School-based health promotion: understanding the educational context to facilitate change

The World Health Organisation recommends children and adolescents aged 5-18 years engage in an average of 60 minutes of at least moderate-intensity physical activity per day across the week. This helps them meet their multiple physical, mental and well-being needs. A substantial proportion (67-81%) of children and adolescents worldwide are not meeting these guidelines. Global intervention efforts, which largely focus on school settings, are reported to have failed and reasons for intervention outcomes remain poorly understood. To improve understanding of these outcomes, and the school context as a venue to facilitate change, I adopted an interdisciplinary approach, integrating theory and evidence from the fields of both Public Health and Educational research, to consider and address existing knowledge gaps in the field. In the first part of this thesis, I examined how interventions have been implemented to date. Teachers are typically tasked with delivering interventions, but the effectiveness of the training they receive is poorly understood. I investigated programmes provided in research and real-world contexts. Study 1 involved a systematic review and meta-analysis of staff training programmes within 51 trials of school-based physical activity interventions. I identified characteristics (e.g., use of theory) and behaviour change techniques (e.g., feedback, action planning) positively associated with intervention fidelity and student outcomes. Most training programmes included few of these features, and were not designed based on Educational research about teacher professional development. In study 2, I surveyed teachers (n=170) who participated in professional development programmes aimed at supporting the implementation of the UK government’s largest policy targeting physical activity promotion in primary schools in England. I assessed the design features of programmes undertaken, and measured the use of 14 mechanisms hypothesised to facilitate four proposed purposes of professional development: 1) to learn knowledge, 2) to master skills, 3) to motivate action towards a goal, and 4) to facilitate implementation of acquired knowledge into practice. Most participants attended programmes that addressed just one or two of these functions. Teachers that attended programmes addressing all four functions, comprising less than 25% of participants, reported experiencing greater impacts on their practice. In the second part of this thesis, I aimed to improve understanding of the school context as a venue to facilitate change, exploring understudied school-level environmental and policy correlates of student physical activity. In study 3, I analysed data from primary school-age students in Australia (n=684). I examined students’ use of school playground infrastructure and associations between infrastructure use, break time step cadence and cardio-respiratory fitness. Boys reported greater use of playground infrastructure than girls. Regular use of some items (e.g., playing fields) was associated with a higher break time step cadence and fitness test score. Gender differences were observed in the strength of some associations. For example, associations between playing field use and cardio-respiratory fitness were stronger in boys; associations between teacher-organised games and break time step cadence were stronger in girls. In the final study, I examined associations between school uniforms and student physical activity, using population-level data from 135 countries. Across all age groups, compliance with physical activity guidelines was lower in countries with uniform practices compared to those without. Among primary school-aged students, uniformed countries showed a greater gender gap in meeting activity guidelines, favouring boys, compared to non-uniformed countries. Associations between school uniforms and population gender inequalities in physical activity were also greater in high-income countries than in countries with other income classifications. This thesis contributes valuable insights into how interventions have been implemented to date and the school context as a setting to facilitate change. Studies 1 and 2 indicate that teachers tasked with implementing interventions are often provided with training that is unlikely to change their behaviour. Studies 3 and 4 identify novel school-level environmental and policy correlates of student physical activity. The interdisciplinary literature and studies presented in this thesis can contribute to the development of more effective and gender-equitable interventions to promote physical activity.

Name dc:type.qualificationname

Doctor of Philosophy (PhD)

Level dc:type.qualificationlevel

Doctoral

Grantor dc:publisher.institution

University of Cambridge

Year dc:date.issued

2023

Author dc:creator

• Ryan, Mairead

Advisors dc:contributor.advisor

• Van Sluijs, Esther
• Hofmann, Riikka

• Education
• Intervention
• Physical activity
• Public health
• School

Licence

• https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/7c7b1343-e191-4178-82b8-cdf502ddf92f/download
• http://purl.org/NET/rdflicense/allrightsreserved

Language dc:language

eng

Author Identifier

0000-0001-8165-4978

OAI identifier oai:identifier

oai:www.repository.cam.ac.uk:1810/361578