ORCID Profile
0000-0003-1303-6064
Current Organisation
Deakin University
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Publisher: Human Kinetics
Date: 11-2011
Abstract: Little is known about how the type and context of physical activity behaviors varies among adolescents with differing activity levels. The aim of this study was to assess differences in the type and context of physical activity behaviors in adolescents by level of objectively measured physical activity. Cross-sectional analysis of 2728 adolescents (1299 males, 1429 females) participating in the Avon Longitudinal Study of Parents and Children (ALSPAC). The mean (SD) age was 13.8 (+0.1) years. Physical activity was measured using an Actigraph over 7 days. Adolescents were categorized into tertiles of activity (less, moderately, highly active) using counts/min and min/d of moderate-to-vigorous activity (MVPA). Activity type was reported using the Previous Day Physical Activity Recall (PDPAR). Differences in the type and context of activity by activity level were analyzed using Chi squared. Highly active boys reported more job, outside, and sports activities on school days ( P .05), and more sports activities on nonschool days ( P .05). Highly active girls reported more outside activities on school days ( P .05). Identifying the type and context of physical activity behaviors associated with more active adolescents, can help inform policy and physical activity interventions aimed at increasing activity levels in adolescents.
Publisher: JMIR Publications Inc.
Date: 23-01-2020
Abstract: oronary heart disease (CHD) is a leading cause of disability and deaths worldwide. Secondary prevention, including cardiac rehabilitation (CR), is crucial to improve risk factors and to reduce disease burden and disability. Accessibility barriers contribute to underutilization of traditional center-based CR programs therefore, alternative delivery models, including cardiac telerehabilitation (ie, delivery via mobile, smartphone, and/or web-based apps), have been tested. Experimental studies have shown cardiac telerehabilitation to be effective and cost-effective, but there is inadequate evidence about how to translate this research into routine clinical practice. his systematic review aimed to synthesize research evaluating the effectiveness of implementing cardiac telerehabilitation interventions at scale in routine clinical practice, including factors underlying successful implementation processes, and experimental research evaluating implementation-related outcomes. EDLINE, Embase, PsycINFO, and Global Health databases were searched from 1990 through November 9, 2018, for studies evaluating the implementation of telerehabilitation for the self-management of CHD. Reference lists of included studies and relevant systematic reviews were hand searched to identify additional studies. Implementation outcomes of interest included acceptability, appropriateness, adoption, feasibility, fidelity, implementation cost, penetration, and sustainability. A narrative synthesis of results was carried out. o included studies evaluated the implementation of cardiac telerehabilitation in routine clinical practice. A total of 10 studies of 2250 participants evaluated implementation outcomes, including acceptability (8/10, 80%), appropriateness (9/10, 90%), adoption (6/10, 60%), feasibility (6/10, 60%), fidelity (7/10, 70%), and implementation cost (4/10, 40%), predominantly from the participant perspective. Cardiac telerehabilitation interventions had high acceptance among the majority of participants, but technical challenges such as reliable broadband internet connectivity can impact acceptability and feasibility. Many participants considered telerehabilitation to be an appropriate alternative CR delivery model, as it was convenient, flexible, and easy to access. Participants valued interactive intervention components, such as real-time exercise monitoring and feedback as well as in idualized support. The penetration and sustainability of cardiac telerehabilitation, as well as the perspectives of CR practitioners and health care organizations, have received little attention in existing cardiac telerehabilitation research. xperimental trials suggest that participants perceive cardiac telerehabilitation to be an acceptable and appropriate approach to improve the reach and utilization of CR, but pragmatic implementation studies are needed to understand how interventions can be sustainably translated from research into clinical practice. Addressing this gap could help realize the potential impact of telerehabilitation on CR accessibility and participation as well as person-centered, health, and economic outcomes. nternational Prospective Register of Systematic Reviews (PROSPERO) CRD42019124254 www.crd.york.ac.uk rospero/display_record.php?RecordID=124254
Publisher: Elsevier BV
Date: 03-2019
Publisher: BMJ
Date: 17-05-2019
DOI: 10.1136/BMJOPEN-2018-027841
Abstract: India has high prevalence of hypertension but low awareness, treatment and control rate. A cluster randomised trial entitled ‘m-Power Heart Project’ is being implemented to test the effectiveness of a nurse care coordinator (NCC) led complex intervention to address uncontrolled hypertension in the community health centres (CHCs). The trial’s process evaluation will assess the fidelity and quality of implementation, clarify the causal mechanisms and identify the contextual factors associated with variation in the outcomes. The trial will use a theory-based mixed-methods process evaluation, guided by the Consolidated Framework for Implementation Research. The process evaluation will be conducted in the CHCs of Visakhapatnam (southern India). The key stakeholders involved in the intervention development and implementation will be included as participants. In-depth interviews will be conducted with intervention developers, doctors, NCCs and health department officials and focus groups with patients and their caregivers. NCC training will be evaluated using Kirkpatrick’s model for training evaluation. Key process evaluation indicators (number of patients recruited and retained concordance between the treatment plans generated by the electronic decision support system and treatment prescribed by the doctor and so on) will be assessed. Fidelity will be assessed using Borrelli et al ’s framework. Qualitative data will be analysed using the template analysis technique. Quantitative data will be summarised as medians (IQR), means (SD) and proportions as appropriate. Mixed-methods analysis will be conducted to assess if the variation in the mean reduction of systolic blood pressure between the intervention CHCs is influenced by patient satisfaction, training outcome, attitude of doctors, patients and NCCs about the intervention, process indicators etc. Ethical approval for this study was obtained from the ethics committees at Public Health Foundation of India and Deakin University. Findings will be disseminated via peer-reviewed publications, national and international conference presentations. NCT03164317 Pre-results.
