Intervention fidelity in a school-based diet and physical activity intervention in the UK: Active for Life Year 5

Abstract

BackgroundActive for Life Year 5 (AFLY5) is an educational programme for Year 5 children (aged 9–10) designed to increase children’s physical activity, decrease sedentary behaviour and increase fruit and vegetable intake. This paper reports findings from a process evaluation embedded within a randomised controlled trial evaluating the programme’s effectiveness. It considers the fidelity of implementation of AFLY5 with a focus on three research questions:To what extent was the intervention delivered as planned?In what ways, if any, did the teachers amend the programme? andWhat were the reasons for any amendments?MethodsMixed methods were used including data collection via observation of the intervention delivery, questionnaire, teacher’s intervention delivery log and semi-structured interviews with teachers and parents. Qualitative data were analysed thematically and quantitative data were summarised using descriptive statistics.ResultsFollowing training, 42 of the 43 intervention school teachers/teaching staff (98 %) were confident they could deliver the nutrition and physical activity lessons according to plan. The mean number of lessons taught was 12.3 (s.d. 3.7), equating to 77 % of the intervention. Reach was high with 95 % of children in intervention schools receiving lessons. A mean of 6.2 (s.d. 2.6) out of 10 homeworks were delivered. Median lesson preparation time was 10 min (IQR 10–20) and 28 % of lessons were reported as having been amended. Qualitative findings revealed that those who amended the lessons did so to differentiate for student ability, update them for use with new technologies and to enhance teacher and student engagement. Teachers endorsed the aims of the intervention, but some were frustrated with having to adapt the lesson materials. Teachers also a reported tendency to delegate the physical activity lessons to other staff not trained in the intervention.ConclusionsFidelity of intervention implementation was good but teachers’ enthusiasm for the AFLY5 programme was mixed despite them believing that the messages behind the lessons were important. This may have meant that the intervention messages were not delivered as anticipated and explain why the intervention was found not to be effective.Trial registrationISRCTN50133740.

Long-term effects of the Active for Life Year 5 (AFLY5) school-based cluster-randomised controlled trial

“…Our intervention was based on theory,22 23 built on a similar intervention that had been previously shown to work in the USA21 and in pilot work, conducted by us, it was shown to fit well with the primary school national curriculum in the UK 27. Furthermore, the detailed process evaluation conducted as part of the full AFLY5 RCT, in which we used quantitative measures of intervention delivery and qualitative focus groups with children and indepth interviews with teachers and parents,28 showed that on average 77% of the intervention lessons and homeworks were delivered and reached 95% of the children in intervention schools. However, teachers felt lack of time and the need to prioritise numeracy and literacy skills over the health-promoting lessons of our intervention were important barriers to them and the children being more fully engaged with AFLY5 28.…”

“…Furthermore, the detailed process evaluation conducted as part of the full AFLY5 RCT, in which we used quantitative measures of intervention delivery and qualitative focus groups with children and indepth interviews with teachers and parents,28 showed that on average 77% of the intervention lessons and homeworks were delivered and reached 95% of the children in intervention schools. However, teachers felt lack of time and the need to prioritise numeracy and literacy skills over the health-promoting lessons of our intervention were important barriers to them and the children being more fully engaged with AFLY5 28. The process evaluation also highlighted that in general, teachers did not like teaching physical activity, and had a tendency to delegate such lessons to teaching assistants.…”

“…Pressures on schools to deliver academic success and the fact that teachers do not necessarily feel equipped, responsible for, or in the case of physical activity, enjoy promoting health behaviours,28 suggest that curriculum-based health promotion alone is unlikely to benefit population health. Our RCT was large and well conducted and the results suggest that further investment in RCTs of curriculum-based interventions (alone) to improve children's diet and activity are not wanted.…”

Process evaluation results of a cluster randomised controlled childhood obesity prevention trial: the WAVES study

“…Recently, several extensive process evaluations which have used multiple methods for data collection, similar to the WAVES study, have been undertaken [13, 15, 22]. However, reporting tends to focus on the findings of each method (e.g.…”

“…Similarly, data collection methods limited to questionnaires [9, 10], survey data [11], or qualitative data [5, 12], provide no opportunity for data triangulation. The MRC guidance has increased recognition of the importance of using multiple methods for process evaluation data collection [13–15] (usually a combination of observations, logbooks, questionnaires and qualitative methods [6]), however guidance for amalgamation and analysis of such data is lacking.…”