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Scaling up Action Schools! BC: How Does Voltage Drop at Scale Affect Student Level Outcomes? A Cluster Randomized Controlled Trial

Author

Listed:
  • Lindsay Nettlefold

    (Active Aging Research Team, Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC V5Z 1M9, Canada)

  • Patti-Jean Naylor

    (School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC V8P 5C2, Canada)

  • Heather M. Macdonald

    (Active Aging Research Team, Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC V5Z 1M9, Canada
    Department of Family Practice, University of British Columbia, Vancouver, BC V6T 1Z3, Canada)

  • Heather A. McKay

    (Active Aging Research Team, Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC V5Z 1M9, Canada
    Department of Family Practice, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
    Department of Orthopaedics, University of British Columbia, Vancouver, BC V5Z 1M9, Canada)

Abstract

Action Schools! BC (AS! BC) was scaled-up from an efficacy trial to province-wide delivery across 11 years (2004–2015). In this study we: (1) describe strategies that supported implementation and scale-up; (2) evaluate implementation (teachers’ physical activity (PA) delivery) and student’s PA and cardiorespiratory fitness (CRF) within a cluster randomized controlled trial during years 2 and 3 of scale-up; and (3) assess relationships between teacher-level implementation and student-level outcomes. We classified implementation strategies as process, capacity-building or scale-up strategies. Elementary schools ( n = 30) were randomized to intervention (INT; 16 schools; 747 students) or usual practice (UP; 14 schools; 782 students). We measured teachers’ PA delivery ( n = 179) using weekly logs; students’ PA by questionnaire ( n = 30 schools) and accelerometry ( n = 9 schools); and students’ CRF by 20-m shuttle run ( n = 25 schools). INT teachers delivered more PA than UP teachers in year 1 (+33.8 min/week, 95% CI 12.7, 54.9) but not year 2 (+18.8 min/week, 95% CI −0.8, 38.3). Unadjusted change in CRF was 36% and 27% higher in INT girls and boys, respectively, compared with their UP peers (year 1; effect size 0.28–0.48). Total PA delivered was associated with change in children’s self-reported MVPA (year 1; r = 0.17, p = 0.02). Despite the ‘voltage drop’, scaling-up school-based PA models is feasible and may enhance children’s health. Stakeholders must conceive of new ways to effectively sustain scaled-up health promoting interventions if we are to improve the health of students at a population level. Clinical Trials registration: NCT01412203.

Suggested Citation

  • Lindsay Nettlefold & Patti-Jean Naylor & Heather M. Macdonald & Heather A. McKay, 2021. "Scaling up Action Schools! BC: How Does Voltage Drop at Scale Affect Student Level Outcomes? A Cluster Randomized Controlled Trial," IJERPH, MDPI, vol. 18(10), pages 1-24, May.
  • Handle: RePEc:gam:jijerp:v:18:y:2021:i:10:p:5182-:d:553971
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    References listed on IDEAS

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    1. Gavin Yamey, 2011. "Scaling Up Global Health Interventions: A Proposed Framework for Success," PLOS Medicine, Public Library of Science, vol. 8(6), pages 1-5, June.
    2. Rick L. Williams, 2000. "A Note on Robust Variance Estimation for Cluster-Correlated Data," Biometrics, The International Biometric Society, vol. 56(2), pages 645-646, June.
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    1. Harriet Koorts & Adrian Bauman & Nancy Edwards & William Bellew & Wendy J. Brown & Mitch J. Duncan & David R. Lubans & Andrew J. Milat & Philip J. Morgan & Nicole Nathan & Andrew Searles & Karen Lee &, 2022. "Tensions and Paradoxes of Scaling Up: A Critical Reflection on Physical Activity Promotion," IJERPH, MDPI, vol. 19(21), pages 1-16, November.
    2. Man Jiang & Hongli Yu & Juan He & Guoping Qian & Marcin Bialas, 2023. "Professional Development Workshop for Physical Education Teachers in Southwest China: Benefiting Tai Chi Students with Pedagogical Content Knowledge," Sustainability, MDPI, vol. 15(13), pages 1-16, July.

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