Pathways to Increasing Adolescent Physical Activity and Wellbeing: A Mediation Analysis of Intervention Components Designed Using a Participatory Approach
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Participant Recruitment and Inclusion Criteria
2.3. Intervention
2.4. Measures
2.5. Outcomes
2.5.1. Physical Activity (Accelerometry)
2.5.2. Wellbeing
2.6. Exposures: Engagement with Intervention Components
2.7. Potential Mediators
2.8. Potential Confounders
2.9. Statistical Analysis
3. Results
4. Discussion
Summary in Relation to Participatory Co-Design Approach
5. Strengths and Limitations
6. Conclusion
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Concept | Participatory Perspective Summary [20] | Component | Supporting Evidence |
---|---|---|---|
Choice | Adolescents identified that providing choice was important for Year 9 to be interested physical activity with the limited choice of school sports available considered to be a barrier to participation. | Each tutor group chooses two different activities weekly. | Adolescents given an activity choice have better programme attendance [27]. Choice may improve intrinsic motivation, self-efficacy and self-esteem, important for long-term activity maintenance [28,29]. |
Novelty | The small number of school sports available was a barrier to interest in physical activity and adolescents suggested introducing new types of activities. New activities were stated as important for reducing barriers regarding confidence and lack of skill in common sports as students would begin a new sport with equal ability. | There are 20 activities available, designed to utilise little or no equipment. Intervention materials are available on the study website, which include “quick-cards” (overviews of chosen activities). | Introducing adolescents to new activities is important; those given the opportunity to try new activities are more likely to want to do more [30]. |
Mentorship | Using older mentors or role models was suggested as more appealing than an intervention delivered by researchers or teachers. Participants suggested that these mentors should be slightly older but not too far from the participants’ age. | Older adolescents in the school (mentors) are paired with each Year 9 class and are responsible for encouraging their class to participate in new activities. Mentors are helped by Year 9 in-class leaders who change weekly. | Peers are crucial for adolescents to attain the best health behaviours in the transition to adulthood [31]. Cross-age mentorship can successfully improve adolescent health behaviours e.g., substance use [32,33], sexual health [34] and nutrition [35] but is understudied in physical activity research [36], particularly in young people [37]. |
Competition | Competition between tutor groups was suggested to promote participation among a whole school year group and to appeal to those students who would not normally get involved in physical activity. To encourage confidence, participants suggested private individual competition as well as class level competition. They suggested that the former should be kept private so as not to demotivate participants with lower scores. Teachers suggested that competition between tutor groups was an additional way to motivate teachers. | Students gain points every time they do an activity; there is no time limit, students just have to try an activity to get points. Individual points are kept private with class level totals announced to encourage inter-class competition. Students can enter their points on the GoActive website with individual passwords and login details. | Competitions improve engagement and retention in health promotion [38]. |
Rewards | Receiving rewards for certain levels of participation rather than performance were also suggested as motivating. This was thought to appeal to the competitive nature of students without emphasis on physical activity ability which may not appeal to less active participants. | Students gain small individual prizes for reaching certain points levels with everyone gaining a certain amount of points being entered into a prize draw for a bike. | Reward-based interventions appear effective in improving weight management behaviours in children [39]. |
