Identifying local authority need for, and uptake of, school-based physical activity promotion in England-a cluster analysis.

Abstract

BACKGROUND: School-based physical activity interventions such as The Daily Mile (TDM) are widely promoted in children's physical activity guidance. However, targeting such interventions to areas of greatest need is challenging since determinants vary across geographical areas. Our study aimed to identify local authorities in England with the greatest need to increase children's physical activity and assess whether TDM reaches school populations in areas with the highest need. METHODS: This was a cross-sectional study using routinely collected data from Public Health England. Datasets on health, census and the built environment were linked. We conducted a hierarchical cluster analysis to group local authorities by 'need' and estimated the association between 'need' and registration to TDM. RESULTS: We identified three clusters of high, medium and low need for physical activity interventions in 123 local authorities. Schools in high-need areas were more likely to be registered with TDM (incidence rate ratio 1.25, 95% confidence interval: 1.12-1.39) compared with low-need areas. CONCLUSIONS: Determinants of children's physical activity cluster geographically across local authorities in England. TDM appears to be an equitable intervention reaching schools in local authorities with the highest needs. Health policy should account for clustering of health determinants to match interventions with populations most in need.TV is funded by an NIHR SPHR PhD Studentship (Grant Reference Number PD-SPH-2015). The NIHR School for Public Health Research is a partnership between the Universities of: Sheffield; Bristol; Cambridge; Imperial; and University College London; The London School for Hygiene and Tropical Medicine (LSHTM); LiLaC – a collaboration between the Universities of Liverpool and Lancaster; and Fuse - The Centre for Translational Research in Public Health a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities. KH is funded by Imperial NIHR Biomedical Research Centre: NIHR-BRC-P68711. BR is funded by The Daily Mile Foundation supported by INEOS. CC is funded by a personal NIHR Career Development Fellowship (2016-10-95). EvS is supported by the Medical Research Council (MRC) (Grant MC_UU_12015/7). This work was undertaken under the auspices of the Centre for Diet and Activity Research (CEDAR), where funding from Cancer Research UK, the British Heart Foundation, the Economic and Social Research Council, the Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged [MR/K023187/1]. SS holds grants from The Daily Mile Foundation, the National Institute for Health Research School for Public Health Research (NIHR SPHR) (Grant Reference Number PD-SPH-2015) and the NIHR Applied Research Collaboration (ARC)