- Title
- Optimising an intervention to improve schools' implementation of a physical activity policy at scale
- Creator
- Lane, Cassandra
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2022
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Introduction and aims: The potential impact of school-based physical activity policies are not being realised due to their failure to be routinely implemented in practice. Concurrently, little is known about effective support strategies to assist schools to achieve implementation. The multi-strategy Physically Active Children in Education (PACE) intervention was designed to support schools’ implementation of a government mandate for school day physical activity in New South Wales (NSW), Australia. Although PACE has been found to be effective, it was not considered suitable (due to cost of delivery) by stakeholders to support the large-scale implementation of school based physical activity polices. As such, we sought to apply an optimisation process (i.e., data-driven activities to improve interventions to achieve pre-specified objectives) to enhance its potential application to achieve policy implementation at scale. This thesis described the optimisation of PACE using a staged approach of sequential randomised controlled trials (RCTs). Within each stage, assessments of intervention effectiveness, costs and implementation measures were used to identify opportunities to incrementally improve PACE for delivery at-scale. The aim was to establish an effective, cost-efficient and acceptable (i.e., ‘optimal’ from the perspective of end-users) implementation strategy to deploy for scale-up. The specific thesis objectives were to: Evaluate the costs and cost-effectiveness of PACE in terms of physical activity policy implementation (Chapter Two); Systematically review the effectiveness of community-based physical activity interventions that have been scaled-up, and to describe adaptations that were made to interventions as part of the scale-up process (Chapter Three); Adapt the more resource-intensive PACE strategies to make it more suitable for scale-up and determine if this 'Adapted PACE' maintains a meaningful intervention effect (Chapter Four);Explore the delivery of the eight discrete PACE implementation strategies from the perspective of school stakeholders and PACE delivery personnel, including a comparison of PACE and Adapted PACE (Chapter Five); and Summarise implications for future policy, practice and research (Chapter Six). Results: An economic evaluation showed that PACE was a cost-effective approach for assisting schools to implement a physical activity policy, given the health service provider’s likely willingness to pay. Within this, a cost-breakdown of each strategy showed that the strategies delivered in-person were the most costly, contributing 68% of the average total delivery cost. A systematic review of eleven scaled-up physical activity interventions showed that the majority of scaled-up interventions maintained a significant effect on a measure of physical activity, however they also experienced an attenuation in effect size (average scale-up penalty=58.8%). In addition, adaptations were common as part of the scale-up process (≥1 adaptation made to each); the most prevalent being those made to mode of delivery. A randomised and controlled noninferiority trial conducted in 48 primary schools found that, when compared with the original PACE, Adapted PACE minimised the relative cost of delivery without adversely impacting on the intervention effect. An accompanying mixed methods process evaluation revealed that implementation varied by school based on level of principal support and in-school champion’s interest rather than the mode by which strategies were delivered; thus, corroborating results from the noninferiority trial. Conclusion: The optimised PACE intervention is effective, cost-efficient and uses scalable modes of delivery. The optimisation of PACE is an innovative undertaking that led to achievement of shared research-practice goals and may set precedence for future researchers and policy makers seeking to improve the impact of health interventions.
- Subject
- optimisation; implementation; physical activity; policy; public health; scale-up; schools; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1508721
- Identifier
- uon:56149
- Rights
- Copyright 2022 Cassandra Lane
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 6 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 404 KB | Adobe Acrobat PDF | View Details Download |