School of Population Health & Environmental Sciences, King's College London, London, UK.
Public Health, London Borough of Lewisham, London, UK.
BMC Public Health. 2019 Aug 27;19(1):1167. doi: 10.1186/s12889-019-7511-9.
Existing evidence identifies health benefits for children of additional daily physical activity (PA) on a range of cardiovascular and metabolic outcomes. The Daily Mile (TDM) is a popular scheme designed to increase children's PA within the school day. Emerging evidence indicates that participation in TDM can increase children's PA, reduce sedentarism and reduce skinfold measures. However, little is known about the potential effects of TDM as a public health intervention, and the benefits and disbenefits that might flow from wider implementation in 'real world' settings.
We aimed to identify how TDM is being implemented in a naturalistic setting, and what implications this has for its potential impact on population health. We undertook a rapid ethnographic assessment of uptake and implementation in Lewisham, south London. Data included interviews (n = 22) and focus groups (n = 11) with stakeholders; observations of implementation in 12 classes; and analysis of routine data sources to identify school level factors associated with uptake.
Of the 69 primary schools in one borough, 33 (48%) had adopted TDM by September 2018. There were no significant differences between adopters and non-adopters in mean school population size (means 377 vs 397, P = 0.70), mean percentage of children eligible for free school meals (16.2 vs 14.3%, P = 0.39), or mean percentage of children from Black and Minority Ethnic populations (76.3 vs 78.2%, P = 0.41). Addressing obesity was a key incentive for adoption, although a range of health and educational benefits were also hypothesised to accrue from participation. Mapping TDM to the TIDierR-PHP checklist to describe the intervention in practice identified that considerable adaption happened at the level of borough, school, class and pupil. Population health effects are likely to be influenced by the interaction of intervention and context at each of these levels.
Examining TDM in 'real world' settings surfaces adaptions and variations in implementation. This has implications for the likely effects of TDM, and points more broadly to an urgent need for more appropriate methods for evaluating public health impact and implementation in complex contexts.
现有证据表明，儿童每天进行额外的身体活动（PA）对一系列心血管和代谢结果都有健康益处。“每日一英里”（TDM）是一种流行的方案，旨在增加学生在校期间的 PA。新出现的证据表明，参与 TDM 可以增加儿童的 PA，减少久坐行为，并减少皮脂厚度测量值。然而，对于 TDM 作为一种公共卫生干预措施的潜在影响，以及在“真实世界”环境中更广泛实施可能带来的益处和弊端，人们知之甚少。
我们旨在确定 TDM 在自然环境中是如何实施的，以及这对其对人群健康的潜在影响有何影响。我们在伦敦南部的刘易舍姆进行了一项快速的人种学评估，以了解其采用和实施情况。数据包括对利益相关者进行的访谈（n=22）和焦点小组讨论（n=11）；在 12 个班级中进行的实施观察；以及分析常规数据源，以确定与采用相关的学校层面因素。
在一个行政区的 69 所小学中，截至 2018 年 9 月，有 33 所（48%）采用了 TDM。采用 TDM 的学校和未采用 TDM 的学校在平均学校人数（分别为 377 人和 397 人，P=0.70）、符合条件的免费学校餐儿童的平均比例（分别为 16.2%和 14.3%，P=0.39）或儿童来自黑人和少数民族人口的平均比例（分别为 76.3%和 78.2%，P=0.41）方面没有显著差异。解决肥胖问题是采用 TDM 的一个关键动机，尽管也假设参与 TDM 还会带来一系列健康和教育方面的益处。根据 TIDierR-PHP 清单对 TDM 进行映射以描述实践中的干预措施，发现干预措施在行政区、学校、班级和学生层面都发生了很大的变化。人群健康效果可能受到这些层面上干预措施和背景之间相互作用的影响。
在“真实世界”环境中检查 TDM 会发现实施中的适应和变化。这对 TDM 的可能效果有影响，并更广泛地指出迫切需要更适当的方法来评估复杂环境中的公共卫生影响和实施情况。