Publisher: JMIR Publications Inc.
Date: 04-02-2019
Abstract: earable technology interventions combined with digital behavior change resources provide opportunities to increase physical activity in adolescents. The implementation of such interventions in real-world settings is unknown. The Raising Awareness of Physical Activity (RAW-PA) study was a 12-week cluster randomized controlled trial targeting inactive adolescents attending schools in socioeconomically disadvantaged areas of Melbourne, Australia. The aim was to increase moderate- to vigorous-intensity physical activity using (1) a wrist-worn Fitbit Flex and app, (2) weekly challenges, (3) digital behavior change resources, and (4) email or text message alerts. his paper presents adolescents’ and teachers’ perceptions of RAW-PA in relation to program acceptability, feasibility and perceived impact, adolescent engagement and adherence, and the potential for future scale-up. mixed methods evaluation of the RAW-PA study assessed acceptability, engagement, feasibility, adherence, and perceived impact. A total of 9 intervention schools and 144 intervention adolescents were recruited. Only adolescents and teachers (n=17) in the intervention group were included in the analysis. Adolescents completed web-based surveys at baseline and surveys and focus groups postintervention. Teachers participated in interviews postintervention. Facebook data tracked engagement with web-based resources. Descriptive statistics were reported by sex. Qualitative data were analyzed thematically. urvey data were collected from 142 adolescents at baseline (mean age 13.7 years, SD 0.4 years 51% males) and 132 adolescents postintervention. A total of 15 focus groups (n=124) and 9 interviews (n=17) were conducted. RAW-PA had good acceptability among adolescents and teachers. Adolescents perceived the intervention content as easy to understand (100/120, 83.3%) and the Fitbit easy to use (112/120 93.3%). Half of the adolescents perceived the text messages to be useful (61/120 50.8%), whereas 47.5% (57/120) liked the weekly challenges and 38.3% (46/120) liked the Facebook videos. Facebook engagement declined over time only 18.6% (22/118) of adolescents self-reported wearing the Fitbit Flex daily postintervention. Adolescents perceived the Fitbit Flex to increase their physical activity motivation (85/120, 70.8%) and awareness (93/119, 78.2%). The web-based delivery facilitated implementation of the intervention, although school-level policies restricting phone use were perceived as potential inhibitors to program roll-out. AW-PA showed good acceptability among adolescents attending schools in socioeconomically disadvantaged areas and their teachers. Low levels of teacher burden enhanced their perceptions concerning the feasibility of intervention delivery. Although adolescents perceived that RAW-PA had short-term positive effects on their motivation to be physically active, adolescent adherence and engagement were low. Future research exploring the feasibility of different strategies to engage adolescents with wearable technology interventions and ways of maximizing system-level embeddedness of interventions in practice would greatly advance the field.
Publisher: JMIR Publications Inc.
