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Trial registered on ANZCTR

Registration number

ACTRN12622000861752

Ethics application status

Approved

Date submitted

3/06/2022

Date registered

17/06/2022

Date last updated

7/04/2024

Date data sharing statement initially provided

17/06/2022

Type of registration

Prospectively registered

Titles & IDs

Public title

Identifying strategies to support implementation of the Resistance Training for Teens (RT for Teens) school-based health-related fitness program for adolescents

Scientific title

Optimising the implementation of the Resistance Training for Teens program in secondary schools

Secondary ID [1]

None

Universal Trial Number (UTN)

Trial acronym

Linked study record

This study is the next phase of the state-wide dissemination study ACTRN12621000352808.

Health condition

Health condition(s) or problem(s) studied:

Poor health-related fitness

Physical inactivity

Psychological well-being

Sedentary behaviour

Obesity

Condition category

Condition code

Public Health

Health promotion/education

Diet and Nutrition

Obesity

Mental Health

Studies of normal psychology, cognitive function and behaviour

Intervention/exposure

Study type

Interventional

Description of intervention(s) / exposure

In a recent cluster randomised controlled trial (RCT) delivered in New South Wales (NSW) government schools, we demonstrated that the ‘Resistance Training for Teens’ (RT for Teens) intervention improved adolescents’ muscular fitness, body composition and RT skill competency (e.g., squat, lunge and push-up technique).

In the current project, we will partner with the NSW Department of Education (DoE) and five Local Health Districts (LHDs) to evaluate strategies to support the implementation of the RT for Teens program in NSW government and non-government secondary schools. Using findings from our previous RCT and dissemination studies, we have adapted our implementation support strategies to optimise reach, dose delivered, fidelity, sustainability, and impact. The aim of our proposed study is to assess the effect of three implementation support models (i.e., Low, Moderate and High) on the implementation (i.e., reach, effectiveness, dose delivered, fidelity, adoption, sustainability, impact and cost) of the RT for Teens program in NSW schools. To achieve this aim, we will conduct a hybrid type III implementation-effectiveness cluster RCT in 90 schools to determine the most effective and cost-effective RT for Teens implementation model.

One teacher from each school will attend the RT for Teens professional learning workshop, provided by members of the RT for Teens design team from University of Newcastle, and serve as the “School Champion”. School Champions will attend 1 full day face-to-face training and be provided with curricular materials, including units of work, lesson plans, assessments task, technique and workout cards. The workshop will occur in Term 2 (2023), while the RT for Teens program can be delivered from Term 2 until Term 4 (2023). The School Champions will train the other teachers of their school who will also deliver the program to the students. This training (delivered by the School Champions to other teachers in school) include a 2-hour workshop and will be scheduled during Term 2 (2023) prior start of the program. The attendance of the School Champion workshop will be monitored by the Project Manager (i.e., by using an attendance list) and the teachers are required to complete an Action Plan to support implementation in their school, this plan will be evaluated by the Project Manager to ensure it is of high quality. In addition, app analytics will be accessed to monitor students' participation in the practical sessions.

In addition to the teacher workshop, the Medium and High support groups will both include on-going support from external change agents (i.e., LHD Project Officers). Contact includes guidance via email, phone or face-to-face, depending teachers' preferences. Furthermore, Project Officers will observe one or two teachers per school who deliver an RT for Teens session and provide feedback to teachers on the structure of the RT for Teens session. The SAAFE observation checklist will be used to determine intervention fidelity and a brief checklist will be completed after each school meeting. This approach is consistent with the existing NSW health model for supporting the implementation of healthy eating and physical activity programs in schools. Project Officers from 5 LHDs will work directly with School Champions to facilitate implementation of the RT for Teens program. The 'High' support group will also receive a basic resistance training equipment pack valued at approximately $1000 AUD.

The RT for Teens program includes the following:

Resistance training (RT) sessions: Teachers will be trained to deliver the RT for Teens sessions. The 8-week program will utilise the following structured format: i) Warm-up (~5 mins); ii) GymFit (~20-25 mins); iii) Workout Of the Day (WOD)/GameFit/FunFit (~10-15 mins); and iv) StretchFit (i.e., a cool down including static stretching) (~5 mins). Within the 8-week implementation period, teachers will be encouraged to deliver approximately one session (theory and practice) per week.

