BackgroundExtracurricular programmes could provide a mechanism to increase the physical activity (PA) of primary-school-aged children. The aim of this feasibility study was to examine whether the Action 3:30 intervention, which is delivered by teaching assistants, holds promise as a means of increasing the PA of Year 5 and 6 children.MethodsA cluster randomised feasibility trial was conducted in 20 primary schools. Ten schools received the Action 3:30 intervention and 10 schools were allocated to the control arm. The intervention was 40 one-hour sessions, delivered twice a week by teaching assistants. The proportion of participants recruited per school was calculated. Session delivery and session attendance was calculated for intervention schools. Weekday and after-school (3.30 to 8.30 pm) moderate to vigorous intensity physical (MVPA) was assessed by accelerometer at baseline (T0), during the last few weeks of the intervention (T1) and four months after the intervention had ended (T2). The costs of delivering the intervention were estimated.ResultsFive intervention schools ran all 40 of the intended sessions. Of the remaining five, three ran 39, one ran 38 and one ran 29 sessions. Mean attendance was 53%. The adjusted difference in weekday MVPA at T1 was 4.3 minutes (95% CI −2.6 to 11.3). Sex-stratified analyses indicated that boys obtained 8.6 more minutes of weekday MVPA than the control group (95% CI 2.8 to 14.5) at T1 with no effect for girls (0.15 minutes, 95% CI −9.7 to 10.0). There was no evidence that participation in the programme increased MVPA once the club sessions ceased (T2). The indicative average cost of this intervention was £2,425 per school or £81 per participating child during its first year and £1,461 per school or £49 per participating child thereafter.ConclusionsThe effect of the Action 3:30 intervention was comparable to previous physical activity interventions but further analysis indicated that there was a marked sex difference with a positive impact on boys and no evidence of an effect on girls. The Action 3:30 intervention holds considerable promise but more work is needed to enhance the effectiveness of the intervention, particularly for girls.Trial registrationISRCTN58502739

The implementation, fidelity, and receipt of a self-determination-theory-based after-school physical activity intervention (Action 3:30) delivered by teaching assistants (TAs) was examined using a mixed-methods process evaluation. Physical activity motivation and need satisfaction were reported by 539 participants at baseline, the end of intervention, and 4-month follow-up. Pupil-and TA-reported autonomy-support and teaching efficacy were collected alongside interviews with 18 TAs and focus groups with 60 participants. Among intervention boys there were small increases in identified, introjected, and external motivation and no differences in need satisfaction. Among girls, intrinsic and identified motivation and autonomy and relatedness were lower in the intervention group. Qualitative evidence for fidelity was moderate, and boys reported greater need satisfaction than girls. TAs provided greater structure than involvement or autonomy-support and felt least efficacious when facing school-based challenges. The findings highlight the refinements needed to enhance theoretical fidelity and intervention effectiveness for boys and girls.

30Objective Hypertriglyceridaemic waist (HW) and waist-to-height ratio (WHTR)

BackgroundAsian medical students and doctors receive lower scores on average than their white counterparts in examinations in the UK and internationally (a phenomenon known as “differential attainment”). This could be due to examiner bias or to social, psychological or cultural influences on learning or performance. We investigated whether students’ scores or feedback show influence of ethnicity-related bias; whether examiners unconsciously bring to mind (activate) stereotypes when judging Asian students’ performance; whether activation depends on the stereotypicality of students’ performances; and whether stereotypes influence examiner memories of performances.MethodsThis is a randomised, double-blinded, controlled, Internet-based trial. We created near-identical videos of medical student performances on a simulated Objective Structured Clinical Exam using British Asian and white British actors. Examiners were randomly assigned to watch performances from white and Asian students that were either consistent or inconsistent with a previously described stereotype of Asian students’ performance. We compared the two examiner groups in terms of the following: the scores and feedback they gave white and Asian students; how much the Asian stereotype was activated in their minds (response times to Asian-stereotypical vs neutral words in a lexical decision task); and whether the stereotype influenced memories of student performances (recognition rates for real vs invented stereotype-consistent vs stereotype-inconsistent phrases from one of the videos).ResultsExaminers responded to Asian-stereotypical words (716 ms, 95% confidence interval (CI) 702–731 ms) faster than neutral words (769 ms, 95% CI 753–786 ms, p < 0.001), suggesting Asian stereotypes were activated (or at least active) in examiners’ minds. This occurred regardless of whether examiners observed stereotype-consistent or stereotype-inconsistent performances. Despite this stereotype activation, student ethnicity had no influence on examiners’ scores; on the feedback examiners gave; or on examiners’ memories for one performance.ConclusionsExaminer bias does not appear to explain the differential attainment of Asian students in UK medical schools. Efforts to ensure equality should focus on social, psychological and cultural factors that may disadvantage learning or performance in Asian and other minority ethnic students.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0943-0) contains supplementary material, which is available to authorized users.

BackgroundMany children do not engage in recommended levels of physical activity (PA), highlighting the need to find ways to increase children’s PA. Process evaluations play an important role in improving the science of randomised controlled trials. We recently reported the results of the Action 3:30 cluster randomised feasibility trial illustrating higher levels of moderate to vigorous intensity PA among boys but not girls. The aim of this paper is to report the process evaluation results including intervention fidelity, implementation, context and how intervention components and trial design could be improved before proceeding to a definitive RCT.MethodsChildren’s session enjoyment was assessed every two weeks. Reasons for non-attendance were provided by questionnaire at the end of the intervention. Post intervention interviews were held with participating teaching assistants (TAs) and school key contacts (KCs), and focus groups were conducted with children in all 10 intervention schools. Interviews and focus groups examined how recruitment and session attendance might be improved and established which elements of the programme that were and were not well received.ResultsData indicated good intervention fidelity with TA’s adopting enjoyment-focussed teaching styles and the sessions improving children’s skills and self-esteem. Several positive aspects of implementation were identified, including high session variety, the opportunity to work in teams, the child-led sessions and the engaging leader style. In terms of context there was evidence that TA’s faced difficulties managing challenging behaviour and that further training in this area was needed. TAs and KCs felt that recruitment could be improved by providing taster sessions during PE lessons and clarifying the days that the clubs would run at the point of recruitment. The programme could be improved to enhance interest for girls, by including training for managing disruptive behaviour and making some activities more age-group appropriate.ConclusionsAction 3.30 showed promise but could be improved by ensuring age appropriate activities, providing more appeal to girls and improving recruitment through taster sessions and early establishment of days of the week it is to be offered on.Trial registrationISRCTN58502739.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1501-3) contains supplementary material, which is available to authorized users.