Diagnostic assessment and the first intervention strategies in a program to promote physical activity from secondary eduaction centres

RESUMEN

The study appears the concern that has schools and current society to find appropriate strategies for promoting physical activity, with solutions that necessarily take into account the empowerment of the actors to be real agents of the promotion of physical activity (Grenier, Otis & Harvey, 2010). The strategies are designed from an interdisciplinary approach, adopting a social-ecological framework (Sallis & Owen, 1997).

The aim was to perform a diagnostic evaluation to obtain regular physical activity levels with accelerometry and to show the influence of mediating variables. Through focus groups we have obtained also the expectations of different sectors (students, teachers and parents). The study is conducted in four schools, two as controls and two as experimental groups, using as a target group of 223 adolescents in the first year of secondary education.

Our study shows not comply with international recommendations, in the case of girls is more pronounced (Martínez-Gómez, Welk, Calle, Mark & Veiga, 2009). Variables such as gender and perception of competence have to take into account for intervention proposals (Troiano, Berrigan, Dodd, Masse, Tilert & McDonnell, 2008). The knowledge and analysis of these results is a first step to design together strategies that promote physical activity.

INTRODUCTION

In recent years the literature has reinforced the knowledge on the relationship between adequate levels of physical activity and health benefits (Ferreira, Van der Horst, Wendel-Vos, Kremers, Van Lenthe & Brug, 2006). Because of the lack of effectiveness in the actions carried out, is essential a change of direction in the search for strategies to promote physical activity (Timperio, Salmon & Ball, 2004; Hillsdon, Foster, & Thorogood, 2005).

Our goal was to intervene in a school setting to encourage the development of a healthier environment, more dynamic, more able to promote active lifestyles, creating more opportunities to be physically active during recess, before or after school hours or at other times of the day.

The results obtained in earlier studies were consistent with the concerns, which in recent years has been collecting the scientific literature that suggests that interventions in school settings can be effective to develop behaviors related with a healthy lifestyle among children and adolescents .The results indicate that the best strategy to improve long-term health may be to create lifestyle models that include the practice of regular physical activity to persist into adulthood (Dobbins, from Corby, Robeson, Husson & Tirillis, 2009 ) and look for solutions to promote the empowerment and the awareness of all agents and actors (Gillander Gadin, Weiner & Ahlgren, 2009).

OBJECTIVES

The main objective of this study was to perform a diagnostic evaluation as to show the influence of mediating in physical activity levels as a first step to design strategies that promote physical activity in an adolescent population in the city of Huesca. 

methodology

Sample

The development of the study was carried out in four schools in the city of Huesca.
After measuring the baseline, the schools were selected by assigning two of them the character of the experimental group to receive 3 years of intervention and the role the other two control group. The target group are 223 adolescents, 116 boys (12.16 SD = 0.52 years) and 107 girls (12.16 SD = 0.50 years).
Being a study with objective measurement of physical activity levels using accelerometers, selection has been conditioned by the availability of access to subjects that are likely to carry the accelerometer for 7 days and completing the questionnaires, students were selected by voluntary participation always having the legal permission of the head teacher and the parents or guardian, and the consent for each participant.

The intervention is, however, with the all school community (teachers, parents and the students). The control group continued with their programs and structure of normal work, without receiving intervention.

Design   

This study present a cuasiexpermiental design structure, with the participation of two experimental groups and two control groups to compare the results between these groups (pre-postest measures) after the implementation of an intervention program.
A special part is the preparation of the intervention program, who is contextualized in the micro-environment of each of the schools identified as experimental groups, with the participation of the educational community (students, teachers and parents) using focus group.

The research project is designed for a three-year. In the first year, which corresponds to the data reported in this work, we performed the diagnostic evaluation to start the first intervention strategies, which continue for the next two years. The evolution of the variables involved in the study will be done annually.

Dependent variables and instruments

The variables presented in the following table have been taken into account in the diagnostic evaluation.

