Development and Feasibility of an Incentive Scheme to Promote Walking/Cycling to School
Condition: Physical Activity
Study type: Interventional

Summary: 
      The aim of this study is to investigate whether an incentive scheme is a feasible approach to
      increase walking/cycling to school.
    

Detailed description: 
      This will be a feasibility study using a two-arm cluster randomised controlled design; the
      Year 5 group (and respective school) will be the unit of randomisation. Participants will be
      Year 5 pupils, aged 9-10.

      Data will be collected throughout approximately three months. In total, assessments will be
      carried out over a nine week period, which excludes an interval week between baseline and the
      first intervention week, and half-term (school holidays).

      All children in Year 5's in the selected schools will be approached to participate and will
      be allocated randomly (according to the school they attend) to the two arms: (i) intervention
      group taking part in the incentive scheme and (ii) control group receiving ongoing curricular
      advice on active travel.

      Parents' participation consists in completing a socio-demographic questionnaire and consent
      form, and in completing a daily form (or answering daily text messages) reporting whether
      child has actively traveled to school (AST report) .

      A number of schools will be invited to participate by email. A reply by post, phone or email
      to the lead researcher will be requested within two weeks, at the end of which pending
      schools will be contacted by phone to confirm their decision. Of those interested, two
      schools will be selected, ideally matched for characteristics such as location, free school
      meals and AST rates.

      Once the two participating schools have been identified, a meeting in person will be arranged
      with each head teacher at a time/place of their choice.

      The researcher will then visit the schools and introduce the RIGHT TRACKS study to the Year 5
      class. After the study has been presented and questions answered, an information pack will be
      sent home in the pupil's school folder. This pack will include an information leaflet for
      child, an information leaflet for the parent/carer, a parent questionnaire, a participant
      information sheet and a consent form. Two of the points stressed are confidentiality and the
      freedom to drop out of the study at any time without giving justification. After reading and
      having the chance of asking questions (by phone/email to the lead researcher), parents will
      be required to formally consent (opt in procedure) to their and to their child's
      participation.

      Parental questionnaires and consent forms are expected to be filled in at home but phone or
      email inquiries may be made to the researcher during working hours. Within one week after
      delivery, parents will be requested to return completed and signed documents to the
      researcher. Specific methods of distribution and collection will be decided with the school
      beforehand to accommodate local circumstances and preferences.

      Questionnaire completion will be requested of parents, however only return of the signed
      consent form will be essential to determine the child's participation. In addition,
      participating children will complete an assent form in the classroom.

      Baseline assessment Following the identification of participants, children in both schools
      will be given and instructed to wear an accelerometer on a waist band above the lateral hip
      over the ensuing seven days, from the moment they get up until they go to bed, except for
      water-based activities and certain sports.

      Together with the accelerometer, the child will be given the parent AST report form, which
      he/she must take home and return at the end of the seven day period, completed by the parent,
      together with the accelerometer. Four questions will be asked to parents in the parent AST
      report form, in relation to each day of the week: e.g. "On Monday did your child walk or
      cycle to school, all or part of the journey?", "At what time did your child leave home?", "At
      what time did your child arrive at school?", "Did your child stop anywhere on the way? If
      yes, how long was the stop for? ____ minutes".

      Upon collection of the accelerometer and completed parents AST report forms, children's AST
      form will be filled out in the classroom retrospectively in relation to the five previous
      school days (mornings). The only question to be asked to children in relation to the five
      days is: e.g. "On Monday did you walk or cycle to school, all or part of the journey?" At the
      end of the baseline week, those complying with the study protocol will be rewarded, as stated
      in advance on the information materials: a prompt return of the completed parent AST report
      form and undamaged accelerometer, and completed child AST report form in the classroom, will
      be essential requisites for receiving a £5 thank you voucher.

      Intervention phase The next stage of the RIGHT TRACKS consists in testing the feasibility of
      the incentive scheme. Similar to baseline, the quality of data from the three sources -
      accelerometry, parental AST report and child self-report of AST - will be examined. In
      particular, the validity of parental and child-reported AST will be assessed vis-à-vis
      accelerometry, currently considered to be one of the gold-standards. However, parental report
      of AST will be used as the basis of the incentive scheme. Once again, in both intervention
      and control conditions, there will be a £5 thanks voucher for every child taking part in the
      measurement procedures, in compliance with the protocol. At the end of the study, a debrief
      sheet will be handed to all participants, including parents and children, and to the two head
      teachers.

      Intervention group - incentive scheme The incentive scheme will be explained to the
      intervention group in an introductory session. Partway active trips will be given particular
      emphasis. Each subsequent session is anticipated to take no more than 25 minutes per week of
      the classroom time.

