Development and feasibility of an intervention to promote active travel to school

PhD ThesisIntroduction: Active travel to school (ATS) is a source of physical activity for children. Aim: a) Develop an ATS intervention and b) test its feasibility in Year 5 children. Methods: a) Intervention development: Review of ATS and other relevant interventions; review of behaviour change theory; public involvement. Intervention: every ATS day equalled one ticket into a £5 voucher draw. b) Feasibility testing: Cluster-randomised pilot trial in two primary schools with process evaluation. Daily outcome measures: parental ATS reports (optionally by SMS); child ATS reports; accelerometry (moderate-to-vigorous physical activity [MVPA] during journey to school). Results: a) Limited evidence for ATS intervention effectiveness but some evidence for using incentives in health promotion. Twelve theories identified but their utility for ATS intervention development was unclear. Eight families, a head teacher, and a young person’s group supported the development of an ATS incentive scheme. b) Four schools agreed to participate in the study (3.3%) and two were selected, 29 child-parent pairs were recruited (33.0%), and 27 retained for the 9 week study (93.1%). Materials returned on time: accelerometers (81.9%), parental ATS reports (82.1%), and child reports (97.9%). Parent-child agreement on school travel mode was moderate (k=0.53, CI 95% 0.45; 0.60). MVPA differences (minutes) for parent-reported ‘ATS vs non-ATS trips’ were significant, during parent-reported times as corresponding to the school journey (U=390.5, p<0.05; 2.46 (n=99) vs 0.76 (n=13)) and in the pre-classes hour (U=665.5, p<0.05; 4.99 (n=104) vs 2.55 (n=19)). MVPA differences for child-reported ‘ATS vs non-ATS trips’ were also significant, both during parent-reported trip times (U=596.5, p<0.05; 2.40 (n=128) vs 0.81 (n=15)) and the pre-classes hour (U=955.0, p<0.05; 4.99 (n=146) vs 2.59 (n=20)). In a process evaluation, interviewees reported that procedures were generally appropriate. Conclusion: An ATS incentive scheme seems feasible. ATS reports showed validity vis-à-vis accelerometry. Further work is required to improve recruitment.Thank you also to the MOVE Project (Durham University) for the loan of 90 accelerometers and accessories, to my PhD funder (Sir James Knott Fellowship), to the Catherine Cookson Foundation for the award of £2100 for my research, and to the NIReS (now IfS) for the provision of 10 brand new accelerometers and accessories (worth £1750) at the very beginning of this project

Accelerometer-measured physical activity in Portuguese children from a rural area: a school-based cross-sectional study

Young people are leading increasingly sedentary lives replacing physical activity with activities such as watching TV, internet surfing and video gaming. Of particular importance for physical activity promotion are schools where physical activity can be incorporated to improve student health outcomes and cognitive performance. The World Health Organization (WHO) recommends that children engage in at least 60 minutes per day of moderate to vigorous physical activity (MVPA) for children and adolescents (between 5-18 years of age). However, few children follow these recommendations. In Portugal, some data suggest that as few as 7% do so. Furthermore, most physical activity studies take place in urban areas, so little is known about how active children and adolescents are in more rural parts of the country. The Acti-Study is a collaboration between the Instituto Politécnico de Bragança (Portugal) and Ulster University (UK) with the primary aim of assessing MVPA levels in students (age 10-16) from a high school in a rural town, in the Northeast of Portugal. Data collection will take place between September 2022 and January 2023, using a cross-sectional design. Students will receive a study pack containing information materials, a sociodemographic questionnaire and consent form for parental completion, and an assent form for student completion. Optionally, the questionnaire may be completed online. Participants will be informed that participation is voluntary and that they can withdraw at any time. Once children have returned the relevant documents completed and signed, they will be instructed to wear a hip-worn accelerometer (ActiGraph®, either GT3X or GT1M), on an elastic belt, for seven consecutive days (including weekend). Children who return their accelerometer will be rewarded with a 5€ voucher, and with a second one if they wore the accelerometer for a minimum of three days (at least 6h/day and at least one weekend). Data will be analysed through descriptive statistics, mostly in tables, divided by gender. With participant consent, data on anthropometric measures (height and weight), available through the school, will also be used. Primary analysis will consist of percentage of students who meet MVPA guidelines; secondary analyses will include exploring the relationship between sociodemographic variables (e.g., parental education) and MVPA, between parent-reported MVPA and accelerometer MVPA, and between accelerometer MVPA and anthropometric data. The results are expected to provide an understanding of the levels and factors associated with MVPA in rural Portugal, to allow comparison with other samples (e.g., from urban areas), to raise awareness to the problem and stimulate more physical activity initiatives. Study with ethics approval by Ulster University (REC/22/0060).This work was supported by PARSUK (Portuguese Association of Researchers and Students in the UK), with funding from the Bilateral Research Fund provided by the Portuguese Foundation for Science and Technology (FCT) and the British Embassy Lisbon / UK Science and Innovation Network through the project. This work was supported by FCT - Foundation for Science and Technology within the Project UIDB/05777/2020.info:eu-repo/semantics/publishedVersio

