Psychosocial mediators of change in physical activity in the Welsh national exercise referral scheme: secondary analysis of a randomised controlled trial

Objective: While an increasing number of randomised controlled trials report impacts of exercise referral schemes (ERS) on physical activity, few have investigated the mechanisms through which increases in physical activity are produced. This study examines whether a National Exercise Referral Scheme (NERS) in Wales is associated with improvements in autonomous motivation, self-efficacy and social support, and whether change in physical activity is mediated by change in these psychosocial processes.<p></p> Methods: A pragmatic randomised controlled trial of NERS across 12 LHBs in Wales. Questionnaires measured demographic data and physical activity at baseline. Participants (N = 2160) with depression, anxiety or CHD risk factors were referred by health professionals and randomly assigned to control or intervention. At six months psychological process measures were collected by questionnaire. At 12 months physical activity was assessed by 7 Day PAR telephone interview. Regressions tested intervention effects on psychosocial variables, physical activity before and after adjusting for mediators and socio demographic patterning.<p></p> Results: Significant intervention effects were found for autonomous motivation and social support for exercise at 6 months. No intervention effect was observed for self-efficacy. The data are consistent with a hypothesis of partial mediation of the intervention effect by autonomous motivation. Analysis of moderators showed significant improvements in relative autonomy in all subgroups. The greatest improvements in autonomous motivation were observed among patients who were least active at baseline.<p></p> Discussion: The present study offered key insights into psychosocial processes of change in an exercise referral scheme, with effects on physical activity mediated by autonomous motivation. Findings support the use of self-determination theory as a framework for ERS. Further research is required to explain socio-demographic patterning in responses to ERS, with changes in motivation occurring among all sub-groups of participants, though not always leading to higher adherence or behavioural change. This highlights the importance of socio-ecological approaches to developing and evaluating behaviour change interventions, which consider factors beyond the individual, including conditions in which improved motivation does or does not produce behavioural change

From complex interventions to complex systems: towards a better understanding of school health improvement

Interventions to improve young peoples’ health are commonly delivered via schools. Challenges in changing the functioning of complex school systems are commonly underestimated and recognition is growing that interventions cannot be described in isolation from the contexts they attempt to alter. However, school health research has typically paid less attention to understanding schools’ current orientations toward health improvement than to attempts to introduce change. This thesis analyses data from a survey of schools to explore variability in their responses to school-level health needs data in terms of its discussion, distribution and perceived likelihood of impact on health improvement. It then employs ego social network analysis, focused on Wellbeing Leads within four case study schools, to identify potential explanations for variability between schools, before undertaking semi-structured interviews with staff, students and parents within each case study school to qualitatively explore health-related system functioning. Results highlighted the potential role of staff seniority in explaining schools’ variable engagement with feedback. Highly organised structures with allocation of responsibility for wellbeing to a member of senior management, systematisation of dedicated wellbeing roles, a high level of brokerage and embeddedness of outside agencies within school systems were characteristics of the more engaged case study schools. These factors were found to contribute to the orientation of school systems towards health in terms of engaging parents, implementing Personal and Social Education and promoting a healthy school ethos. By examining system functioning through a complex systems lens, whilst layering theory within this to facilitate its practical application, and employing mixed methodology, this thesis furthers our understanding of how variance in existing school system dynamics may impede or facilitate efforts to respond to student health needs. This higher level of understanding could be utilised to design complex interventions, which work with the system to achieve change

School- and family-level socioeconomic status and health behaviors: multilevel analysis of a national survey in Wales, United Kingdom

The work was conducted with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research: Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council (RES-590-28-0005), Medical Research Council, the Welsh Government, and the Wellcome Trust (WT087640MA), under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The Health Behavior in School-aged Children (HBSC) study is an international survey conducted in collaboration with the WHO Regional Office for Europe. The authors would like to acknowledge the HBSC international research network that developed the study's research protocol. Fieldwork in Wales was funded by the Welsh Government. Thanks to Chris Roberts within the Social Research and Information Division Welsh Government for his support

