Glenda Jessup

Increasing physical activity in young primary school children - it's child's play: a cluster randomised controlled trial.

OBJECTIVE To explore the effects of an innovative school-based intervention for increasing physical activity. METHODS 226 children (5-7 years old) randomly selected from 12 Australian primary schools were recruited to a cluster randomised trial with schools randomly allocated to intervention or control conditions. The 13-week intervention comprised: (1) altering the school playground by introducing loose materials and (2) a teacher-parent intervention exploring perceptions of risk associated with childrens free play. The primary outcomes were total accelerometer counts and moderate-vigorous physical activity during break times. Testing took place in Sydney, 2009-2010. RESULTS 221 participants were tested at baseline. Mixed-effect multilevel regression revealed a small but significant increase from the intervention on total counts (9400 counts, 95% CI 3.5-15.2, p=0.002) and minutes of MVPA (1.8 min, 95% CI 0.5-3.1, p=0.006); and a decrease in sedentary activity (2.1 min, 95% CI 0.5-3.8, p=0.01) during break times. We retested children in one intervention school after 2 years; they maintained the gains. CONCLUSIONS Capturing childrens intrinsic motivations to play while simultaneously helping adults reconsider views of free play as risky provided increases in physical activity during break times. Using accelerometry as the sole measure of physical activity may underestimate the effect. TRIAL REGISTRATION ACTRN12611000089932.

The sydney playground project: popping the bubblewrap - unleashing the power of play: a cluster randomized controlled trial of a primary school playground-based intervention aiming to increase children's physical activity and social skills

BackgroundIn the Westernised world, numerous children are overweight and have problems with bullying and mental health. One of the underlying causes for all three is postulated to be a decrease in outdoor free play. The aim of the Sydney Playground Project is to demonstrate the effectiveness of two simple interventions aimed to increase childrens physical activity and social skills.Methods/DesignThis study protocol describes the design of a 3-year cluster randomised controlled trial (CRCT), in which schools are the clusters. The study consists of a 13-week intervention and 1 week each of pre-and post-testing. We are recruiting 12 schools (6 control; 6 intervention), with 18 randomly chosen participants aged 5 to 7 years in each school. The two intervention strategies are: (1) Child-based intervention: Unstructured materials with no obvious play value introduced to the playground; and (2) Adult-based intervention: Risk reframing sessions held with parents and teachers with the aim of exploring the benefits of allowing children to engage in activities with uncertain outcomes. The primary outcome of the study, physical activity as measured by accelerometer counts, is assessed at baseline and post-intervention. Additional assessments include social skills and interactions, self-concept, after school time use and anthropometric data. Qualitative data (i.e., transcriptions of audio recordings from the risk reframing sessions and of interviews with selected teacher and parent volunteers) are analysed to understand their perceptions of risk in play. The control schools have recess as usual. In addition to outcome evaluation, regular process evaluation sessions are held to monitor fidelity to the treatment.DiscussionThese simple interventions, which could be adopted in every primary school, have the potential of initiating a self-sustaining cycle of prevention for childhood obesity, bullying and mental ill health.Trial registrationAustralian and New Zealand Clinical Trials Registration Number ACTRN12611000089932.

To be or to refuse to be? Exploring the concept of leisure as resistance for young people who are visually impaired.

This study explored the concept of leisure as resistance to social constraints of blindness. Leisure, because of its relative freedoms, has been conceptualised as a forum in which dominant cultural discourses and stereotypes can be challenged or resisted. A post-structural analysis of the leisure narratives of five young people who are blind revealed that they intentionally used aspects of leisure to resist some constraints and stereotypes of disability. Three strategies were identified: advocacy, redefinition and passing. Advocacy targeted other people’s beliefs; yet, some activities done to resist dominant discourses actually perpetuated them. Redefinition was a covert strategy to show themselves that they could be the same as everyone else. Passing was used in different ways. One young person used it when advocating, another to maintain social connections. However, maintaining social connections by passing was often at the cost of enjoyment, engagement and perceptions of ability. Empowerment through resistance in leisure related primarily to gains in self-confidence. These gains in self-confidence have the potential to contribute to social interactions and perhaps influence some of the discourses that operate as ‘truths’ about people who are blind.

