementation strategies which may be further tested in professional practice future studies. Recommendations for increased adoption and sustained implementation related to seven core areas: presence of a school/programme champion(s); collaborative knowledge sharing; online training; school-based workshops; promotion of behavioural and mental health outcomes; teacher autonomy in delivery; and a supportive implementation environment.
Originality/value
School leaders have a unique scope to influence the adoption and implementation of physical activity and sedentary behaviour interventions. This study outlines specific barriers and facilitators for implementation of a physical activity programme in the Australian educational setting and offers recommendations for programme optimisation.
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Koorts H, Salmon J, Timperio A, Ball K, Macfarlane S, Lai SK, Brown H, Chappel SE, Lewis M, Ridgers ND. Translatability of a Wearable Technology Intervention to Increase Adolescent Physical Activity: Mixed Methods Implementation Evaluation. J Med Internet Res 2020; 22:e13573. [PMID: 32763872 PMCID: PMC7442941 DOI: 10.2196/13573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 08/30/2019] [Accepted: 04/15/2020] [Indexed: 01/04/2023] Open
Abstract
Background Wearable technology interventions combined with digital behavior change resources provide opportunities to increase physical activity in adolescents. The implementation of such interventions in real-world settings is unknown. The Raising Awareness of Physical Activity (RAW-PA) study was a 12-week cluster randomized controlled trial targeting inactive adolescents attending schools in socioeconomically disadvantaged areas of Melbourne, Australia. The aim was to increase moderate- to vigorous-intensity physical activity using (1) a wrist-worn Fitbit Flex and app, (2) weekly challenges, (3) digital behavior change resources, and (4) email or text message alerts. Objective This paper presents adolescents’ and teachers’ perceptions of RAW-PA in relation to program acceptability, feasibility and perceived impact, adolescent engagement and adherence, and the potential for future scale-up. Methods A mixed methods evaluation of the RAW-PA study assessed acceptability, engagement, feasibility, adherence, and perceived impact. A total of 9 intervention schools and 144 intervention adolescents were recruited. Only adolescents and teachers (n=17) in the intervention group were included in the analysis. Adolescents completed web-based surveys at baseline and surveys and focus groups postintervention. Teachers participated in interviews postintervention. Facebook data tracked engagement with web-based resources. Descriptive statistics were reported by sex. Qualitative data were analyzed thematically. Results Survey data were collected from 142 adolescents at baseline (mean age 13.7 years, SD 0.4 years; 51% males) and 132 adolescents postintervention. A total of 15 focus groups (n=124) and 9 interviews (n=17) were conducted. RAW-PA had good acceptability among adolescents and teachers. Adolescents perceived the intervention content as easy to understand (100/120, 83.3%) and the Fitbit easy to use (112/120; 93.3%). Half of the adolescents perceived the text messages to be useful (61/120; 50.8%), whereas 47.5% (57/120) liked the weekly challenges and 38.3% (46/120) liked the Facebook videos. Facebook engagement declined over time; only 18.6% (22/118) of adolescents self-reported wearing the Fitbit Flex daily postintervention. Adolescents perceived the Fitbit Flex to increase their physical activity motivation (85/120, 70.8%) and awareness (93/119, 78.2%). The web-based delivery facilitated implementation of the intervention, although school-level policies restricting phone use were perceived as potential inhibitors to program roll-out. Conclusions RAW-PA showed good acceptability among adolescents attending schools in socioeconomically disadvantaged areas and their teachers. Low levels of teacher burden enhanced their perceptions concerning the feasibility of intervention delivery. Although adolescents perceived that RAW-PA had short-term positive effects on their motivation to be physically active, adolescent adherence and engagement were low. Future research exploring the feasibility of different strategies to engage adolescents with wearable technology interventions and ways of maximizing system-level embeddedness of interventions in practice would greatly advance the field.
