Using a co-creational approach to develop, implement and evaluate an intervention to promote physical activity in adolescent girls from vocational and technical schools: a case control study

Background: As physical inactivity is particularly prevalent amongst lower-educated adolescent girls, interventions are needed. Using a co-creational approach increases their engagement and might be effective. This study aimed to: (1) describe the co-creation process, (2) evaluate how girls experienced co-creation, and (3) evaluate the effect of the co-creational interventions on physical activity, individual, sociocultural and school-based factors. Methods: Three intervention schools (n = 91) and three control schools (n = 105) across Flanders participated. A questionnaire was completed pre (September-October 2014) and post (April-May 2015). In between, sessions with a co-creation group were organised to develop and implement the intervention in each intervention school. Focus groups were conducted to evaluate the co-creational process. Results: School 1 organised sport sessions for girls, school 2 organised a fitness activity and set up a Facebook page, school 3 organised a lunch walk. Girls were positive about having a voice in developing an intervention. No significant effects were found, except for small effects on extracurricular sports participation and self-efficacy. Conclusions: Using a co-creational approach amongst adolescent girls might be a feasible approach. However, as interventions were minimal, effects were limited or undetectable. Future co-creation projects could consider the most optimal co-creation process, evaluation design and intensively test this approach

Effectiveness of intervention strategies exclusively targeting reductions in children’s sedentary time: a systematic review of the literature

Methodological quality assessment of included studies. (DOCX 57 kb

Is the transition from primary to secondary school a risk factor for energy balance-related behaviours? A systematic review

Abstract Objective: The substantial changes in the physical and social environment during the transition from primary to secondary school may significantly impact adolescents’ energy balance-related behaviours (i.e. dietary behaviour, sedentary behaviour, sleep behaviour, and physical activity). This is the first review systematically summarising evidence on changes in four energy balance-related behaviours of adolescents across the school transition from primary to secondary school. Design: For this systematic review the electronic databases Embase, PsycINFO and SPORTDiscus were searched for relevant studies from inception to August 2021. PubMed was searched for relevant studies from inception to September 2022. Inclusion criteria were: i) longitudinal studies reporting ii) one or more energy balance-related behaviours iii) across the school transition i.e. with measurement(s) during both primary and secondary school. Setting: Transition from primary to secondary school Participants: Adolescents across the transition from primary to secondary school. Results: Thirty-four studies were eligible. We found strong evidence for an increase in sedentary time, moderate evidence for a decrease in fruit and vegetable consumption, and inconclusive evidence for a change in total, light, and moderate-to-vigorous physical activity, active transport, screen time, unhealthy snack consumption, and sugar sweetened beverages consumption among adolescents across the school transition. Conclusions: During the transition from primary to secondary school, sedentary time and fruit and vegetable consumption tend to change unfavourably. More high-quality, longitudinal research is needed specifically on changes in energy balance-related behaviour across the school transition, especially regarding sleep behaviour. (Prospero registration: CRD42018084799

Combining participatory action research with intervention mapping to develop and plan the implementation and evaluation of a healthy sleep intervention for adolescents

Background: Adolescents’ sleep deteriorated over the last decades, urging the need to develop effective interventions. Using participatory action research (PAR) is a promising and unique approach to target adolescents’ sleep. This study aims to describe the process and results of combining PAR and intervention mapping (IM) to guide future researchers on developing and planning of the implementation and evaluation of interventions promoting healthy sleep in adolescents. Methods: In each of three intervention schools (two with general and technical education and one with technical and vocational education), an action team including adolescents (age 13- 15 years, n=max. 12) and a researcher was composed to develop and plan the intervention. During weekly sessions (n=ranging from 23 to 34 per school), the action team went through the six steps of IM. A short PAR was performed with parents (n=7) to develop parental intervention components. Results: Combining PAR and IM resulted in interventions focusing on the importance of healthy sleep, regular sleep patterns and associated behaviors: screen behaviors, physical activity, dietary behavior and relaxation. Several differences in the participatory process (i.e. more guidance needed during brainstorms in the vocational/technical school) and developed intervention (i.e. less intrusive intervention components in the vocational/technical school) were observed between schools. Conclusion: Combining PAR with IM resulted in more extensive interventions than other existing school-based sleep interventions. Future studies should investigate whether a participatory developed sleep intervention could be transferred to another setting using a shorter participatory process

