Promoting Adolescent Development Through Sports in Hong Kong
Condition: Adolescent Development
Study type: Interventional

Summary: 
      Background

      A physically active lifestyle is crucial for development but a large number of youth in Hong
      Kong are sedentary and do not meet the International (World Health Organisation) and the
      local (Leisure and Cultural Services Department) recommendation for physical activity. On the
      other hand, the evidence for implementing positive youth development programme through
      physical activity and sports is elusive.

      Purpose

      This study aimed to promote physical activity and sports amongst adolescents in Hong Kong
      through a structured sports mentorship intervention. The study also aimed to investigate the
      effect of such programme in positive youth development.

      Methods

      This was a two-phased study with Phase I being the preparatory stage and Phase II being the
      implementation stage. In Phase I, questionnaire surveys and focus group interviews were
      conducted to understand the relevant perceptions and opinions amongst various stakeholders
      (e.g. teachers, parents, and students). The data collected was analysed to inform the design
      and planning of the Phase II intervention. Phase II was an experimental trial of our sports
      mentorship programme. Participating students were divided into intervention and control
      group, where the former received the sports mentorship programme and the later did not. The
      intervention was 18 weeks long providing an additional 90 minutes of active time per week for
      all students in the intervention group. Programme mentors were trained and supported in
      reference to previous evidence. Intervention effectiveness were evaluated by comparing the
      outcomes between intervention and control group.
    

Detailed description: 
      Introduction

      Physical activity is beneficial to all aspects of health, from physical fitness and metabolic
      control to mental and psychosocial well-being. These benefits are particularly important to
      children and adolescents as they are undergoing an active development and building up a
      foundation for their future success. Unfortunately, Hong Kong children are becoming less and
      less physically active. Data from government surveys in 2009 showed that only 34.2% of
      children aged 7 to 12 years had at least 60 minutes of moderate or vigorous activity five
      days a week over a 3 month period. Another recent survey reported that only 6.6% of secondary
      school students in Hong Kong met the WHO recommended standard of physical activity - 60
      minutes of moderate and vigorous activity every day. In fact, 27.1% of adolescents did not
      even have moderate and vigorous physical activity in any days of the past week.

      Upsurging adolescent problems have been identified in Hong Kong, including smoking, underage
      drinking, substance abuse, and the deterioration of mental well-being (D. T. Shek, 2006).
      Take mental health as an example. Mental health problems were estimated to affect 10 to 20%
      of children and adolescents worldwide (Kieling et al., 2011), resulting in short-term and
      long-term adverse consequences (Johnson, Roth, Schultz, & Breslau, 2006). Conventionally,
      mental health problems were tackled using a disease model, which focuses on disease
      treatment. However, it has been more recognised in recent decade that primary prevention
      would be important to improve the overall mental well-being of children and adolescents
      (Kieling et al., 2011).

      Instead of the traditional disease model, strength-based positive prevention models has been
      called upon, where Positive Youth Development (PYDs) is one of the most successful one
      targeting adolescents. To understand the concept of PYD, it is important to have a glimpse at
      the traditional view of adolescence. The transition period located at the second decade of
      the human lifespan was conventionally regarded as the period of 'storm and stress' (Hall,
      1904). It was suggested that adolescents often alternate between the extremes of sorrow and
      exuberance (N. Holt, 2008). Nonetheless, it was later recognised that the emphasis on these
      negative characteristics was disproportionately too much and a new perspective on adolescent
      development emerged. This new perspective is later named the PYD. Instead of the conventional
      deficit-reduction (or 'disease') approach, the PYD focuses on how to strengthen adolescents'
      internal and external asset so that problems could be prevented or alleviated. Since the
      establishment of this new concept in the 80s and 90s, a growing number of research has been
      conducted to investigate the actual implementation of such model.

      The PYD model could be implemented in many context, but it is argued that sports and physical
      activity is one of the most suitable (Fraser-Thomas, Cote, & Deakin, 2005; Larson, 2000;
      Perkins & Noam, 2007). Actually such claim was consistent with the 'QK Blog', an existing
      adolescent strengthening platform (Kwai Tsing Safe Community and Healthy City Association,
      2012). Nevertheless, the actual benefit of these sports-based PYD problem was rarely
      investigated, especially in China (Coakley, 2011; Fraser-Thomas et al., 2005). Therefore, we
      conducted the present project to promote two major aspects among adolescents in Hong Kong:
      physically activity and adolescent development.

      Purpose/Objectives/Aims

      This project will explore the possibility of fostering positive adolescent development
      through tailoring a community-based youth project in Kwai Tsing district in Hong Kong.
      Specifically, physical activity would benefit the adolescents in terms of physical,
      psychological/emotional, and social development, together of which forms the important
      foundation for a healthy and productive adult life. The project will incorporate a physical
      activity intervention guided by behavioural theory in a secondary school-based setting.

