Physical activity (PA) is associated with lower levels of many risk factors among children including lipid levels [1
], blood pressure [1
] and body mass [3
]. Screen-viewing (SV), (e.g., watching television, playing video games and surfing the internet), is associated with an increased risk of heart disease [5
] and obesity [3
]. Many children exceed recommended hours of SV [6
] and do not engage in sufficient amounts of PA [9
]. The early school years (6–8 years of age) are a key period when children’s PA and SV behaviors are established [3
]. A number of systematic reviews have indicated that currently there are only a limited number of effective interventions to change children’s physical activity [11
] or prevent obesity via increased PA [12
] highlighting a need for new, more effective approaches.
The majority of interventions that have attempted to increase children’s PA or reduce their SV have been delivered during curriculum time at school and have required manipulation of physical education provision, or involved educational components that are designed to increase children’s ability to change their behavior [11
]. However, a number of systematic reviews and meta-analyses have shown that PA / SV interventions delivered within the school setting have reported null, weak or inconsistent effects [11
]. Where interventions were successful, they tended to use several different intervention strategies [11
]. As such, non-school approaches that utilize multiple intervention strategies need to be investigated [16
Parents provide key socializing influences on their children’s PA [17
] with parental support for PA being strongest before children’s transition to adolescence [18
]. Parental PA facilitation (i.e., providing access, financial and transportation forms of PA support) is positively associated with objectively-assessed PA [18
] among children. In addition, parental restriction of SV is associated with lower child SV [20
]. Efforts to empower parents with the knowledge, skills, resources and support to facilitate active lifestyles among their children are warranted.
Although it has been argued that PA and SV are distinct behaviors [21
] and that change in one behavior does not necessarily affect the other, it is important to recognize that reducing SV time can make more time in which it is possible to engage in PA. Reducing SV and increasing PA together also offers contextually compatible targets, which allow families to tailor behavior change interventions to their own requirements. Providing separate interventions for each would not be pragmatic in the public health context, whereas addressing both has the potential to increase effectiveness. There is, however, a shortage of research focusing on how parents can help their children engage in more PA and less SV. A systematic review of PA interventions found only four family-based studies that met the study inclusion criteria and as such there is insufficient evidence to draw conclusions on the utility of this approach [11
]. As all four studies were conducted in the US and three focused exclusively on children from minority ethnic groups, the extent to which their findings are applicable to other countries and population groups may be limited. Furthermore, a review of multiple-component interventions to increase PA also highlights the absence of parent engagement in current approaches [22
]. No study was found involving working directly with families, and parent engagement was restricted to newsletters home or the occasional parent evening. This lack of research is surprising as group-based parenting program interventions have been shown to be successful in engaging parents in providing support for behavior change in their children [23
]. For example, Golan and colleagues have shown that interventions involving parents have been successful in childhood obesity treatment [24
]. To date, no study has developed a parenting intervention to increase PA and reduce SV for non-obese children.
Behavior change interventions that have been based on psychological theory tend to be more successful than those that have not [29
]. As well as improving impact, theory also supports evaluation design by assisting with the identification of key mediators of behavior change [29
]. From an intervention perspective, self-determination theory (SDT) focuses on fostering autonomous (voluntary) types of motivation and feelings of competence, autonomy and belonging [30
]. Previous research has found associations between these factors and self-reported exercise behavior and pedometer counts in children and adolescents [31
] and as such, SDT could provide a useful basis for intervention. As SDT [30
] addresses the role of social agents in fostering people’s motivation it may be particularly appropriate for working with parents to help their children feel more physically competent and build motivation in children for increased PA and reduced SV behaviors.
In light of the evidence reported above, we developed a new PA / SV group-based parenting intervention called Teamplay which incorporates best practice in group-based parent programs to deliver a SDT informed intervention. In this paper we report on the design of the Teamplay intervention and a feasibility trial evaluation of the intervention. The six specific aims of the feasibility trial were to:
1. Develop an intervention, an intervention manual, and resources for a group parenting program to promote increased PA and decreased SV in children.
2. Assess the feasibility of recruiting and retaining parents of 6–8 year old children to a PA/SV parenting program.
3. Examine the feasibility of collecting accelerometer data from children of this age and their parents.
4. Examine the potential change in MVPA and SV as a result of participating in the intervention and the potential future effect size.
5. Conduct post-intervention qualitative work to identify any factors that affect the measurement processes.
6. Provide the necessary information to calculate the sample size for an adequately powered RCT evaluation of the Teamplay intervention.