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Multi-strategy intervention increases school implementation and maintenance of a mandatory physical activity policy: outcomes of a cluster randomised controlled trial
  1. Nicole Nathan1,2,3,
  2. Alix Hall1,3,
  3. Nicole McCarthy1,2,3,
  4. Rachel Sutherland1,2,3,
  5. John Wiggers1,2,3,
  6. Adrian E Bauman1,4,
  7. Chris Rissel5,
  8. Patt-Jean Naylor6,
  9. Angie Cradock7,
  10. Cassandra Lane1,2,3,
  11. Kirsty Hope1,2,
  12. Benjamin Elton2,3,
  13. Adam Shoesmith1,2,3,
  14. Christopher Oldmeadow3,
  15. Penny Reeves3,
  16. Karen Gillham2,
  17. Bernadette Duggan8,
  18. James Boyer9,
  19. Christophe Lecathelinais2,3,
  20. Luke Wolfenden1,2,3
  1. 1School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
  2. 2Hunter New England Population Health, Hunter New England Health, Wallsend, New South Wales, Australia
  3. 3Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia
  4. 4Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
  5. 5Centre for Health Advancement, NSW Health, North Sydney, New South Wales, Australia
  6. 6School of Exercise Science, Physical and Heal, University of Victoria, Victoria, British Columbia, Canada
  7. 7Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  8. 8Catholic Schools Office Diocese of Maitland-Newcastle, Newcastle, New South Wales, Australia
  9. 9School Sport Unit, NSW Department of Education, Turrella, New South Wales, Australia
  1. Correspondence to Dr Nicole Nathan, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; nicole.nathan{at}health.nsw.gov.au

Abstract

Objectives To assess if a multi-strategy intervention effectively increased weekly minutes of structured physical activity (PA) implemented by classroom teachers at 12 months and 18 months.

Methods A cluster randomised controlled trial with 61 primary schools in New South Wales Australia. The 12-month multi-strategy intervention included; centralised technical assistance, ongoing consultation, principal’s mandated change, identifying and preparing school champions, development of implementation plans, educational outreach visits and provision of educational materials. Control schools received usual support (guidelines for policy development via education department website and telephone support). Weekly minutes of structured PA implemented by classroom teachers (primary outcome) was measured via teacher completion of a daily log-book at baseline (October–December 2017), 12-month (October–December 2018) and 18-month (April–June 2019). Data were analysed using linear mixed effects regression models.

Results Overall, 400 class teachers at baseline, 403 at 12 months follow-up and 391 at 18 months follow-up provided valid primary outcome data. From baseline to 12-month follow-up, teachers at intervention schools recorded a greater increase in weekly minutes of PA implemented than teachers assigned to the control schools by approximately 44.2 min (95% CI 32.8 to 55.7; p<0.001) which remained at 18 months, however, the effect size was smaller at 27.1 min (95% CI 15.5 to 38.6; p≤0.001).

Conclusion A multi-strategy intervention increased mandatory PA policy implementation. Some, but not all of this improvement was maintained after implementation support concluded. Further research should assess the impact of scale-up strategies on the sustainability of PA policy implementation over longer time periods.

Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12617001265369).

  • school
  • physical activity
  • children
  • implementation
  • intervention effectiveness

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Footnotes

  • Twitter @NicoleKNathan, @Dr_Alix_Hall, @RachSutherland, @AdrianBauman, @AcademiCat, @adamjsmith_92, @luke.wolfenden1

  • Correction notice This article has been corrected since it published Online First. The results section, table 1 and contributor sections have been updated.

  • Contributors NN led the development of this manuscript. NN, NM and RS LW conceived the intervention concept. LW, JW, AB, CR, NN, CO secured funding for the study. NN, PJN, ALC, RS, KG, BD, NM, JB, LW guided the piloting and design of the intervention. NN, AH, CL, LW, AB, CR, PJN, ALC, KH, AS, BE, CL guided the evaluation design and data collection. PR contributed to the development of data collection methods specific to the cost and cost-effectiveness measures. CO, AH and CLecathelinais developed the analysis plan. NN, JW, AB, CR, AS, CO, PJN, ALC, BD, SC, NM, KH, JB, LW are all members of the Advisory Group that oversaw the program. All authors contributed to developing the protocols and reviewing, editing, and approving the final version of the paper.

  • Funding LW was supported by an NHMRC Career Development Fellowship (APP1128348), Heart Foundation Future Leader Fellowship (101175) and a Hunter New England Clinical Research Fellowship; RS was supported by an NHMRC TRIP Fellowship (APP1150661).

  • Competing interests Authors NN, RS, KG, NM, MP, RJ, VA, JW and LW receive salary support from Hunter New England Local Health District, which contributes funding to the project outlined in this study. Similarly, author CR and receive salary support from the New South Wales Health Office of Preventive Health which also contributed funding to this project. All other authors declare that they have no competing interests. The project is funded by the National Health and Medical Research Council (NHMRC) Partnership Project grant (APP1133013). The NHMRC has not had any role in the design of the study as outlined in this protocol and will not have a role in data collection, analysis of data, interpretation of data and dissemination of findings. As part of the NHMRC Partnership Grant funding arrangement, the following partner organisations also contribute fund: Hunter New England Local Health District and the NSW Health Office of Preventive Health. Individuals in positions that are fully or partly funded by these partner organisations (as described in the Competing interests section) had a role in the study design, data collection, analysis of data, interpretation of data and dissemination of findings. At the time of this study NN was supported by an NHMRC TRIP Fellowship (APP1132450) and a Hunter New England Clinical Research Fellowship; LW was supported by an NHMRC Career Development Fellowship (APP1128348), Heart Foundation Future Leader Fellowship (101175) and a Hunter New England Clinical Research Fellowship; RS was supported by an NHMRC TRIP Fellowship (APP1150661).

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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