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Protocol for the Virtual Traveller Cluster-Randomised Controlled Trial: A behaviour change intervention to increase physical activity in primary-school Maths and English lessons Journal: BMJ Open Manuscript
Protocol for the Virtual Traveller Cluster-Randomised Controlled Trial: A behaviour change intervention to increase physical activity in primary-school Maths and English lessons Journal: BMJ Open Manuscript ID bmjopen-0-0 Article Type: Protocol Date Submitted by the Author: -Mar-0 Complete List of Authors: Norris, Emma; Epidemiology & Public Health Dunsmuir, Sandra; University College London, Department of Clinical, Educational and Health Psychology Duke-Williams, Oliver; University College London, Department of Information Studies Stamatakis, Emmanuel; University of Sydney, Charles Perkins Centre; University of Sydney Faculty of Health Sciences Shelton, Nicola; University College London, Department of Epidemiology and Public Health b primary Subject Heading /b : Public health Secondary Subject Heading: Paediatrics Keywords: physical activity, schools, intervention, physically active lessons - Page of BMJ Open Protocol for the Virtual Traveller Cluster-Randomised Controlled Trial: A behaviour change intervention to increase physical activity in primary-school Maths and English lessons Norris, E a,*., Dunsmuir, S b., Duke-Williams, O c., Stamatakis, E., d,e,a Shelton, N a. a Department of Epidemiology & Public Health, University College London, - Torrington Place, London, WCE HB, UK b Department of Clinical, Educational and Health Psychology, University College London, Bedford Way, London, WCH 0AP, UK c Department of Information Studies, University College London, Foster Court, London, WCE BT, UK d Charles Perkins Centre, Prevention Research Collaboration, School of Public Health, Sydney Medical School, University of Sydney, Australia e Faculty of Health Sciences, University of Sydney, Australia * Corresponding author Tel address: Word count: words (main text only) - Page of Abstract Introduction: Physical activity has been shown to be a vital factor for health and educational outcomes in children. However, a large proportion of children s school day is spent in sedentary lesson time. There is emerging evidence about the effectiveness of physically active lessons: integrating physical movements and educational content in the classroom. Virtual Traveller is a novel -week intervention of 0-minute sessions using classroom interactive whiteboards to integrate movement into primary-school Maths and English teaching. The primary aim of this project is to evaluate the effect of the Virtual Traveller intervention on children s physical activity, on-task behaviour and student engagement. Methods and analysis: This study will be a randomised controlled trial with a waiting-list control group. Ten Year (aged - years) classes across ten primary schools will be randomised by class to either the -week Virtual Traveller intervention or waiting-list control group. Data will be collected five times: at baseline, at weeks and of the intervention and week and months postintervention. At baseline, anthropometric measures, -day objective physical activity monitoring (including two weekend days; Actigraph accelerometer), physical activity and on-task behaviour observations and student engagement questionnaires will be performed. All but anthropometric measures will be repeated at all other data collection points. Changes in overall physical activity levels and levels during different time-periods (e.g lesson-time) will be examined. Changes to on-task behaviour and student engagement between intervention groups will also be examined. Multilevel regression modelling will be used to analyse the data. Process evaluation will be carried out during the intervention period. Ethics and dissemination: The results of this study will be disseminated through peer-review publications and conference presentations. Ethical approval was obtained through the University College London Research Ethics Committee (Reference Number: 00-00). - Page of BMJ Open Strengths and Limitations Strengths of this study are: use of objective monitoring to assess physical activity assessment of both physical activity and educational outcomes A limitation of this study is its reliance on self-selected participation from teachers and classes. This may limit the applicability of findings to wider teaching environments. Introduction Physical activity in children has been linked to a range of positive health outcomes, including improved cardio-metabolic profiles and motor skills. Physical activity has also been shown to improve educational outcomes, such as on-task behaviour, cognitive function and academic achievement. However despite these wide-ranging benefits, children currently spend around. hours a day in sedentary activities, found to be negatively associated with health and educational outcomes. Obligatory seated classroom lessons are an important contributor to this typically sedentary lifestyle. As both physical activity 0 and sedentary behaviour levels have been found to track into adulthood, it is vital that active habits are facilitated as much as possible during childhood. Although schools and teachers are obliged by the National Curriculum and OFSTED assessments to facilitate physical activity and overall health and wellbeing; a lack of time is typically cited by teachers as the primary barrier for physical activity provision. As such, interventions have - Page of attempted to make educational time more physically active via physically active lessons. These integrate educational content with physical movements in the classroom environment: allowing curriculum and health objectives to be simultaneously addressed. Physically active lessons are distinct from activity- or brain-breaks which provide bouts of classroom-based PA without educational content. Examples of physically active lesson programmes include Take 0! and Physical Activity Across the Curriculum (PAAC) : largely limited to American populations. A recent systematic review of emerging physically active lesson research found increased light and moderate-to-vigorous physical activity (MVPA) levels, 0 on-task behaviour and academic achievement. However, this existing evidence-base has mostly assessed physical activity during the school day only and featured limited sample sizes. Despite being relatively novel interventions, reporting of intervention details in physically active lesson research is often poor, preventing replication in research and educational contexts. The effects of physically active lessons on student engagement, an essential precursor for learning reflecting