Mclaughlin Matthew, Duff Jed, McKenzie Tom, Campbell Elizabeth, Sutherland Rachel, Wiggers John, Wolfenden Luke
School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
Hunter New England Population Health, Wallsend, Australia.
JMIR Pediatr Parent. 2021 Jul 26;4(3):e26690. doi: 10.2196/26690.
Effectively scaled-up physical activity interventions are urgently needed to address the high prevalence of physical inactivity. To facilitate scale-up of an efficacious school-based physical activity program (Physical Activity 4 Everyone [PA4E1]), provision of implementation support to physical education (PE) teachers was adapted from face-to-face and paper-based delivery modes to partial delivery via a website. A lack of engagement (usage and subjective experience) with digital delivery modes, including websites, may in part explain the typical reduction in effectiveness of scaled-up interventions that use digital delivery modes. A process evaluation focused on the PA4E1 website was undertaken.
The 2 objectives were to (1) describe the usage of the PA4E1 program website by in-school champions (PE teachers leading the program within their schools) and PE teachers using quantitative methods; (2) examine the usage, subjective experience, and usability of the PA4E1 program website from the perspective of in-school champions using mixed methods.
The first objective used website usage data collected across all users (n=273) throughout the 9 school terms of the PA4E1 implementation support. The 4 usage measures were sessions, page views, average session duration, and downloads. Descriptive statistics were calculated and explored across the duration of the 26-month program. The second objective used mixed methods, triangulating data from the first objective with data from a think-aloud survey and usability test completed by in-school champions (n=13) at 12 months. Qualitative data were analyzed thematically alongside descriptive statistics from the quantitative data in a triangulation matrix, generating cross-cutting themes using the "following a thread" approach.
For the first objective, in-school champions averaged 48.0 sessions per user, PE teachers 5.8 sessions. PE teacher sessions were of longer duration (10.5 vs 7.6 minutes) and included more page views (5.4 vs 3.4). The results from the mixed methods analysis for the second objective found 9 themes and 2 meta-themes. The first meta-theme indicated that the website was an acceptable and appropriate delivery mode, and usability of the website was high. The second meta-theme found that the website content was acceptable and appropriate, and identified specific suggestions for improvement.
Digital health interventions targeting physical activity often experience issues of lack of user engagement. By contrast, the findings from both the quantitative and mixed methods analyses indicate high usage and overall acceptability and appropriateness of the PA4E1 website to school teachers. The findings support the value of the website within a multidelivery mode implementation intervention to support schools to implement physical activity promoting practices. The analysis identified suggested intervention refinements, which may be adopted for future iterations and further scale-up of the PA4E1 program.
Australian New Zealand Clinical Trials Registry ACTRN12617000681358; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372870.
为应对身体活动不足的高患病率，迫切需要有效扩大身体活动干预措施。为促进一项有效的校本身体活动计划（全民身体活动[PA4E1]）的扩大推广，对体育教师的实施支持从面对面和纸质交付模式调整为通过网站进行部分交付。对包括网站在内的数字交付模式缺乏参与度（使用情况和主观体验），可能部分解释了使用数字交付模式的扩大推广干预措施效果通常会降低的原因。针对PA4E1网站进行了一项过程评估。
两个目标是：（1）使用定量方法描述校内倡导者（在其学校领导该计划的体育教师）和体育教师对PA4E1计划网站的使用情况；（2）从校内倡导者的角度，使用混合方法检查PA4E1计划网站的使用情况、主观体验和可用性。
第一个目标使用了在PA4E1实施支持的9个学校学期中收集的所有用户（n = 273）的网站使用数据。4项使用指标为会话次数、页面浏览量、平均会话时长和下载量。在为期26个月的计划期间计算并探索描述性统计数据。第二个目标使用混合方法，将第一个目标的数据与12个月时校内倡导者（n = 13）完成的出声思考调查和可用性测试的数据进行三角测量。定性数据与定量数据的描述性统计数据一起在三角测量矩阵中进行主题分析，使用“顺藤摸瓜”方法生成交叉主题。
对于第一个目标，校内倡导者平均每位用户有48.0次会话，体育教师有5.8次会话。体育教师的会话持续时间更长（10.5分钟对7.6分钟），且包含更多页面浏览量（5.4次对3.4次）。第二个目标的混合方法分析结果发现了9个主题和2个元主题。第一个元主题表明该网站是一种可接受且合适的交付模式，网站的可用性很高。第二个元主题发现网站内容是可接受且合适的，并确定了具体的改进建议。
针对身体活动的数字健康干预措施经常遇到用户参与度不足的问题。相比之下，定量和混合方法分析的结果均表明，PA4E1网站对学校教师的使用率很高，总体上可接受且合适。这些结果支持了该网站在多交付模式实施干预中的价值，以支持学校实施促进身体活动的实践。分析确定了建议的干预改进措施，可用于PA4E1计划的未来迭代和进一步扩大推广。
澳大利亚新西兰临床试验注册中心ACTRN12617000681358；https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372870。
