Development and feasibility of a multi-component intervention to promote children’s physical activity in schools (SOKKA Schools)

Physical activity (PA) promotion and sedentary behaviour (SB) reduction in childhood are important as PA and SB are independently associated with individual and clustered cardiometabolic risk factors. Primary schools are a key setting for child PA promotion, yet even with the provision of PA opportunities and the supporting role of physical education (PE) co-ordinators, few school-based United Kingdom (UK) PA interventions have been effective. While various reasons for this exist, it is suggested that many-school based PA interventions skip the critical development and feasibility/piloting stages of multi-component intervention design. Consequently, the overarching aims of the thesis were to design, develop, implement and evaluate a multi-component primary school-based PA intervention. Study one used interviews to explore the barriers and facilitators of children’s school-based PA from the perspective of headteachers, PE-coordinators and a deputy headteacher. At an organisational level headteachers were the predominant driving force in the promotion of PA opportunities, yet institutional barriers including low priority for PA and PE were perceived to negate delivery. At an interpersonal level, strategies to increase the delivery of school-based PA were developed, however poor teacher-coach relationships and significant others reduced PA promotion opportunities. Child PA was further negated through intrapersonal factors, including lack of PE-specific teacher training and varying teacher interest in PA and sport. To increase primary school children’s school-based PA, barriers and facilitators at the organisational, interpersonal and intrapersonal level must be considered and targeted, and researchers and schools should work in partnership to develop future interventions. Study two used focus groups to investigate children’s perceptions of factors that influence PE enjoyment, and interpreted findings in the context of self-determination theory (SDT) and the promotion of autonomous motivation. Factors reported to influence children’s perceived PE enjoyment included 1) individual preferences, 2) peer behaviour, 3) instructor behaviour. PE instructors and peers are important in creating an environment that supports children’s psychological needs for autonomy, competence and relatedness, which influence PE enjoyment. To consistently provide children with enjoyable PE lessons, primary schools are advised to support the ongoing development of generalist teachers and facilitate better working relationships between generalist teachers and specialist coaches. SDT can be used by instructors to guide practice that enhances children’s enjoyment of PE. Study three used school educator’ experiences and perspectives to refine and justify a proposed multi-component primary school-based PA intervention. Focus group and interview data indicated that for the proposed and other health-based interventions, acceptance into schools and consideration of how to increase educator buy-in is essential. Further, for educators to feel confident, comfortable and motivated to deliver the proposed intervention, it appears important to support school educators’ understanding of the proposed intervention and its impact on pupil outcomes, reduce possible training fears, enhance delivery competence and confidence, and provide easy to implement resources and support frameworks that encourage sustainable delivery. Study four assessed the acceptability and feasibility of a classroom-based SDT intervention to increase teacher’s motivation orientation to facilitate PA throughout the school day. Findings indicated the four-week intervention was acceptable and feasible to deliver in the school environment. Teacher response and recruitment rates were high (100%) possibly to due to head teacher commitment to the intervention. For children however, recruit rates were low and attrition from participants was relatively high. Qualitative findings suggested that for children of all ages to engage in the resources, it is desirable for resources to be developed to support children’s psychological needs (i.e. provide optimal challenge). Furthermore, there was evidence that the training increased teacher’s intrinsic motivation to implement and deliver the resource. Larger trials are needed to evaluate the impact of classroom PA lessons on teacher and student outcomes. The thesis highlights the importance of stakeholder buy-in from headteachers, teachers and pupils if school-based PA programs are to be successful. The results highlight the importance of targeting barriers to PA implementation at all levels of the socio-ecological model. Schools provide an important target setting to increase children’s PA and staff, when appropriately trained, are able to facilitate the delivery of school-based PA. Training teachers in a need-supportive way and providing them with interpersonal strategies to increase children’s PA motivation appears to be an important avenue for further investigation. The findings support evidence for developing interventions as guided by the MRC framework. This is important as this process not only calls for important formative work to take place before intervention implementation, but for researchers to work alongside school educators and pupils to ensure what is being designed is appropriate and fits within the needs of the schools