Closing the gap between practice and science in school- and community-based participatory physical literacy promotion: study protocol of the StuPs project

Increasingly sedentary behavior in children constitutes a growing global challenge, although awareness of the role of physical activity in optimizing children’s health is ubiquitous [1, 2]. Despite the various health benefits of physical activity on physical, psychosocial, cognitive, motor skill, and language development [3], only 20% of children and adolescents worldwide meet the World Health Organization (WHO)‘s physical activity recommendations of 60 min per day [2]. Similar data resulted from a German health survey from 2014 to 2017 conducted by the Robert Koch Institute: only 22.4% of girls and 29.4% of boys met the WHO’s recommendations [4] - a far cry from the German physical activity recommendations of 90 min or more per day among elementary school children [5]. These data have also shown that time spent physically exercising correlates positively with socioeconomic status and negatively with age. Therefore, the challenge remains to develop efficient and sustainable strategies for promoting physical activity among children. The StuPs project: a school- and community-based participatory approach for promoting physical activity in children and their families, was developed for this purpose, particularly in response to “Bewegung und Bewegungsförderung” (“exercise and physical activity promotion”), the German Federal Ministry of Health’s call for funding [6]. The aim of this call was to spread the knowledge of the German recommendations for physical activity in the sense of health in all policies. Currently, there is no gold standard for promoting physical activity in young children, especially among vulnerable groups; despite this, school-based and multicomponent approaches are suspected to be most efficient. Because schools are the optimal environment for reaching a great number of youth demographics, school-based approaches seem to have high efficacy [5]. However, physical activity promotion in schools seems to have a limited impact on children’s movement behavior during their leisure time [7]. Current evidence assumes greater success in preventing childhood obesity if entire communities are involved in creating and promoting healthy environments [8]. The inclusion of additional out-of-school aspects within the scope of multicomponent approaches and the inclusion of families, communities, policies, and stakeholders in a participatory manner is recommended [5, 7]. Participatory approaches, such as community-based participatory research (CBPR) [9], have the potential to generate synergy, reach greater acceptance within the target group, and engender increased engagement [8, 10], especially in combination with capacity building [8, 11]. On a behavioral level, the available evidence supports an approach that promotes physical literacy, a construct that indicates the basis for an active lifestyle and serves as “a primary determinant of health and disease” [12]. Physical literacy thus focuses on skill acquisition. In this way, it is similar to the construct of health literacy, which inculcates the ability to find, understand, evaluate, and apply health information and therefore combines knowledge with motivation and competence [13, 14]. To date, no intervention combining physical literacy with community-based strategies has been conducted. Therefore, the StuPs project aims to close this gap between science and practice by implementing a participatory and interdisciplinary multicomponent approach targeting both schools and communities in two socially deprived areas in Cologne (North Rhine-Westphalia, Germany) within the scope of capacity building for physical literacy promotion.

Individual habits and behaviors as well as environments (e.g., immediate surroundings, neighborhoods, schools, local policies) have a great impact on a child’s health status [19]. Therefore, healthy environments need to be created, and StuPs has been developed to achieve this aim. This approach is grounded in CBPR [9] and intervention mapping [16], both of which have evidence-based efficacy e.g. in terms of anthropometric and behavioral changes as well as environmental and political outcomes [8, 16, 17]. Previous studies have reported increasing success in terms of intensity of community engagement and participation [8, 10]. In addition, the StuPs approach has been developed following CBPR and intervention mapping to build upon existing knowledge and experiences. Although the rough procedure is comparable with other approaches, StuPs differs in its aim to improve physical literacy in children and their families. Most other community-based approaches have addressed health promotion in general or healthy weight in children specifically [8]. Currently reported physical literacy interventions have mainly been conducted in schools, especially physical education classes [20]. StuPs is unique in its aim to promote physical literacy at the community level, thereby reaching children not only where they learn but also where they live and play. This potential arises from increased scientific attention because physical literacy is assumed to be fundamental in creating physically active lifestyles [20]. According to Carney et al. [12], physical literacy is “a gateway” to lifelong physical activity and is crucial for a positive attitude toward movement. In addition to personal and individual factors such as age, gender, motor skills and psychosocial development, one’s environment is assumed to impact one’s degree of physical literacy [21]. The development of healthy environments - including walkable neighborhoods, opportunities to move and play, and opportunities to participate in sports and physical activity - could motivate and support children and families to develop active and therefore healthy lifestyles. For this reason, the intention of the StuPs project is to spread the knowledge of the physical literacy construct beyond schools and among community stakeholders, which, in combination with capacity building, will create healthy environments and therefore support children in developing more active lifestyles. It is expected that improved physical literacy knowledge among stakeholders will lead to increased readiness to change structures and build capacities for healthy environments for districts’ children. To maintain closure of the gap between science and practice in these efforts, there will be cyclical, iterative reports at the community level within specific working groups. The members of the working groups are practical experts on different community- and district-related issues, and they will support the overall project duration through discussion of any barriers and obstacles that appear. The project will benefit from their expertise and experience as well as incorporate feedback and further impulses and ideas. This will be especially helpful when preparing the transfer guideline to ensure that it is as feasible as possible. With this approach, StuPs intends to contribute knowledge of supporters and barriers to promote sustainable physical activity in the scientific interest of the German Federal Ministry of Health.