Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2022 Aug 20;19(1):106.
doi: 10.1186/s12966-022-01345-6.

Optimising a multi-strategy implementation intervention to improve the delivery of a school physical activity policy at scale: findings from a randomised noninferiority trial

Cassandra Lane  1   2   3   4 , Luke Wolfenden  5   6   7   8 , Alix Hall  5   6   7   8 , Rachel Sutherland  5   6   7   8 , Patti-Jean Naylor  9 , Chris Oldmeadow  8 , Lucy Leigh  8 , Adam Shoesmith  5   6   7   8 , Adrian Bauman  10 , Nicole McCarthy  5   6   7   8 , Nicole Nathan  5   6   7   8
Affiliations
Randomized Controlled Trial

Optimising a multi-strategy implementation intervention to improve the delivery of a school physical activity policy at scale: findings from a randomised noninferiority trial

Cassandra Lane et al. Int J Behav Nutr Phys Act. .

Erratum in

Abstract

Background: To maximise their potential health benefits, school-based physical activity policies need to be implemented at scale. This paper describes the third in a sequence of trials that sought to optimise an effective strategy (PACE) to assist schools' implementation of a physical activity policy. Specifically, it aimed to determine the probability that a multi-strategy intervention adapted to reduce in-person contact (Adapted PACE) was "as good as" the original intervention (PACE) in increasing the weekly minutes of structured physical activity implemented by classroom teachers.

Methods: A noninferiority cluster randomised controlled trial was undertaken with 48 primary schools in New South Wales, Australia. Schools were randomised to receive PACE or a model with adaptations made to the delivery modes (Adapted PACE). Teachers' scheduled minutes of weekly physical activity was assessed at baseline (Oct 2018-Feb 2019) and 12-month follow-up (Oct-Dec 2019). The noninferiority margin was set at - 16.4 minutes based on previous data and decision panel consensus. A linear mixed model analysed within a Bayesian framework was used to explore noninferiority between the two PACE models. A cost minimisation analysis was conducted from the health service provider perspective, using the Australian dollar (AUD).

Results: The posterior estimate for the between group difference at follow-up was - 2.3 minutes (95% credible interval = - 18.02, 14.45 minutes). There was an estimated 96% probability of Adapted PACE being considered noninferior (only 4% of the posterior samples crossed the noninferiority margin of - 16.4 minutes). That is, the minutes of physical activity implemented by teachers at Adapted PACE schools was not meaningfully less than the minutes of physical activity implemented by teachers at PACE schools. The mean total cost was AUD$25,375 (95% uncertainty interval = $21,499, $29,106) for PACE and AUD$16,421 (95% uncertainty interval = $13,974, $19,656) for Adapted PACE; an estimated reduction of AUD$373 (95% uncertainty interval = $173, $560) per school.

Conclusions: It is highly probable that Adapted PACE is noninferior to the original model. It is a cost-efficient alternative also likely to be a more suitable approach to supporting large scale implementation of school physical activity policies.

Trial registration: Retrospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001229167).

Keywords: adaptations; children; implementation; noninferiority; optimisation; physical activity; policy; scale-up; school.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of school enrolment and data collection throughout the study
Fig. 2
Fig. 2
Distribution of the posterior estimated differences in teacher's total scheduled minutes of physical activity between groups (uninformative prior)
See this image and copyright information in PMC

References

    1. World Health Organization. Global action plan on physical activity 2018–2030: more active people for a healthier world. Geneva: World Health Organization; 2018. Available from: https://apps.who.int/iris/handle/10665/272722
    1. Stylianou M, Walker JL. An assessment of Australian school physical activity and nutrition policies. Aust N Z J Public Health. 2018;42(1):16–21. - PubMed
    1. Olstad DL, Campbell EJ, Raine KD, Nykiforuk CI. A multiple case history and systematic review of adoption, diffusion, implementation and impact of provincial daily physical activity policies in Canadian schools. BMC Public Health. 2015;15(1):385. - PMC - PubMed
    1. Carlson JA, Sallis JF, Chriqui JF, Schneider L, McDermid LC, Agron P. State policies about physical activity minutes in physical education or during school. J Sch Health. 2013;83(3):150–6. - PubMed
    1. Nørager Johansen DL, Neerfeldt Christensen BF, Fester M, Koch B, Lund Kristensen P, Runge Larsen L, et al. Results from Denmark's 2018 report card on physical activity for children and youth. J Phys Act Health. 2018;15(s2):S341–S3. - PubMed

Publication types