Scale-up of the Physical Activity 4 Everyone (PA4E1) intervention in secondary schools: 12-month implementation outcomes from a cluster randomized controlled trial

Abstract

Background: 'Physical Activity 4 Everyone' (PA4E1) was an efficacious multi-component school-based physical activity (PA) program targeting adolescents. PA4E1 has seven PA practices. It is essential to scale-up, evaluate effectiveness and assess implementation of such programs. Therefore, the aim is to assess the impact of implementation support on school practice uptake of the PA4E1 program at 12 and 24 months. Methods: A cluster randomised controlled trial, utilising a type III hybrid implementation-effectiveness design, was conducted in 49 randomly selected disadvantaged Australian Government and Catholic secondary schools. A blinded statistician randomly allocated schools to a usual practice control (n = 25) or the PA4E1 program group (n = 24), with the latter receiving seven implementation support strategies to support school PA practice uptake of the seven practices retained from the efficacy trial. The primary outcome was the proportion of schools adopting at least four of the seven practices, assessed via telephone surveys with Head Physical Education Teachers and analysed using exact logistic regression modelling. This paper reports the 12-month outcomes. Results: Schools were recruited from May to November 2017. At baseline, no schools implemented four of the seven practices. At 12 months significantly more schools in the program group had implemented four of the seven practices (16/24, 66.7%) than the control group (1/25, 4%) (OR = 33.0[4.15-1556.4], p < 0.001). The program group implemented on average 3.2 (2.5-3.9) more practices than the control group (p < 0.001, mean 3.9 (SD 1.5) vs 0.7 (1.0)). Fidelity and reach of the implementation support intervention were high (both > 80%).

Extent, Type and Reasons for Adaptation and Modification When Scaling-Up an Effective Physical Activity Program: Physical Activity 4 Everyone (PA4E1)

“…Firstly, MM identi ed a list of adaptations between the e cacy and scale-up trial on physical activity practices, implementation support strategies and evaluation by triangulating data from a number of sources. The rst source was published PA4E1 research papers: the trial protocol (25), 12 and 24-month outcome papers (28, 32) and costeffectiveness paper for the e cacy trial (27); and the trial protocol (29), process evaluation protocol (31) and 12month practice outcome paper (30) for the scale-up trial. Secondly, we drew upon the trial registries for both trials.…”

“…The scale-up trial recruited 49 schools (24 program, 25 control) (30).…”

“…The scale-up trial (2017-2019) tested the adapted PA4E1 program in a larger number of low-socioeconomic secondary schools (n=49) across a larger geographic area (HNELHD leading three other local health districts, in a research-practice partnership with the University of Newcastle and NSW Department of Education (34)). Program schools were offered seven implementation support strategies (incorporating 23 sub-strategies) to support their adoption of seven physical activity practices (29)(30)(31).…”

“…Summary of the implementation support strategies offered to schools in the PA4E1 e cacy trial (24)(25)(26)28) and the PA4E1 scale-up trial (29)(30)(31).…”

Evaluating Digital Program Support for the Physical Activity 4 Everyone (PA4E1) School Program: Mixed Methods Study

“…We have previously reported that the multimode implementation support strategies used in the PA4E1 scale-up trial increased the implementation of physical activity-promoting practices in lower socioeconomic secondary schools in New South Wales, Australia [32]…”