Development of Theory

Development of theory involved relating the categories and subcategories through a coding paradigm and subsequently refining the theory. Within the coding paradigm

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existed the conditions that arose out of social, physical, economic and cultural settings, explaining why a group responds in a certain way; the interactions that occurred in individuals or groups as a response to the issues, problems and happenings arising under those conditions; and the consequences of what happened as a result of the interactions, or the failure of an individual or group to respond to a situation. The coding paradigm allowed consideration of the ways in which the categories related to one another.

Open coding analysis of initial focus groups revealed that themes were related to economic, decision making, social and physical aspects of the environment, and could also be categorised as either facilitators or barriers to physical activity. When these findings were reviewed with consideration of the existing literature, categories emerging from open coding were similar to other research into the impact of the environment on behaviour. The initial categorisation of the economic, social, decision making and physical aspects of the environment were congruent with the Social Ecology Model (Stokols, 1992, 1996, 2000) (see Chapter 2.3)

The Social Ecology Model provided confirmation of similarities between the theory emerging from this data and literature. The elements of the emerging theory and of the Social Ecology Model had been identified and categorised either as political, physical, social or economic components of the environment. Further, the emergent theory grounded in the data from the current study could be categorised as either facilitators or barriers to physical activity.

Themes emerging from the current data which related to whole school environmental physical activity facilitators were categorised as relating to either PE and school sport policies, social, physical or physical and economic aspects of the environment. Themes relating to PE and school sport policy were enjoyment of PE and other school-based physical activities, choice of activities, and appropriateness of activities for different age groups. Specifically, young children (aged six and seven) preferred activities that emphasised fun and enjoyment over technical activities and competition. Older children aged between nine and eleven preferred activities that

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employed elements of skill acquisition and competition. Themes relating to social aspects of the environment were support from parents, siblings and peers, and were consistently associated with participation in physical activity. The theme relating to the physical aspect of the environment was weather, where warm and dry weather enabled the children to play outside and on the school field (in schools where this was an option). Wet play time resulted in children participating in craft type activities, where they would prefer to play games with equipment in an indoor environment. Themes that related to both physical and economic aspects of the environment were PE and playground facilities and resources, including equipment and presence of Playground Leaders. Children enjoyed participating in games with specific equipment, such as balls, hoops and a parachute, and enjoyed the direction and ideas given by the Playground Leaders. Diagrams illustrating the relationships between the theoretical categories were developed as part of the higher level analysis. An explanatory model of whole school environmental facilitators to physical activity explains the theoretical processes (Figure 3).

Figure 3: Conceptual Model of Environmental Facilitators to Physical Activity Whole school micro-

environmental PA facilitators PE and School Sport

Policies Enjoyment Choice Age appropriate activities Social

Parents, peer, sibling support Physical Weather Physical and Economical PE and play-ground facilities and resources Equipment

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Themes relating to the whole school environmental barriers to physical activity could be categorised as relating to PE and school sport policies, social, and physical and economic aspects of the environment (Figure 3). Themes relating to PE and school sport policies were competition and team sports, where the younger children in particular (aged six and seven) did not enjoy activities where there was an emphasis on competition or team sports, and school policies could support these issues.

Themes relating to both PE and school sport policies and social aspects of the environment were parent, peer and sibling support, where gender stereotyping was raised as a particular issue. Here, girls in particular would have liked an opportunity to participate in ‗boys‘ games such as football during break time. Themes relating to both physical and economic aspects of the environment were negative experiences of the school environment, specifically poor (or non-existent) changing room facilities, sports facilities and lack of equipment. Lack of equipment was a particular problem where there was a mixed quality of apparatus (for example low quality and sometimes broken tennis racquets mixed with a limited number of newer metal racquets). This evidently created competition and antagonism within a class, and strategies were required to ensure the equipment was used fairly. Collectively, these processes comprise an explanatory model of whole school environmental barriers to physical activity (Figure 4).