Date: 27-11-2020
DOI: 10.2196/17957
Abstract: Coronary heart disease (CHD) is a leading cause of disability and deaths worldwide. Secondary prevention, including cardiac rehabilitation (CR), is crucial to improve risk factors and to reduce disease burden and disability. Accessibility barriers contribute to underutilization of traditional center-based CR programs therefore, alternative delivery models, including cardiac telerehabilitation (ie, delivery via mobile, smartphone, and/or web-based apps), have been tested. Experimental studies have shown cardiac telerehabilitation to be effective and cost-effective, but there is inadequate evidence about how to translate this research into routine clinical practice. This systematic review aimed to synthesize research evaluating the effectiveness of implementing cardiac telerehabilitation interventions at scale in routine clinical practice, including factors underlying successful implementation processes, and experimental research evaluating implementation-related outcomes. MEDLINE, Embase, PsycINFO, and Global Health databases were searched from 1990 through November 9, 2018, for studies evaluating the implementation of telerehabilitation for the self-management of CHD. Reference lists of included studies and relevant systematic reviews were hand searched to identify additional studies. Implementation outcomes of interest included acceptability, appropriateness, adoption, feasibility, fidelity, implementation cost, penetration, and sustainability. A narrative synthesis of results was carried out. No included studies evaluated the implementation of cardiac telerehabilitation in routine clinical practice. A total of 10 studies of 2250 participants evaluated implementation outcomes, including acceptability (8/10, 80%), appropriateness (9/10, 90%), adoption (6/10, 60%), feasibility (6/10, 60%), fidelity (7/10, 70%), and implementation cost (4/10, 40%), predominantly from the participant perspective. Cardiac telerehabilitation interventions had high acceptance among the majority of participants, but technical challenges such as reliable broadband internet connectivity can impact acceptability and feasibility. Many participants considered telerehabilitation to be an appropriate alternative CR delivery model, as it was convenient, flexible, and easy to access. Participants valued interactive intervention components, such as real-time exercise monitoring and feedback as well as in idualized support. The penetration and sustainability of cardiac telerehabilitation, as well as the perspectives of CR practitioners and health care organizations, have received little attention in existing cardiac telerehabilitation research. Experimental trials suggest that participants perceive cardiac telerehabilitation to be an acceptable and appropriate approach to improve the reach and utilization of CR, but pragmatic implementation studies are needed to understand how interventions can be sustainably translated from research into clinical practice. Addressing this gap could help realize the potential impact of telerehabilitation on CR accessibility and participation as well as person-centered, health, and economic outcomes. International Prospective Register of Systematic Reviews (PROSPERO) CRD42019124254 www.crd.york.ac.uk rospero/display_record.php?RecordID=124254
Publisher: Emerald
Date: 26-10-2020
Abstract: Little is known about the experiences of school leaders adopting and implementing real-world, scaled-up physical activity interventions in the Australian educational system. Transform-Us! is a novel physical activity and sedentary behaviour intervention available to all primary schools in Victoria, Australia, since September 2018. This study explored barriers and facilitators experienced by school leaders during the adoption and early implementation phases of Transform-Us!. Qualitative study involving seven semi-structured telephone interviews with school leaders implementing Transform-Us! in primary schools in Victoria, Australia. Interview schedules were developed based on the theoretical domains framework (TDF). Interviews were coded using a framework analysis approach. Four key themes emerged relating to ten of the 14 TDF domains. Themes included: knowledge, goals, implementation factors and leadership. School leaders play a central role in creating a positive implementation environment including the delivery setting (classroom) and a supportive culture (knowledge sharing) in the school. The application of the TDF to the study bridges the gap between theory and practice and identifies potential future implementation strategies which may be further tested in professional practice future studies. Recommendations for increased adoption and sustained implementation related to seven core areas: presence of a school rogramme ch ion(s) collaborative knowledge sharing online training school-based workshops promotion of behavioural and mental health outcomes teacher autonomy in delivery and a supportive implementation environment. School leaders have a unique scope to influence the adoption and implementation of physical activity and sedentary behaviour interventions. This study outlines specific barriers and facilitators for implementation of a physical activity programme in the Australian educational setting and offers recommendations for programme optimisation.
Publisher: Springer Science and Business Media LLC
Date: 06-11-2015
Publisher: Springer Science and Business Media LLC
Date: 11-06-2019
Publisher: Springer Science and Business Media LLC
Date: 08-06-2018
Publisher: Springer Science and Business Media LLC
Date: 16-01-2020
DOI: 10.1186/S12966-020-0909-Z
Abstract: Ineffective research-practice translation is a major challenge to population health improvement. This paper presents an international perspective on the barriers and facilitators associated with the uptake of and engagement in Dissemination and Implementation (D& I) research in the fields of physical activity and nutrition. A mixed methods study involving participants from the International Society for Behavioral Nutrition and Physical Activity (ISBNPA) network. Participants completed an online survey (May–July 2018) and/or participated in a focus group during the annual ISBNPA conference (June 2018). Descriptive statistics were generated for quantitative online and pre-focus group survey data. Fisher’s exact tests investigated associations of (i) length of time in academia, (ii) career stage and (iii) country of work, and agreement with ‘perceptions of D& I’. Qualitative data were analysed thematically. In total, 141 participants responded to the survey (76% female, 21% aged 35–39 years, 14 countries represented) and 25 participated in focus groups ( n = 3). Participants self-identified as having knowledge (48%), skills (53%) and experience supporting others (40%) to conduct D& I research. The majority (96%) perceived D& I was important, with 66% having organizational support for D& I, yet only 52% reported prioritizing D& I research. Perceptions of D& I differed by length of time in academia, career stage and country of work. Barriers included: (i) lack of D& I expertise (ii) lack of organisational support/value for D& I (iii) embedded scientific beliefs/culture (iv) methodological challenges with D& I research (v) funding ublishing priorities and (vi) academic performance structures. Facilitators included: (i) increased presence/value of D& I (ii) collective advocacy (iii) organisational support for D& I (iv) recruitment of D& I scientists and (v) restructure of academic performance models, funding ublishing criteria. In idual, organisational and system-wide factors hindered academics’ engagement with and support for D& I research, which was perceived to reduce opportunities for research-practice translation. Factors were mostly consistent across countries and in idual career stages/time spent in academia. Embedding D& I early within academic training, and system-wide reorientation of academic performance and funding structures to promote and facilitate D& I research, are some of the necessary actions to reduce the research-practice gap. Consistent with public health more broadly, these changes are long overdue in the fields of physical activity and nutrition.