Flexibility | There was no clear consensus about when was the best time for physical activity promotion with a range of times suggested, perhaps highlighting the need for flexibility within physical activity promotion. There was a lack of agreement regarding timing and location of activity, however, being able to participate with friends was considered important. Preferences for locations of activity also varied and highlighted the need for flexibility and choices that are sensitive to self-conscious adolescents. | During the feasibility and pilot work, one tutor time weekly has been used to do an activity and participants are also encouraged to do activities at other times, especially out of school. | A range of co-participants, timing and locations for activity are preferred by Year 9 adolescents with preferences differing on an individual level [30]. |
Activity Sessions | Teachers stated that time was an important barrier to teacher enthusiasm in physical activity interventions. Using tutor time (registration/roll call) physical activity promotion was suggested by teachers. Tutor time usually occurs first thing in the morning and after lunch at British schools when students attend a short class; their form tutor marks attendance and gives out school notices and reminders. Teachers could choose which tutor time(s) were used for running GoActive activities. | Each class was encouraged to use at least one tutor time weekly to participate in activities as a class together. In addition to during tutor time in the classroom, students were also encouraged to do activities at other times in and out of school. Some of the activities were group activities and some were individual. The full list of available activities is available as Supplementary Material. | Providing a new occasion to be active by replacing sedentary time for physical activity has been suggested to lead to successful physical activity promotion [40]. |
Boys (n = 360) | Girls (n = 311) | P Value for Sex Difference | |
---|---|---|---|
Descriptive Characteristics | |||
Baseline age (years) | 13.23 (0.42) | 13.24 (0.43) | 0.966 |
Body mass index z-score | 0.19 (1.25) | 0.38 (1.15) | 0.077 |
Language (only English), % | 91.64 | 93.06 | 0.490 |
Ethnicity (white), % | 84.89 | 87.50 | 0.327 |
Outcomes | |||
Moderate-to vigorous physical activity change (min/day) | −1.98 (23.40) | −1.55 (17.04) | 0.901 |
Wellbeing change (score) | −0.03 (0.79) | −0.11 (0.72) | 0.146 |
Exposures | |||
Perceived teacher support (score) | 2.47 (0.93) | 2.58 (0.91) | 0.113 |
Perceived mentor support (score) | 2.61 (0.83) | 2.80 (0.77) | 0.002 |
Web-based points entered (% versus not entered) | 52.73 | 48.89 | 0.321 |
Perceived peer-leaders support (score) | 0.47 (0.50) | 0.36 (0.48) | 0.006 |
Rewards | 3.53 (1.17) | 3.76 (1.35) | 0.024 |
Competition | 3.40 (1.07) | 3.42 (1.25) | 0.745 |
Class sessions | 3.42 (1.16) | 3.42 (1.24) | 0.462 |
Potential Mediators | |||
Self-efficacy change (score) | −0.09 (0.91) | −0.10 (0.87) | 0.955 |
Self-esteem change (score) | −0.02 (0.50) | −0.06 (0.45) | 0.108 |
Social support change (score) | −0.11 (0.55) | −0.12 (0.46) | 0.629 |
Group cohesion in-degree | −0.16 (1.37) | −0.28 (1.30) | 0.159 |
Group cohesion out-degree | −0.05 (1.44) | −0.03 (1.24) | 0.883 |
Friendship quality change (score) | −0.23 (0.55) | −0.21 (0.55) | 0.990 |
Boys | Girls | |||
---|---|---|---|---|
Physical Activity | Wellbeing | Physical Activity | Wellbeing | |
Perception of Intervention Component | ||||
Teacher support | 2.93 (0.31 to 5.54) | 0.08 (0.01 to 0.16) | −0.50 (−2.41 to 1.43) | 0.06 (−0.02 to 0.14) |
Mentor support | 1.47 (−1.51 to 4.45) | 0.14 (0.03 to 0.23) | 0.31 (−1.87 to 2.50) | 0.11 (0.02 to 0.20) |
Class sessions | 1.83 (−0.31, 3.96) | 0.10 (0.03, 0.18) | 0.20 (−1.18, 1.57) | 0.04 (−0.02, 0.05) |
Peer-leadership | −4.42 (−9.25 to 0.41) | 0.11 (−0.04 to 0.25) | −0.91 (−4.56 to 2.74) | −0.09 (−0.23 to 0.06) |
Rewards | 2.53 (0.35 to 4.71) | 0.07 (0.01 to 0.14) | 0.35 (−0.97 to 1.67) | 0.10 (0.05 to 0.15) |
Competition | 1.26 (−1.16 to 3.67) | 0.06 (−0.02 to 0.14) | 0.53 (−0.87 to 1.92) | 0.13 (0.07 to 0.18) |
Online Intervention Component | ||||
Web-based points | −0.04 (−4.79 to 4.71) | 0.06 (−0.09 to 0.20) | −1.74 (−5.15 to 1.67) | 0.06 (−0.07 to 0.19) |
Potential Mediators | ||||
Self-efficacy | −1.10 (−3.94 to 1.75) | 0.08 (−0.01 to 0.16) | 1.75 (−0.32 to 3.82) | 0.20 (0.12 to 0.28) |
Self-esteem | 4.19 (−1.25 to 9.63) | 0.66 (0.51 to 0.80 | 1.22 (−2.71 to 5.15) | 0.95 (0.83 to 1.08) |
