Multi-strategy intervention increases school implementation and maintenance of a mandatory physical activity policy: outcomes of a cluster randomised controlled trial

Abstract

ObjectivesTo 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.MethodsA 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.ResultsOverall, 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).ConclusionA 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 numberAustralian New Zealand Clinical Trials Registry (ACTRN12617001265369).

Adaptation and Validation of the Program Sustainability Assessment Tool (PSAT) for Use in the Elementary School Setting

“…This is of concern, as sustained teacher scheduling of physical activity was the focus and primary outcome of the public health program that our implementation intervention was aiming to continue. Despite our intervention illustrating a significant and maintained effect on this outcome [32], the adapted PSAT failed to differentiate between teachers from the intervention schools with high and low scheduling behaviour, which we propose theoretically should reflect program sustainment. This finding highlights the potential usefulness of the adapted PSAT in its current form as a measure of determinants of sustainment of physical activity programs in elementary schools.…”

“…Sustainment data collection occurred 18-months following active implementation support. The second study was a larger effectiveness trial [32], with 31 schools randomised to receive the implementation strategies. Sustainment data collection occurred six months after active implementation support ceased.…”

“…Elementary schools from the Hunter New England (HNE) region of New South Wales (NSW), Australia were eligible to participate in the trials if they were not participating in another physical activity intervention, and did not enrol only students who require specialist care [31,32]. HNE is a demographically and geographically diverse region in NSW Australia.…”

“…Only data from the sustainment data collection time-point from the intervention schools were included in this study. A complete description of the pilot [31] and effectiveness trials [32] are reported elsewhere.…”

“…This data provided an indication of teachers' implementation of the current state Department of Education policy, which mandates that teachers schedule a minimum of 150 min of physical activity across the school week [34], and which was the target behaviour of the implementation intervention being tested in both trials. Sustainment of this behaviour was considered at 18 months following completion of the implementation intervention in the pilot trial [31] and 6 months in the effectiveness trial [32].…”