The Bumps and BaBies Longitudinal Study (BaBBLeS): a multi-site cohort study of first-time mothers to evaluate the effectiveness of the Baby Buddy app

Background: Health mobile applications (apps) have become very popular, including apps specifically designed to support women during the ante- and postnatal periods. However, there is currently limited evidence for the effectiveness of such apps at improving pregnancy and parenting outcomes. Aim: to assess the effectiveness of a pregnancy and perinatal app, Baby Buddy, in improving maternal self-efficacy at three months post-delivery. Methods: Participants were 16-years and over, first-time pregnant women, 12-16 weeks gestation, recruited from five English study sites. The Tool of Parenting Self-efficacy (TOPSE) (primary outcome) was used to compare mothers at three months post-delivery who had downloaded the Baby Buddy app compared to those who had not downloaded the app, controlling for confounding factors. Results: 488 participants provided valid data at baseline (12-16 weeks gestation), 296 participants provided valid data at 3 months post-birth, 114 (38.5%) of whom reported that they had used the Baby Buddy app. Baby Buddy app users were more likely to use pregnancy or parenting apps (80.7% vs 69.6%, p=.035), more likely to have been introduced to the app by a healthcare professional (p=.005) and have a lower median score for perceived social support (81 vs 83, p=.034) than non-app users. The Baby Buddy app did not illicit a statistically significant change in TOPSE scores from baseline to 3 months post-birth (adjusted OR 1.12, 95%CI 0.59 to 2.13, p=.730). Finding out about the Baby Buddy app from a healthcare professional appeared to grant no additional benefit to app users compared to all other participants in terms of self-efficacy at three months post-birth (adjusted OR 1.16, 95%CI 0.60 to 2.23, p=.666). There were no statistically significant differences in the TOPSE scores for the in-app data between either the type of user who was engaged with the app and non-app users (adjusted OR 0.69, 95%CI 0.22 to 2.16, p=.519) or those who were highly engaged and non-app users (adjusted OR 0.48, 95%CI 0.14t o 1.68, p=.251). Conclusion: This study is one of few, to date, that has investigated the effectiveness of a pregnancy and early parenthood app. No evidence for the effectiveness of the Baby Buddy app was found. New technologies can enhance traditional healthcare services and empower users to take more control over their healthcare but app effectiveness needs to be assessed. Further work is needed to consider, a) how we can best use this new technology to deliver better health outcomes for health service users and, b) methodological issues of evaluating digital health interventions

Bumps and Babies Longitudinal Study (BABBLES): An independent evaluation of the Baby Buddy app