Publisher: Springer Science and Business Media LLC
Date: 07-11-2019
DOI: 10.1186/S40814-019-0507-5
Abstract: Low levels of physical activity and high levels of sedentary behaviour are pervasive, especially in schools. Pre-service teacher education is pivotal to school and educational reform but is an under-studied setting for physical activity and sedentary behaviour intervention research. The objective of this pilot study was to test the feasibility and potential impact of embedding evidence-based active pedagogy based on an adapted version of Transform-Us! , Transform-Ed! in one core unit of an undergraduate teacher education degree. Baseline and follow-up measures (i.e. surveys) were conducted with Bachelor of Education (Primary) pre-service teachers who received the Transform-Ed! intervention and academic educators who delivered the intervention. Focus groups of senior academics and telephone interviews with primary school principals examined perceptions of intervention feasibility and explored potential real-world relevance and impact of pre-service teachers training in active pedagogy. After 12 weeks, pre-service teachers ( n = 218) were significantly more willing ( pre–post change Δ = 0.54, 95% CI [0.16, 0.91]), confident (Δ = 1.40, 95% CI [0.89, 1.91]) and competent (Δ = 2.39, 95% CI [1.85, 2.92]) to deliver Transform-Ed! , had more positive feelings about the impact of physical activity on student outcomes (Δ = 2.05, 95% CI [1.58, 2.52]), and perceived fewer barriers to integrating Transform-Ed! into current and future teaching (Δ = − 7.26, 95% CI [− 8.88, − 5.64]). Four major themes emerged from the focus groups ( n = 9) and interviews ( n = 5) around participant perceptions of Transform-Ed! : (i) acceptability and appropriateness, (ii) need (tertiary level), (iii) need (primary level) and (iv) overcoming challenges. The Transform-Ed! pilot study demonstrated promising results across multiple participant levels, as it was perceived to be feasible, acceptable and appropriate by pre-service teachers, academics and school principals. The findings have direct implications for the progression of Transform-Ed! from pilot to a future definitive trial.
Publisher: Springer International Publishing
Date: 22-07-2017
Publisher: BMJ
Date: 10-2023
Publisher: Springer Science and Business Media LLC
Date: 03-2021
DOI: 10.1186/S12961-021-00679-0
Abstract: Despite a number of important global public health successes, for many health behaviours there is a continued lack of interventions that have been sufficiently scaled up to achieve system-wide integration. This has limited sustainable and equitable population health improvement. Systems change plays a major role in the relation between implementation processes and at-scale institutionalisation of public health interventions. However, in research, systems approaches remain underutilised in scaling up. Public health scale-up models have typically centred on intervention replication through linear expansion. In this paper, we discuss current conceptualisations and approaches used when scaling up in public health, and propose a new perspective on scaling that shifts attention away from the intervention to focus instead on achieving the desired population-level health outcomes. In our view, ‘scaling up’ exists on a continuum. At one end, effective scaling can involve a linear, intervention-orientated expansive approach that prioritises the spread of evidence-based interventions into existing systems in order to drive expansion in the application of that intervention. At the other end, we contend that scale-up can sit within a complex systems paradigm in which interventions are conceptualised as events in systems. In this case, implementation and scale-up activities should focus on generating changes within the system itself to achieve the desired outcome. This we refer to as ‘systems-orientated scale-up’ to achieving population health improvement, which can complement traditional approaches in relevant situations. We argue that for some health behaviours, our proposed approach towards scaling up could enhance intervention implementation, sustainability and population health impact.
Publisher: BMJ
Date: 03-2022
DOI: 10.1136/BMJOPEN-2021-057521
Abstract: Despite being an important period for the development of movement behaviours (physical activity, sedentary behaviour and sleep), few interventions commencing prior to preschool have been trialled. The primary aim of this trial is to assess the 12-month efficacy of the Let’s Grow mHealth intervention, designed to improve the composition of movement behaviours in children from 2 years of age. Let’s Grow is novel in considering composition of movement behaviours as the primary outcome, using non-linear dynamical approaches for intervention delivery, and incorporating planning for real-world implementation and scale-up from its inception. A randomised controlled trial will test the effects of the 12-month parental support mHealth intervention, Let’s Grow , compared with a control group that will receive usual care plus electronic newsletters on unrelated topics for cohort retention. Let’s Grow will be delivered via a purpose-designed mobile web application with linked SMS notifications. Intervention content includes general and movement-behaviour specific parenting advice and incorporates established behaviour change techniques. Intervention adherence will be monitored by app usage data. Data will be collected from participants using 24-hour monitoring of movement behaviours and parent report at baseline (T 0 ), mid-intervention (T 1 6 months post baseline), at intervention conclusion (T 2 12 months post baseline) and 1-year post intervention (T 3 2 years post baseline). The trial aims to recruit 1100 families from across Australia during 2021. In addition to assessment of efficacy, an economic evaluation and prospective scalability evaluation will be conducted. The study was approved by the Deakin University Human Ethics Committee (2020-077). Study findings will be disseminated through publication in peer-reviewed journals, presentation at scientific and professional conferences, and via social and traditional media. ACTRN12620001280998 U1111-1252-0599.
