Unpacking the ‘black box’:Implementation evaluation of interventions to improve motor skill competence in children and adolescents.

Despite the irrefutable evidence of the health benefits of adequate physical activity, children and adolescents worldwide are not sufficiently active. Motor skill competence (MC) has been suggested as integral to individuals being able to competently participate in physical activity. However, levels of MC in children and adolescents are low globally. This is despite the preponderance of effective interventions and initiatives promoting MC in schools (e.g., Physical Education), thus highlighting a potential gap between effective MC interventions and sustained routine practice that benefits the wider population (e.g., integration into teaching practice). The process of integrating effective interventions into practice is defined as implementation. To improve the implementation of MC interventions, and thus their translatability into practice, factors that influence the implementation process need greater focus. Yet, implementation research in MC interventions is underdeveloped and limited. This PhD therefore aimed to improve the understanding of the process(es), factors, and strategies relevant to the implementation of MC interventions into routine practice and provide suggestions regarding implementation evaluation.A systematic review was conducted to investigate how process evaluations (a study that examines the intervention process) have been reported in MC interventions and identify any factors that may impact MC intervention outcomes. Only half of the identified intervention studies (n = 30) reported process evaluation and no studies reported (or employed) theoretical frameworks to guide process evaluation. Common process evaluation measures and potential moderators of MC intervention outcomes were identified in this review, but this was insufficient to fully understand the implementation of MC interventions given process evaluation is underused. Subsequently, a systems science approach, namely Collective Intelligence (CI), was employed in three stakeholder consultations in the UK and Ireland to identify barriers to the implementation and sustainability of school-based MC interventions and their interrelationships, as well as design solutions to the barriers. Critical barriers were identified relating to policy, physical education curriculum, and stakeholders’ knowledge and appreciation. A roadmap of actions was created to inform decisions when supporting implementation of MC interventions. The synthesised findings from the review and CI were then used to develop strategies intended to improve the implementation of a specific MC intervention—Project FLAME, followed by a mixed methods evaluation to understand the influences of the strategies on the implementation of the intervention. Findings highlighted that the intervention could be effectively integrated into routine practice, provided adaptations specific to teachers’ practice and students’ needs are made.This PhD research presents the first systematic inquiry into the implementation evaluation of MC interventions. Findings highlighted the complex and context-specific influences on the implementation and sustainability of interventions. The thesis considers the implications for researchers regarding improving evaluation practice, as well as strategies to improve the implementation of MC interventions into practice

Good practice characteristics of diet and physical activity interventions and policies : an umbrella review

BACKGROUND: This umbrella review aimed at eliciting good practice characteristics of interventions and policies aiming at healthy diet, increasing physical activity, and lowering sedentary behaviors. Applying the World Health Organization's framework, we sought for 3 types of characteristics, reflecting: (1) main intervention/policy characteristics, referring to the design, targets, and participants, (2) monitoring and evaluation processes, and (3) implementation issues. This investigation was undertaken by the DEDPIAC Knowledge Hub (the Knowledge Hub on the DEterminants of DIet and Physical ACtivity), which is an action of the European Union's joint programming initiative. METHODS: A systematic review of reviews and stakeholder documents was conducted. Data from 7 databases was analyzed (99 documents met inclusion criteria). Additionally, resources of 7 major stakeholders (e.g., World Health Organization) were systematically searched (10 documents met inclusion criteria). Overall, the review yielded 74 systematic reviews, 16 position review papers, and 19 stakeholders' documents. Across characteristics, 25% were supported by ≥ 4 systematic reviews. Further, 25% characteristics were supported by ≥ 3 stakeholders' documents. If identified characteristics were included in at least 4 systematic reviews or at least 3 stakeholders' documents, these good practice characteristics were classified as relevant. RESULTS: We derived a list of 149 potential good practice characteristics, of which 53 were classified as relevant. The main characteristics of intervention/policy (n = 18) fell into 6 categories: the use of theory, participants, target behavior, content development/management, multidimensionality, practitioners/settings. Monitoring and evaluation characteristics (n = 18) were grouped into 6 categories: costs/funding, outcomes, evaluation of effects, time/effect size, reach, the evaluation of participation and generalizability, active components/underlying processes. Implementation characteristics (n = 17) were grouped into eight categories: participation processes, training for practitioners, the use/integration of existing resources, feasibility, maintenance/sustainability, implementation partnerships, implementation consistency/adaptation processes, transferability. CONCLUSIONS: The use of the proposed list of 53 good practice characteristics may foster further development of health promotion sciences, as it would allow for identification of success vectors in the domains of main characteristics of interventions/policies, their implementation, evaluation and monitoring processes