an individual s behaviours and cognitions related to learning and the school environment has not yet been assessed. Physically active lesson research has also not utilised available classroom technology of interactive whiteboards, used to deliver educational content in over 0% of UK classrooms. The Virtual Traveller intervention was developed to address these identified issues. It provides 0- minute sessions of physically active Virtual Field Trips (VFTs) for teachers to deliver via the class interactive whiteboard during Maths and English teaching. VFTs allow classes to explore pre-selected locations around the world, using their movements to simulate interaction with and travel to destinations. The Virtual Traveller intervention has been developed following mixed methods feasibility work. A one-off VFT pilot intervention comparing a physically active VFT with a sedentary version found significantly reduced sedentary time and increased light and MVPA time in active VFT pupils. A qualitative feasibility study of teacher interviews and pupil focus groups found positive - Page of BMJ Open perceptions of active VFTs as a fun, simple and inclusive method of combining movement and teaching. Hypotheses and Aims Following previous evidence into physically active lessons and a pilot study, we hypothesise that the Virtual Traveller intervention will: ) increase children s time in light physical activity and MVPA and reduce sedentary time during the school day, ) increase children s time in light physical activity and MVPA and reduce sedentary time during lesson-time and ) improve on-task behaviour during lesson times. The primary aim of the study is to evaluate the provision of the Virtual Traveller intervention on children s physical activity, on-task behaviour and student engagement. Methods and analysis Study design Virtual Traveller is a -week classroom-based physically active lesson intervention. It will be evaluated using a cluster-randomised randomised controlled trial with a waiting-list control group. The waiting-list control group will be provided with the full programme of Virtual Traveller sessions after the final data collection period. Data collection will take place on a rolling basis from March 0 until May 0. Baseline data collection will take place, before classes are randomised by computer programme to either intervention or waiting-list control groups. Data will be collected twice during the -week intervention period at weeks and and twice at week and months follow-up (Figure ). Recruitment and study participants Ten public primary schools from in and around Greater London will be recruited to participate in the Virtual Traveller study. One Year (aged -) class from each school will participate, with the Virtual Traveller programme content developed around Maths and English National Curriculum for this - Page of year-group. Single classes across multiple schools will be recruited as adding sites (schools in this study) is more consequential for multilevel modelling power than adding participants per site. Schools will be recruited via ) Public Health and School Sports organisations in boroughs across Greater London and ) via social media participant calls from the study s developed Twitter account. These recruitment approaches will be used as a very low follow-up rate (0%) was experienced by approaching schools on an individual basis via in the previous pilot study. Following initial expressed interest, a face-to-face visit will be organised to explain the study details to participating head-teachers and teachers before schools give their final agreement to participate. To recruit children into the study, the lead researcher (EN) will deliver a 0-minute presentation to participating classes two weeks prior to baseline assessment, introducing the Virtual Traveller project, accelerometer devices and benefits of participating. At the end of presentations, participants were provided with hard copy parent and pupil information and informed consent sheets and a parent questionnaire to complete and return. To encourage participant retention and accelerometer wear adherence, an ongoing incentive competition will be run within each class. A certificate will be given to the child in each class with the longest accelerometer wear-time at each data collection phase. Also, the child in each class with the longest overall wear time across intervention phases will be given a certificate and 0 activity vouchers for their local leisure centre. To prevent potential bias from this competition element, the researcher will remind all pupils at each data collection phase that the prize is based on their wear-time alone and not based on how active they are. Intervention The Virtual Traveller programme is designed to be integrated into Year National Curriculum Maths and English teaching. The programme consists of eighteen, 0-minute physically active Virtual Field Trip sessions, to be run times a week over the -week intervention period. Nine sessions are based - Page of BMJ Open on English and nine on Maths content. Sessions were developed with consultative support from two Year teachers identified during qualitative feasibility work. Each session has its own identifying code number, with a summary of all sessions provided in Figure. Sessions can be run in any order to best suit content being taught by teachers at the time. Sessions can also be run at any point of Maths and English teaching, i.e. not restricted to being used as a starter or plenary only. Globebased movement throughout sessions also makes them highly cross-curricular, combining Maths, English and Geographical content. Qualitative feasibility work identified that the sessions should be provided on simple, familiar software to best facilitate teacher-use. Virtual Traveller sessions will hence be provided on ubiquitous Microsoft Powerpoint software with embedded Google Earth videos via USB stick. Sessions will be delivered using classroom interactive whiteboards. Teachers will stand and lead each session, read included questions and movement prompts and demonstrate movements. Pupils will stand behind their desks and complete prompted movements throughout each session. Included Google Earth videos will show transitions between locations on a virtual globe, with accompanying text prompting children to simulate appropriate movements as they travel, such as running on-thespot. Additional images, YouTube videos and sound effects were also included to add interest. Detailed overviews of example Maths and English Virtual Traveller sessions are provided in Appendices A & B. - Teacher training Following baseline measurements and randomisation, all intervention classroom teachers will be required to attend