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Affiliation(s)
- Harriet Koorts
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Jo Salmon
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Anna Timperio
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Kylie Ball
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | | | - Samuel K Lai
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Helen Brown
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Stephanie E Chappel
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Marina Lewis
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Nicola D Ridgers
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
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Sharp CA, McNarry MA, Eddolls WTB, Koorts H, Winn CON, Mackintosh KA. Identifying facilitators and barriers for adolescents participating in a school-based HIIT intervention: the eXercise for asthma with commando Joe's® (X4ACJ) programme. BMC Public Health 2020; 20:609. [PMID: 32357869 PMCID: PMC7195754 DOI: 10.1186/s12889-020-08740-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 04/20/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND High-intensity interval training (HIIT) elicits numerous health benefits, but little evidence is available regarding the feasibility of delivering school-based HIIT interventions. The aim of this study was to explore adolescents' perceptions of a 6-month, 3 × 30-min sessions per week, HIIT intervention delivered either before or after school. METHOD Eighty adolescents allocated to the intervention group (13.3 ± 1.0 years; 45 boys) were invited to take part in semi-structured focus groups post-intervention. Participants were categorised as attendees (≥40% attendance) or non-attendees (< 5% attendance). Data were transcribed verbatim and thematically analysed deductively, with key emergent themes represented using pen profiles. RESULTS Results showed that a school-based HIIT intervention can be an enjoyable form of exercise. Irrespective of attendance, similar facilitators and barriers to participating were highlighted, including benefits of participation, content of the exercise session and the intervention instructor. CONCLUSION This study provides support for the delivery of a HIIT intervention in a school setting but highlights the importance of a flexible design and delivery to accommodate competing interests. There is a need to educate adolescents on the possible benefits of participation and to make the sessions enjoyable in order to increase their extrinsic and intrinsic motivation to sustain participation.
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Affiliation(s)
- Catherine A Sharp
- Public Health Collaborating Unit, School of Health Sciences, Bangor University, Bangor, UK
| | - Melitta A McNarry
- Applied Sports Science Technology, Exercise and Medicine (A-STEM) Research Centre, College of Engineering, Bay Campus, Swansea University, Swansea, UK.
| | - William T B Eddolls
- Applied Sports Science Technology, Exercise and Medicine (A-STEM) Research Centre, College of Engineering, Bay Campus, Swansea University, Swansea, UK
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Charles O N Winn
- Applied Sports Science Technology, Exercise and Medicine (A-STEM) Research Centre, College of Engineering, Bay Campus, Swansea University, Swansea, UK
| | - Kelly A Mackintosh
- Applied Sports Science Technology, Exercise and Medicine (A-STEM) Research Centre, College of Engineering, Bay Campus, Swansea University, Swansea, UK
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Veitch J, Denniss E, Ball K, Koorts H, Deforche B, Timperio A. Increasing translation of research evidence for optimal park design: a qualitative study with stakeholders. Int J Behav Nutr Phys Act 2020; 17:49. [PMID: 32295650 PMCID: PMC7160899 DOI: 10.1186/s12966-020-00952-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/01/2020] [Indexed: 11/18/2022] Open
Abstract
Background The design of parks is critical to ensure they are appealing, meet the needs of the community and optimise opportunities for physical activity, relaxation, exposure to nature and social interaction. There is currently a lack of understanding on how research evidence is informing park design and how to reduce the many challenges associated with research-practice-policy translation. Understanding how organisations use evidence for decision-making regarding park design is critical for reducing the research-practice-policy gap and ensuring evidence based strategies inform park design to support healthy active living. This study explored stakeholder perceptions regarding factors that influence the use of research evidence to inform park planning and design, and potential strategies to enhance effective translation of research evidence for optimal park design into policy and practice. Methods One-on-one in-depth interviews were conducted with 23 stakeholders within the park design, planning and management sector. Participants shared experiences regarding: influences on park development and design; current park development policies; ways to facilitate use of evidence; and priorities for future research. Interviews were recorded and transcribed verbatim and content analysis performed using NVivo 12. Results Research evidence is used and considered important for park planning; however, several barriers were highlighted: time and cost constraints; difficulties accessing research; and limited research relevant to specific needs. Developing partnerships between researchers and park developers and providing evidence in a more accessible format such as short summaries/reports, infographics, presentations, research updates and dedicated research databases emerged as key enablers. The main research gaps identified included research into park features to encourage visitation and cost-benefit analyses studies. Conclusions This research is a first step to better understand strategies to promote more effective uptake and use of evidence to inform park planning. Researchers must develop multi-sectoral collaborations and generate policy-relevant research in a readily accessible, timely and user-friendly format to ensure evidence is used to enhance park design and ultimately public health.
