title: Lessons learned from the AFLY5 RCT process evaluation: implications for the design of physical activity and nutrition interventions in schools.
abstract: BACKGROUND
  Systematic reviews have highlighted that school-based diet and physical activity (PA) interventions have had limited effects. This study used qualitative methods to examine how the effectiveness of future primary (elementary) school diet and PA interventions could be improved.
  
  
  METHODS
  Data are from the Active For Life Year 5 (AFLY5) study, which was a cluster randomised trial conducted in 60 UK primary schools. Year 5 (8-9 years of age) pupils in the 30 intervention schools received a 12-month intervention. At the end of the intervention period, interviews were conducted with: 28 Year 5 teachers (including 8 teachers from control schools); 10 Headteachers (6 control); 31 parents (15 control). Focus groups were conducted with 70 year 5 pupils (34 control). Topics included how the AFLY5 intervention could have been improved and how school-based diet and PA interventions should optimally be delivered. All interviews and focus groups were transcribed and thematically analysed across participant groups.
  
  
  RESULTS
  Analysis yielded four themes. Child engagement: Data suggested that programme success is likely to be enhanced if children feel that they have a sense of autonomy over their own behaviour and if the activities are practical. School: Finding a project champion within the school would enhance intervention effectiveness. Embedding diet and physical activity content across the curriculum and encouraging teachers to role model good diet and physical activity behaviours were seen as important. Parents and community: Encouraging parents and community members into the school was deemed likely to enhance the connection between schools, families and communities, and "create a buzz" that was likely to enhance behaviour change. Government/Policy: Data suggested that there was a need to adequately resource health promotion activity in schools and to increase the infrastructure to facilitate diet and physical activity knowledge and practice.
  
  
  CONCLUSIONS
  Future primary school diet and PA programmes should find ways to increase child engagement in the programme content, identify programme champions, encourage teachers to work as role models, engage parents and embed diet and PA behaviour change across the curriculum. However, this will require adequate funding and cost-effectiveness will need to be established.
  
  
  BACKGROUND
  ISRCTN50133740.
authors.affiliation: Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, BS8 1TZ, UK. Russ.Jago@bristol.ac.uk.
authors.forename: R
authors.initials: R
authors.lastname: Jago
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK. emma.rawlins7@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Rawlins
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK. Ruth.Kipping@bristol.ac.uk.
authors.forename: R R
authors.initials: RR
authors.lastname: Kipping
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK. Sian.Wells@bristol.ac.uk.
authors.forename: S
authors.initials: S
authors.lastname: Wells
authors.affiliation: School of Population Health, University of Adelaide, Adelaide, SA, 5005, Australia. catherine.chittleborough@adelaide.edu.au.
authors.forename: C
authors.initials: C
authors.lastname: Chittleborough
authors.affiliation: School of Clinical Sciences, University of Bristol, Bristol, BS2 8DZ, UK. Tim.Peters@bristol.ac.uk.
authors.forename: T J
authors.initials: TJ
authors.lastname: Peters
authors.affiliation: Public Health, Bristol City Council, Avonquay Office, Cumberland Basin, Bristol, BS1 6XL, UK. Julie.Mytton@uwe.ac.uk.
authors.forename: J
authors.initials: J
authors.lastname: Mytton
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK. d.a.lawlor@bristol.ac.uk.|MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, BS8 2BN, UK. d.a.lawlor@bristol.ac.uk.
authors.forename: D A
authors.initials: DA
authors.lastname: Lawlor
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK. Rona.Campbell@bristol.ac.uk.
authors.forename: R
authors.initials: R
authors.lastname: Campbell
mesh_terms: D002648:Child; D004032:Diet; D005260:Female; D017144:Focus Groups; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D009043:Motor Activity; D063766:Pediatric Obesity / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D040242:Risk Reduction Behavior; D012572:School Health Services; D012574:Schools