Introduction: Developments in information and communication technologies have enabled and supported the development and expansion of electronic health in the last decade. This has increased the possibility of self-management and care of health issues.Objectives: To assess the effectiveness of on maternal self-efficacy and mental wellbeing three months post-birth in a sample of mothers recruited during the antenatal period. In addition, to explore when, why and how mothers use the app and consider any benefits the app may offer them in relation to their parenting, health, relationships or communication with their child, friends, family members or health professionals.Design: A mixed methods approach, including a longitudinal cohort study, a qualitative study and detailed analysis and synthesis of data from the Baby Buddy app about the way in which mothers accessed and used the app content.Setting: The study was conducted in five geographically separate sites in England: Coventry, Lewisham, Bradford, Blackpool and Leicester. These areas were chosen as they were geographically, ethnically and socio-economically diverse and where the Baby Buddy app was reported to be well-embedded, both formally and informally, into the maternity and child health pathways by the relevant healthcare staff.Participants: Pregnant women who were aged 16 years and over, had no previous live child, were between 12-16 weeks and six days gestation and booked with the maternity services in each of the five study sites were invited to take part.Interventions: Self-reported use of the Baby Buddy app at one of the three data collection time-points: 12-16+6 weeks gestation, 35 weeks gestation and three months post-birth.Outcome measures: The primary outcome measure was parental self-efficacy at three months post-birth using the Tool to measure Parenting Self-Efficacy (TOPSE). The main secondary outcome was maternal mental well-being at three months post-birth using the Warwick and Edinburgh Mental Wellbeing Scale (WEMWBS).Results: Recruitment took place between September 2016 and February 2017. A total of 488 participants provided valid data at baseline (12-16 weeks gestation), 296 participants also provided valid data at 3 months post-birth, 114 (38.5%) of whom reported that they had used the Baby Buddy app at one or more of the data collection time-points (‘app user’). Seventeen first-time mothers participated in the qualitative arm via telephone interviews (n=9) and a focus group (n=8). Twenty healthcare professionals participated in interviews (n=5) and two focus groups (n=15). Consent was gained from 98 participants who gave permission for their in-app4data to be made accessible but just 61 participants could be identified from the database provided, of whom 51 were included in the analyses.At recruitment there were no differences between Baby Buddy app users and non-app users in respect to: age, IMD, ethnicity, highest education, employment, relationship status. Baby Buddy app users were more likely to use pregnancy or parenting apps (80.7% vs 69.6%, p=.035), more likely to have been introduced to the app by a healthcare professional (p=.005) and have a lower median score for perceived social support (81 vs 83, p=.034) than non-app users. The Baby Buddy app did not illicit a statistically significant change in TOPSE scores from baseline to 3 months post-birth (adjusted OR 1.12, 95%CI 0.59 to 2.13, p=.730). Finding out about the Baby Buddy app from a healthcare professional appeared to grant no additional benefit to app users compared to all other participants in terms of self-efficacy at three months post-birth (adjusted OR 1.16, 95%CI 0.60 to 2.23, p=.666).Apps were popular; Baby Buddy app users were more likely to use other pregnancy-related apps than non-Baby Buddy users and the most frequent source from which Baby Buddy app users found out about the app was a midwife. A post-hoc analysis found that Baby Buddy app users were more likely to breastfeed than non-Baby Buddy app users. This was a consistent pattern for both exclusive breastfeeding and any breast feeding: there was a 9% increase in exclusive breastfeeding at any time up to 3 months post-birth in Baby Buddy app users and a 12% increase in any breastfeeding up to three months post-birth, compared to non-app users. Whilst this is an important finding, this needs to be used with care due to the post-hoc element of the analysis.First-time mothers who participated in the qualitative arm of the study found that the Baby Buddy app worked well due to its accessibility and that the information was concise and easy to find. They liked that it followed the progress of pregnancy with appropriately-timed information and that different aspects could be accessed as and when needed. The app was designed to be an adjunct to service delivery not a replacement for healthcare. The importance of this was demonstrated by many first-time mothers reporting that they preferred in-practice support from a healthcare professional.The qualitative data indicated that the four preconditions of normalisation process theory: implementation, adoption, translation and stabilisation were met in regard to healthcare professionals’ use of the Baby Buddy app. This suggests that the healthcare professionals were actively integrating the Baby Buddy app into clinical practice with other professionals and first-time mothers, therefore embedding the Baby Buddy app into their service delivery.The in-app data from the sub-sample of participants (n=51) suggest that there was a difference in the amount of time participants spent accessing elements of the app; the median time spent using the app per session was 8.3 minutes (SD 5.8 minutes). The most popular features that5were used were ‘Today’s Information’, videos, ‘Bump/Baby Booth’, ‘Ask Me’ and ‘What does that mean?’