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Randomized Controlled Trial
. 2021 Oct 23;18(1):137.
doi: 10.1186/s12966-021-01206-8.

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  1   2   3   4 , Elizabeth Campbell  1   2   3   4 , Matthew McLaughlin  5   6   7   8 , Nicole Nathan  1   2   3   4 , Luke Wolfenden  1   2   3   4 , David R Lubans  4 , Philip J Morgan  4 , Karen Gillham  1   3 , Chris Oldmeadow  3 , Andrew Searles  3 , Penny Reeves  2   3 , Mandy Williams  9 , Nicole Evans  10 , Andrew Bailey  11 , James Boyer  12 , Christophe Lecathelinais  1   2   3 , Lynda Davies  1   3 , Tom McKenzie  1   3 , Katie Robertson  1   3 , John Wiggers  1   2   3   4
Affiliations
Randomized Controlled Trial

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 et al. Int J Behav Nutr Phys Act. .

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 < 0.001). At 24-months, program schools were implementing an average of 3.6 more practices than control schools (4.1 (1.7) vs. 0.5 (0.8), respectively) (P < 0.001). Fidelity and reach of the implementation intervention were high (> 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.

Keywords: Adolescents; Cost-effectiveness; Fidelity; Implementation; Multi-component; Physical activity; Randomised controlled trial; Reach; Scale-up; School.

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Conflict of interest statement

Authors RS, LC, NN, LW, KG, MW, NE, AB and JW receive salary support from their respective Local Health Districts. Hunter New England Local Health District contributes funding to the PA4E1 program.. All other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Consort Flow Diagram describing progress to 24 months (final follow-up). *Grade 7 enrolments [19]. # of Head PE Teacher
Fig. 2
Fig. 2
Proportion of secondary schools meeting primary outcome at baseline, 12-months and 24-months (primary outcome). *At 24mth N = 23
Fig. 3
Fig. 3
Mean number of practices implemented by program and control group schools at baseline, 12 and 24 months (secondary outcome). *At 24mth N = 23
See this image and copyright information in PMC

References

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