Background
Methods
Study protocol
The UP4FUN intervention
Step 1: Analysis of health and quality of health
|
Development of chronic diseases and overweight and obesity in children
|
Step 2: Analysis of risk factors
|
Role of sedentary behaviour, independent from PA
|
Sedentary behaviour = both screen-time and non-screen time activities
| |
Step 3: Analysis of determinants of risk behaviours
|
Literature reviews
|
- importance of family environment
| |
- importance of individual factors
| |
Step 4: Intervention program development
|
Stakeholders interviews on parental involvement and possible intervention activities
|
Choosing behaviour change techniques for the identified determinants
| |
Pretesting of core components in five European countries
| |
Step 5: Implementation of the UP4FUN intervention
|
Teacher training
|
Teacher manual
|
Themes | Intervention components | Link with determinants and behavior change techniques |
---|---|---|
Week 1: Introduction to the project
| - Teacher gives information on the project | - Knowledge: information about the health-behaviour link (I) |
- Children start wearing bracelet | - Attitude: Intention information (I) | |
- NEWS 1: ‘Welcome!’ | - Knowledge: Information about health-behaviour link (IP) | |
Week 2: Awareness of children’s sitting time
| - Children register sitting time for several sedentary activities (e.g. reading, TV,.) | - Awareness: self-monitoring with normative feedback (I) |
- Children register steps for three activities at home | ||
- Children make a list of 3 indoor and 3 outdoor fun non-sedentary activities and share it with family | ||
- NEWS 2: ‘Awareness of time spent sitting’ | ||
Week 3: Evaluation of the sitting time
| - Based on sitting time in week 2, children write personal goal and try it out for one week | - Awareness: Goal setting with self-rewarding use (I) |
- Children evaluate personal goal with ‘smileys’ and ‘frownies ‘(stickers) | - Automaticity: Use of prompts (I) | |
- Children write down 3 difficulties regarding achieving their personal goal and 3 solutions | - Self-efficacy: Barrier identification (I) | |
- NEWS 3: ‘Helping and supporting your child to aim for less sitting time’ | - Awareness of child behaviour: Monitoring child behaviour (IP) | |
Week 4: Influencing factors at home
| - Children write down number of pupils in class with rules about screen-time and some examples of the rules, share this with parents and discuss family rules | - Parenting rules: Opportunities for social comparison (IP) |
- Children and then parents guess number of screens at home by category (TV, computer, games) before children count them | - Availability of screens: Barrier identification (IP) | |
- NEWS 4: ‘Do screens control your family life?’ | ||
Week 5: Breaking up sitting time and active transportation
| - Children brainstorm ideas for non-sedentary recess activities and write it down on a poster | - Role modeling: modeling and demonstrating behaviour (O) |
- Teacher conduct activity breaks per sitting lesson | - Role modeling: identification as role models (I) | |
- Children are motivated to try the activity breaks at home | ||