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Figure 4: Conceptual Model of Environmental Barriers to Physical Activity

5.1.7 Discussion

The findings from the focus group interviews were integrated into the Social Ecology framework to enable the examination of the interactions between the economic, physical, political and social aspects of the environment and health and physical activity behaviours. The Social Ecology Model (Stokols, 1992, 1996, 2000) was used to identify and understand the obesogenicity of the school environment, to enable the effective promotion of behaviour change. These findings gave insight into the complexity of the determinants of physical activity and health behaviours within the school micro-environment. This analysis of the school environment provided an understanding of the gaps, barriers and facilitators to physical activity embedded in the political, economic, physical and social situations of the school environment. It was clear from the findings that the environmental determinants of physical activity were influenced by political, economic, physical and social resources. These

PE and School Sport Policies

Competition

Team sports – younger children

PE and School Sport Policies

Social

Gender stereotyping

Whole school micro- environmental PA

barriers

Physical and Economical Negative experiences of school environment: Changing rooms Sports facilities Lack of equipment Weather

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environmental resources acted upon the individuals within the school environment, and impacted upon their physical activity and health behaviour needs, goals, desires, and ability to cope with their environment. The majority of identified barriers and facilitators to physical activity supported findings from previous, predominantly quantitative literature. Identification of these barriers and facilitators within a qualitative environmental model through the present study offers a unique contribution to the evidence base.

Micro-environmental facilitators to physical activity

Weather was identified as a physical aspect of the school micro-environment that was a facilitator to physical activity, as participants discussed their enjoyment of undertaking activities outdoors. This supports previous research which found that low levels of rainfall were related to higher levels of physical activity (Broderson, Steptoe, Williamson, & Wardle, 2005) however, findings regarding the influence of weather conditions on physical activity have been conflicting. Some research suggests that hot and sunny weather causes a decrease in physical activity amongst children (Baranowski, Thompson, DuRant, Baranowski, & Puhl, 1993; Broderson, et al., 2005), where others found no association between weather and physical activity (Gordon-Larson, McMurray, & Popkin, 2000; Sirard, Ainsworth, McIver, & Pate, 2005).

The findings that enjoyment, choice and social support were important facilitators of physical activity supported previous findings regarding uptake and maintenance of physical activity in previous studies (Cale & Harris, 2006; Green, 2004; Sherwood, et al., 2008). Evidence has demonstrated that providing options for physical activity increases the likelihood that children enjoy participating in activity (Sherwood, et al., 2008). In addition, support from parents, siblings and peers has been found to increase the likelihood that children enjoy and maintain participation in physical activity (Sherwood, et al., 2008). Age appropriateness of activity was also a facilitator to physical activity, and again existing evidence has shown that children

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who participate in age-appropriate physical activities have an increased likelihood of enjoying and maintaining participation in physical activities (Strong, et al., 2005).

Choice, enjoyment and age appropriateness of physical activity were classed as political factors of the school micro-environment that were facilitators to physical activity, and could be addressed within this intervention. School physical activity policies should endeavour to ensure that children are provided with physical activity options which are appropriate to their age. Research has identified the significant role that political factors have on the amount and type of physical activity that children receive at school, supported by an extensive examination of education frameworks and policies in Canada. This research identified that public health policies are strongly related to the physical activity policies in schools (Gladwin, Church, & Plotnikoff, 2008). Here, political physical activity drivers were examined and it was identified that successful physical activity programmes worked because the individuals and groups influencing policy at both macro and micro levels understood and advocated their potential. Political drivers at macro level would be the education ministers, for example, whereas political drivers at micro level include the School Sport Partnerships and their related staff, school head teachers, teachers, and staff other than teachers. The research undertaken by Gladwin, et al., (2008) identified that the beliefs of the education minister, and the school head teacher, teachers and staff other than teachers were the reasons why in school daily physical activity was mandated in schools. It was identified that interventions need to ensure that the policy at macro and micro level supports initiatives, are led by politically strong organisations, and are viewed as an important priority amongst educators (Gladwin, et al., 2008).

Social support was identified as a social aspect of the school micro-environment that was a facilitator to physical activity. The social environment relates to the constraints on perceived availability of choices, opportunities to participate in activities, patterns of social control, norms, and the production or reduction of stress upon the individual (Institute of Medicine, 2003). Broadly defined, social support relates to the resources provided by other people (Cohen & Syme, 1985). The finding that

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social support was a facilitator to physical activity is similar to previous research that identified social support as a correlate of physical activity (Biddle, et al., 2004; Fox, 2007; Sallis, et al., 2000; Strauss, Rodzilsky, Burack, & Colin, 2001). Social support and social networks have been identified as one dimension of the social environment that influences health-related behaviour (McNeil, Kreuter, & Subramanian, 2006). The relationships between social support and health-related behaviours have been well reported in models and theories (see Chapter 2.2.3).

