Action330: Promoting children's physical activity via enhanced after-school leadership

Lead Research Organisation: University of Bristol
Department Name: Sch for Policy Studies

Abstract

Context
Many children do not meet the Chief Medical Officer's target of an hour of physical activity every day. Adults who are physically active are less likely to develop heart disease, diabetes and obesity. These diseases result in large healthcare costs, reduced work productivity work and adversely impact quality of life. Ensuring everyone is physically active is therefore important for the nation's physical and economic health.

The end of primary school is a critical period for the establishment of children's physical activity patterns. Developing children's skills and interest in physical activity at this age is likely to help the children to be more active in adolescence and onto adulthood.

The after-school period that has been recognised as a time when children could engage in physical activity. Data from the USA and Spain indicates that programmes delivered after-school can increase children's physical activity. Although many UK schools provide after-school physical activity interventions none of these programmes has been rigorously evaluated.

Teaching Assistants (TAs) are a resource in all primary schools and our experience indicates that many TAs would welcome an opportunity to deliver after-school activities but lack the skills and confidence to do so. Head-teachers are keen to allow their TAs to deliver after-school activities because it shows that the school is developing the skills of its work-force. An after-school physical activity intervention delivered by TAs could therefore be a cost-effective, sustainable intervention.

Aims and objectives
The overall aim of the study is to design and then evaluate a new physical activity programme for Year 5 & 6 (9-11 year old) students which will be delivered by TAs. There will be two elements to the work. First we will conduct qualitative work with TAs, national experts, children and parents on how best to deliver an after-school physical activity programme. We will then use this information to develop a new Teaching Assistant training programme and physical activity session plans that TAs will deliver.

Once the intervention has been developed we will conduct a pilot evaluation of the intervention. This will involve randomly assigning ten schools to take part in the new programme for two school terms with students in ten further schools randomly assigned to a control (non-intervention) group. We will collect physical activity and related questionnaire data on the children's preferences for physical activity and perceived ability to be active from both groups before the new programme starts, during the programme and 6 months after the programme has ended. These data will be compared to indicate whether participation in the intervention led to increases in physical activity or related perceived ability to be active, and if changes are maintained six months later.

Applications and benefits
The research is designed to indicate whether the new after-school programme is likely to increase children's physical activity and if any positive effect is likely to be maintained 6 months later when half of the students are in secondary school. The information obtained will tell us whether the intervention is of sufficient merit to warrant a full randomised controlled trial evaluation and if so what size the trial is likely to be and what data need to be collected. The pilot evaluation will also tell us what cost data will need to be collected so that we determine the potential "value for money" of the project. The information will also be of use to agencies such as the Youth Sport Trust who design and disseminate physical activity programmes for children. The study will also be of interest to schools as it will provide evidence of the potential utility of training TAs to deliver physical activity programmes and how physical activity training could contribute towards the contributing professional development of TAs.

Technical Summary

The project includes both formative research and then a feasibility trial. A summary of the research methods that will be used in each phase is outlined below.

Formative research: Phases 1 and 2 will involve interviews with Teaching Assistants, teacher trainers and parents along with focus groups with Year 5/6 students. All interviews and focus groups will be digitally recorded, transcribed verbatim and the transcripts verified. All transcripts will be thematically analysed.

Feasibility trial: Phase 4 of the project will be a feasibility trial in which 600, Year 5 and 6 students are recruited from 20 primary schools. Half of the schools will be randomly allocated to the intervention arm with the remaining schools allocated to the control arm. Schools will be stratified according to school district and the school tax credit information.

Two Teaching Assistants in each intervention school will attend a 5-day training programme that will focus on developing their physical activity management skills. Teaching Assistants will also be provided with 36 session plans. Teaching Assistants will deliver the new programme for 18-weeks in intervention schools. Children in control schools will participate in data collection only.

Students in intervention and control schools will provide data at baseline (time 0), in the middle of the intervention (time 0+9 weeks), at the end of the intervention period (time 0 + 18 weeks) and 4-months after the intervention has ended (time 0+36 weeks). The primary outcome will be accelerometer determined minutes of MVPA per day. Participants will also complete questionnaires to assess change in scores on psychosocial constructs.

