Please use this identifier to cite or link to this item:
https://hdl.handle.net/2440/137080
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Type: | Journal article |
Title: | Is level of implementation linked with intervention outcomes? Process evaluation of the TransformUs intervention to increase children's physical activity and reduce sedentary behaviour |
Author: | Koorts, H. Timperio, A. Abbott, G. Arundell, L. Ridgers, N.D. Cerin, E. Brown, H. Daly, R.M. Dunstan, D.W. Hume, C. Chinapaw, M.J.M. Moodie, M. Hesketh, K.D. Salmon, J. |
Citation: | International Journal of Behavioral Nutrition and Physical Activity, 2022; 19(1):122-1-122-24 |
Publisher: | BioMed Central |
Issue Date: | 2022 |
ISSN: | 1479-5868 1479-5868 |
Statement of Responsibility: | Harriet Koorts, Anna Timperio, Gavin Abbott, Lauren Arundell, Nicola D. Ridgers, Ester Cerin, Helen Brown, Robin M. Daly, David W. Dunstan, Clare Hume, Mai J. M. Chinapaw, Marj Moodie, Kylie D. Hesketh and Jo Salmon |
Abstract: | Background: TransformUs was a four-arm school-based intervention to increase physical activity and reduce sedentary behaviour among primary school children. Pedagogical and environmental strategies targeted the classroom, school grounds and family setting. The aims of this study were to evaluate program fidelity, dose, appropriateness, satisfaction and sustainability, and associations between implementation level and outcomes among the three intervention arms. Methods: At baseline, 18-months (mid-intervention) and 30-months (post-intervention), teachers, parents and children completed surveys, and children wore GT3X ActiGraph accelerometers for 8 days at each time point to determine physical activity and sedentary time. Implementation data were pooled across the three intervention groups and teachers were categorised by level of implementation: (i) ‘Low’ (< 33% delivered); (ii) ‘Moderate’ (33–67% delivered); and (iii) ‘High’ (> 67% delivered). Linear and logistic mixed models examined between group differences in implementation, and the association with children’s physical activity and sedentary time outcomes. Qualitative survey data were analysed thematically. Results: Among intervention recipients, 52% (n = 85) of teachers, 29% (n = 331) of parents and 92% (n = 407) of children completed baseline evaluation surveys. At 18-months, teachers delivered on average 70% of the key messages, 65% set active/standing homework, 30% reported delivering > 1 standing lesson/day, and 56% delivered active breaks per day. The majority of teachers (96%) made activity/sports equipment available during recess and lunch, and also used this equipment in class (81%). Fidelity and dose of key messages and active homework reduced over time, whilst fidelity of standing lessons, active breaks and equipment use increased. TransformUs was deemed appropriate for the school setting and positively received. Implementation level and child behavioural outcomes were not associated. Integration of TransformUs into existing practices, children’s enjoyment, and teachers’ awareness of program benefits all facilitated delivery and sustainability. Conclusions: This study demonstrated that intervention dose and fidelity increased over time, and that children’s enjoyment, senior school leadership and effective integration of interventions into school practices facilitated improved intervention delivery and sustainability. Teacher implementation level and child behavioural outcomes were unrelated, suggesting intervention efficacy was achieved irrespective of implementation variability. The potential translatability of TransformUs into practice contexts may therefore be increased. Findings have informed scale-up of TransformUs across Victoria, Australia. |
Keywords: | Implementation; process evaluation; physical activity; sedentary behaviour; school-based intervention |
Description: | Published online: 17 September 2022 |
Rights: | © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/ licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
DOI: | 10.1186/s12966-022-01354-5 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/533815 http://purl.org/au-research/grants/arc/DE220100847 http://purl.org/au-research/grants/arc/FT140100085 http://purl.org/au-research/grants/nhmrc/1078360 http://purl.org/au-research/grants/arc/FT130100637 http://purl.org/au-research/grants/nhmrc/1176885 |
Published version: | http://dx.doi.org/10.1186/s12966-022-01354-5 |
Appears in Collections: | Public Health publications |
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hdl_137080.pdf | Published version | 1.54 MB | Adobe PDF | View/Open |
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