Social support | −2.90 (−7.51 to 1.71) | 0.43 (0.29 to 0.56) | 1.25 (−2.47 to 4.98) | 0.28 (0.14 to 0.42) |
Friendship quality | 4.86 (−0.05 to 9.76) | 0.42 (0.28 to 0.57) | 2.29 (−1.19 to 5.78) | 0.66 (0.53 to 0.78) |
Group cohesion in-degree | 0.65 (−1.42 to 2.71) | −0.01 (−0.08 to 0.07) | 0.08 (−1.44 to 1.60) | −0.01 (−0.07 to 0.06) |
Group cohesion out-degree | −0.87 (−3.00 to 1.26) | 0.04 (−0.03 to 0.12) | −0.38 (−2.08 to 1.33) | 0.04 (−0.03 to 0.11) |
Self-Efficacy | Self-Esteem | Social Support | Friendship Quality | GC In-Degree | GC Out-Degree | |
---|---|---|---|---|---|---|
Boys | ||||||
Teacher support | 0.12 (0.01 to 0.22) | 0.02 (−0.04 to 0.07) | 0.09 (0.03 to 0.15) | 0.00 (−0.05 to 0.06) | −0.14 (−0.29 to 0.01) | 0.01 (−0.14 to 0.15) |
Mentor support | 0.15 (0.04 to 0.27) | 0.07 (0.01 to 0.13) | 0.14 (0.07 to 0.21) | 0.06 (−0.01 to 0.13) | −0.09 (−0.26 to 0.09) | 0.12 (−0.05 to 0.28) |
Class sessions | 0.02 (−0.07 to 0.11) | 0.05 (0.01 to 0.10) | 0.05 (0.01 to 0.10) | 0.09 (0.04 to 0.13) | 0.01 (−0.12 to 0.13) | 0.20 (0.08 to 0.31) |
Peer-leadership | 0.15 (−0.05 to 0.34) | −0.08 (−0.18 to 0.02) | 0.06 (−0.05 to 0.17) | −0.04 (−0.15 to 0.08) | −0.22 (−0.50 to 0.53) | 0.14 (−0.14 to 0.41) |
Rewards | 0.06 (−0.03 to 0.14) | 0.01 (−0.04 to 0.06) | 0.04 (−0.01 to 0.09) | 0.04 (−0.02 to 0.09) | −0.07 (−0.21, 0.08) | 0.01 (−0.15, 0.16) |
Competition | 0.02 (−0.07 to 0.12) | −0.02 (−0.07 to 0.03) | 0.04 (−0.02 to 0.10) | 0.04 (−0.01 to 0.08) | −0.14 (−0.29, 0.02) | −0.02 (−0.19, 0.14) |
Web-based points | 0.11 (−0.09 to 0.31) | −0.03 (−0.13 to 0.07) | 0.06 (−0.05 to 0.17) | −0.04 (−0.15 to 0.07) | 0.25 (−0.02 to 0.52) | 0.32 (0.06 to 0.58) |
Girls | ||||||
Teacher support | 0.06 (−0.03 to 0.16) | 0.04 (−0.01 to 0.09) | 0.03 (−0.01 to 0.08) | 0.05 (−0.01 to 0.11) | −0.16 (−0.02 to −0.29) | −0.05 (−0.17 to 0.06) |
Mentor support | 0.10 (−0.01 to 0.20) | 0.11 (0.05 to 0.17) | 0.06 (0.01 to 0.12) | −0.01 (−0.08 to 0.06) | −0.21 (−0.04 to −0.37) | −0.01 (−0.16 to 0.14) |
Class sessions | 0.05 (−0.02, 0.12) | 0.07 (0.03 to 0.10) | 0.06 (0.02 to 0.10) | 0.05 (0.01, 0.09) | 0.03 (−0.07, 0.13) | 0.04 (−0.05 to 0.13) |
Peer-leadership | 0.04 (−0.14 to 0.22) | −0.01 (−0.10 to 0.09) | 0.00 (−0.10 to 0.10) | −0.02 (−0.13 to 0.09) | −0.16 (−0.43 to 0.11) | −0.07 (−0.31 to 0.17) |
Rewards | 0.10 (0.03 to 0.16) | 0.08 (0.04 to 0.11) | 0.04 (0.01 to 0.07) | 0.04 (0.01 to 0.08) | −0.07 (−0.17, 0.04) | 0.06 (−0.04, 0.16) |
Competition | 0.10 (0.03 to 0.17) | 0.10 (0.06 to 0.13) | 0.04 (0.01 to 0.08) | 0.03 (−0.02 to 0.09) | −0.04 (−0.15, 0.08) | 0.12 (0.01, 0.23) |
Web-based points | 0.12 (−0.04 to 0.28) | 0.00 (−0.09 to 0.09) | 0.01 (−0.11 to 0.08) | 0.02 (−0.08 to 0.12) | −0.06 (−0.30 to 0.19) | 0.01 (−0.21 to 0.23) |
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Corder, K.; Werneck, A.O.; Jong, S.T.; Hoare, E.; Brown, H.E.; Foubister, C.; Wilkinson, P.O.; van Sluijs, E.M. Pathways to Increasing Adolescent Physical Activity and Wellbeing: A Mediation Analysis of Intervention Components Designed Using a Participatory Approach. Int. J. Environ. Res. Public Health 2020, 17, 390. https://doi.org/10.3390/ijerph17020390
Corder K, Werneck AO, Jong ST, Hoare E, Brown HE, Foubister C, Wilkinson PO, van Sluijs EM. Pathways to Increasing Adolescent Physical Activity and Wellbeing: A Mediation Analysis of Intervention Components Designed Using a Participatory Approach. International Journal of Environmental Research and Public Health. 2020; 17(2):390. https://doi.org/10.3390/ijerph17020390
Chicago/Turabian StyleCorder, Kirsten, André O. Werneck, Stephanie T. Jong, Erin Hoare, Helen Elizabeth Brown, Campbell Foubister, Paul O. Wilkinson, and Esther MF van Sluijs. 2020. "Pathways to Increasing Adolescent Physical Activity and Wellbeing: A Mediation Analysis of Intervention Components Designed Using a Participatory Approach" International Journal of Environmental Research and Public Health 17, no. 2: 390. https://doi.org/10.3390/ijerph17020390
APA StyleCorder, K., Werneck, A. O., Jong, S. T., Hoare, E., Brown, H. E., Foubister, C., Wilkinson, P. O., & van Sluijs, E. M. (2020). Pathways to Increasing Adolescent Physical Activity and Wellbeing: A Mediation Analysis of Intervention Components Designed Using a Participatory Approach. International Journal of Environmental Research and Public Health, 17(2), 390. https://doi.org/10.3390/ijerph17020390