Acceptability of a School-Based Incentivised Physical Activity Intervention: The B-Active Program

The purpose of this study was to examine the acceptability to students, parents and teachers of a school-based intervention that incentivised students using prizes to be more physically active (the B-Active program). Three hundred and eighty-five children (54% boys, 46% girls) in Years 3 – 6 from five schools participated in the study. Six parents and three teachers were also interviewed about their perception of the B-Active program. Overall, the students enjoyed the B-Active program but the level of acceptability was lower for the parents and teachers. This study indicates that to increase acceptability, parents need to be well informed and engaged and teachers need to be well supported so as to not add to their administrative responsibilities. Introduction Physical activity (PA) is of paramount importance to the health of children (Active Healthy Kids Australia, 2014). Lack of PA in childhood is associated with increased overweight and obesity, type II diabetes and risk factors for cardiovascular disease, as well as sub-optimal skeletal growth and poor psychosocial measures (Biddle & Asare, 2011; Must & Tybor, 2005; Motl, Birnbaum, Kubik et al., 2004; Pontiroli, 2004; Slemenda, Miller, Hui et al., 1991). Clearly it is imperative that children meet recommended PA guidelines to avoid the illeffects of physical inactivity. Disturbingly, the 2014 Australian Report Card on PA for children and young people awarded a “D-grade” based on the evidence that the majority of Australian children ages 5 – 17 years are not meeting the Australian Physical Activity Guidelines (Active Healthy Kids Australia, 2014). Initiatives to increase PA in children are desperately needed. As the largest portion of a typical child’s weekday is spent at school and the school environment offers an accessible infrastructure through which students may be informed and monitored, school-based programs to promote PA are desirable (Powers, Conway, McKenzie, et al., 2002; Lubans, Morgan, Weaver et al., 2012). School-based programs have been shown to increase children’s’ PA (Naylor et al 2010, Mâsse et al 2012); however, for long-term sustainability such programs need to be acceptable to the children and administering stakeholders, including teachers and parents. This study examined the acceptability of a school-based PA program (the B-Active Program) to Year 3-6 students, their parents and teachers. The B-Active program encouraged students to participate in organised and unorganised PA both inside and outside the school environment through a reward-based, prize incentive scheme. PA-promoting programs involving rewards have been shown to increase children’s PA (Cohen, Morgan, Plontnikoff et al., 2014; Epstein, Saelens, & O’Brien, 1995; Lubans, Morgan, Weaver et al., TEACHjournal 8-2b.indd 48 25/11/14 11:11 AM 48 | TEACH | v8 n2 v8 n2 | TEACH | 49 Research & Scholarship ” “The B-Active program aimed to incentivise the PA of children by utilising a web-based interface through which students could log their participation 2012; Hardman, Horn, Fergus et al., 2011); however, the acceptability of these programs has not been determined. Method Participants All students (N ≈ 750) in Years 3 – 6 (aged 7-13 years) from five primary schools located in outercity suburbs of Sydney and Melbourne were invited to participate in the B-Active program and take part in the study. Of these students, 385 children (54% boys, 46% girls) returned parental consent forms and hence constituted the study sample. Additionally, six parents and three teachers were randomly selected to be interviewed about their perception of the B-Active program. Approval for the study was gained from the Avondale College of Higher Education Ethics Committee. Study design A mixed methods approach (Creswell & Clark, 2011) was used involving a student questionnaire and parent and teacher interviews. The B-Active program and Implementation The B-Active program aimed to incentivise the PA of children by utilising a web-based interface through which students could log their participation in both organised and unorganised PA to earn points that could be redeemed for prizes. Students were introduced to the B-Active program through their school. Printed material about the B-Active program was sent home with the students to share with their parent(s). Parents were encouraged to play an enabling role in supporting their child to participate in both organised and unorganised PA by “signing off” on the PA that their child undertook. Members of the research team visited the schools and instructed the students about the B-Active program and the process of earning and redeeming prizes. The students were guided and trained in how to record their PA and how to enter it into the B-Active website, which involved creating a unique B-Active profile. The web-interface was user-friendly and once their profile had been created the students could easily log their PA participation by indicating the duration (in minutes) and type of activity (using drop-down menus). The web-interface automatically calculated and awarded points to the student’s profile, with higher intensity activities earning more points. The B-Active program commenced in Term 1 and ended in Term 4 (a total of 34 weeks). During this time the students were encouraged to record their PA. The students were able to redeem their accrued points for prizes at any time throughout the program, or they could accumulate their points so as to earn a more valuable prize. Prizes consisted of sportsrelated equipment and there were four tiers of prizes, each requiring a different minimum number of points TEACHjournal 8-2b.indd 49 25/11/14 11:11 AM 50 | TEACH | v8 n2 v8 n2 | TEACH | 51 Research & Scholarship ” “The students could order the prizes through the website and these were delivered to the school for presentation with the more expensive items requiring more points. The students could order the prizes through the website and these were delivered to the school for presentation. Funding for the prizes was supplied by the BUPA Health Foundation. Classroom teachers were involved in the program by monitoring and supporting their students throughout the program and also “signing off’ on their students’ PA participation during school time. Data collection and presentation The students completed a questionnaire at the end of the B-Active program that comprised 19 attitudinal questions relating to the program. All questions used a 4 point Likert scale with the options ranging from true for me, sort of true for me, sort of not true for me to not true for me (see Table 1). The data from the student questionnaire are presented as descriptive statistics (Table 1). The qualitative data was gathered through parent and teacher interviews which were recorded through hand written notes. These were subsequently coded into themes through an analysed process of constant comparison. Results Students’ attitudes toward the B-Active Program The responses of the 385 students to the questionnaire administered at the end of the B-Active Program are shown in Table 1. As seen in Table 1, the majority of the students enjoyed being involved in the B-Active program (Q1) and would have liked to continue in the Table 1: Student attitudes to the B-Active Program