Analyses will mainly be descriptive in nature and will include means (SD) or N (%) as appropriate. Between group comparisons will be made using appropriate regression models, but with the focus on 95% confidence intervals in order to estimate possible effect sizes. P-values will not be considered.

Planned Impact

The proposed research has the potential to benefit: 1) Children and families; 2) schools and local education authorities; 3) Teaching Assistants; 4) Policy makers; 5) researchers; and 6) Society. The way in which each group could benefit and the timescales for benefits are summarised below.
1. Children and their families: It is intended that children in the intervention schools will find the programme to be enjoyable and that the programme will result in improved physical activity and positive attitudes towards physical activity. Parents of children in intervention schools will also benefit from the provision of a safe environment in which their child can be active immediately after-school. In previous research we have found that many children like to be part of research and find wearing accelerometers and answering questionnaires enjoyable. We therefore feel that both intervention and control school children will receive an immediate benefit from the project. Over the long-term, if the feasibility trial indicates that the intervention warrants further examination via a full RCT and the RCT indicates that intervention is effective the programme could positively affect the physical activity patterns and attitudes of a large number of children.

2. Schools and local education authorities: Intervention schools will benefit from a new programme that will run immediately after-school. Intervention schools will also immediately benefit from the training of the Teaching Assistants which fulfils workforce development requirements. More broadly control schools and the two local education authorities with whom we are collaborating will benefit from an understanding of the potential utility of using Teaching Assistants to deliver physical activity programmes after-school. These benefits will be evident at the end of the study (Spring 2014).

3. Teaching Assistants: It is intended that the training programme will increase the skills of Teaching Assistants. Many Teaching Assistants are looking to develop their skills as a means of either getting promoted to a "Higher Level Teaching Assistant", securing acceptance onto a Teacher Training Course or as part of their general career development. As such, Teaching Assistants will receive an immediate benefit from being in an intervention school.

4. Policy makers: The information obtained from the study will provide policy makers with information about the potential utility of the intervention. This information will help policy makers form future public health policy over the next 5-10 years.

5. Researchers: All aspects of the research will be of great interest to fellow researchers. Data from phases 1 and 2 will provide information about means of delivering physical after-activity programmes after-school and how best to work with Teaching Assistants to deliver these programmes. The data from the feasibility trial will provide information about the likely effect of the intervention, the school-associated intra-class correlation and how that may affect future sample sizes. Each of these aspects of the study will help researchers who are designing interventions that focus on changing physical activity or related health behaviours in the after-school period. As we will communicate findings at the end of each phase of the project via peer-reviewed papers and conference presentations we would envisage that all necessary information will be available to fellow researchers within 12-months of the end of the project (i.e. Spring 2015).

6. Society: In the longer-term (i.e. 5-10 years) it is envisaged that the data obtained from this project will inform new physical activity interventions which in turn will positively affect the physical activity patterns of children and adolescents. If the interventions increase physical activity there will be associated improvements in the health of UK children and adolescents.

Publications

10 25 50
 
Description Membership of Chief Medical Officer's Physical Activity (Infographic group) Jago
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
 
Description NIHR - Public health Research Board
Amount £743,500 (GBP)
Funding ID 11/3050/01 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 04/2013 
End 08/2015
 
Description Public Health Research
Amount £299,000 (GBP)
Funding ID PHR 15-55-09 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 04/2017 
End 09/2018
 
Title Validiated new SDT scales 
Description New (adapted) version of self-report questionnanire 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2014 
Provided To Others? Yes  
Impact The scale has been shared with colleagues 
 