. Participants used the app most often between 9-10am with another peak in the evening around 8-9pm. There were also a broad range of topics and issues that the participants searched for, of which the most searched words included: ‘labour’, ‘form’, ‘birth’, ‘pregnant’ and ‘developing’. In the sub-sample for whom we had in-app data, there was a large range for the number of times the app was used, from 0-593 times. The median number of times the app was opened was 146.5 but the data were positively skewed (LQ 52.5 – UQ 329). This indicates that the data are bunched towards the smaller number of times opened. Within this sub-sample, 21.6% of the engaged type of user used the app up to 25 times and 47% of this type of user used the app more than 100 times. This contrasts with the highly engaged type of user where 43% used the app 25 or less times and just 9.8% of this proactive type of user used it more than 100 times.We found no statistically significant difference in the TOPSE or the WEMWBS scores between the type of user who was engaged with the app and non-app users (adjusted OR 0.69, 95%CI 0.22 to 2.16, p=.519 and adjusted OR 1.54, 95%CI 0.57 to 4.16, p=.329, respectively). Similarly, we found no statistically significant difference between the type of users who were highly engaged users and non-app users (TOPSE: adjusted OR 0.48, 95%CI 0.14t o 1.68, p=.251; WEMWBS: adjusted OR 1.40, 95%CI 0.52 to 3.76, p=.509).Strengths and limitations: The primary objective was to explore the impact of the Baby Buddy app on parental self-efficacy and the Tool for Parenting Self-Efficacy (TOPSE website, Kendall, Bloomfield and Nash 2009), a validated measure, was selected to measure the primary outcome. The retention rate of 60.7% from baseline to three months post-birth demonstrates the difficulty of engaging new mothers during this demanding period of their lives. Nevertheless, in the initial and final samples, app users and non-users remained generally comparable and relevant confounders were adjusted for. Mothers were invited to take part in interviews and/or focus groups, the latter of which were held in a baby-friendly, welcoming environment for women and babies. Telephone interviews were offered for greater convenience for the women. Analysing the in-app data, we were able to compare outcomes for both the high versus low or non-user app groups and for those mothers who were the type of highly engaged users versus those who were a less engaged type. This was for a relatively small number of mothers but was a new method of analysing the in-app data.The Baby Buddy app was publicly available, meaning randomisation was not possible and therefore participants were only asked about their specific use of the app after the 35 weeks gestation data collection point to avoid directed app use. The participants were a self-selected group, especially those for whom we had in-app data and this is reflected in the higher than the national average for women who were degree holders (58.6% in final sample versus 42% nationally). The overall TOPSE scores were high at baseline which meant there was little room6for improvement. Nevertheless, there was no difference between the Baby Buddy app users and those participants who did not use the app.Conclusions: First-time mothers in the study found the app accessible and the information concise. The quantitative results, including those from the in-app data, found no evidence of impact from the Baby Buddy app on the primary outcome of parental self-efficacy or mental well-being (secondary outcome) at three months post-birth. The participant mothers had lower social support scale scores, which might suggest that the app attracted mothers who had a smaller social support network. Both mothers and healthcare professionals valued the fact that the Baby Buddy app was professionally endorsed which encouraged the women to trust the contents and the healthcare professionals to use it in their everyday practice. The most frequent source from which Baby Buddy app users found out about the app was a midwife, which suggests that the embedding of the app into service delivery by Best Beginnings was beneficial. A post-hoc finding was that women who used the Baby Buddy app were significantly more likely to exclusively breastfeed, or ever breastfeed, than those not using the app. The Baby Buddy app has gone some way to help to ‘Make Every Contact Count’ for both first-time mothers and healthcare professionals