Publisher: Springer Science and Business Media LLC
Date: 12-2019
DOI: 10.1186/S12966-019-0876-4
Abstract: Globally, many children fail to meet the World Health Organization’s physical activity and sedentary behaviour guidelines. Schools are an ideal setting to intervene, yet despite many interventions in this setting, success when delivered under real-world conditions or at scale is limited. This systematic review aims to i) identify which implementation models are used in school-based physical activity effectiveness, dissemination, and/or implementation trials, and ii) identify factors associated with the adoption, implementation and sustainability of school-based physical activity interventions in real-world settings. The review followed PRISMA guidelines and included a systematic search of seven databases from January 1st, 2000 to July 31st, 2018: MEDLINE, EMBASE, CINAHL, SPORTDiscus, PsycINFO, CENTRAL, and ERIC. A forward citation search of included studies using Google Scholar was performed on the 21st of January 2019 including articles published until the end of 2018. Study inclusion criteria: (i) a primary outcome to increase physical activity and/or decrease sedentary behaviour among school-aged children and/or adolescents (ii) intervention delivery within school settings, (iii) use of implementation models to plan or interpret study results and (iv) interventions delivered under real-world conditions. Exclusion criteria: (i) efficacy trials (ii) studies applying or testing school-based physical activity policies, and (iii) studies targeting special schools or pre-school and/or kindergarten aged children. 27 papers comprising 17 unique interventions were included. Fourteen implementation models (e.g., RE-AIM, Rogers’ Diffusion of Innovations, Precede Proceed model), were applied across 27 papers. Implementation models were mostly used to interpret results ( n = 9), for planning evaluation and interpreting results ( n = 8), for planning evaluation ( n = 6), for intervention design ( n = 4), or for a combination of designing the intervention and interpreting results ( n = 3). We identified 269 factors related to barriers ( n = 93) and facilitators ( n = 176) for the adoption ( n = 7 studies), implementation ( n = 14 studies) and sustainability ( n = 7 studies) of interventions. Implementation model use was predominately centered on the interpretation of results and analyses, with few ex les of use across all study phases as a planning tool and to understand results. This lack of implementation models applied may explain the limited success of interventions when delivered under real-world conditions or at scale. PROSPERO ( CRD42018099836 ).
Publisher: Wiley
Date: 29-06-2023
DOI: 10.1002/HPJA.767
Abstract: Supporting healthy behaviours (quality diet, physical activity, sleep) through home‐based interventions is feasible to improve postnatal mental health. Involving stakeholders in developing interventions is essential for maximising accessibility, implementation and scale‐up. This study aimed to identify factors affecting the sustainable implementation and scalability of the Food, Move, Sleep (FOMOS) for Postnatal Mental Health program, including strategies to enhance research‐practice translation. Stakeholders ( n = 13) involved in promoting physical activity, healthy eating, postnatal and mental health, public health and/or policy participated in semi‐structured interviews. Interviews, based on PRACTIS Guide recommendations for implementation and scale‐up, explored perceptions of program design, implementation and scalability. Reflexive thematic analysis was undertaken. Identified implementation and scale‐up strategies were mapped against the Expert Recommendations for Implementing Change compendium and PRACTIS Guide. In idual‐level : Targeting multiple systems (primary, tertiary, community‐based care) and entry points (early, mid‐postpartum) for uptake was important. For equity, screening women in public hospitals, engaging with community agencies and targeting most at‐risk women, was suggested. Provider‐level : Stakeholders identified strategies to enhance future roll‐out (organisations assisting with recruitment). Factors impacting sustainability included high demand for the FOMOS program, and governance around screening and funding online delivery, connecting with partners and providers and integration into existing services may enhance sustainability. Systems‐level : Political support and community ch ions were perceived important for program dissemination. Nine strategies addressing program uptake, reach, implementation, potential scalability and sustainability were identified. For sustainable implementation and potential scalability of a home‐based multi‐behaviour postnatal intervention, multi‐level implementation and scale‐up strategies, aligned with existing health systems, policies and initiatives to support postnatal mental health should be considered. This paper provides a comprehensive list of strategies that can be used to enhance sustainable implementation and scalability of healthy behaviour programs targeting postnatal mental health. Further, the interview schedule, systematically developed and aligned with the PRACTIS Guide, may serve as a useful resource for researchers conducting similar studies in future.
