Do socioeconomic inequities arise during school-based physical activity interventions? An exploratory case study of the GoActive trial

Abstract

Objective To investigate socioeconomic inequities in the intervention and evaluation process of the GoActive school-based physical activity intervention and demonstrate a novel approach to evaluating intervention-related inequalities.Design Exploratory post-hoc secondary data analysis of trial data.Setting The GoActive trial was run in secondary schools across Cambridgeshire and Essex (UK), between September 2016 and July 2018.Participants 13–14 years old adolescents (n=2838, 16 schools).Methods Socioeconomic inequities across six stages in the intervention and evaluation process were evaluated: (1) provision of and access to resources; (2) intervention uptake; (3) intervention effectiveness (accelerometer-assessed moderate-to-vigorous physical activity (MVPA)); (4) long-term compliance; (5) response in evaluation; and (6) impact on health. Data from self-report and objective measures were analysed by individual-level and school-level socioeconomic position (SEP) using a combination of classical hypothesis tests and multilevel regression modelling.Results Stage: (1) There was no difference in the provision of physical activity resources by school-level SEP (eg, quality of facilities (0–3), low=2.6 (0.5); high=2.5 (0.4). (2) Students of low-SEP engaged significantly less with the intervention (eg, website access: low=37.2%; middle=45.4%; high=47.0%; p=0.001). (3) There was a positive intervention effect on MVPA in adolescents of low-SEP (3.13 min/day, 95% CI −1.27 to 7.54, but not middle/high (−1.49; 95% CI −6.54 to 3.57). (4) At 10 months post-intervention, this difference increased (low SEP: 4.90; 95% CI 0.09 to 9.70; middle/high SEP: −2.76; 95% CI −6.78 to 1.26). (5) There was greater non-compliance to evaluation measures among adolescents of low-SEP (eg, % accelerometer compliance (low vs high): baseline: 88.4 vs 92.5; post-intervention: 61.6 vs 69.2; follow-up: 54.5 vs 70.2. (6) The intervention effect on body mass index (BMI) z-score was more favourable in adolescents of low-SEP (low SEP: −0.10; 95% CI −0.19 to 0.00; middle/high: 0.03; 95% CI −0.05 to 0.12).Conclusions These analyses suggest the GoActive intervention had a more favourable positive effect on MVPA and BMI in adolescents of low-SEP, despite lower intervention engagement. However, differential response to evaluation measures may have biassed these conclusions. We demonstrate a novel way of evaluating inequities within young people’s physical activity intervention evaluations.Trial registration number ISRCTN31583496.