Intergenerational Communication – an interdisciplinary mapping review of research between 1996 and 2017

Concerns have been raised regarding the limited opportunities for intergenerational communication both outside and within the family. This “mapping review” draws together empirical literature in the topic published since 1996. Three hundred and twenty-four published studies met inclusion criteria, based on abstract review. The contents of each study were subjected to thematic analysis and nine broad themes emerged. These were (1) Dynamics of relationships, (2) Health & Well-being, (3) Learning & Literacy, (4) Attitudes, (5) Culture, (6) Digital, (7) Space, (8) Professional Development, and (9) Gender & Sexual Orientation. Studies commonly intersected disciplinary research areas. There was a marked rise across three key academic journals since 2007. An emergent finding was that a third of the studies relate to programs addressing intergenerational interventions, but many of these were primarily descriptive and failed to specify a primary outcome. Review implications and future research directions are discussed

Associations between social support, mental wellbeing, self-efficacy and technology use in first-time antenatal women: data from the BaBBLeS cohort study

Background: Information and communication technologies are used increasingly to facilitate social networks and support women during the perinatal period. This paper presents data on how technology use affects the association between women’s social support and, (i) mental wellbeing and, (ii) self-efficacy in the antenatal period. Methods: Data were collected as part of an ongoing study - the BaBBLeS study - exploring the effect of a pregnancy and maternity software application (app) on maternal wellbeing and self-efficacy. Between September 2016 and February 2017, we aimed to recruit first-time pregnant women at 12–16 gestation weeks in five maternity sites across England and asked them to complete questionnaires. Outcomes included maternal mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale), and antenatal self-efficacy (antenatal version of the Tool to Measure Parenting Self-Efficacy). Other variables assessed were perceived social support (Multidimensional Scale of Perceived Social Support), general technology use (adapted from Media and Technology Usage and Attitudes Scale). Potential confounders were age, ethnicity, education, socioeconomic deprivation, employment, relationship status and recruitment site. Linear regression models were developed to analyse the relationship between social support and the outcomes. Results: Participants (n = 492, median age = 28 years) were predominantly white British (64.6%). Half of them had a degree or higher degree (49.3%), most were married/living with a partner (83.6%) and employed (86.2%). Median (LQ-UQ) overall scores were 81.0 (74.0–84.0) for social support (range 12–84), 5.1 (4.7–5.4) for technology use (range 1–6), 54.0 (48.0–60.0) for mental well-being (range 14–70), and 319.0 (295.5–340) for self-efficacy (range 0–360). Social support was significantly associated with antenatal mental well-being adjusting for confounders [adj R2 = 0.13, p < .001]. The addition of technology use did not alter this model [adj R2 = 0.13, p < .001]. Social support was also significantly associated with self-efficacy after adjustment [adj R2 = 0.14, p < .001]; technology had limited impact on this association [adj R2 = 0.13, p < .001]. Conclusions: Social support is associated with mental well-being and self-efficacy in antenatal first-time mothers. This association was not significantly affected by general technology use as measured in our survey. Future work should investigate whether pregnancy-specific technologies yield greater potential to enhance the perceived social support, wellbeing and self-efficacy of antenatal women

Reliability and feasibility of a voucher‐based strategy for physical activity assessment based on accelerometer in Portuguese children from a rural area