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Affiliation(s)
- Jenny Veitch
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
| | - Emily Denniss
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Benedicte Deforche
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium.,Physical Activity, Nutrition and Health Research Unit, Department of Movement and Sport Sciences, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium
| | - Anna Timperio
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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20
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Owen N, Healy GN, Dempsey PC, Salmon J, Timperio A, Clark BK, Goode AD, Koorts H, Ridgers ND, Hadgraft NT, Lambert G, Eakin EG, Kingwell BA, Dunstan DW. Sedentary Behavior and Public Health: Integrating the Evidence and Identifying Potential Solutions. Annu Rev Public Health 2020; 41:265-287. [DOI: 10.1146/annurev-publhealth-040119-094201] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In developed and developing countries, social, economic, and environmental transitions have led to physical inactivity and large amounts of time spent sitting. Research is now unraveling the adverse public health consequences of too much sitting. We describe improvements in device-based measurement that are providing new insights into sedentary behavior and health. We consider the implications of research linking evidence from epidemiology and behavioral science with mechanistic insights into the underlying biology of sitting time. Such evidence has led to new sedentary behavior guidelines and initiatives. We highlight ways that this emerging knowledge base can inform public health strategy: First, we consider epidemiologic and experimental evidence on the health consequences of sedentary behavior; second, we describe solutions-focused research from initiatives in workplaces and schools. To inform a broad public health strategy, researchers need to pursue evidence-informed collaborations with occupational health, education, and other sectors.
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Affiliation(s)
- Neville Owen
- Centre for Urban Transitions, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia;,
- Behavioural Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - Genevieve N. Healy
- School of Public Health, University of Queensland, Herston, Queensland 4006, Australia;, , ,
| | - Paddy C. Dempsey
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia;,
| | - Jo Salmon
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria 3125, Australia;, , ,
| | - Anna Timperio
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria 3125, Australia;, , ,
| | - Bronwyn K. Clark
- School of Public Health, University of Queensland, Herston, Queensland 4006, Australia;, , ,
| | - Ana D. Goode
- School of Public Health, University of Queensland, Herston, Queensland 4006, Australia;, , ,
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria 3125, Australia;, , ,
| | - Nicola D. Ridgers
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria 3125, Australia;, , ,
| | - Nyssa T. Hadgraft
- Centre for Urban Transitions, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia;,
| | - Gavin Lambert
- Iverson Health Innovation Institute, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - Elizabeth G. Eakin
- School of Public Health, University of Queensland, Herston, Queensland 4006, Australia;, , ,
| | - Bronwyn A. Kingwell
- CSL Limited, Bio21 Institute, Melbourne, Victoria 3010, Australia
- Metabolic and Vascular Physiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - David W. Dunstan
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia;,
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria 3000, Australia
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Drehlich M, Naraine M, Rowe K, Lai SK, Salmon J, Brown H, Koorts H, Macfarlane S, Ridgers ND. Using the Technology Acceptance Model to Explore Adolescents' Perspectives on Combining Technologies for Physical Activity Promotion Within an Intervention: Usability Study. J Med Internet Res 2020; 22:e15552. [PMID: 32141834 PMCID: PMC7084284 DOI: 10.2196/15552] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/30/2019] [Accepted: 12/16/2019] [Indexed: 01/26/2023] Open
Abstract
Background Wearable activity trackers and social media have been identified as having the potential to increase physical activity among adolescents, yet little is known about the perceived ease of use and perceived usefulness of the technology by adolescents. Objective The aim of this study was to use the technology acceptance model to explore adolescents’ acceptance of wearable activity trackers used in combination with social media within a physical activity intervention. Methods The Raising Awareness of Physical Activity study was a 12-week physical activity intervention that combined a wearable activity tracker (Fitbit Flex) with supporting digital materials that were delivered using social media (Facebook). A total of 124 adolescents aged 13 to 14 years randomized to the intervention group (9 schools) participated in focus groups immediately post intervention. Focus groups explored adolescents’ perspectives of the intervention and were