a 0-minute one-on-one training session with the lead researcher. This will organised according to the teachers availability, either before- or after-school, or during teachers preparation, planning and assessment (PPA) time. Training will briefly outline research showing the benefits of child physical activity on health, education and wellbeing (~ minutes). Teachers will then be asked to reflect on the extent they integrate physical activity into their own teaching and discuss - Page of their experiences of this (~ minutes). An outline of Virtual Traveller will then be given, detailing the length, intensity and features of the intervention. A sample Virtual Traveller session will be demonstrated by the researcher on their laptop (~ minutes). The process evaluation log sheet will then be introduced: requiring teachers to record which Virtual Traveller sessions they run, when and their perceived success out of. Teachers will be requested to complete the log immediately after each session to minimise forgetting. Finally, a Virtual Traveller Guide will be introduced and provided for teachers to use as a reference document during the intervention (~ minutes). This includes brief information on how to access the Virtual Traveller sessions, a brief summary of all sessions and description of physical activities included, and an answer key for questions included within sessions. The researcher will also discuss the teacher s upcoming short and medium term planning to see how the Virtual Traveller programme could best be imbedded into their Maths and English teaching (~0 minutes). and telephone contact details for the researcher will be given to support all teachers with intervention or measurement procedure queries during the study. Procedures Data collection procedures will take place over months in each participating class. The lead researcher will collect data on a date convenient to each class teacher. Data collection sessions will last approximately twenty minutes. Anthropometric assessments will be taken at baseline only, taking an additional 0 minutes. Objective devices (accelerometers) will be given to children to monitor their physical activity behaviour as soon as they arrive at school on the first day of each data collection phase. It is recommended that accelerometers are worn for at least days to provide a reliable estimate of children s habitual physical activity. 0 Devices will hence be provided to participating children for full days ( weekdays and weekend days) at each data collection phase, to capture school- and leisure-time activity. Trained researchers will observe children s physical activity and on-task behaviour during Virtual Traveller sessions (in intervention pupils only) or typical teaching (control pupils and intervention pupils during baseline and follow-up assessments). A - Page of BMJ Open student engagement questionnaire will be provided to pupils. On day, participants will return the device to the lead researcher at school. This process will be repeated at all data collection points. After baseline assessments, cluster randomisation of classes to intervention or waiting-list control groups will be done via computer programme. Randomisation will continue until five intervention classes and five control classes are allocated. Waiting-list control classes will continue to receive their normal teaching during the study: receiving teacher training and the full intervention on USB stick after the final data collection point. Use of behaviour change theory and techniques As identified in the aforementioned systematic review, physically active lesson research has been largely atheoretical to date. This study embeds the COM-B model (Figure ) to increase children s physical activity during lesson-time and beyond. The key COM-B model cognitions of Capability, Opportunity and Motivation are applied within the Virtual Traveller intervention context to maximise physical activity behaviour change. As the provision of physically active lessons is ultimately the decision of the teacher, it is important that such interventions address teacher cognitions specifically. Firstly, teachers capability to integrate activity into teaching is addressed in this study via teacher training: planning how and when Virtual Traveller sessions will be integrated into Maths and English teaching. Head-teacher support is also secured via a face-to-face meeting with the researcher to ensure teachers capability is supported at an institutional level. Secondly, teachers opportunity to teach physically active lessons must be increased. Virtual Traveller provides this by physically supplying relevant, ready-made teaching resources and ensuring activities are suitable given class space restrictions. Teacher s motivation to teach physically active lessons is addressed by providing Virtual Traveller sessions that are quick to run, provided on familiar Powerpoint software and produce visible activity and educational benefits to pupils. - Page 0 of As identified in the aforementioned systematic review, specific reporting of physically active lesson intervention details to date has been mostly weak. By reporting the exact nature and content of these novel interventions in a standardised way, studies can be more accurately compared and replicated. To aid replication of the Virtual Traveller intervention, the Behaviour Change Techniques (BCTs) embedded into the intervention and its procedures are reported according to the Behaviour Change Technique Taxonomy Version (BCTTv). BCTs represent the active ingredients of interventions influencing behaviour change in participants. The BCTs embedded during teacher training and the intervention itself are listed in Figure. For example, during teacher training the researcher worked with participating teachers to formulate action plans (BCT.) on how they would integrate the three Virtual Traveller sessions each week into their Maths and English teaching. During the intervention, a Virtual Traveller-branded teacher log was placed on the wall by the teacher s computer as a prompt (BCT.) to remind them to run the Virtual Traveller sessions. Measurement and instruments - Anthropometric At baseline, weight was assessed by the researcher to the nearest 0. kg (Weight Watchers U electronic scales, Milton Keynes, UK) and height to the nearest mm ( metre tape measure). Body Mass Index (BMI; kg m²) was then produced from these measurements, to allow assessments of potential differential effects of the Virtual Traveller intervention between BMI categories. Underweight, overweight and obesity prevalence was estimated using the nd, th and th percentiles of the 0 UK reference curves. - Acce
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