Last decades, children have left the streets, the pranks and the playgrounds for the physical inactive and sedentary times of watching TV, internet surfing and video gaming (Carbone et al., 2021; Kelly et al., 2005). It is therefore important to understand whether this trend covers Portuguese children from rural areas, previously characterized as presenting greater opportunities for physical activity (PA) practice (Machado-Rodrigues et al., 2012). However, the adherence to observational studies is often low and it is important to create strategies for increased participation (Shrank et al., 2011). Thus, this research aimed to assess the reliability and feasibility of voucher‐based strategy for physical activity assessment based on accelerometer in Portuguese children from a rural area. An observational cross-sectional research was conducted between September 2022 and January 2023. The ACTI-Study evaluated the moderate to vigorous physical activity (MVPA) levels and sedentary behavior (SB) in students (age 10-16) from a high school in a Portuguese Northeast rural area. The PA assessment were conducted a hip-worn accelerometer (ActiGraph®, either GT3X or GT1M), on an elastic belt, for seven consecutive days (including weekend) (Vasques et al., 2023). Body mass index (BMI) was computed by dividing weight (kg) by height (m2). Normal (25.0 kg/m2), overweight (25.0 to 29.9 kg/m2), and obese (30.0 kg/m2) were defined using European BMI cut-offs (Magalhães et al., 2023; Vasques et al., 2014). Previous, a questionnaire for sample's sociodemographic and determinants of physical activity practice was applied. For applying the voucher-based strategy, children who returned the accelerometer were rewarded with a 5€ voucher, and a second one was given if they wore the accelerometer for a minimum of three days (at least 6h/day and at least one weekend) (Ginja et al., 2019). After, wore the accelerometer for a minimum of three days (two weekdays and one of the weekend) would mean receiving an extra 5€ voucher. Friedson's (2005) criteria was used to measure MVPA levels. Troiano (2007) algorithm was computed to assess compliance with the minimum of 360 minutes over three monitored days (Kakinami et al., 2018; Vanhelst et al., 2012). Only two children did not fulfill the criterion established for the use of the accelerometer, which means that the values found in the study correspond to the MVPA levels and SB time is representative in 97.8% of the selected sample. This means that applying voucher-based strategies for accelerometer-based physical activity assessment in Portuguese rural children is reliable and feasible, and all researchers should consider this strategy if they want to reduce research dropouts (Ginja et al., 2017, 2019). Finally, the next ACTI-Study milestones will be to assess the average daily number of MVPA minutes (accelerometer based and parent reported), percentage spent in MVPA (accelerometer based), number of steps (accelerometer based) and sedentary time bouts.This work was supported by PARSUK (Portuguese Association of Researchers and Students in the UK), with funding from the Bilateral Research Fund provided by the Portuguese Foundation for Science and Technology (FCT) and the British Embassy Lisbon I UK Science and Innovation Network through the project. Also, this work has been supported by FCT - Fundação para a Ciência e Tecnologia within the Project Scope: UIDB/05777/2020N/

Assessment of physical activity levels in children in Trás-os-Montes region: a pos-pandemic perspective

O confinamento, motivado pela pandemia da COVID-19, teve um impacto significativo ao nível da atividade física (AF) e da exploração motora das crianças. Baseado neste pressuposto, o presente projeto tem como objetivo avaliar os níveis de AF após pandemia em crianças, com idades compreendidas entre os dez e dezasseis anos, que habitam em zonas rurais da região de Trás-os-Montes (Portugal). Posteriormente, pretende-se analisar as diferenças nos níveis de AF entre crianças de zonas rurais e urbanas. O projeto contempla 2 fases: (1) Implementação de questionários sociodemográficos para a obtenção de dados gerais da população alvo; (2) fase de intervenção através da avaliação dos níveis de AF por acelerometria (ActiGraph GT3X®) e aferição da composição corporal por medidas antropométricas. A primeira fase será baseada na aplicação de questionários sociodemográficos numa amostra representativa de crianças da zona rural brigantina, de forma a entender quais as determinantes para a prática de AF. A recolha de dados será realizada no concelho de Alfandega da Fé entre setembro e dezembro de 2022. Como hipótese de estudo, delimitam-se níveis mais elevados de prática de AF habitual para as crianças das zonas rurais. O estudo pretende fornecer uma atualização epidemiológica do possível impacto da pandemia nos níveis de AF das crianças de um concelho da região de Trás-os-Montes.info:eu-repo/semantics/publishedVersio

Acti-study: avaliação dos níveis de atividade física em crianças da região de Trás-os-Montes

The World Health Organization (WHO) recommends that children engage in at least 60 minutes per day of moderate to vigorous physical activity (FA) for children and adolescents. However, there are few children who follow these recommendations. In Portugal, some data suggest that only 7% of young people comply with it. Unfortunately, most studies on physical activity take place in urban areas, so we still know relatively little about how active children and adolescents are in regions such as Alfândega da Fé. Thus, the Acti-study aims to evaluate the levels of PA in children and adolescents between 5th and 9th grade with ages between 10 and 16 years, of the Alfândega da Fé. Subsequently, it is intended to analyse the differences in PA levels between rural and urban areas. The project includes two phases: (1) Implementation of sociodemographic questionnaire to obtain general information about the target population; (2) An intervention phase through the assessment of the PA levels using accelerometry (ActiGraph®) and body composition by anthropometric measures. The first phase will be based socio-demographic questionnaires in representative sample of children living in rural zones to understand the determinants for the physical activity. Data collection will be conducted in the municipality of Alfandega da Fé between September and December 2022. As a research hypothesis, higher levels of regular PA are defined for children in rural areas.N/