International Journal of Behavioral Nutrition and Physical Activity (Oct 2021)

Scale-up of the Physical Activity 4 Everyone (PA4E1) intervention in secondary schools: 24-month implementation and cost outcomes from a cluster randomised controlled trial

  • Rachel Sutherland,
  • Elizabeth Campbell,
  • Matthew McLaughlin,
  • Nicole Nathan,
  • Luke Wolfenden,
  • David R. Lubans,
  • Philip J. Morgan,
  • Karen Gillham,
  • Chris Oldmeadow,
  • Andrew Searles,
  • Penny Reeves,
  • Mandy Williams,
  • Nicole Evans,
  • Andrew Bailey,
  • James Boyer,
  • Christophe Lecathelinais,
  • Lynda Davies,
  • Tom McKenzie,
  • Katie Robertson,
  • John Wiggers

DOI
https://doi.org/10.1186/s12966-021-01206-8
Journal volume & issue
Vol. 18, no. 1
pp. 1 – 18

Abstract

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Abstract Background Physical Activity 4 Everyone (PA4E1) is an evidence-based program effective at increasing adolescent physical activity (PA) and improving weight status. This study aimed to determine a) the effectiveness of an adapted implementation intervention to scale-up PA4E1 at 24-month follow-up, b) fidelity and reach, and c) the cost and cost-effectiveness of the implementation support intervention. Methods A cluster randomised controlled trial using a type III hybrid implementation-effectiveness design in 49 lower socio-economic secondary schools, randomised to a program (n = 24) or control group (n = 25). An adapted implementation intervention consisting of seven strategies was developed to support schools to implement PA4E1 over 24-months. The primary outcome was the proportion of schools implementing at least four of the 7 PA practices, assessed via computer assisted telephone interviews (CATI) with Head Physical Education Teachers. Secondary outcomes included the mean number of PA practices implemented, fidelity and reach, cost and cost-effectiveness. Logistic regression models assessed program effects. Results At baseline, no schools implemented four of the 7 PA practices. At 24-months, significantly more schools in the program group (16/23, 69.6%) implemented at least four of the 7 PA practices than the control group (0/25, 0%) (p 75%). The total cost of the program was $415,112 AUD (2018) ($17,296 per school; $117.30 per student). Conclusions The adapted implementation intervention provides policy makers and researchers with an effective and potentially cost-effective model for scaling-up the delivery of PA4E1 in secondary schools. Further assessment of sustainability is warranted. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12617000681358 prospectively registered 12th May 2017.

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