      The incentive scheme run in the intervention school consists of a prize draw taking place
      once a week. The prize is a £5 shopping gift voucher valid in a number of high street shops.
      Chances of winning depend entirely on the number of "points": the number of active trips to
      school reported exclusively by the parent on the AST report form, through the same questions
      used at baseline. For each week day that they travel to school the child gets one point. This
      point is the equivalent to a ticket with the child's ID number that will then be entering the
      draw. Each child can earn between zero and five tickets per week, depending on the number of
      active travel trips to school reported by the parent. Discrepant numbers between parental
      reports and those reported by the child or recorded on the accelerometer are of great
      interest for measurement, but will be disregarded for the purposes of the draw. In the
      absence of the parent AST report, the child report may be use for point count, but the child
      will be reminded that the parental report will be necessary for the next draw.

      A difference between baseline and intervention phase concerns the format of the parent AST
      report form, which may now be completed in writing as before, or by SMS text messages on the
      weeks the child is not wearing the accelerometer. Preference for either of the options can be
      stated in advance in the consent form. Parents will be asked to keep them, fill in and return
      on time every week (personally or via the child), as the programme proceeds. Mobile phone
      respondents will be notified daily by SMS, to which they can reply directly. Questions asked
      will be the same in the paper version and mobile phone. However, on the two weeks the child
      wears the accelerometer, all participants will be asked to use the parent AST report. When
      the child is not wearing the accelerometer, the only question asked on the parental form or
      text messages is whether the child walked/cycled to school all or part of the journey. For
      those wearing the accelerometer in the intervention school, the point will be credited as
      long as the first question is answered (i.e. if parent indicated whether child actively
      traveled but failed to complete questions on times).

      During the intervention phase, three tasks will be expected from children: (1) wearing an
      accelerometer for another seven-day period, which they must return to the classroom, together
      with the parent AST report form, (2) returning the parent AST report form in the remaining
      weeks (if applicable) and (3) complete an AST report form in the classroom each day of the
      draw.

      Thank you vouchers (£5) will be issued on timely receipt of the accelerometer (together with
      AST forms), even if the accelerometer turns out to not have been worn for the requested time
      (i.e. at least four days, including at least one weekend day, and 10 hours each day).

      The researcher will retire to a different room (or section of the school) and based on the
      parent AST report form only, points relative to the five previous days will be calculated. In
      the case of SMS, responses will be gathered in the evening, at the researcher's workplace,
      and next day's point will only be credited if received before 12noon (this will be stated in
      every text message that parents receive on a draw day). Class scores will be anonymously
      displayed on a graphic/chart week-after-week, in a printed version if possible or by hand if
      necessary. Depending on the school's preferences and availability, the logistics of counting
      points and producing tickets may be slightly different. For example, a teacher may agree to
      return all the completed parent AST reports to the school office in the morning, in which
      case the researcher could collect them and prepare the tickets in advance.

      After producing all the tickets, the researcher will return to the classroom to distribute
      the accelerometers to the next batch of users. Once the thank you vouchers and accelerometers
      have been sorted out, the draw will finally take place in the classroom. A ticket will be
      picked out of a black string bag, probably by a school staff member of by the researcher.
      Depending on parental choice specified on the consent form, the incentive scheme voucher will
      be provided to the winner straight away, or will be left in the school office for later
      collection by the parent. The class score graphic/chart will be put on display on the wall.

      Control group - normal curricular AST advice With the exception of the incentive scheme,
      identical procedures will be followed in both intervention and control groups. Each week, new
      groups of participants (e.g. the next five on the list) will be requested to wear the
      accelerometer, return the parent AST report form (if applicable) and complete their own AST
      report form.

      Qualitative study One component of this study consists of semi-structured interviews with
      children, parents/carers and stakeholders, both from experimental and control groups, to
      explore different perspectives associated with the proposed intervention and trial procedures
      and to help refine both. Willingness to be interviewed will be expressed in the consent form
      before baseline in the case of parents (in addition to assent form in the case of children),
      from which a purposive sample will be selected based on the socio-demographic variables
      assessed in the questionnaire. The researcher will directly invite teachers and head
      teachers, who in turn will suggest other stakeholders for interview among their acquaintances
      (snowball sampling).

      The aim will be to interview dropout participants throughout the intervention phase (as soon
      as they leave the study), and full participants immediately after the study has ended
      (January 2015). Sessions are expected to last between 30-45 minutes for adults and 15-30
      minutes for children. Verbal consent to take part and to have the session audio-taped will be
      requested at the onset (in the case of children, to parents first and then by verbal assent),
      and the confidential nature of all records will be reiterated. Data will be securely stored
      in compliance with Newcastle University's regulations.
    

Intervention name(s): Incentive scheme
Intervention type(s): Behavioral
Intervention description(s): Children who actively travel to school, full or partway, enter a weekly £5 voucher draw, whereby chances of winning are proportional to the number of trips as reported by the parent.
Other intervention name(s): Incentive-scheme, lottery-based scheme, intervention
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: active school travel; active travel; incentive scheme; children; school; behaviour change