Sydney Playground Project: A Cluster-Randomized Trial to Increase Physical Activity, Play, and Social Skills.

BACKGROUND We assessed the effectiveness of a simple intervention for increasing childrens physical activity, play, perceived competence/social acceptance, and social skills. METHODS A cluster-randomized controlled trial was conducted, in which schools were the clusters. Twelve Sydney (Australia) primary schools were randomly allocated to intervention or control conditions, with 226 children (5-7 years old) selected randomly to participate. Data were collected at baseline and after 13 weeks. The intervention consisted of introducing recycled materials without an obvious play purpose into school playgrounds and a risk-reframing workshop for parents and teachers. RESULTS Children from the intervention schools increased physical activity and reduced sedentary time while control schools decreased physical activity and increased sedentary time. The intervention yielded increases in total accelerometer counts (β = 9350 counts, 95% CI 3490-1522, p = .002), minutes of moderate/vigorous physical activity (MVPA) (β = 1.8 min, 95% CI 0.52-3.12, p = .006), and reductions in sedentary time (β = -2.1 min, 95% CI -3.77-(-0.51), p = .01). Although the changes in time spent in play and nonplay were not statistically different (p = .08) the effect size (d = .27) indicates clinical significance. CONCLUSIONS This intervention was effective for increasing MVPA during recess and demonstrated capacity to improve play opportunities in school playgrounds.

Being noticed for the way you are: Social inclusion and high school students with vision impairment

This study explored the social inclusion in high school of Australian students with vision impairment (VI). We sought to understand how students described school social inclusion, whether they felt included and what influenced these perceptions. As part of a larger mixed methods study, 12 students with VI, who had previously answered the Psychological Sense of School Membership (PSSM) questionnaire, were interviewed about the social aspects of school. These interviews were analysed thematically. Participants described social inclusion as about being noticed and not overlooked by others. While two-thirds of participants reported satisfactory social relationships in high school, one-third, including all those with additional disabilities, reported being teased or rejected by their school peers. Five themes encompassed the varying influences on school social inclusion. These were: (a) putting myself forward; (b) knowing me; (c) having control; (d) having a place to shine; and finally a negative influence (e) peer exclusion and rejection. These themes largely parallel those of competence, autonomy, and relatedness found in self-determination theory. This suggests that staff can enhance the social inclusion of students with VI by facilitating these students’ self-determination. In practice, this would require school staff to focus on enabling students with VI to explore and build on strengths, fully access the curriculum alongside their peers, and have time and opportunity to develop friendships with these peers.

Understanding the ups and downs of living well: the voices of people experiencing early mental health recovery

BackgroundThe aim of this study was to better understand early-stage mental health recovery experiences of people living with severe and persistent mental illness and complex needs.MethodsSemi-structured, in-depth interviews were conducted with 13 people engaged in an Australian program specifically designed for people facing complex barriers to their recovery. Interview data were analysed thematically using constant comparative methods.ResultsParticipants described engaging with seven interconnecting aspects of early recovery: (1) engaging with the challenge of recovery; (2) struggling for a secure and stable footing; (3) grieving for what was and what could have been; (4) seeking and finding hope; (5) navigating complex relationships; (6) connecting with formal and informal support, and finally, (7) juggling a complexity of health issues.ConclusionsThis study illuminated the complexity of earlier-stage recovery which was characterised both by challenging personal circumstances and a hope for the future. It illustrated that even at an early point in their recovery journey, and amidst these challenging circumstances, people still actively engage with support, draw on inner strengths, source resources and find accomplishments. Stability and security was foundational to the ability of participants to draw on their own strengths and move forward. Stability came when material needs, including housing, were addressed, and an individual was able to connect with a supportive network of workers, carers, friends and family.