Development of a School-Based Intervention to Increase Physical Activity Levels Among Chinese Children: A Systematic Iterative Process Based on Behavior Change Wheel and Theoretical Domains Framework.

Haiquan Wang,Kaushik Chattopadhyay,Holly Blake

doi:10.3389/fpubh.2021.610245

Abstract

Regular physical activity has a range of benefits for children's health, academic achievement, and behavioral development, yet they face barriers to participation. The aim of the study was to systematically develop an intervention for improving Chinese children's physical activity participation, using the Behavior Change Wheel (BCW) and Theoretical Domains Framework (TDF). The BCW and TDF were used to (i) understand the behavior (through literature review), (ii) identify intervention options (through the TDF-intervention function mapping table), (iii) select content and implementation options [through behavior change technique (BCT) taxonomy and literature review], and (iv) finalize the intervention content (through expert consultation, patient and public involvement and engagement, and piloting). A systematic iterative process was followed to design the intervention by following the steps recommended by the BCW. This systematic process identified 10 relevant TDF domains to encourage engagement in physical activity among Chinese children: knowledge, memory, attention and decision processes, social influences, environmental context and resources, beliefs about capabilities, beliefs about consequences, social/professional role and identity, emotions, and physical skills. It resulted in the selection of seven intervention functions (education, persuasion, environmental restricting, modeling, enablement, training, and incentivization) and 21 BCTs in the program, delivered over a period of 16 weeks. The BCW and TDF allowed an in-depth consideration of the physical activity behavior among Chinese children and provided a systematic framework for developing the intervention. A feasibility study is now being undertaken to determine its acceptability and utility.

Highlights

Health benefits of physical activity among children are vast [1, 2]
We identified four systematic reviews that synthesized the reasons for low engagement in physical activity among Chinese children [14, 76,77,78]
Chinese children are reported to have insufficient physical activity opportunities, and they spend the majority of their time on academic attainment [54,55,56,57]

Summary

Introduction

Health benefits of physical activity among children are vast [1, 2]. Regular participation in physical activity can improve children’s overall health (e.g., cardiovascular health, mental health, musculoskeletal health) and can contribute to their social well-being [3]. The World Health Organization’s (WHO) physical activity guideline recommends a minimum of 60 min of moderate-to-vigorous physical activity (MVPA) per day among children aged 5–17 years, including vigorous activities and activities that strengthen muscles and bones at least 3 days per week [1]. 25% of Chinese children have spent over 30 min on MVPA in primary school (aged 7–12 years) whilst only 15% and 10% of junior middle children (aged 13–15 years) and junior high children (aged 16–18 years), respectively [10] This is consistent with several national and international surveys that have reported children’s physical activity starts to decline at 10–12 years of age [17, 18]. It can be beneficial to target health behaviors (including physical activity) at this transition period as children approach adolescence

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