- Title
- Scaling-up a school-based physical activity program: Physical Activity 4 Everyone (PA4E1)
- Creator
- Mclaughlin, Matthew Philip Michael
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2022
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- One in four adults globally are considered physically inactive. The health and economic burden of physical inactivity in Australia is comparable or higher than that of other major health risk factors, such as tobacco and poor diet. Given physical activity levels in adolescence have benefits during adolescence, as well as tracking into adulthood, the implementation, at-scale, of effective interventions are recommended. Broadly, this thesis reviews evidence regarding the epidemiology of physical activity (and sitting time) in adolescents and seeks to review evidence regarding the burden and prevalence of physical activity and sedentary (in particular sitting) behaviour; the rationale for targeting adolescents; schools as a setting for intervention; and the current evidence-base regarding scaling-up physical activity interventions in schools (Chapters 1 and 2). The literature review identified a number of evidence gaps that are explicitly addressed by the thesis via a program of studies. These include: i) A randomised controlled trial (RCT) to assess the effectiveness of a multi-strategy intervention to support the scale-up of an evidence-based physical activity intervention (PA4E1) in schools for which a trial methods (Chapter 4 – protocol); implementation outcomes (Chapter 7) and cost-effectiveness (Chapter 8) are reported.; ii) A process evaluation (Chapter 5 – protocol) of the trial, including a study assessing how the intervention and the strategies to implement it were changed prior (adapted) to during (modified) its delivery (Chapter 6); and the usage, subjective experience and usability of digital (web) components of the strategy using mixed-methods (Chapter 9).; iii) A systematic review examining the direction and strength of the association between engagement with digital health interventions and physical activity and/or sedentary behaviour in adults (Chapter 10). Forty-nine schools took part in the scale-up RCT. Schools receiving the program (n=24) implemented an average of 3.6 more practices than control schools (4.1 vs. 0.5, respectively) (P < 0.001). Regarding the primary outcome of schools implementing four or more practices (of the seven), 69.6% of schools in the program group achieved this, whereas zero control schools achieved this (P < 0.001). The total cost of the program scale-up was $415,112 AUD (2018) (equivalent to $17,296 per school; $117.30 per student). A large number of modifications and adaptations were made to the physical activity intervention and implementation support strategies, although they were typically fidelity consistent and thought to have a positive impact on intervention effectiveness. Overall, the website usage and subjective experience engagement of the website supporting delivery of the implementation support within the scale-up RCT was rated highly and perceived to be generally positive. A mixed-methods analysis generated specific themes which can be used to further improve the content and delivery of the website. A systematic review of the association between digital health intervention usage and subjective experience engagement outcomes found a small but consistently positive association between usage of a digital health intervention and physical activity outcomes. This thesis presents new knowledge to help address low levels of physical activity in adolescents – who are an important target group for public health promotion. The evidence presented in this thesis highlights how the implementation of evidence-based interventions in disadvantaged secondary schools can be scaled-up. Firstly, it provides evidence of an adaptation process for scale-up and comprehensively outlines changes made to the program for scale-up. It also reports the effectiveness of the PA4E1 program, exploring in detail key under-researched areas for scale-up. The program of research has a number of important implications to guide future research, policy and practice for PA4E1. Five implications emerged, these were to (i) assess the effects of PA4E1 program scale-up on student physical activity; (ii) assess the potential for program impacts in other contexts; (iii) to understand the impact of program adaptations; (iv) to assess scalability; and (v) to improve program adoption to broaden impact.
- Subject
- physical activity; sedentary behaviour; digital; engagement; thesis by publication; adolescents; school; randomised controlled trial; process evaluation; scale-up; implementation science; adaptation; modifications
- Identifier
- http://hdl.handle.net/1959.13/1508514
- Identifier
- uon:56130
- Rights
- Copyright 2022 Matthew Philip Michael Mclaughlin
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 3 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 597 KB | Adobe Acrobat PDF | View Details Download |