A systematic review of digital interventions for improving the diet and physical activity behaviors of adolescents

Many adolescents have poor diet and physical activity behaviors, which can lead to the development of noncommunicable diseases in later life. Digital platforms offer inexpensive means of delivering health interventions, but little is known about their effectiveness. This systematic review was conducted to synthesize evidence on the effectiveness of digital interventions to improve diet quality and increase physical activity in adolescents, to effective intervention components and to assess the cost-effectiveness of these interventions. Following a systematic search, abstracts were assessed against inclusion criteria, and data extraction and quality assessment were performed for included studies. Data were analyzed to identify key features that are associated with significant improvement in behavior. A total of 27 studies met inclusion criteria. Most (n = 15) were Web site interventions. Other delivery methods were text messages, games, multicomponent interventions, emails, and social media. Significant behavior change was often seen when interventions included education, goal setting, self-monitoring, and parental involvement. None of the publications reported cost-effectiveness. Due to heterogeneity of studies, meta-analysis was not feasible.It is possible to effect significant health behavior change in adolescents through digital interventions that incorporate education, goal setting, self-monitoring, and parental involvement. Most of the evidence relates to Web sites and further research into alternate media is needed, and longer term outcomes should be evaluated. There is a paucity of data on the cost-effectiveness of digital health interventions, and future trials should report these data

Mobile exergaming in adolescents’ everyday life—contextual design of where, when, with whom, and how: the SmartLife case

Exergames, more specifically console-based exergames, are generally enjoyed by adolescents and known to increase physical activity. Nevertheless, they have a reduced usage over time and demonstrate little effectiveness over the long term. In order to increase playing time, mobile exergames may increase potential playing time, but need to be engaging and integrated in everyday life. The goal of the present study was to examine the context of gameplay for mobile exergaming in adolescents’ everyday life to inform game design and the integration of gameplay into everyday life. Eight focus groups were conducted with 49 Flemish adolescents (11 to 17 years of age). The focus groups were audiotaped, transcribed, and analyzed by means of thematic analysis via Nvivo 11 software (QSR International Pty Ltd., Victoria, Australia). The adolescents indicated leisure time and travel time to and from school as suitable timeframes for playing a mobile exergame. Outdoor gameplay should be restricted to the personal living environment of adolescents. Besides outdoor locations, the game should also be adaptable to at-home activities. Activities could vary from running outside to fitness exercises inside. Furthermore, the social context of the game was important, e.g., playing in teams or meeting at (virtual) meeting points. Physical activity tracking via smart clothing was identified as a motivator for gameplay. By means of this study, game developers may be better equipped to develop mobile exergames that embed gameplay in adolescents’ everyday life

Minority Adolescents at Risk for Obesity: Health Behaviors and Perceptions

The purpose of this study was to examine behaviors related to nutrition and physical activity of inner-city minority adolescents, and their perception of normal weight and overweight. The research study used a descriptive, non-experimental design which had a convenience sample of thirty-seven 8th grade minority adolescents who attended a chartered urban K-8 grade school in Northern California. There were no statistically significant differences in the results, however, over 50% of the students reported not eating the recommended daily servings of fruits and vegetables. Another 68% reported participating more than 30 minutes in exercising or playing sports during physical education class. Although 42% of the students reported being the right weight, they wanted to lose weight. This demonstrates a need for healthy nutritional behavior and physical activity amongst this population. School nurses can play an important role in identifying at risk students for obesity and provide education in nutrition, structured physical activities, and obesity prevention strategies

Short- and long-term effects of a multi-component physical activity intervention in primary school