      Project

      Overview

      This is a two-phase project with Phase I being the preparatory stage and Phase II being the
      Implementation stage. Phase I mainly focused on the attitude, perceived benefits and barriers
      among various stakeholders, including students, parents, and teachers. The stakeholders were
      then interviewed in a focus group setting or surveyed using questionnaires.

      The data collected in Phase I were then analysed, which guided the design and implementation
      of Phase II - the actual implementation of the intervention. In addition to the results of
      Phase I, a thorough literature search were also conducted in order to understand the existing
      evidence regarding the correlates of physical activity as well as the theoretical construct
      in promoting adolescent development through sports / physical activity.

      Recruitment

      To ensure sufficient support from the school, we contacted the secondary schools with
      physical education teacher graduated from the Department of Physical Education, Hong Kong
      Baptist University. A formal invitation letter were sent to each school, outlining the
      background, implementations, and expected outcomes of the programmes. Telephone calls were
      also made to each schools' principal, extra-curricular master, or physical education (PE)
      panel heads for discussing the feasibility and other details of implementing the programme in
      their school. To allow flexibility, schools may only participate in either Phase I or Phase
      II or both, depending on their preference.

      The Phase I PE teacher survey questionnaires were sent directly to all the 454 secondary
      schools. All schools in Hong Kong were invited so as to obtain a more representative sample,
      which may inform both the current intervention programme and relevant research and services
      in the future.

      Intervention Design

      Design of the intervention was guided by both the empirically results of Phase I and a
      through literature review. The theoretical framework and the practical implementation of the
      interventions are as follows:

      Framework

      Our programme was informed by two theoretical frameworks: first, the Theory of Planned
      Behaviour (TPB) for encouraging students' participation in sports and PA, and second, the
      Positive Youth Development (PYD) framework for enhancing students' holistic development.

      The TBP is a successful framework in predicting physical activity behaviour in young people
      (Craig, Goldberg, & Dietz, 1996). It was found that attitude, perceived behavioural control,
      and subjective social norm has a strong influence in taking part physical activity. In
      particular, the effect of self-efficacy and attitude on PA were even significant after
      controlling for youth's past PA habit. In other words, improving students' self-efficacy and
      attitude may increase their participation in PA, regardless of their current activity level.

      Whereas the TBP could assist in motivating students' participation in PA, the PYD framework
      may help to define the structure of the programme for enhancing holistic adolescent
      development. Specifically, we adapted the United States National Research Council and
      Institute of Medicine (NRCIM) suggestion in developing this programme.

      Apart from these principles, we also blended in well-established psychological theories in
      the present programme. For example, we regarded the person who guide and facilitate the
      exercise sessions to be 'mentors' instead of 'coaches'. These mentors did not only teach
      students sporting skills, but were also responsible to maintain the exercise sessions fun,
      democratic and empowering. The mentors were also educated with the means in establishing a
      'mastery-oriented' atmosphere, instead of a 'performance-oriented' one, during teaching and
      exercising. The former attitude encourages a constant improvement for each of the students
      while the later one encourages comparison of performance within the group. Previous
      psychological experiments have shown that people in mastery-oriented attitude would be more
      motivated in constant improvements. All the mentors of the programme were introduced with the
      present programme principle and supported by our project members, including health and
      physical education experts.

      Implementation

      Eighteen 1.5-hour activity sessions were carried out weekly for all students participating in
      this programme. The total activity time for each student was 27 hours. The quantity 1.5 hours
      per week was chosen to conform the physical activity baseline indicator of the Hong Kong
      Leisure and Cultural Services Department (Department of Sports Science & Physical Education
      of The Chinese University of Hong Kong, 2009).

      Roughly speaking, the programme could be categorised into four stages: Introduction /
      Recapitulation, Goal Setting, Skill Building, and Reflection. The Introduction /
      Recapitulation stages were for students and mentors to warm up and building their bonds.
      Mentors were advised to set up their own rules with students within these periods. Exercises
      and physical activities during these sessions were designed to be relatively easy for
      encouragement and motivation purpose. The Goal Setting stages were transition periods where
      students were assisted in establishing their own goals during the programme. During these
      stages, mentors helped students in realising their current sporting skills, which acted as
      the starting point of goal setting. Skill Building stages were the major components of the
      programme. Students were instructed to reach their own goals through practice and play.
      Finally, the Reflection sessions were for students reflect on their own improvement and
      barriers encountered during the Skill Building stages with the assistance of the mentors. The
      inclusion of reflections ensured that students' benefits in the programme were consolidated
      and could be sustained in a longer period. Details of the intervention frameworks,
      principles, implementations, and mentor education could be found in the Programme Guidebook
      for Mentors)
    

Intervention name(s): Sports mentorship programme; Health promotion
Intervention type(s): Behavioral; Behavioral
Intervention description(s): 1.5-hour sports mentorship session once a week, 18 weeks total.; The access to a health promotion website any time during the intervention period. The website contains general health information including those related to physical activity.
Other intervention name(s): Physical activity; Sports
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Positive youth development; Sports / physical activity