Process evaluation of a sport-for-health intervention to prevent smoking amongst primary school children: SmokeFree Sports

Abstract

BackgroundSmokeFree Sports (SFS) was a multi-component sport-for-health intervention aiming at preventing smoking among nine to ten year old primary school children from North West England. The purpose of this study was to evaluate the process and implementation of SFS, examining intervention reach, dose, fidelity, acceptability and sustainability, in order to understand the feasibility and challenges of delivering such interventions and inform interpretations of intervention effectiveness.MethodsProcess measures included: booking logs, 18 focus groups with children (n = 95), semi-structured interviews with teachers (n = 20) and SFS coaches (n = 7), intervention evaluation questionnaires (completed by children, n = 1097; teachers, n = 50), as well direct observations (by researchers, n = 50 observations) and self-evaluations (completed by teachers, n = 125) of intervention delivery (e.g. length of sessions, implementation of activities as intended, children’s engagement and barriers). Descriptive statistics and thematic analysis were applied to quantitative and qualitative data, respectively.ResultsOverall, SFS reached 30.8% of eligible schools, with 1073 children participating in the intervention (across 32 schools). Thirty-one schools completed the intervention in full. Thirty-three teachers (55% female) and 11 SFS coaches (82% male) attended a bespoke SFS training workshop. Disparities in intervention duration (range = 126 to 201 days), uptake (only 25% of classes received optional intervention components in full), and the extent to which core (mean fidelity score of coaching sessions = 58%) and optional components (no adaptions made = 51% of sessions) were delivered as intended, were apparent. Barriers to intervention delivery included the school setting and children’s behaviour and knowledge. SFS was viewed positively (85% and 82% of children and teachers, respectively, rated SFS five out of five) and recommendations to increase school engagement were provided.ConclusionSFS was considered acceptable to children, teachers and coaches. Nevertheless, efforts to enhance intervention reach (at the school level), teachers’ engagement and sustainability must be considered. Variations in dose and fidelity likely reflect challenges associated with complex intervention delivery within school settings and thus a flexible design may be necessary. This study adds to the limited scientific evidence base surrounding sport-for-health interventions and their implementation, and suggests that such interventions offer a promising tool for engaging children in activities which promote their health.

Children’s learning from a Smokefree Sports programme: Implications for health education

“…The Love Life, Smokefree Sports programme is a UK-based preventative tobacco intervention, informed by work conducted with more than 30 primary schools in the North West of England between 2010(McGee et al, 2016Trigwell et al, 2015). Delivered in primary schools over six physical education learning periods, the programme utilised sports, games and physical activities to convey a range of anti-smoking messages ( Table 1) (Brady et al, 2015).…”

“…At one school, sessions were 30 minutes long with 26-28 pupils in each session (each session was delivered three times). At the other school, sessions were one hour long with 41 pupils in each session.Like the original programme in the North West of England, the intervention design was guided by the Socioecological Model of Health, the Health Belief Model, the Theory of Planned Behaviour and Social Cognitive Learning(McGee et al, 2016;Trigwell et al, 2015) and the key themes addressed were broadly the same. Similarly, both interventions were delivered in areas of high deprivation, replaced regular PE sessions (six in the Love Life and five in the original programme) and included a final celebration assembly and a Smokefree pledge.…”

Effect of a sport-for-health intervention (SmokeFree Sports) on smoking-related intentions and cognitions among 9-10 year old primary school children: a controlled trial

“…To the authors knowledge SFS was the first sport-for-health intervention to engage children in smoking prevention. A recently published process evaluation of the intervention suggests that this unique approach was well-received by children, and was considered acceptable to coaches and teachers as intervention deliverers [ 64 ]. However, there were variations in intervention fidelity and teachers’ implementation of intervention activities that may have reduced the potency of the intervention and the ability to sustain short term effects one year after the intervention [ 64 ].…”

“…To aid the credibility of data, facilitators’ reflected interpretations back to children during the focus groups. The present study focuses on children’s perceptions surrounding the impact of SFS on intentions (not) to smoke and individual smoking-related cognitions, thus other findings are discussed in the process evaluation paper, which has been published elsewhere [ 64 ].…”

Validation of the Chinese Non‐pharmacological Therapy Experience Scale in persons with intellectual disability

“…Researchers are aiming to better understand the key components in an intervention process and the fidelity in the implementation of that intervention (i.e. whether the intervention was delivered as planned) (Arends, Bode, Taal, & Van de Laar, ; Trigwell et al, ; Van Olmen et al, ). In this way, they can improve the process of implementing the intervention (Driediger et al, ; Liu et al, ).…”