Cross-validation of cut-points in preschool children using different accelerometer placements and data axes

The present study cross-validated various cut-points to assess physical activity and sedentary behaviour in preschoolers, using hip- and wrist-worn accelerometers and both vertical axis and vector magnitude data. Secondly, we examined the influence of epoch length on time estimates of physical activity and sedentary behaviour. Sixty-four preschoolers (34 girls) wore two accelerometers, on their right hip and dominant wrist, during 1 hour of free play. Preschoolers’ activities were observed by two trained researchers. Area under the curve (AUC) was calculated for the receiving operating characteristic (ROC) curves as a measure of precision. AUC ranges were 0.603–0.723 for sedentary behaviour, 0.472–0.545 for light physical activity and 0.503–0.661 for moderate-to-vigorous physical activity (MVPA), indicating poor to fair precision. Percentage of time classified as sedentary behaviour, light or MVPA according to observation and accelerometer data varied largely between cut-points, accelerometer placements and axes. The influence of epoch length on time estimates was minimal across cut-points, except for one hip-based vector magnitude cut-point. Across all accelerometer placements and data axes, no set of cut-points demonstrated adequate precision for sedentary behaviour, light physical activity and MVPA. The highly variable and omnidirectional activity pattern of preschoolers may explain the lack of adequate cut-points

Child-and parent-related correlates of total and prolonged sedentary time in 5-to 6-year-old children

The primary aim was to examine child-and parent-related correlates of accelerometer-assessed overall total and prolonged (i.e., accumulated in bouts of ≥10 consecutive minutes) sedentary time (SED) in 5-to 6-year-old children. Second, child-and parent-related correlates of total and prolonged SED during weekend days and the after school period were examined, as associations with parent-related correlates may be stronger during these periods. SED and moderate-to-vigorous-intensity physical activity (MVPA) were assessed by ActiGraph accelerometers in children (n = 836) and one of their parents/carers. Parents completed a questionnaire examining potential parent-related correlates. Multilevel models examined associations between potential correlates and children’s total and prolonged SED. Children’s MVPA was the only correlate that was consistently negatively associated with both total and prolonged SED across the different time periods (overall, after school, and weekend days). Higher total SED in parents was associated with higher overall total SED and weekend total SED in children. Higher body mass index z-scores of children were associated with lower overall total and prolonged SED. Girls had lower prolonged SED after school than boys. Older children had lower total SED during the weekend. In conclusion, few potential correlates were associated with young children’s total or prolonged SED and most associations differed by time period

Bone adaptation to altered loading after spinal cord injury: a study of bone and muscle strength

Bone loss from the paralysed limbs after spinal cord injury (SCI) is well documented. Under physiological conditions, bones are adapted to forces which mainly emerge from muscle pull. After spinal cord injury (SCI), muscles can no longer contract voluntarily and are merely activated during spasms. Based on the Ashworth scale, previous research has suggested that these spasms may mitigate bone losses. We therefore wished to assess muscle forces after SCI with a more direct measure and compare it to measures of bone strength. We hypothesized that the bones in SCI patients would be in relation to the loss of muscle forces. Six male patients with SCI 6.4 (SD 4.3) years earlier and 6 age-matched, able-bodied control subjects were investigated. Bone scans from the right knee were obtained by pQCT. The knee extensor muscles were electrically stimulated via the femoral nerve, isometric knee extension torque was measured and patellar tendon force was estimated. Tendon force upon electrical stimulation in the SCI group was 75% lower than in the control subjects (p<0.01). Volumetric bone mineral density of the patella and of the proximal tibia epiphysis were 50% lower in the SCI group than in the control subjects (p<0.01). Cortical area was lower by 43% in the SCI patients at the proximal tibia metaphysis, and by 33% at the distal femur metaphysis. No group differences were found in volumetric cortical density. Close curvilinear relationships were found between stress and volumetric density for the tibia epiphysis (r(2)=0.90) and for the patella (r(2)=0.91). A weaker correlation with the tendon force was found for the cortical area of the proximal tibia metaphysis (r(2)=0.63), and none for the distal femur metaphysis. These data suggest that, under steady state conditions after SCI, epiphyseal bones are well adapted to the muscular forces. For the metaphysis of the long bones, such an adaptation appears to be less evident. The reason for this remains unclear