analyzed using pen profiles using a coding framework based on the technology acceptance model. Results Adolescents reported that Fitbit Flex was useful as it motivated them to be active and provided feedback about their physical activity levels. However, adolescents typically reported that Fitbit Flex required effort to use, which negatively impacted on their perceived ease of use. Similarly, Facebook was considered to be a useful platform for delivering intervention content. However, adolescents generally noted preferences for using alternative social media websites, which may have impacted on negative perceptions concerning Facebook’s ease of use. Perceptions of technological risks included damage to or loss of the device, integrity of data, and challenges with both Fitbit and Facebook being compatible with daily life. Conclusions Wearable activity trackers and social media have the potential to impact adolescents’ physical activity levels. The findings from this study suggest that although the adolescents recognized the potential usefulness of the wearable activity trackers and the social media platform, the effort required to use these technologies, as well as the issues concerning risks and compatibility, may have influenced overall engagement and technology acceptance. As wearable activity trackers and social media platforms can change rapidly, future research is needed to examine the factors that may influence the acceptance of specific forms of technology by using the technology acceptance model. Trial Registration Australian and New Zealand Clinical Trials Registry ACTRN12616000899448; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370716
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Affiliation(s)
- Mark Drehlich
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Michael Naraine
- Deakin Business School, Deakin University, Burwood, Australia
| | - Katie Rowe
- Deakin Business School, Deakin University, Burwood, Australia
| | - Samuel K Lai
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Helen Brown
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | | | - Nicola D Ridgers
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
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Koorts H, Naylor PJ, Laws R, Love P, Maple JL, van Nassau F. What hinders and helps academics to conduct Dissemination and Implementation (D&I) research in the field of nutrition and physical activity? An international perspective. Int J Behav Nutr Phys Act 2020; 17:7. [PMID: 31948456 PMCID: PMC6966833 DOI: 10.1186/s12966-020-0909-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background Ineffective research-practice translation is a major challenge to population health improvement. This paper presents an international perspective on the barriers and facilitators associated with the uptake of and engagement in Dissemination and Implementation (D&I) research in the fields of physical activity and nutrition. Methods A mixed methods study involving participants from the International Society for Behavioral Nutrition and Physical Activity (ISBNPA) network. Participants completed an online survey (May–July 2018) and/or participated in a focus group during the annual ISBNPA conference (June 2018). Descriptive statistics were generated for quantitative online and pre-focus group survey data. Fisher’s exact tests investigated associations of (i) length of time in academia, (ii) career stage and (iii) country of work, and agreement with ‘perceptions of D&I’. Qualitative data were analysed thematically. Results In total, 141 participants responded to the survey (76% female, 21% aged 35–39 years, 14 countries represented) and 25 participated in focus groups (n = 3). Participants self-identified as having knowledge (48%), skills (53%) and experience supporting others (40%) to conduct D&I research. The majority (96%) perceived D&I was important, with 66% having organizational support for D&I, yet only 52% reported prioritizing D&I research. Perceptions of D&I differed by length of time in academia, career stage and country of work. Barriers included: (i) lack of D&I expertise; (ii) lack of organisational support/value for D&I; (iii) embedded scientific beliefs/culture; (iv) methodological challenges with D&I research; (v) funding/publishing priorities and; (vi) academic performance structures. Facilitators included: (i) increased presence/value of D&I; (ii) collective advocacy; (iii) organisational support for D&I; (iv) recruitment of D&I scientists and; (v) restructure of academic performance models, funding/publishing criteria. Conclusions Individual, organisational and system-wide factors hindered academics’ engagement with and support for D&I research, which was perceived to reduce opportunities for research-practice translation. Factors were mostly consistent across countries and individual career stages/time spent in academia. Embedding D&I early within academic training, and system-wide reorientation of academic performance and funding structures to promote and facilitate D&I research, are some of the necessary actions to reduce the research-practice gap. Consistent with public health more broadly, these changes are long overdue in the fields of physical activity and nutrition.