Title Action 330 database 
Description Data are from the Action 3:30 feasibility randomised controlled trial (RCT), an after-school PA programme taught by TAs within the school in which children in the intervention arm participated in a structured 20 week (40 session) after-school club that aimed to increase overall levels of physical activity measured by minutes of moderate and vigorous physical activity (MVPA) .Thirty pupils from years five and six were recruited from each of 20 primary schools within Bristol, Bath and North-East Somerset (BANES), and South Gloucester. After the initial baseline measures had been take, schools were randomised to either receive the intervention or to act as a control school. The study received ethical approval from the School for Policy Studies ethics and research committee at the University of Bristol (ref: Action 3:30 Project) and written parental consent was obtained for all participants. Quantitative measurements were taken at three time points (baseline; exit from programme or an equivalent time for control schools; and four months after the end of the intervention). Measurements included height and weight; Accelerometer-determined PA; self-reported screen viewing; six self-reported psycho-social measures. Children in the intervention schools were also asked to rate their perceived exertion and enjoyment at one session per week. Individual attendance was also recorded. Qualitative interviews with key contacts (at control and intervention schools) as well as teaching assistants and a subsample of children from each intervention school were conducted after the programme had been implemented. The interviews aimed to gather information about what worked well and also about changes that were suggested for the club and the overall research process. Interviews also explored the perceived impact of the club on the children and teaching assistants at intervention schools. 
Type Of Material Database/Collection of data 
Provided To Others? No  
Impact Research has been archived ready for dissemination 
 
Title UK Deprivation Indices 
Description The study of inequalities between countries relies on having accurate and consistent measures of socioeconomic deprivation across the country borders. However, in the UK most deprivation measures are not comparable between countries. These data comprise adjusted Indices of Multiple Deprivation (IMD) for use across the UK. 
Type Of Material Database/Collection of data 
Year Produced 2016 
Provided To Others? Yes  
 
Description Action 3:30 Local collaborations 
Organisation Bristol City Council
Country United Kingdom 
Sector Public 
PI Contribution We are collaborating with Bristol City Council to develop the intervention.
Collaborator Contribution Council staff are playing a leading role in the development of the intervention materials and delivery of the intervention - which we will then evaluate.
Impact None yet
Start Year 2012
 
Title ACTION 330 Intervention 
Description This is a 40 session plan programme for Teaching Assistants to deliver after-school physical activity programmes. 
Type Preventative Intervention - Behavioural risk modification
Current Stage Of Development Refinement. Non-clinical
Year Development Stage Completed 2013
Development Status Under active development/distribution
Impact Still in development 
 
Description Academic presentation - University of Birmingham - May 2014 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact 50 staff and research students attended an activity that sparked questions and debate

Discussed with colleagues a potential new research bid
Year(s) Of Engagement Activity 2014
 
Description Inaugural - Public lecture - Dec 2013 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Work provided suggestions for how families could help children to be more physically active

Schools enquired about engaging in our future research project
Year(s) Of Engagement Activity 2014
 
Description National coverage of paper by BBC 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact On 23rd June our paper https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-017-0492-0 received extensive coverage by the BBC as part of the Women's Sport Week. RJ did live Breakfast radio interviews with BBC Shropshire, BBC Wales, BBC Jersey, BBC Leicester, BBC Coventry, BBC Cornwall, BBC Newcastle, BBC Ulster and BBC Lancashire. These interviews were then edited and used across all BBC Local Radion stations and 5Live across the day.
BBC Sport also produced a video of the work http://www.bbc.co.uk/sport/cricket/40383183 which was covered in BBC Breakfast at 7:40 and 8:40 and shown on BBC News's Sports Programme at 6:30pm. The video is also on the BBC Website.
Year(s) Of Engagement Activity 2017
URL http://www.bbc.co.uk/sport/cricket/40383183
 
Description Presentation - UKPE Association June 2014 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Approx 100 PE professionals saw our work sharing the findings from the Action 330 project

Discussion about potential kite marking of our programme
Year(s) Of Engagement Activity 2014
 
Description Presentation at NIHR Schools Research meeting - 21st October 2014 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact An oral presentation entitled "Lessons learnt from conducting extra-curricular physical activity interventions in schools" was presented at the NIHR Schools research meeting in London on 21st October 2014
Year(s) Of Engagement Activity 2014
 
Description Talk to Public Health England Southwest 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Data from several projects was presented at a Public Health England Southwest meeting (28th Feb 2017)
Year(s) Of Engagement Activity 2017
 
Description UKSBM - December 2013 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Poster presentation - viewed by over 100 colleagues.

Disccussion with colleagues on potential similar papers
Year(s) Of Engagement Activity 2014