Physical activity and PE facilities and resources, including equipment and presence of Playground Leaders, were identified as facilitating aspects of the school micro- environment. These factors were classified as both physical (as physical contexts of the environment) and economic (as dependent on financially ability to provide such resources) aspects of the school micro-environment. The availability and quality of equipment was a theme of particular importance to the children. Sallis, et al. (2002), and Fein, Plotnikoff, Wild and Spence (2004) also found that a wide availability and good functionability of physical activity equipment for PE, play time and other physical activities were associated with higher levels of physical activity amongst children. The relationship between playground markings, equipment and physical activity has also shown to be positive (Stratton & Mullan, 2005), and this was a recurring theme during focus groups. Conversely, Zask, et al. (2001) found no association between physical activity levels and the availability and quality of playground equipment.

Micro-environmental barriers to physical activity

Team sports and competition were identified as two political aspects of the micro- environment that were barriers to physical activity. Several research papers identified that team games were often favoured within the curriculum, and were generally competitive in nature (Cale & Harris, 2005; Fairclough, Stratton, & Baldwin, 2002; Green & Thurston, 2002). Curricular and extra-curricular provisions for physical activity tend to be competitive team games, and concerns have been raised regarding the physical activity provisions for those children who dislike team

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games and competitive sports (Boyle, Jones, & Walters, 2008). Boyle, et al., (2008) examined the delivery of PE in schools through the views of heads of PE and head teachers. Several participants in this qualitative study discussed their desire to offer a wider range of physical activities within school, but had time constraints (for example no free evening to deliver additional activities to cater for a wider range of children). The authors discussed their concerns that only a minority of pupils who were talented at sport were being catered for, and the lack of physical activity provision for all (Boyle, et al., 2008). Other papers provided support for the notion that although a wide range of opportunities were available for children to participate in physical activity, the minority of pupils who were gifted and talented at sport tend choose to participate (Green & Thurston, 2002; Sallis, et al., 2002; Moe, Pickerel, & McKenzie, 2006).

Negative experiences of the school environment were classified as both physical and economic aspects of the micro-environment that were barriers to physical activity; physical because of their physical context, and economic given the reliance on financial resources. Inadequate changing room facilities were an identified barrier. Not having a suitable area to change into PE kit made children less willing to participate in PE or other curricular/ extra-curricular activities. O‘Dea (2003) similarly found that inadequate changing room facilities provided a barrier to physical activity, and proposed restructuring the physical environment. The finding that a lack of equipment was a barrier to physical activity is supported by a review of correlates of physical activity behaviours (Van der Horst, et al., 2007). Gender stereotyping was a barrier to physical activity that was classified as both a social and political factor of the school micro-environment. It was particularly raised by female pupils, who wished to participate in a wider range of activities in PE, during play time and during other physical activities. Gender stereotyping was classified as a political aspect of the school environment due to the school sports policies imparted by teaching staff and staff other than teachers, which advocated which sports, exercises and activities were undertaken in PE lessons, and in and around the school day. This issue was also classified as a social aspect of the school environment because of the beliefs of the peers attaining to traditional views of PE and sport.

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Intervention Design

6.1 Introduction

The environmental determinants of health have been well documented (see Chapter 2.3). The aim of the pilot physical activity intervention was to increase opportunities for children to be physically active in and around the school day by creating a whole school environment that promoted and facilitated physical activity, rather than focusing on individual behaviour change (Weshler, et al., 2000). This pilot physical activity intervention was designed to draw on existing resources available to schools, to promote sustainable behaviour change. It was important to make use of existing resources to increase the chances of the intervention being sustained and to minimise additional costs.

The main tenets of this intervention were:

 Ecological theoretical approach

 Assessment of the micro-environment

 Main focus on policy, and provision and quality of activities and facilities

 Collaborative (in terms of both development and delivery) with school staff, pupils, relevant stakeholders

 Effective and efficient use of existing resources

Intervention aims

Based upon previous research, associated recommendations for future research, and baseline measures of this research, the intervention specifically aimed to:

 Increase physical activity levels amongst girls to reduce the gender discrepancy (whilst increasing physical activity levels in boys also)

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 Increase physical activity levels of older children to reduce the age-related decline in physical activity levels of the younger children (whilst increasing physical activity levels in younger children also)

 Ensure that physical activity opportunities are accessible to all children, with no differences in the physical activity levels of children with higher and lower BMI scores.