ABSTRACT

Background:

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.

Objective:

The two objectives were (i) 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; (ii) examine the usage, subjective experience and usability of the PA4E1 program website from the perspective of in-School Champions using mixed-methods.

Methods:

The first objective used website usage data collected across all users (n=273) throughout the nine school terms of the PA4E1 implementation support. The four 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.

Results:

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 nine themes and two 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 the website content was acceptable and appropriate, and identified specific suggestions for improvement.

Conclusions:

Digital health interventions targeting physical activity often suffer with issues of lack of user engagement. In 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 multi-delivery 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. Clinical Trial: ACTRN12617000681358