Hankonen Nelli, Absetz Pilvikki, Araújo-Soares Vera
Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
Department of Public Health and Clinical Nutrition, University of Eastern Finland, Joensuu, Finland.
Health Psychol Behav Med. 2020 Sep 27;8(1):440-460. doi: 10.1080/21642850.2020.1813036.
School-based interventions that increase physical activity (PA) in a sustainable way are lacking. Systematic and participatory, theory and evidence-based intervention development may enhance the effectiveness of complex behavioural interventions in the long term. However, detailed descriptions of the intervention development process are rarely openly published, hindering transparency and progress in the field. To illustrate a stepwise process to develop intervention targeting PA and sedentary behaviour (SB) among older adolescents, and to describe the final, optimised version of the intervention, detailing content of sessions by theoretical determinants and techniques. Two established intervention development frameworks (Intervention Mapping and Behaviour Change Wheel) were integrated, leading to a comprehensive evidence and theory-based process. It was informed by empirical studies, literature reviews, expert and stakeholder consultation, including scenario evaluation and component pre-testing. In all steps, contextual fit and potential for sustainability were ensured by stakeholder engagement. As a large majority of youth opposed decreasing screen time, increasing PA and decreasing SB were defined as target behaviours, with peers and the school context including classroom practices as key social environments in influencing youth PA (problem specification, step 1). Behavioural diagnosis (step 2) identified a variety of determinants in the domains of capability (e.g. self-regulation skills), motivation (e.g. outcome expectations) and environmental opportunities. These were organised into an intervention theory integrating several formal theories, including Self-Determination Theory. Theory-aligned principles guided material design (Step 3). Feasibility RCT allowed optimisation into a final intervention protocol (step 4). Intervention elements target students directly, and indirectly by changing teacher behaviour and the school and wider environment. A systematic development and optimisation led to a high potential for sustainability. The detailed intervention content, with specification of the hypothesised mechanisms, allows for other researchers to replicate, adapt or refine parts or the whole intervention, considering specific target groups and (sub-)cultures.
缺乏以可持续方式增加身体活动（PA）的校本干预措施。系统的、参与性的、基于理论和证据的干预措施开发可能会长期提高复杂行为干预措施的有效性。然而，干预措施开发过程的详细描述很少公开出版，这阻碍了该领域的透明度和进展。为了说明针对青少年晚期PA和久坐行为（SB）开发干预措施的逐步过程，并描述干预措施的最终优化版本，按理论决定因素和技术详细说明各环节的内容。整合了两个既定的干预措施开发框架（干预映射和行为改变轮），形成了一个全面的基于证据和理论的过程。该过程以实证研究、文献综述、专家和利益相关者咨询为依据，包括情景评估和组件预测试。在所有步骤中，通过利益相关者的参与确保了与背景的契合度和可持续性潜力。由于绝大多数青少年反对减少屏幕时间，因此将增加PA和减少SB定义为目标行为，将同龄人以及包括课堂实践在内的学校环境视为影响青少年PA的关键社会环境（问题明确，步骤1）。行为诊断（步骤2）确定了能力（如自我调节技能）、动机（如结果期望）和环境机会等领域的多种决定因素。这些因素被组织成一个整合了多种正式理论（包括自我决定理论）的干预理论。与理论一致的原则指导材料设计（步骤3）。可行性随机对照试验允许将其优化为最终的干预方案（步骤4）。干预要素直接针对学生，并通过改变教师行为以及学校和更广泛的环境间接针对学生。系统的开发和优化带来了很高的可持续性潜力。详细的干预内容以及假设机制的说明，使其他研究人员能够考虑特定目标群体和（亚）文化，复制、调整或完善部分或整个干预措施。