- Children are encouraged to practice active transport to school | ||
- NEWS 5: ‘Short activity breaks are better than no breaks at all’ | ||
Week 6: Family Fun Event
| - The family participates in the Family Fun Event (to summarize the project and share experiences) | - Social support: Plan social support and social change (IP) |
- NEWS 6: ‘Thank you for taking part in the UP4FUN project’ |
Sedentary time and PA measurement
Instrumentation
Measurement protocol
Demographic variables
Statistical analyses
Results
Sample characteristics
Effect of the UP4FUN-intervention on sedentary time, LPA and MVPA
n = 372 | n(I) = 141 | PRE | POST | Time | Time * COND |
---|---|---|---|---|---|
n(C) = 231 | ß (SE) | ß (SE) | |||
SED day | I | 63.3% | 66.5% |
2.18 (0.59)***
| 0.96 (0.86) |
C | 63.8% | 66.0% | |||
SED weekday | I | 64.1% | 66.7% |
1.07 (0.47)*
| 1.48 (0.78) |
C | 64.8% | 65.9% | |||
SED weekend day | I | 62.2% | 66.4% |
4.17 (0.88)***
| 0.03 (1.41) |
C | 63.2% | 67.4% | |||
SED school hours | I | 62.4% | 62.9% | -0.22 (0.46) | 0.70 (0.75) |
C | 62.9% | 62.7% | |||
SED after school | I | 60.8% | 65.8% |
3.32 (0.67)***
| 1.69 (1.09) |
C | 62.3% | 65.7% | |||
SED boutsa
| I | 14.57 min | 14.49 min | 0.20 (0.14) | -0.28 (0.23) |
C | 14.43 min | 14.63 min | |||
LPA day | I | 32.2% | 30.1% |
-1.51 (0.44)***
| -0.56 (0.71) |
C | 31.7% | 30.2% | |||
LPA weekday | I | 31.5% | 28.9% |
-0.89 (0.41)*
| -0.83 (0.67) |
C | 31.2% | 30.3% | |||
LPA weekend day | I | 34.1% | 30.9% |
-3.52 (0.76)***
| 0.29 (1.22) |
C | 33.6% | 30.1% | |||
LPA school hours | I | 32.4% | 32.5% | 0.03 (0.40) | 0.10 (0.65) |
C | 32.4% | 32.4% | |||
LPA after school | I | 34.9% | 31.1% |
-2.30 (0.55)***
| -1.48 (0.90) |
C | 33.7% | 31.4% | |||
MVPA day | I | 3.9% | 3.2% | -0.22 (0.12) |
-0.44 (0.19)*
|
C | 3.6% | 3.3% | |||
MVPA weekday | I | 4.1% | 3.4% | -0.12 (0.13) |
-0.58 (0.20)**
|
C | 3.8% | 3.7% | |||
MVPA weekend day | I | 3.7% | 2.7% |
-0.65 (0.22)**
| -0.30 (0.36) |
C | 3.2% | 2.6% | |||
MVPA school hours | I | 5.0% | 4.3% | 0.17 (0.15) |
-0.80 (0.25)**
|
C | 4.6% | 4.7% | |||
MVPA after school | I | 4.0% | 2.9% |
-1.00 (0.17)***
| -0.06 (0.28) |
C | 3.9% | 2.8% |
n = 225 | n(I) = 84 | PRE | POST | Time | Time * COND |
---|---|---|---|---|---|
n(C) = 141 | ß (SE) | ß (SE) | |||
SED day | I | 62.7% | 65.2% |
1.89 (0.69)**
| 0.66 (1.13) |
C | 64.6% | 66.5% | |||
SED weekday | I | 63.3% | 65.4% | 0.79 (0.60) | 1.36 (0.99) |
C | 65.7% | 66.4% | |||
SED weekend day | I | 62.0% | 64.8% |
3.32 (1.14)**
| -0.53 (1.85) |
C | 64.2% | 67.5% | |||
SED school hours | I | 61.8% | 62.0% | -0.50 (0.58) | 0.69 (0.95) |
C | 63.5% | 63.0% | |||
SED after school | I | 60.4% | 64.7% |
3.01 (0.82)***
| 1.28 (1.35) |
C | 63.0% | 66.0% | |||
SED boutsa
| I | 14.43 min | 14.33 min | 0.22 (0.17) | -0.32 (0.28) |
C | 14.48 min | 14.70 min | |||
LPA day | I | 32.6% | 31.2% | -1.06 (0.56) | -0.41 (0.92) |
C | 30.9% | 29.9% | |||
LPA weekday | I | 32.1% | 30.7% | -0.70 (0.53) | -0.71 (0.87) |
C | 30.6% | 29.9% | |||
LPA weekend day | I | 34.1% | 32.1% |
-2.68 (0.97)**
| 0.64 (1.58) |
C | 32.8% | 30.1% | |||