Publisher: Elsevier BV
Date: 10-2019
Publisher: Springer Science and Business Media LLC
Date: 17-09-2022
DOI: 10.1186/S12966-022-01354-5
Abstract: 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. 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. 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. 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. International Standard Randomized Controlled Trial Number ISRCTN83725066 Australian New Zealand Clinical Trials Registry Number ACTRN12609000715279. Registered 19 August 2009. Available at: www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=308387& isReview=true
Publisher: Springer Science and Business Media LLC
Date: 12-05-2022
DOI: 10.1186/S12966-022-01292-2
Abstract: Active recreation contributes to child and adolescent physical activity, however, factors affecting uptake are poorly understood at the systems level. The aims of this study were: (1) to use systems analysis methods to understand youth active recreation in Victoria, Australia, (ii) identify potential system leverage points to enhance active recreation, and (iii) explore stakeholder views of systems analysis methods for informing practice and policy decision-making. Phase 1 : Umbrella review of systematic reviews (2013–2018), synthesising evidence for correlates, determinants and intervention evidence for promoting active recreation. Phase 2 : Development of three systems models (ActorMap and two ActivMaps), depicting active recreation actors/organisations, correlates, determinants and intervention evidence. Phase 3 : Development of causal loop diagrams (CLDs) and identification of leverage points based on the Action Scales Model. Phase 4 : Model feedback via stakeholder interviews ( n = 23 16 organisations). From the literature, 93 correlates and determinants, and 49 intervention strategies were associated with child and adolescent active recreation the majority located at a social or in idual level. Ten potential system leverage points were identified in the CLDs, which differed for pre-schoolers versus children and adolescents. Only time outdoors (an event leverage point) emerged for all age groups. Changes to the built and natural environment (i.e., land use planning, urban design) as a complete domain was a key structural leverage point for influencing active recreation in children and adolescents. Subject matter experts and stakeholder interviews identified 125 actors operating across seven hierarchical active recreation system levels in Victoria. Stakeholder interviews identified 12 areas for future consideration and recommendations for practice olicy influence. Our findings underscore the need for dynamic models of system behaviour in active recreation, and to capture stakeholder influence as more than a transactional role in evidence generation and use. Effective responses to youth inactivity require a network of interventions that target specific leverage points across the system. Our models illustrate areas that may have the greatest system-level impact, such as changes to the built and natural environment, and they provide a tool for policy, appraisal, advocacy, and decision-making within and outside of government.
Publisher: Frontiers Media SA
Date: 08-11-2021
DOI: 10.3389/FENDO.2021.717468
Abstract: Promoting healthy eating and active play in early life is critical, however few interventions have been delivered or sustained at scale. The evaluation of interventions at scale is a crucial, yet under-researched aspect of modifying population-level health behaviours. INFANT is an evidence-based early childhood healthy lifestyle intervention that aims to improve parents’ knowledge and skills around promoting optimal energy balance-related behaviours that, in turn, influence children’s diet, activity and adiposity. It consists of: 1) Four group sessions delivered via first time parent groups across the first 12 months of life 2) access to the My Baby Now app from birth to 18 months of age. This research aims to assess real-world implementation, effectiveness and cost-effectiveness of INFANT when delivered at scale across Victoria, Australia. A hybrid type II implementation-effectiveness trial applying a mixed methods design will be conducted. INFANT will be implemented in collaboration with practice and policy partners including maternal and child health services, population health and Aboriginal health, targeting all local government areas (n=79) in Victoria, Australia. Evaluation is based on criteria from the ‘Outcomes for Implementation Research’ and ‘RE-AIM’ frameworks. Implementation outcomes will be assessed using descriptive quantitative surveys and qualitative interviews with those involved in implementation, and include intervention reach, organisational acceptability, adoption, appropriateness, cost, feasibility, penetration and sustainability. Process measures include organizational readiness, fidelity, and adaptation. Effectiveness outcomes will be assessed using a s le of INFANT participants and a non-randomized comparison group receiving usual care (1,500 infants in each group), recruited within the same communities. Eligible participants will be first time primary caregivers of an infant aged 0-3 months, owning a personal mobile phone and able to communicate in English. Effectiveness outcomes include infant lifestyle behaviours and BMIz at 12 and 18 months of age. This is the first known study to evaluate the scale up of an evidence based early childhood obesity prevention intervention under real world conditions. This study has the potential to provide generalisable implementation, effectiveness and cost-effectiveness evidence to inform the future scale up of public health interventions both in Australia and internationally. Australian and New Zealand Clinical Trial Registry www.anzctr.org.au/ , identifier ACTRN12620000670976.
Publisher: Annual Reviews
Date: 06-04-2018
DOI: 10.1146/ANNUREV-PUBLHEALTH-040119-094201
Abstract: In developed and developing countries, social, economic, and environmental transitions have led to physical inactivity and large amounts of time spent sitting. Research is now unraveling the adverse public health consequences of too much sitting. We describe improvements in device-based measurement that are providing new insights into sedentary behavior and health. We consider the implications of research linking evidence from epidemiology and behavioral science with mechanistic insights into the underlying biology of sitting time. Such evidence has led to new sedentary behavior guidelines and initiatives. We highlight ways that this emerging knowledge base can inform public health strategy: First, we consider epidemiologic and experimental evidence on the health consequences of sedentary behavior second, we describe solutions-focused research from initiatives in workplaces and schools. To inform a broad public health strategy, researchers need to pursue evidence-informed collaborations with occupational health, education, and other sectors.
