Active Children Through Individual Vouchers Evaluation: A Mixed-Method RCT

Abstract

Introduction: Physical activity declines in adolescence, especially among those in deprived areas. Research suggests this may result from accessibility barriers (e.g., cost and locality). The Active Children Through Individual Vouchers Evaluation RCT aimed to improve the fitness and heart health of teenagers in Wales with the help of teenagers who co-produced the study.

Physical Activity Behaviors of Children Who Register for the Universal, State-Wide Active Kids Voucher: Who Did the Voucher Program Reach?

“…These sub-groups are known to be less active than their counterparts and have the greatest potential to benefit from using a voucher [ 28 , 29 ]. Small-scale financial incentive studies propose co-design of eligible activities with children in low socioeconomic circumstances might increase their use of the voucher [ 30 , 31 ]. Intervention components that are delivered in partnership with stakeholders beyond the physical activity and sport sectors, such as mass media and communications campaigns targeted towards culturally and linguistically diverse families or adolescents, might further increase the intervention reach in the subsequent years of delivery of Active Kids [ 32 ].…”

Effects of the Active Kids voucher program on children and adolescents’ physical activity: a natural experiment evaluating a state-wide intervention

“…There is strong evidence that comprehensive, multi-component strategies are required to increase physical activity and prevent non-communicable disease [ 1 , 48 ]. The ACTIVE trial included peer mentoring and support worker engagement components in addition to the financial incentives, although these were unsuccessful [ 18 ]; James et al reported a need to overcome accessibility barriers [ 18 ]. Scalable components which address modifiable barriers, in addition to cost, such as mass-media campaigns and enhanced active travel infrastructure have not been investigated with financial incentive interventions to date.…”

“…There has been a marked increase in public sector investment for financial incentive programs that directly reduce the cost barrier to structured physical activity participation [15,16]. To date, heterogenous interventions tested in randomised controlled trials suggest that financial incentives hold promise to get more children active [17][18][19][20]. The ACTIVE trial adopted a co-design approach with teenagers, providing them free choice of unstructured activities the vouchers could be used for, which had a positive impact on cardiovascular fitness, cardiovascular health, and perspectives of activity [17,18]; Dunton tested after-school physical activity programs for primary school children in lowincome families which has limited effectiveness [20]; Financial incentives have also been used to promote physical activity in overweight/obese American Indian youth (11-20 years old) resulting in longer session duration but minimal effect on the number of sessions youth participated in [19].…”

“…To date, heterogenous interventions tested in randomised controlled trials suggest that financial incentives hold promise to get more children active [17][18][19][20]. The ACTIVE trial adopted a co-design approach with teenagers, providing them free choice of unstructured activities the vouchers could be used for, which had a positive impact on cardiovascular fitness, cardiovascular health, and perspectives of activity [17,18]; Dunton tested after-school physical activity programs for primary school children in lowincome families which has limited effectiveness [20]; Financial incentives have also been used to promote physical activity in overweight/obese American Indian youth (11-20 years old) resulting in longer session duration but minimal effect on the number of sessions youth participated in [19]. A cross-sectional study of the Government of Canada's Canadian Fitness Tax Credit, which provided a non-refundable tax credit for structured physical activity programs (including sport and dance) for all children up to 16 years old found the tax credit benefited the wealthier families most [21].…”

Reach, Recruitment, Dose, and Intervention Fidelity of the GoActive School-Based Physical Activity Intervention in the UK: A Mixed-Methods Process Evaluation

“…In order for peer mentors to be effective, consideration should be given to the mentor selection process. For example, previous studies have used a peer nomination questionnaire to identify ‘influential’ peers to undertake mentor training, and provide support and encourage participation in the trial [ 41 , 42 ]. In addition, due to the reliance on mentor time, it may be best to build in mentorship into pre-existing leadership roles within the school.…”