There is compelling evidence that physical activity has numerous health benefits during childhood and adolescence. Insufficient levels of physical activity on the other hand can consequently affect cardiovascular and bone health, which may result in severe chronic diseases later in life. Cardiovascular disease and osteoporosis are two of the major chronic diseases affecting a large proportion of the adult population. Both diseases have their origins in childhood and it has been shown that for both, physical activity plays an important role in their prevention. The number of children not being sufficiently active has reached an alarming level and threatens to impose major health burdens worldwide. Thus, developing effective strategies to enhance children’s physical activity levels is of paramount interest for public health. School provides an optimal setting for physical activity promotion, since all children spend a large portion of their time there. This dissertation discusses a school-based randomized controlled trial aimed at increasing children’s physical activity levels and consequently their cardiovascular and bone health. The „Kinder- und Jugendsportstudie“ (KISS) is a school-based physical activity intervention lasting one school year. Of all primary school classes in the cantons of Aargau and Baselland comprising about 10% of the Swiss population, 28 first and fifth grade classes were randomly selected and allocated into an intervention (16 classes; n=297 children) and a control (12 classes, n=205 children) group. The mandatory and stringent multi-component intervention program consisted of daily physical education lessons, daily short activity breaks during academic lessons, and physical activity homework. Children in the control group had the compulsory three physical educations per week. The aim of this dissertation was to assess the effectiveness of KISS on cardiovascular risk and bone health and to explore whether the program was sufficiently effective in order to maintain health benefits over the following three years. In addition, this dissertation will provide a systematic update of existing school-based intervention studies aiming at increasing children’s physical activity and a quantification of physical education-related physical activity. There is strong evidence that school provides a promising setting for physical activity promotion. All school-based intervention studies done in recent years showed positive effects in at least one domain of physical activity. The most successful interventions had the design of a randomized controlled trial, were done over one school year using a multi-component approach integrated into the school curriculum, taught by physical education experts and involving family members. A common intervention strategy was to increase quantity and/or quality of physical education lessons. The particular role of physical education and its contribution to overall physical activity was the center of attention in the second publication of this dissertation. Even if children’s physical activity levels during physical education are relatively low, physical education contributes substantially to overall physical activity. Due to its nature of being a randomized controlled trial in children with a stringent physical activity program in and outside physical education over one school year and with the inclusion of physical education experts, KISS had excellent pre-conditions for being an effective program. Indeed, the results after nine month of intervention are promising. Compared to controls, children of the intervention group showed 14% reduced cardiovascular risk score, 5% reduced body mass index and skinfold thickness, 6% improved aerobic fitness, 18% higher physical activity levels, and 5-8% higher bone mineral content and bone mineral density. Three years after cessation of the program, intervention children still showed higher aerobic fitness and bone mineral content levels at weight-bearing sites of the skeleton compared to the control group. All other beneficial effects have disappeared. Even if short-term effects of the intervention are promising, the major key from a public health perspective is whether the effects of the prevention done during childhood will persist into late adolescence and adulthood. Although the maintained effects on aerobic fitness and bone health have considerable impact on public health, most of the beneficial health effects were not maintained three years after the intervention. This indicates that an intervention over one year is too short for maintained overall health effects. Thus, physical activity programs throughout the school years are needed. Our findings contribute to the growing body of evidence that school-based interventions can increase children’s health; however the major challenge now, is to find effective implementation strategies to transfer such programs into the real-world setting

Effectiveness of social marketing strategies to reduce youth obesity in European school-based interventions : a systematic review and meta-analysis

Peer reviewedPublisher PD

Use of behaviour change techniques in lifestyle change interventions for people with intellectual disabilities: A systematic review

Background: People with intellectual disabilities (ID) experience more health problems and have different lifestyle change needs, compared with the general population. Aims: To improve lifestyle change interventions for people with ID, this review examined how behaviour change techniques (BCTs) were applied in interventions aimed at physical activity, nutrition or physical activity and nutrition, and described their quality. Methods and procedures: After a broad search and detailed selection process, 45 studies were included in the review. For coding BCTs, the CALO-RE taxonomy was used. To assess the quality of the interventions, the Physiotherapy Evidence Database (PEDro) scale was used. Extracted data included general study characteristics and intervention characteristics. Outcomes and results: All interventions used BCTs, although theory-driven BCTs were rarely used. The most frequently used BCTs were ‘provide information on consequences of behaviour in general’ and ‘plan social support/social change’. Most studies were of low quality and a theoretical framework was often missing. Conclusion and implications: This review shows that BCTs are frequently applied in lifestyle change interventions. To further improve effectiveness, these lifestyle change interventions could benefit from using a theoretical framework, a detailed intervention description and an appropriate and reliable intervention design which is tailored to people with ID