Wang, Haiquan
(2022)
A school-based behaviour change intervention to increase physical activity levels among Chinese children: intervention development and cluster non-randomised controlled feasibility trial.
PhD thesis, University of Nottingham.
Abstract
Children in China have low levels of physical activity. The aim of this thesis was to develop a school-based behaviour change intervention to increase physical activity levels among Chinese children and to determine the feasibility of undertaking the definitive cluster randomised controlled trial (RCT) in China. In order to achieve this aim, four inter-related studies were conducted:
First, a qualitative systematic review (study 1) synthesised barriers and facilitators to physical activity among ethnic Chinese children. These findings highlighted the challenges faced by Chinese children in their physical activity participation as well as the factors that could facilitate their participation in physical activities. From studies conducted in the Chinese territories, four synthesised findings (personal, socio-cultural, environmental, and policy- and programme-related barriers and facilitators) were aggregated from 37 extracted findings and 14 aggregated categories. From studies conducted in the non-Chinese territories, only two synthesised findings (personal and socio-cultural barriers and facilitators) were derived from 19 extracted findings and seven aggregated categories.
Second, the synthesised barriers and facilitators (from study 1) were used for behavioural analysis to systematically develop an intervention for improving Chinese children’s physical activity participation, using the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF) (study 2). This systematic process identified 10 relevant TDF domains to encourage engagement in physical activity among Chinese children: knowledge, memory, attention and decision processes, social influences, environmental context and resources, beliefs about capabilities, beliefs about consequences, social/professional role and identity, emotions, and physical skills. It resulted in the selection of seven intervention functions (education, persuasion, environmental restricting, modelling, enablement, training, and incentivisation) and 21 behaviour change techniques in the intervention, delivered over a period of 16 weeks.
Third, this thesis aimed to determine the feasibility of undertaking a cluster RCT in China (study 3). Specifically, a cluster non-RCT design was used, and the trial was conducted in two public schools (one intervention and one control) in Yangzhou, China. Participants in one school received the intervention i.e., a 16-week behaviour change intervention. Participants in the other school continued with usual physical activities. Eventually, sixty-four children and their parents participated in the study (32 per study group). The standard deviation of the primary outcome (i.e., seven-day steps) was 34519 steps. The intraclass correlation coefficient was 0.03. The recruitment and follow-up rates were 100%. The completion of data collection was 100% (except for the seven-day steps at baseline—one child lost the step log in the intervention group and two children lost their pedometer in the control group). The time needed to complete the self-reported questionnaire by children was around 15 min per study group, and the measurement of their anthropometric parameters took around 40 min per study group. The intervention attendance was 100%.
Fourth, a qualitative process evaluation was conducted to 1) explore the experiences and perceptions of participants and providers in the intervention and trial, and 2) generate recommendations to inform a future intervention and full-scale cluster RCT (study 4). Findings believed to reflect experience and perceptions of participants in the intervention and the trial are presented as eight major themes: 1) perceived high efficacy of the intervention components to help children become more active, 2) appreciation of the intervention features, 3) factors that facilitated or impeded intervention attendance and delivery, 4) positive experiences and feelings gained through data collection process, 5) satisfaction regarding the organisation and implementation of the trial, 6) influences of personal beliefs and emotional responses to the trial, 7) social influences on participatory decision-making, and 8) key barriers to consider regarding the recruitment of participants. These findings indicated that the intervention and trial methods were acceptable to children, parents, and education providers. School-based behaviour change intervention was perceived to be a useful approach to increase physical activity in children aged 10-12 years in China. However, there were barriers to intervention delivery and engagement that should be considered when designing a future cluster RCT to assess the intervention efficacy.
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