Exposure to secondhand smoke in cars and e-cigarette use among 10-11 year old children in Wales: CHETS Wales 2 key findings report

No abstract available

Student health and well-being in secondary schools: the role of school support staff alongside teaching staff

A growing evidence base indicates that health and educational attainment are synergistic goals. Students’ relationships with teachers and other students in the school environment are consistently predictive of a broad range of health and well-being outcomes. Despite the potential importance of relationships between students and a broad range of actors within a school, research tends to reduce ‘school staff’ to ‘teachers’. Previous research has highlighted incongruence between the power imbalance within a teacher–student relationship and the dynamics required to address health and well-being-related issues. To date, there has been no investigation into how the nature of the relationships between students and support staff may differ from those with teaching staff. This article aims to conceptualise the role of support versus teaching staff in promoting health and well-being to understand how school system functioning may affect relationships between school staff and students. Semi-structured interviews were conducted to obtain the perceptions of staff, students and parents within four exploratory case study schools of differing socio-economic status, geographical location and size. In line with the Theory of Health Promoting Schools and Human Functioning, findings demonstrated that the prominence of well-being relies on provision of staffing structures which include a team of support staff to work alongside teaching staff to provide the time and space to deal with issues immediately and build trust and rapport in a one-to-one setting. Further mixed-methods research is required to investigate how staffing structures can facilitate the development of mutually trusting relationships between staff and students

'Breakfast: how important is it really?' A response

No abstract available

Predictors of physical activity and sedentary behaviours among 11-16 year olds: Multilevel analysis of the 2013 Health Behaviour in School-aged Children (HBSC) study in Wales

Background The present study investigated associations between individual- and school-level predictors and young people’s self-reported physical activity (total activity and moderate-to-vigorous activity) and sedentary behaviours. Methods Individual-level data provided by the 2013/14 cross-sectional survey ‘Health Behaviour in School-aged Children (HBSC) study in Wales’ were linked to school-level data within the ‘HBSC School Environment Questionnaire’. The final sample comprised 7,376 young people aged 11-16 years across 67 schools. Multilevel modelling was used to examine predictors of total physical activity, moderate-to-vigorous physical activity (MVPA) and sedentary behaviours (screen-based behaviours). Results Taking more physical activity (less than 5 days vs. 5 or more days per week), engaging in higher levels of MVPA (less than 4 hours vs. 4 or more hours per week) and reporting 2 or less hours of sedentary time were predicted by several individual level variables. Active travel to school positively predicted high levels of physical activity, however, gender stratified models revealed active travel as a predictor amongst girls only (OR:1.25 (95 % CI:1.05 - 1.49)). No school-level factors were shown to predict physical activity levels, however, a lower school socio-economic status was associated with a higher level of MVPA (OR:1.02 (95 % CI:1.01 - 1.03)) and a lower risk of sedentary behaviour (OR:0.97 (95 % CI:0.96 – 0.99)). A shorter lunch break (OR:1.33 (95 % CI:1.11 - 1.49)) and greater provision of facilities (OR:1.02 (95 % CI:1.00 - 1.05)) were associated with increased sedentary activity. Gender stratified models revealed that PE lesson duration (OR:1.18 (95 % CI:1.01 - 1.37)) and the provision of sports facilities (OR:1.03 (95 % CI:1.00 - 1.06)) were predictors of boy’s sedentary behaviours only. Conclusion Shorter lunch breaks were associated with increased sedentary time. Therefore, while further research is needed to better understand the causal nature of this association, extending lunch breaks could have a positive impact on sedentary behaviour through the provision of more time for physical activity. The findings also suggest that active travel could offer a mechanism for increasing physical activity levels particularly amongst girls. Particularly, the design and evaluation of interventions to promote physical activity during school hours should employ a comprehensive approach, including a focus on school policies and behaviours both in and out of school hours. Keywords Physical activity – Sedentary behaviour – Active travel – School – Policy – Environmen