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Affiliation(s)
- Harriet Koorts
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Rachel Laws
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Penelope Love
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jaimie-Lee Maple
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Femke van Nassau
- Department of Public and Occupational Health and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Cassar S, Salmon J, Timperio A, Naylor PJ, van Nassau F, Contardo Ayala AM, Koorts H. Adoption, implementation and sustainability of school-based physical activity and sedentary behaviour interventions in real-world settings: a systematic review. Int J Behav Nutr Phys Act 2019; 16:120. [PMID: 31791341 PMCID: PMC6889569 DOI: 10.1186/s12966-019-0876-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/04/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Globally, many children fail to meet the World Health Organization's physical activity and sedentary behaviour guidelines. Schools are an ideal setting to intervene, yet despite many interventions in this setting, success when delivered under real-world conditions or at scale is limited. This systematic review aims to i) identify which implementation models are used in school-based physical activity effectiveness, dissemination, and/or implementation trials, and ii) identify factors associated with the adoption, implementation and sustainability of school-based physical activity interventions in real-world settings. METHODS The review followed PRISMA guidelines and included a systematic search of seven databases from January 1st, 2000 to July 31st, 2018: MEDLINE, EMBASE, CINAHL, SPORTDiscus, PsycINFO, CENTRAL, and ERIC. A forward citation search of included studies using Google Scholar was performed on the 21st of January 2019 including articles published until the end of 2018. Study inclusion criteria: (i) a primary outcome to increase physical activity and/or decrease sedentary behaviour among school-aged children and/or adolescents; (ii) intervention delivery within school settings, (iii) use of implementation models to plan or interpret study results; and (iv) interventions delivered under real-world conditions. EXCLUSION CRITERIA (i) efficacy trials; (ii) studies applying or testing school-based physical activity policies, and; (iii) studies targeting special schools or pre-school and/or kindergarten aged children. RESULTS 27 papers comprising 17 unique interventions were included. Fourteen implementation models (e.g., RE-AIM, Rogers' Diffusion of Innovations, Precede Proceed model), were applied across 27 papers. Implementation models were mostly used to interpret results (n = 9), for planning evaluation and interpreting results (n = 8), for planning evaluation (n = 6), for intervention design (n = 4), or for a combination of designing the intervention and interpreting results (n = 3). We identified 269 factors related to barriers (n = 93) and facilitators (n = 176) for the adoption (n = 7 studies), implementation (n = 14 studies) and sustainability (n = 7 studies) of interventions. CONCLUSIONS Implementation model use was predominately centered on the interpretation of results and analyses, with few examples of use across all study phases as a planning tool and to understand results. This lack of implementation models applied may explain the limited success of interventions when delivered under real-world conditions or at scale. TRIAL REGISTRATION PROSPERO (CRD42018099836).
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Affiliation(s)
- Samuel Cassar
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Anna Timperio
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, Canada
| | - Femke van Nassau
- Department of Public and Occupational Health and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ana María Contardo Ayala
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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Lander N, Koorts H, Mazzoli E, Moncrieff K, Salmon J. The feasibility and impact of embedding pedagogical strategies targeting physical activity within undergraduate teacher education: Transform-Ed!. Pilot Feasibility Stud 2019; 5:125. [PMID: 31893128 PMCID: PMC6839192 DOI: 10.1186/s40814-019-0507-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 10/01/2019] [Indexed: 02/07/2023] Open
Abstract
Purpose Low levels of physical activity and high levels of sedentary behaviour are pervasive, especially in schools. Pre-service teacher education is pivotal to school and educational reform but is an under-studied setting for physical activity and sedentary behaviour intervention research. The objective of this pilot study was to test the feasibility and potential impact of embedding evidence-based active pedagogy based on an adapted version of Transform-Us!, Transform-Ed! in one core unit of an undergraduate teacher education degree. Methods Baseline and follow-up measures (i.e. surveys) were conducted with Bachelor of Education (Primary) pre-service teachers who received the Transform-Ed! intervention and academic educators who delivered the intervention. Focus groups of senior academics and telephone interviews with primary school principals examined perceptions of intervention feasibility and explored potential real-world relevance and impact of pre-service teachers training in active pedagogy. Results After 12 weeks, pre-service teachers (n = 218) were significantly more willing (pre–post change Δ = 0.54, 95% CI [0.16, 0.91]), confident (Δ = 1.40, 95% CI [0.89, 1.91]) and competent (Δ = 2.39, 95% CI [1.85, 2.92]) to deliver Transform-Ed!, had more positive feelings about the impact of physical activity on student outcomes (Δ = 2.05, 95% CI [1.58, 2.52]), and perceived fewer barriers to integrating Transform-Ed! into current and future teaching (Δ = − 7.26, 95% CI [− 8.88, − 5.64]). Four major themes emerged from the focus groups (n = 9) and interviews (n = 5) around participant perceptions of Transform-Ed!: (i) acceptability and appropriateness, (ii) need (tertiary level), (iii) need (primary level) and (iv) overcoming challenges. Conclusion The Transform-Ed! pilot study demonstrated promising results across multiple participant levels, as it was perceived to be feasible, acceptable and appropriate by pre-service teachers, academics and school principals. The findings have direct implications for the progression of Transform-Ed! from pilot to a future definitive trial.