Publisher: JMIR Publications Inc.
Date: 07-08-2020
DOI: 10.2196/13573
Abstract: Wearable technology interventions combined with digital behavior change resources provide opportunities to increase physical activity in adolescents. The implementation of such interventions in real-world settings is unknown. The Raising Awareness of Physical Activity (RAW-PA) study was a 12-week cluster randomized controlled trial targeting inactive adolescents attending schools in socioeconomically disadvantaged areas of Melbourne, Australia. The aim was to increase moderate- to vigorous-intensity physical activity using (1) a wrist-worn Fitbit Flex and app, (2) weekly challenges, (3) digital behavior change resources, and (4) email or text message alerts. This paper presents adolescents’ and teachers’ perceptions of RAW-PA in relation to program acceptability, feasibility and perceived impact, adolescent engagement and adherence, and the potential for future scale-up. A mixed methods evaluation of the RAW-PA study assessed acceptability, engagement, feasibility, adherence, and perceived impact. A total of 9 intervention schools and 144 intervention adolescents were recruited. Only adolescents and teachers (n=17) in the intervention group were included in the analysis. Adolescents completed web-based surveys at baseline and surveys and focus groups postintervention. Teachers participated in interviews postintervention. Facebook data tracked engagement with web-based resources. Descriptive statistics were reported by sex. Qualitative data were analyzed thematically. Survey data were collected from 142 adolescents at baseline (mean age 13.7 years, SD 0.4 years 51% males) and 132 adolescents postintervention. A total of 15 focus groups (n=124) and 9 interviews (n=17) were conducted. RAW-PA had good acceptability among adolescents and teachers. Adolescents perceived the intervention content as easy to understand (100/120, 83.3%) and the Fitbit easy to use (112/120 93.3%). Half of the adolescents perceived the text messages to be useful (61/120 50.8%), whereas 47.5% (57/120) liked the weekly challenges and 38.3% (46/120) liked the Facebook videos. Facebook engagement declined over time only 18.6% (22/118) of adolescents self-reported wearing the Fitbit Flex daily postintervention. Adolescents perceived the Fitbit Flex to increase their physical activity motivation (85/120, 70.8%) and awareness (93/119, 78.2%). The web-based delivery facilitated implementation of the intervention, although school-level policies restricting phone use were perceived as potential inhibitors to program roll-out. RAW-PA showed good acceptability among adolescents attending schools in socioeconomically disadvantaged areas and their teachers. Low levels of teacher burden enhanced their perceptions concerning the feasibility of intervention delivery. Although adolescents perceived that RAW-PA had short-term positive effects on their motivation to be physically active, adolescent adherence and engagement were low. Future research exploring the feasibility of different strategies to engage adolescents with wearable technology interventions and ways of maximizing system-level embeddedness of interventions in practice would greatly advance the field.
Publisher: JMIR Publications Inc.
Date: 06-03-2020
DOI: 10.2196/15552
Abstract: Wearable activity trackers and social media have been identified as having the potential to increase physical activity among adolescents, yet little is known about the perceived ease of use and perceived usefulness of the technology by adolescents. The aim of this study was to use the technology acceptance model to explore adolescents’ acceptance of wearable activity trackers used in combination with social media within a physical activity intervention. The Raising Awareness of Physical Activity study was a 12-week physical activity intervention that combined a wearable activity tracker (Fitbit Flex) with supporting digital materials that were delivered using social media (Facebook). A total of 124 adolescents aged 13 to 14 years randomized to the intervention group (9 schools) participated in focus groups immediately post intervention. Focus groups explored adolescents’ perspectives of the intervention and were analyzed using pen profiles using a coding framework based on the technology acceptance model. Adolescents reported that Fitbit Flex was useful as it motivated them to be active and provided feedback about their physical activity levels. However, adolescents typically reported that Fitbit Flex required effort to use, which negatively impacted on their perceived ease of use. Similarly, Facebook was considered to be a useful platform for delivering intervention content. However, adolescents generally noted preferences for using alternative social media websites, which may have impacted on negative perceptions concerning Facebook’s ease of use. Perceptions of technological risks included damage to or loss of the device, integrity of data, and challenges with both Fitbit and Facebook being compatible with daily life. Wearable activity trackers and social media have the potential to impact adolescents’ physical activity levels. The findings from this study suggest that although the adolescents recognized the potential usefulness of the wearable activity trackers and the social media platform, the effort required to use these technologies, as well as the issues concerning risks and compatibility, may have influenced overall engagement and technology acceptance. As wearable activity trackers and social media platforms can change rapidly, future research is needed to examine the factors that may influence the acceptance of specific forms of technology by using the technology acceptance model. Australian and New Zealand Clinical Trials Registry ACTRN12616000899448 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370716
Publisher: Springer Science and Business Media LLC
Date: 05-2020
DOI: 10.1186/S12889-020-08740-3
Abstract: High-intensity interval training (HIIT) elicits numerous health benefits, but little evidence is available regarding the feasibility of delivering school-based HIIT interventions. The aim of this study was to explore adolescents’ perceptions of a 6-month, 3 × 30-min sessions per week, HIIT intervention delivered either before or after school. Eighty adolescents allocated to the intervention group (13.3 ± 1.0 years 45 boys) were invited to take part in semi-structured focus groups post-intervention. Participants were categorised as attendees (≥40% attendance) or non-attendees ( 5% attendance). Data were transcribed verbatim and thematically analysed deductively, with key emergent themes represented using pen profiles. Results showed that a school-based HIIT intervention can be an enjoyable form of exercise. Irrespective of attendance, similar facilitators and barriers to participating were highlighted, including benefits of participation, content of the exercise session and the intervention instructor. This study provides support for the delivery of a HIIT intervention in a school setting but highlights the importance of a flexible design and delivery to accommodate competing interests. There is a need to educate adolescents on the possible benefits of participation and to make the sessions enjoyable in order to increase their extrinsic and intrinsic motivation to sustain participation.
