Poster Presentation ANZOS Annual Scientific Meeting 2021

Development, piloting, adaptation and scale-up trial of Physical Activity 4 Everyone (PA4E1): An implementation intervention to improve schools adoption of practices designed to increase students’ physical activity (#224)

Tom C McKenzie 1 , Matthew P Mclaughlin 1 2 3 4 , Rachel Sutherland 1 2 3 4 , Elizabeth Campbell 1 2 3 4 , Lynda Davies 1 2 3 4 , Luke Wolfenden 1 2 3 4 , John H Wiggers 1 2 3 4
  1. Hunter New England Population Health, Wallsend, NSW, Australia
  2. School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
  3. Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
  4. Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, NSW, Australia

Background: School physical activity (PA) programs that have demonstrated effectiveness on a small scale need to be scaled-up to achieve population level health outcomes. We report the development, piloting, adaptation and scale-up trial of Physical Activity 4 Everyone (PA4E1), a 24-month program targeting adolescents attending schools located in low socioeconomic areas.

Methods: PA4E1 has undertaken a four step scale-up process (from 2012-2019): 1) Development of PA4E1 pilot trial (2012), inclusive of both evidence-based school PA practices and implementation support strategies to support schools to embed these practices; 2) Conduct of pilot randomised controlled trial (RCT) (from 2012-2014) in 10 secondary schools, evaluating the effectiveness (student PA and weight status) and cost-effectiveness; 3) Adaptation of PA4E1 for a scale-up trial (2016); 4) A scale-up hybrid implementation effectiveness RCT (n=49) to evaluate practice uptake by schools (primary outcome), device-measured student PA (secondary outcome) and a comprehensive process evaluation (from 2017-2019).

Results: 1) The pilot program comprised of seven PA practices and six implementation support strategies; 2) Pilot RCT found positive intervention effects on student PA and unhealthy weight gain, and was deemed cost-effective; 3) 20 adaptations were made for scale-up, resulting in seven PA practices and seven support strategies. A minority of adaptations (n=2) were fidelity inconsistent; 4) At 24-month follow up of the scale-up trial, school uptake of 4 or more practices (primary outcome) was significantly higher in the program group (16/23, 69%) than the control group (0/25, 0%) (p<0.001). Analysis of student and process evaluation outcomes in progress.

Conclusion: PA4E1 has been developed, piloted, adapted and subsequently scaled-up. Results of the scale-up trial indicate that schools can be supported to implement the seven PA supportive practices. Policy-makers and practitioners responsible for advocating PA in schools should consider this implementation approach.