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Affiliation(s)
- Natalie Lander
- 1Faculty of Arts and Education, School of Education, Deakin University, Geelong, VIC Australia
| | - Harriet Koorts
- 2Institute for Physical Activity and Nutrition Research, Deakin University, Geelong, VIC Australia
| | - Emiliano Mazzoli
- 3Faculty of Health, School of Health and Social Development, Deakin University, Geelong, VIC Australia
| | - Kate Moncrieff
- 1Faculty of Arts and Education, School of Education, Deakin University, Geelong, VIC Australia
| | - Jo Salmon
- 2Institute for Physical Activity and Nutrition Research, Deakin University, Geelong, VIC Australia
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Koorts H, Timperio A, Arundell L, Parker K, Abbott G, Salmon J. Is sport enough? Contribution of sport to overall moderate- to vigorous-intensity physical activity among adolescents. J Sci Med Sport 2019; 22:1119-1124. [PMID: 31277920 DOI: 10.1016/j.jsams.2019.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 05/06/2019] [Accepted: 06/21/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study examined the contribution of sports participation to overall moderate-to-vigorous physical activity (MVPA) among adolescents, and explored potential moderators. DESIGN Cross-sectional observational study using survey and accelerometry data drawn from the NEighbourhood Activity in Youth (NEArbY) study. METHODS Adolescents (n=358) were recruited from secondary schools in Melbourne, Australia. Average min/day in MVPA was assessed using accelerometry. Participants self-reported sports participation (number of teams, type, frequency, and months of participation). Regression models determined the percent variance in MVPA explained by the sport variables, adjusted for wear time, age and sex, and accounting for clustering at the school level. Additional analyses tested if age, sex, body mass index (BMI), and socioeconomic status (SES) moderated relationships between sport variables and MVPA. RESULTS Participants (mean 15.3 years, 59% female) spent a mean (SD) of 68.6 (27.4) min/day in MVPA and 50% reported participating in any sport. Those who participated in sport did so 3.4 times/week on average and accumulated 7min/day of MVPA more than those who did no sport. For each additional sport participated in, on average, there were approximately 5 additional min/day of MVPA. The number and frequency of sports participation explained 3.2% and 3.8% of the variance in MVPA respectively. Participation in field hockey and gymnastics explained 2.2% and 3.6% of the variance in MVPA, respectively. There were no moderating effects. CONCLUSIONS Sport appears to make a very small contribution to adolescents' average daily physical activity. Effectiveness of approaches to increasing youth population levels of physical activity via sports participation needs to be tested.
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Affiliation(s)
- Harriet Koorts
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
| | - Anna Timperio
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Lauren Arundell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Kate Parker
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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Arundell L, Salmon J, Koorts H, Contardo Ayala AM, Timperio A. Exploring when and how adolescents sit: cross-sectional analysis of activPAL-measured patterns of daily sitting time, bouts and breaks. BMC Public Health 2019; 19:653. [PMID: 31182044 PMCID: PMC6558889 DOI: 10.1186/s12889-019-6960-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 05/08/2019] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND This study describes patterns of adolescents' objectively-measured sitting volume, sitting bouts, and breaks in sitting during different days and periods of the day, and explored differences by sex and weekdays versus weekend days. METHODS ActivPAL™ data were collected in August 2014-December 2015 from adolescents attending secondary government schools in Melbourne Australia. Eight periods (early morning, mid-morning, morning break, late morning, lunch, early afternoon, late-afternoon and evening) were extracted for each day. School time, class time and out-of-school time were also extracted for weekdays. The percentage of time sitting, percentage of each hour in prolonged sitting (sitting bout ≥10 min), and number of sitting breaks/hour were calculated for each period. Differences by sex, and week and weekend days were determined using t-tests. RESULTS Participants (n = 297, 15.4 ± 1.6 years) spent 68% of their day sitting; ~ 30% of each hour in prolonged sitting and 3.1 sitting breaks/hour. Sitting time was greater during class time (75%) and school (70%) compared to out-of-school time (65%). Sitting patterns differed between week and weekend days for all periods except the evening period. Girls had higher proportion of sitting during class than boys (76% vs 72% respectively) and school hours (72% vs 67%), more prolonged sitting during school hours (27% vs 23%), and more sitting breaks per hour during out-of-school time (2.6 vs 2.4), but fewer during class (2.5 vs 3.3) and school hours (2.7 vs 3.3). Sitting patterns did not differ by sex on weekend days. CONCLUSIONS Adolescents spent two-thirds of their waking hours sitting, with distinct patterns on weekdays and weekend days. Even though boys and girls were exposed to the same school day routine, girls spent more time sitting and had fewer sitting breaks. Class times, school breaks and the evening period were identified as key intervention periods. Further research is needed to understand the behavioural differences, and guide future intervention design.