Publisher: Springer Science and Business Media LLC
Date: 22-03-2021
DOI: 10.1186/S12966-021-01103-0
Abstract: Sustainable shifts in population behaviours require system-level implementation and embeddedness of large-scale health interventions. This paper aims to understand how different contexts of scaling up interventions affect mechanisms to produce intended and unintended scale up outcomes. A mixed method study combining a realist perspective and systems analysis (causal loop diagrams) of scaled-up physical activity and/or nutrition interventions implemented at a state/national level in Australia (2010–18). The study involved four distinct phases: Phase 1 expert consultation, database and grey literature searches to identify scaled-up interventions Phase 2 generating initial Context-Mechanism-Outcome configurations (CMOs) from the WHO ExpandNet framework for scaling up Phase 3 testing and refining CMOs via online surveys and realist interviews with academics, government and non-government organisations (NGOs) involved in scale up of selected interventions ( Phase 1 ) and Phase 4 generating cross-case mid-range theories represented in systems models of scaling up validated by member checking. Descriptive statistics were reported for online survey data and realist analysis for interview data. Seven interventions were analysed, targeting nutrition ( n = 1), physical activity (n = 1), or a combination ( n = 5). Twenty-six participants completed surveys 19 completed interviews. Sixty-three CMO pathways underpinned successful scale up, reflecting 36 scale up contexts, 8 key outcomes linked via 53 commonly occurring mechanisms. All five WHO framework domains were represented in the systems models. Most CMO pathways included ‘intervention attributes’ and led to outcomes ‘community sustainability/embeddedness’ and ‘stakeholder buy-in erceived value’. Irrespective of interventions being scaled in similar contexts (e.g., having political favourability) mechanisms still led to both intended and unintended scale up outcomes (e.g., increased or reduced sustainability). This paper provides the first evidence for mechanisms underpinning outcomes required for successful scale up of state or nationally delivered interventions. Our findings challenge current prerequisites for effective scaling suggesting other conditions may be necessary. Future scale up approaches that plan for complexity and encourage iterative adaptation throughout, may enhance scale up outcomes. Current linear, context-to-outcome depictions of scale up oversimplify what is a clearly a complex interaction between perceptions, worldviews and goals of those involved. Mechanisms identified in this study could potentially be leveraged during future scale up efforts, to positively influence intervention scalability and sustainability.
Publisher: Springer Science and Business Media LLC
Date: 15-04-2020
DOI: 10.1186/S12966-020-00952-5
Abstract: The design of parks is critical to ensure they are appealing, meet the needs of the community and optimise opportunities for physical activity, relaxation, exposure to nature and social interaction. There is currently a lack of understanding on how research evidence is informing park design and how to reduce the many challenges associated with research-practice-policy translation. Understanding how organisations use evidence for decision-making regarding park design is critical for reducing the research-practice-policy gap and ensuring evidence based strategies inform park design to support healthy active living. This study explored stakeholder perceptions regarding factors that influence the use of research evidence to inform park planning and design, and potential strategies to enhance effective translation of research evidence for optimal park design into policy and practice. One-on-one in-depth interviews were conducted with 23 stakeholders within the park design, planning and management sector. Participants shared experiences regarding: influences on park development and design current park development policies ways to facilitate use of evidence and priorities for future research. Interviews were recorded and transcribed verbatim and content analysis performed using NVivo 12. Research evidence is used and considered important for park planning however, several barriers were highlighted: time and cost constraints difficulties accessing research and limited research relevant to specific needs. Developing partnerships between researchers and park developers and providing evidence in a more accessible format such as short summaries/reports, infographics, presentations, research updates and dedicated research databases emerged as key enablers. The main research gaps identified included research into park features to encourage visitation and cost-benefit analyses studies. This research is a first step to better understand strategies to promote more effective uptake and use of evidence to inform park planning. Researchers must develop multi-sectoral collaborations and generate policy-relevant research in a readily accessible, timely and user-friendly format to ensure evidence is used to enhance park design and ultimately public health.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Harriet Koorts.