Gender-specific social and environmental correlates of active travel to school in four European countries: the HBSC Study

Introduction: Despite the health benefits, a large proportion of girls and boys in Europe do not travel to school actively. A better understanding of the correlates associated with this behavior could guide interventions. This study examines perceived social and environmental correlates of active travel to school (ACTS) from the 2017/18 Health Behavior in School-Aged Children (HBSC) survey in four European countries, with a special emphasis on gender differences (n = 22,023). Methods: Logistic regression was conducted to analyze associations between the perceived importance of each correlate and ACTS behavior for 11-, 13-, and 15-year-old girls and boys from Germany, Czechia, Poland, and Slovakia. All models were adjusted for age, family affluence, and meeting World Health Organization recommendations for moderate-to-vigorous physical activity. Results: Rates of ACTS significantly differed between girls and boys. In Czechia, 65% of girls and boys traveled to school actively, followed by Slovakia (61.4% girls and 58.4% boys), Poland (57.7% girls and 60.2% boys), and Germany (42.6% girls and 48.6% boys). Girls were less likely to actively travel to school compared to boys (odds ratio [OR]: 0.92, 95% confidence interval [CI]: 0.87–0.97). Increasing age (OR: 0.95, 95% CI: 0.93–0.97) and a greater distance to school index (OR: 0.89, 95% CI: 0.88–0.90) were both negatively associated with ACTS. The perceived importance of living closer to school and of road and neighborhood safety was positively associated with ACTS, with a stronger association in boys than in girls for neighborhood safety. On the contrary, the perceived importance of having people to walk with was negatively associated with ACTS, with a stronger association in girls (OR: 0.74, 95% CI: 0.65–0.84) than in boys (OR: 0.77, 95% CI: 0.66–0.88). Discussion: This study provides insights into perceived social and environmental correlates associated with ACTS behavior. Future research should include gender-specific perceptions and more in-depth investigations of correlates encouraging ACTS, especially considering social aspects, safety issues, and the structuring of the environment in different cultural settings.publishedVersio

Navigating process evaluation in co-creation: a Health CASCADE scoping review of used frameworks and assessed components

Background: Co-creation is seen as a way to ensure all relevant needs and perspectives are included and to increase its potential for beneficial effects and uptake process evaluation is crucial. However, existing process evaluation frameworks have been built on practices characterised by top-down developed and implemented interventions and may be limited in capturing essential elements of co-creation. This study aims to provide a review of studies planning and/or conducting a process evaluation of public health interventions adopting a co-creation approach and aims to derive assessed process evaluation components, used frameworks and insights into formative and/or participatory evaluation. Methods: We searched for studies on Scopus and the Health CASCADE Co-Creation Database. Co-authors performed a concept-mapping exercise to create a set of overarching dimensions for clustering the identified process evaluation components. Results: 54 studies were included. Conceptualisation of process evaluation included in studies concerned intervention implementation, outcome evaluation, mechanisms of impact, context and the co-creation process. 22 studies (40%) referenced ten existing process evaluation or evaluation frameworks and most referenced were the frameworks developed by Moore et al (14%), Saunders et al (5%), Steckler and Linnan (5%) and Nielsen and Randall (5%). 38 process evaluation components were identified, with a focus on participation (48%), context (40%), the experience of co-creators (29%), impact (29%), satisfaction (25%) and fidelity (24%). 13 studies (24%) conducted formative evaluation, 37 (68%) conducted summative evaluation and 2 studies (3%) conducted participatory evaluation. Conclusion: The broad spectrum of process evaluation components addressed in co-creation studies, covering both the evaluation of the co-creation process and the intervention implementation, highlights the need for a process evaluation tailored to co-creation studies. This work provides an overview of process evaluation components, clustered in dimensions and reflections which researchers and practitioners can use to plan a process evaluation of a co-creation process and intervention.</p