Co-designing a behaviour change intervention to increase physical activity in a primary school

Purpose: A significant number of children fail to meet recommended daily physical activity levels, increasing their risk of poor health and wellbeing in the future. The us of school settings to deliver physical activity interventions in schools is common despite evidence suggesting they are not effective in increasing physical activity. This failure could, in part, be attributed to a lack of consideration of local context. Acknowledging the importance of local factors, the Medical Research Council emphasises the need for early stakeholder engagement in complex intervention development and implementation.

Method: This study used Experience-Based Co-Design (EBCD) principles and the
Behaviour Change Wheel to develop a primary school intervention for improving childhood physical activity. Purposive sampling was used to recruit 45 participants from one school, 15 pupils, parents, and school staff each. The process involved setting up, collecting pupil, parent, and staff experiences, and a co-design event to finalise and agree on possible intervention for each identified priority. To address power dynamics, initial validation occurred solely with pupils to shape the co-design priorities. Pupils also had opportunity to provide feedback and approval of final interventions. This approach increased the likelihood of designing an intervention acceptable to the student population.

Results: Following the co-design event, two interventions were crafted. The first involves a daily group walk for 15 minutes per day, incorporating gamification with steps or distance tracking and certificates of achievement awarded for engagement. The second is an after-school fitness class for staff, children, and parents, led by school PE department. The school also acted independently to create a walking track with a learning area, fostering outdoor learning during the school day.

Conclusion: EBCD empowers and engages stakeholders in a collaborative process of problem solving and intervention design. It can be effective in developing tailored, complex health interventions for schools which are responsive to local needs and stakeholder contexts. Following completion of the process, the school was able to independently implement interventions enhancing children's activity opportunities leading to increased opportunity for all pupils and staff to be more active during the school .