Abstract
Intervention participants' responses to and engagement with interventions are a key intermediate step between interventions and intended outcomes. The aim of this study was to qualitatively investigate crucial aspects of engagement, namely acceptability (experienced cognitive and emotional responses to the intervention), receipt (comprehension of intervention content), and skill enactment (skill performance in target settings), within the Let's Move It, a multi-component school-based physical activity intervention. A longitudinal qualitative study embedded in a cluster-randomized trial, with individual interviews of purposefully sampled intervention participants immediately post-intervention (n=21) and at 14months (n=14). Semi-structured interviews were analysed using thematic analysis. Abductive coding process was taken to identify categories for themes. The analysis resulted in 12 themes and 18 subthemes. Overall, participants reported perceived effectiveness of and affective attitude towards the intervention (acceptability) and understood the main messages and skills (receipt). For example, findings indicated comprehension of the non-judgemental nature and choice-providing messages of the intervention underpinned by self-determination theory. Despite reporting understanding how and why to perform the skills, not using them was a highlighted theme (skill enactment), particularly for self-regulatory techniques such as planning. Friends' role as key self-motivation technique was a prevalent theme. In the within-individual analysis, three different engager types were identified: positive, ambivalent, and negative. Identifying misunderstandings and difficulties in skill acquisition can help interpret main trial outcomes and inform further intervention optimization. This study provides an example of how to use thematic analysis to assess acceptability, receipt, and enactment in interventions.
Highlights
Analysis Thematic analysis with essentialist approach was used as the analytical method; that is, participants’ responses were assumed to reflect their experiences, meanings, and reality
Not all of the dimensions of the theoretical framework of acceptability (TFA; Sekhon et al, 2017) are present, as the themes were first identified based on the data and compared to TFA
Optimization efforts could be guided towards reframing the self-regulatory skills more clearly as fit for anyone and less time-consuming, and underpinning the automation of their use in daily life
Summary
Intervention participants’ responses to and engagement with interventions are a key intermediate step between interventions and intended outcomes. The student intervention component was formulated based on selfdetermination theory (Deci & Ryan, 2000), reasoned action approach (Fishbein & Ajzen, 2010), and self-regulation theories (Carver & Scheier, 1982) providing participants with behaviour change techniques (BCTs; Michie et al, 2013) and PA-promoting choice architecture (Hankonen et al, 2016) It included (1) group sessions (S1–S6) and a poster campaign (targeting autonomous PA motivation, and self-regulation skills such as planning, SMART goal-setting, self-monitoring, and self-motivation), (2) active classrooms (e.g., gym balls and standing desks, teachers trained to give activity breaks), and (3) enhanced PA opportunities (Hankonen et al, 2016). Skill use outside the intervention setting, and how it aligns with the intended intervention (enactment; Figure 1)
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