TTable 1. Dependent variables of the study

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Independent variable: Intervention Program

The starting point for designing the program was the establishment the baseline to confirm the problems that we had detected in general. For this analysis, we measured regular physical activity levels with accelerometry and the impact of mediating variables with questionnaire. Furthermore, we recorded a number of views of different agents and actors involved in the daily life of the context through focus groups.

The intervention program needs to be extended in time to settle in schools and can generate a positive impact. To monitor and evaluate its implementation is chosenas target first of ESO group and will be increasing gradually during three years (see figure 1).

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Figure 1. Study sample

The main objectives of this intervention program are creating a more active participation of all actors and agents in the educational community and increase the levels of habitual physical activity.

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Figure 2. Summary of the establishment of the baseline

Procedure  

Participants wear an accelerometer for two weeks (one in winter and another in spring) 7 consecutive days every week. Establishing minimum 10 hours to have a valid data in a day (Penpraze, Reilly, MacLean, Montgomery, Kelly, Paton & Aitchison, 2006). Data collection was planned through a period or “epoch” of 30 seg, and the exclusion criteria were not complete records of at least three weekdays and one weekend (Rowlands, Pilgrin & Eston, 2008) and secondly that the student was ill or injured.
The method for the preparation of the intervention program responds to a complex dynamic. It is made in the first place, a Reference Core formed by the project coordinator (who is a member of the research group of the University), and six participants representing different sectors the community in which they are inserted schools (Health, Council, Education, Companies that organized extracurricular activities in schools). This nucleus acts as a reference, and as a guarantee that the development process is connected with the different administrative realities they represent (see Figure 3).

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The strategies of health promotion and physical activity are usually “only” and “unrepeatable”, the program is structured using the Working Groups are formed in each specific context (see Figure 3). Each school will form working groups with representatives of the different actors involved in school life in order to guide strategies for promoting physical activity and to develop a climate of participation and involvement in a gradual way throughout the school year. This working model has been proposed in other studies with empowerment models (Hagquist & Starrin, 1997), and assumed to have the figure of a facilitator in each school in the experimental group, which help in the management and working together toward a common goal trying to get a process of empowerment in the educational community and creating awareness and sensitivity to the center of which is the promotion of physical activity.

At the end of each school year will be a review of the results between the working group and reference core obtained the necessary information for the following years courses.
Statistical analysis
The statistical analysis was performed using the SPSS 15.0 software. for Windows. Different analysis (descriptive statistics, ANOVA, T- Student for related samples and lineal regression analysis) were made.

results and DISCUsSIoN

We first present the results for physical activity levels. The figure 4 shows the moderate-vigorous physical activity by gender and each of the days of the week. We found significant differences (p <0.01) during the seven days among boys and girls, always with higher values in males, like in other studies (Martínez-Gómez, Welk, Calle, Mark & Veiga, 2009; Trost, Pate, Freedson, Sallis & Taylor, 2000; Riddoch, Andersen, Wedderkopp, Harro, Klasson-Heggebo, Sardinha, Cooper & Ekelund, 2004, Welk, Schaber & Shelley, 2004; Treuth, Schmitz, Catelli, McMurray, Murray, Almeida, Going, Norman & Pate, 2004, Armstrong & Welsman, 2006; Hernandez, 2009; Hernández, Ferrando, Quiles, Aragones, & Terreros , 2010).In addition, the figure 4 show that our students do not meet the recommendations in both cases (boys and girls), as reflected in other research with accelerometry (Riddoch & Aznar, 1996; Sarkin, McKenzie & Sallis, 1997; Pate, Stevens, Pratt , Sallis, Schmitz, Webber, Welk & Young, 2006; Hernández, 2009, Hernández et al, 2010).

If we observe the days in weekdays the figure 4 shows similar values between minutes of moderate-vigorous activity, except on Monday that both girls as boys are fewer minutes of physical activity. This data should be contrasted in followings records which may provide more accurate physical activity patterns. At the weekend the values are similar, with a decrease on Sunday compared to Saturday, both girls as for boys. In other studies, the data of moderate-vigorous physical activity on weekdays and weekends, reflecting a greater difference, in some cases reflecting values (Klasson-Heggebo & Anderssen, 2003; Nader, Bradley, Houts, McRitchie & O’Brien, 2009) higher during the week the weekend and in other research with questionnaires (Cantera and Devis, 2002; Peiró-Velert, Devis, Beltran & Fox, 2008) occurs the opposite.