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Affiliation(s)
- Lauren Arundell
- Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria, Australia.
| | - Jo Salmon
- Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria, Australia
| | - Harriet Koorts
- Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria, Australia
| | - Ana Maria Contardo Ayala
- Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria, Australia
| | - Anna Timperio
- Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Victoria, Australia
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Srinivasapura Venkateshmurthy N, Mc Namara K, Koorts H, Mohan S, S Ajay V, Jindal D, Malipeddi BR, Roy A, Tandon N, Prabhakaran D, Worsley T, Maddison R, O’Reilly S. Process evaluation protocol for a cluster randomised trial of a complex, nurse-led intervention to improve hypertension management in India. BMJ Open 2019; 9:e027841. [PMID: 31110103 PMCID: PMC6530308 DOI: 10.1136/bmjopen-2018-027841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION India has high prevalence of hypertension but low awareness, treatment and control rate. A cluster randomised trial entitled 'm-Power Heart Project' is being implemented to test the effectiveness of a nurse care coordinator (NCC) led complex intervention to address uncontrolled hypertension in the community health centres (CHCs). The trial's process evaluation will assess the fidelity and quality of implementation, clarify the causal mechanisms and identify the contextual factors associated with variation in the outcomes. The trial will use a theory-based mixed-methods process evaluation, guided by the Consolidated Framework for Implementation Research. METHODS AND ANALYSIS The process evaluation will be conducted in the CHCs of Visakhapatnam (southern India). The key stakeholders involved in the intervention development and implementation will be included as participants. In-depth interviews will be conducted with intervention developers, doctors, NCCs and health department officials and focus groups with patients and their caregivers. NCC training will be evaluated using Kirkpatrick's model for training evaluation. Key process evaluation indicators (number of patients recruited and retained; concordance between the treatment plans generated by the electronic decision support system and treatment prescribed by the doctor and so on) will be assessed. Fidelity will be assessed using Borrelli et al's framework. Qualitative data will be analysed using the template analysis technique. Quantitative data will be summarised as medians (IQR), means (SD) and proportions as appropriate. Mixed-methods analysis will be conducted to assess if the variation in the mean reduction of systolic blood pressure between the intervention CHCs is influenced by patient satisfaction, training outcome, attitude of doctors, patients and NCCs about the intervention, process indicators etc. ETHICS AND DISSEMINATION: Ethical approval for this study was obtained from the ethics committees at Public Health Foundation of India and Deakin University. Findings will be disseminated via peer-reviewed publications, national and international conference presentations. TRIAL REGISTRATION NUMBER NCT03164317; Pre-results.