LPA school hours | I | 32.7% | 33.2% | 0.15 (0.51) | 0.33 (0.84) |
C | 32.0% | 32.2% | |||
LPA after school | I | 35.4% | 31.9% |
-1.99 (0.69)**
| -1.46 (1.13) |
C | 33.1% | 31.1% | |||
MVPA day | I | 4.1% | 3.6% | -0.15 (0.14) | -0.37 (0.23) |
C | 3.4% | 3.2% | |||
MVPA weekday | I | 4.4% | 3.7% | -0.03 (0.15) |
-0.59 (0.25)*
|
C | 3.6% | 3.6% | |||
MVPA weekend day | I | 3.4% | 2.9% |
-0.44 (0.20)*
| -0.11 (0.48) |
C | 2.7% | 2.3% | |||
MVPA school hours | I | 5.3% | 4.6% | 0.37 (0.19) |
-1.06 (0.31)***
|
C | 4.3% | 4.7% | |||
MVPA after school | I | 4.1% | 3.2% |
-1.06 (0.22)***
| 0.15 (0.36) |
C | 3.8% | 2.7% |
n = 372 | n(I) = 141 | PRE (%) | POST (%) | Time | Time * COND |
---|---|---|---|---|---|
n(C) = 90 | ß (SE) | ß (SE) | |||
SED day | I | 63.8% | 67.8% |
2.69 (0.80)***
| 1.33 (1.28) |
C | 62.4% | 65.1% | |||
SED weekday | I | 64.7% | 67.8% |
1.54 (0.75)*
| 1.61 (1.21) |
C | 63.4% | 65.0% | |||
SED weekend day | I | 61.4% | 67.7% |
5.47 (1.35)***
| 0.80 (2.16) |
C | 60.8% | 66.3% | |||
SED school hours | I | 62.8% | 63.8% | 0.22 (0.74) | 0.70 (1.19) |
C | 61.7% | 61.9% | |||
SED after school | I | 61.2% | 67.3% |
3.81 (1.13)***
| 2.25 (1.82) |
C | 61.4% | 65.2% | |||
SED boutsa
| I | 14.65 min | 14.48 min | 0.25 (0.19) | -0.42 (0.30) |
C | 14.22 min | 14.47 min | |||
LPA day | I | 32.4% | 29.4% |
-2.26 (0.68)***
| -0.73 (1.10) |
C | 33.3% | 31.0% | |||
LPA weekday | I | 31.4% | 29.2% | -1.24 (0.64) | -0.95 (1.03) |
C | 32.5% | 31.2% | |||
LPA weekend day | I | 34.9% | 29.9% |
-4.86 (1.17)***
| -0.14 (1.88) |
C | 35.7% | 30.9% | |||
LPA school hours | I | 32.6% | 32.2% | -0.16 (0.63) | -0.25 (1.02) |
C | 33.5% | 33.3% | |||
LPA after school | I | 34.4% | 30.1% |
-2.79 (0.91)**
| -1.47 (1.47) |
C | 34.5% | 31.7% | |||
MVPA day | I | 3.6% | 2.7% | -0.33 (0.20) | -0.54 (0.32) |
C | 3.8% | 3.4% | |||
MVPA weekday | I | 3.8% | 2.9% | -0.24 (0.22) | -0.58 (0.35) |
C | 4.0% | 3.7% | |||
MVPA weekend day | I | 3.2% | 2.2% |
-0.53 (0.25)*
| -0.46 (0.40) |
C | 3.2% | 2.7% | |||
MVPA school hours | I | 4.4% | 3.9% | -0.13 (0.25) | -0.43 (0.40) |
C | 4.7% | 4.6% | |||
MVPA after school | I | 3.8% | 2.4% |
-1.02 (0.28)***
| -0.37 (0.45) |
C | 3.9% | 2.9% |
Differences within the intervention group
n = 141 | Independent variables | |||||
---|---|---|---|---|---|---|
Age | Gender | Ethnicity | Living status | Having siblings | ||
(ref: Oldest age group; n = 70)
|
(ref: Girls; n = 82)
|
(ref. Dutch language; n = 129)
|
(ref. Living with both parents; n = 109)
|
(ref: Having one or more siblings; n = 122)
| ||
Dependent variables
| ||||||
SED day | ß (SE) | -0.22 (0.42) | -0.49 (0.42) | -0.18 (0.78) |
-1.02 (0.47)*
| -0.84 (0.59) |
(ref: decreasing; n = 35)
| OR (CI) | 0.80 (0.35-1.84) | 0.62 (0.27-1.41) | 0.84 (0.18-3.84) |
0.36 (0.14-0.90)
| 0.43 (0.14-1.37) |
SED weekday | ß (SE) | -0.41 (0.40) | -0.35 (0.40) | 1.31 (1.09) | -0.76 (0.47) | -0.13 (0.61) |
(ref: decreasing; n = 40)
| OR (CI) | 0.67 (0.30-1.46) | 0.70 (0.32-1.55) | 3.71 (0.44-31.73) | 0.47 (0.19-1.17) | 0.88 (0.26-2.94) |
SED weekend day | ß (SE) | -0.32 (0.40) | -0.07 (0.41) | 0.69 (0.88) | -0.14 (0.49) |
-1.51 (0.59)*
|