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Figure 4. Moderate-vigorous activity per weekday and gender. ( *p<0,01)

In addition to obtaining the physical activity levels, it seemed very important to know the incidence of some of the mediating variables that could influence the levels of physical activity. Applying the questionnaires presented in the dependent variables, the results are displayed in table 2. Analyzing the data descriptively, we found significant differences in gender, enjoyment and perceived competence (p <0.01).

Table 2. The descriptive results of the dependent variables.

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 On the other hand, when performing a linear regression analysis (see Figure 5), we found that the factors significantly associated with physical activity levels are gender (β = 0.392 p <0.001) and perceived competence (β = 0.265 p < 0.05), explaining 29.4% of the variance of the behavior of physical activity. In addition we obtain that autonomy (β = 0.282 p <0.001) and perceived competence (β = 0, 158, p <0.05) positively, and demotivation  in Physical Education negatively (β = -0.289 p <0.001), have an indirect impact on physical activity levels through perceived competence (R2 = 0.408).

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Figure 5. Results of the regression analysis

From the results, the intervention program was created and is being generated from the production of working groups from a space or a platform for reflection, awareness, empowerment and ultimately the formation of all actors and agents involved in the life of schools. The process of working groups and the incorporation of new teachers was a fundamental result.
We have created an information channel that work consistently and effectively, who has done more awareness to the education community. This has been the use of reports, present the results of physical activity levels and other mediating variables after each measurement. Are configured as a useful tool for the design of strategies.
After to know the diagnostic evaluation and with the information from all sectors (students, teachers and parents), we designed the features and components of strategies to promote physical activity, and we interpreted the reasonable formula or component to begin the intervention could be from the Tutorial Action.

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Figura 6. Components of the intervention program

conclusions

The study aims, in collaboration with all those who form the educational community intervention centres, maximizing actions to increase physical activity levels and promote healthy lifestyles that encourage optimal levels of health or well-being among adolescents. This research is designed as part of a comprehensive health education, as Jourdan points (2004), requires a culture of common health as well as accompanying actors on their training and also work together. Therefore, the first part of the study, presented at this work has resulted in the creation of working group and working method to follow, after the establishment of the diagnostic evaluation.

Low levels of regular physical activity and gender difference, according to the literature, show the need to promote active lifestyles among adolescents, with an essential organizing strategies to address specific problems evidenced. Therefore, during the next two years we will define and implement specific intervention strategies from the empowerment and participation of agents and actors of the educational community, aimed at enhancing levels of physical activity, focus on gender difference, perceived competence, autonomy and motivation. Assessing whether the implementation of these strategies will increase the physical activity levels.
The educational centers s have started their activity with the premise that at the end of the study will have some data about physical activity levels of their students and other variables that can predict the behaviour of physical activity in adolescents, after the implementation of intervention.

In our country there have been many descriptive studies that indicate low levels of physical activity in adolescents, but there is a lack of intervention studies aimed to reduce this deficit. Finally, in general, intervention programs, national and international, are not defined from the participation of all actors and agents who have responsibility in physical activity promotion. Our intervention, will build strategies that will be directed from a transversal approach, adopting a social-ecological framework. The effectiveness of the program will look for solutions to promote the empowerment and awareness of the agents and actors. Setting a projection out of the results and immediate knowledge, as well as teacher training through different actors that form the Core of Reference (Education and Health). The project will direct their steps toward everyday situations in order to progress beyond the experimental stages.

ACKNOWLEDGEMENTS

Supported by CSD and the Government of Aragon and is integrated into the Red Aragonesa de Proyectos de Promoción de la Salud. We appreciate the vital support of the four schools participating in the study, in addition to the collaboration and involvement of different sectors of the community (Reference Core) that are inserted in the schools we work with.

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