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Affiliation(s)
- Nikhil Srinivasapura Venkateshmurthy
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Kevin Mc Namara
- School of Medicine, Deakin University, Burwood, Victoria, Australia
| | - Harriet Koorts
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Sailesh Mohan
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
| | | | - Devraj Jindal
- Centre for Chronic Disease Control, New Delhi, Delhi, India
| | | | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, Haryana, India
| | - Tony Worsley
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Ralph Maddison
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Sharleen O’Reilly
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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Mazzoli E, Koorts H, Salmon J, Pesce C, May T, Teo WP, Barnett LM. Feasibility of breaking up sitting time in mainstream and special schools with a cognitively challenging motor task. J Sport Health Sci 2019; 8:137-148. [PMID: 30997260 PMCID: PMC6451043 DOI: 10.1016/j.jshs.2019.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/16/2018] [Accepted: 09/26/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Children spend ≤70% of the school day sitting in class. Classroom-based active breaks can benefit children's physical health, but if the breaks are cognitively demanding (i.e., combine physical exertion and mental engagement), they may also improve focus and cognitive functions. Teachers and students play a crucial role in the successful implementation of active breaks, and their perspectives are critical to the feasibility of these strategies. The aim of this study was to assess the feasibility of implementing a cognitively challenging motor task as an active break in mainstream and special primary schools. METHODS A total of 5 teachers in 2 mainstream schools and 7 teachers in 1 special school (attended by children with neurodevelopmental disorders) attended a 20-min training on how to implement a 4-min cognitively challenging active break, before conducting a feasibility trial (twice a day for 1 week). To understand individual perceptions, one-on-one semistructured interviews were conducted before and after the trial with teachers, and focus group interviews were conducted with typically developing children after the trial. Questions were based on a predefined framework for feasibility studies. All interviews were audio recorded, transcribed and analyzed in NVivo 11 using a framework approach. A total of 12 teachers (11 females; 7 between 20 and 34years old) and 34 children (16 girls; 9.3 ± 1.7years, mean ± SD) participated in the interviews. RESULTS In mainstream schools, teachers viewed the cognitively challenging motor task as appropriate and potentially beneficial for children's health and focus. Children reported enjoying the active breaks. Teachers in special schools viewed the task as complex and potentially frustrating for children. In both school types, children's disruptive behavior and lack of time were seen as the main potential barriers to implementation. The use of music, videos, visual cards, and support staff were noted as potential facilitators. CONCLUSION The cognitively challenging motor task was a feasible way to interrupt children's sitting time and promote physical activity in mainstream schools, but required changes in special schools. Further research could investigate the effectiveness of these types of task interruptions on children's physical and cognitive health.
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Affiliation(s)
- Emiliano Mazzoli
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
| | - Caterina Pesce
- Department of Movement, Human and Health Sciences, Italian University of Sport and Movement “Foro Italico”, Rome, 00135, Italy
| | - Tamara May
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
| | - Wei-Peng Teo
- Institute for Physical Activity and Nutrition, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
| | - Lisa Michele Barnett
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
- Institute for Physical Activity and Nutrition, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
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Koorts H, Gillison F. Mixed method evaluation of a community-based physical activity program using the RE-AIM framework: practical application in a real-world setting. BMC Public Health 2015; 15:1102. [PMID: 26545582 PMCID: PMC4635975 DOI: 10.1186/s12889-015-2466-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Communities are a pivotal setting in which to promote increases in child and adolescent physical activity behaviours. Interventions implemented in these settings require effective evaluation to facilitate translation of findings to wider settings. The aims of this paper are to i) present findings from a RE-AIM evaluation of a community-based physical activity program, and ii) review the methodological challenges faced when applying RE-AIM in practice. METHODS A single mixed-methods case study was conducted based on a concurrent triangulation design. Five sources of data were collected via interviews, questionnaires, archival records, documentation and field notes. Evidence was triangulated within RE-AIM to assess individual and organisational-level program outcomes. RESULTS Inconsistent availability of data and a lack of robust reporting challenged assessment of all five dimensions. Reach, Implementation and setting-level Adoption were less successful, Effectiveness and Maintenance at an individual and organisational level were moderately successful. Only community-level Adoption was highly successful, reflecting the key program goal to provide community-wide participation in sport and physical activity. CONCLUSIONS This research highlighted important methodological constraints associated with the use of RE-AIM in practice settings. Future evaluators wishing to use RE-AIM may benefit from a mixed-method triangulation approach to offset challenges with data availability and reliability.
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Affiliation(s)
- Harriet Koorts
- Centre for Physical Activity and Nutrition Research, Deakin University, Burwood, VIC, 3125, Australia.
| | - Fiona Gillison
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
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Koorts H, Mattocks C, Ness A, Deere K, Blair SN, Riddoch C. Patterns Of Physical Activity In Less, Moderately And Highly Active Children. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000355890.21399.4d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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