(ref: decreasing; n = 40)
| OR (CI) | 0.72 (0.33-1.60) | 0.93 (0.42-2.07) | 1.99 (0.36-11.03) | 0.87 (0.33-2.27) |
0.22 (0.07-0.70)
|
SED school | ß (SE) | -0.59 (0.45) | -0.49 (0.39) | 0.06 (0.74) | -0.68 (0.48) | -0.02 (0.59) |
(ref: decreasing; n = 68)
| OR (CI) | 0.55 (0.23-1.34) | -0.49 (0.39) | 1.06 (0.25-4.52) | 0.51 (0.20-1.29) | 0.98 (0.31-3.15) |
SED after school | ß (SE) | -0.014 (0.41) | -0.45 (0.42) | -0.32 (0.76) |
-0.92 (0.47)*
| 1.19 (0.82) |
(ref: decreasing; n = 36)
| OR (CI) | 0.99 (0.44-2.22) | 0.64 (0.28-1.45) | 0.73 (0.16-3.20) |
0.40 (0.16-1.00)
| 3.23 (0.66-16.40) |
SED bouts | ß (SE) | -0.44 (0.40) | 0.30 (0.37) | 0.27 (0.72) | -0.03 (0.44) | -0.67 (0.56) |
(ref: decreasing; n = 66)
a
| OR (CI) | 0.96 (0.44-2.10) | 1.36 (0.66-2.80) | 1.32 (0.32-5.34) | 0.97 (0.41-2.28) | 0.62 (0.32-1.20) |
LPA day | ß (SE) | -0.33 (0.39) | -0.47 (0.40) | 0.05 (0.77) | -0.71 (0.46) | -0.49 (0.34) |
(ref: increasing; n = 43)
| OR (CI) | 0.72 (0.33-1.56) | 0.63 (0.29-1.36) | 1.05 (0.23-4.70) | 0.49 (0.20-1.21) | 0.62 (0.32-1.20) |
LPA weekday | ß (SE) | -0.39 (0.42) | -0.37 (0.39) | 0.77 (0.84) |
-1.08 (0.47)*
| -0.03 (0.60) |
(ref: increasing; n = 52)
| OR (CI) | 0.68 (0.30-1.53) | 0.69 (0.32-1.50) | 0.16 (0.42-11.21) |
0.34 (0.14-0.85)
| 0.97 (0.30-3.16) |
LPA weekend day | ß (SE) | -0.50 (0.38) | 0.25 (0.39) | -0.10 (0.71) | -0.54 (0.45) | -1.06 (0.58) |
(ref: increasing; n = 49)
| OR (CI) | 0.60 (0.29-1.28) | 1.28 (0.59-2.77) | 0.91 (0.23-3.65) | 0.58 (0.24-1.55) | 0.35 (0.11-1.09) |
LPA school | ß (SE) |
-1.17 (0.44)**
|
-1.06 (0.41)*
| -0.50 (0.74) | -0.92 (0.50) | 0.20 (0.63) |
(ref: increasing; n = 77)
| OR (CI) |
0.31 (0.12-0.73)
|
0.35 (0.15-0.78)
| 0.61 (0.14-2.60) | 0.40 (0.15-1.06) | 1.22 (0.35-4.20) |
LPA after school | ß (SE) | -0.10 (0.40) | -0.55 (0.40) | -0.15 (0.74) | -0.68 (0.46) | 0.36 (0.64) |
(ref: increasing; n = 40)
| OR (CI) | 0.90 (0.42-1.96) | 0.58 (0.26-1.26) | 0.86 (0.20-3.71) | 0.51 (0.21-1.25) | 1.43 (0.41-5.01 |
MVPA day | ß (SE) | -0.01 (0.42) | 0.74 (0.45) | 0.08 (0.74) | -0.61 (0.47) | -0.12 (0.65) |
(ref: increasing; n = 35)
| OR (CI) | 0.99 (0.44-2.25) | 2.10 (0.87-5.07) | 0.92 (0.22-3.95) | 0.54 (0.22-1.37) | 0.89 (0.25-3.19) |
MVPA weekday | ß (SE) | 0.09 (0.40) | 0.34 (0.41) | 0.68 (0.84) | -0.82 (0.45) | 0.14 (0.65) |
(ref: increasing; n =39)
| OR (CI) | 1.09 (0.50-2.38) | 1.40 (0.63-3.14) | 1.97 (0.38-10.18) | 0.44 (0.18-1.07) | 1.14 (0.32-4.06) |
MVPA weekend day | ß (SE) | -0.04 (0.19) | -0.10 (0.18) | 0.25 (0.40) | -0.19 (0.25) | 0.13 (0.28) |
(ref: increasing; n = 43)
| OR (CI) | 0.96 (0.67-1.38) | 0.90 (0.63-1.30) | 1.29 (0.59-2.82) | 1.21 (0.74-5.43) | 1.13 (0.65-1.97) |
MVPA school | ß (SE) | 0.08 (0.43) | 0.56 (0.39) | 0.34 (0.73) | -0.56 (0.46) | 0.03 (0.60) |
(ref: increasing; n =54)
| OR (CI) | 1.08 (0.47-2.52) | 1.74 (0.81-3.75) | 1.40 (0.33-5.91) | 0.57 (0.43-1.41) | 1.03 (0.32-3.31) |
MVPA after school | ß (SE) | -0.52 (0.39) | -0.35 (0.39) | 0.19 (0.75) | -0.44 (0.47) | 1.43 (0.81) |
(ref: increasing; n = 43)
| OR (CI) | 0.59 (0.28-1.27) | 0.71 (0.33-1.53) | 0.82 (0.19-3.55) | 0.64 (0.26-1.62) | 4.18 (0.86-20.26) |