Theory lessons: Teachers are provided with 8 x 40 min theory lessons designed by the research team to align with the Australian Curriculum for health and physical education (HPE) and the Australian Physical Literacy Framework. They will be delivered during health lessons, with content covering: (i) introduction to RT, (ii) self-assessment of fitness, motivation and monitoring, (iii) fitness and eHealth technologies, (iv) principles of training and RT program design, (v) social media, physical activity and body image, (vi) Yoga, Pilates and other muscle-strengthening activity, (vii) nutrition myths and recommendations, and (viii) community-based opportunities for RT.

Access to a smartphone app: Students and teachers will be able to access the RT for Teens app. Note: only students that provided their consent (i.e., opt-in) will be able to use the app. The app includes: a fitness testing feature – whereby students are able to use criterion-referenced standards to develop self-assessment skills; skill testing – a function for evaluating competence in six specific RT movements; and workouts – a library of pre-designed bodyweight resistance training workouts organised by difficulty (with a custom workout generator).

Teachers will be encouraged to implement the full program including all sessions, but can still participate in the program when teaching part of the intervention. Teacher logbooks will be consulted by the research team after the implementation period to collect data on what sessions have been delivered by the teachers.

Students fitness results (e.g., number of push-ups until fatigue) will be recorded through the smartphone app (students) or tablet app version (teachers). Data on level of intensity during the RT for Teens sessions will not be collected as the prior focus of the project is on implementation.

Students will not be asked to engage in additional RT exercises outside of school hours or outside this program, but they will be encouraged to get familiar with RT, feel confident about it and include it in their own exercise schedule after participation.

Intervention code [1]

Lifestyle

Intervention code [2]

Prevention

Intervention code [3]

Behaviour

Comparator / control treatment

The 'Low' support group (i.e., usual care in delivering the RT for Teens program) will act as a control group because this is the professional development model typically used by the NSW DoE. This is often referred to as the “train and forget” model because schools are not provided with on-going support.

Schools/teachers in this group will still deliver the RT for Teens program, participate in the one-day school champion workshop and the school champion will be requested to deliver the 2-hour workshop for the other teachers (but without ongoing support/equipment pack).

Control group

Active

Outcomes

Primary outcome [1]

Our primary outcome is Reach, including the proportion of Year 9 and 10 students that participate in the RT for Teens program. This information will be collected using consents for participation and teacher logbooks (i.e., class lists). Participation (%) will be defined as the number of Year 9 and 10 students who have participated in the program divided by the total number of students in Year 9 and 10 at the study schools. All data related to this outcome will be assessed as a composite outcome.

Timepoint [1]

Consents for participation will be collected at baseline (before intervention, during the teacher workshop). Outcomes will be assessed at baseline, 6-month and 18-month follow-up.

Secondary outcome [1]

Dose delivered: The number of RT for Teens sessions delivered to students (including practical sessions and theory lessons). We have prepared a checklist for teachers to keep track of the delivered sessions with the number of students in class (practical and theoretical separately).

Timepoint [1]

6-month and 18-month follow-up (post-intervention commencement).

Secondary outcome [2]

Fidelity: Project Officers will observe about two teachers per school who deliver an RT for Teens session (~120 observations), for the High and Moderate group (60 schools) and will use the 'Supportive, Active, Autonomous, Fair, and Enjoyable' (SAAFE) observation checklist to determine intervention fidelity.

Timepoint [2]

During the 8-week intervention period

Secondary outcome [3]

Sustainability: The extent to which the program has become embedded within the school setting will be determined by interviewing the School Champions at follow-up, by a 30-minute semi-structured one-on-one interview with a member of the research team. In addition, the school champion will complete the Program Sustainability Assessment Tool (with only the items for Environmental support (n=5) and Organizational capacity (n=5)). This feedback will be assessed as a composite secondary outcome.

Timepoint [3]

18-month follow-up (post-intervention commencement)

Secondary outcome [4]

Impact: Impact outcomes will be collected by students using the RT for Teens smartphone app (note: only if they provided their opt-in consent) or teachers using the tablet version of the app (the latter applies only when students don't have access to a smartphone). The current version of the app allows students to enter their own results for fitness, RT skill competency and participation in muscle-strengthening activity. Students can view animated images to get familiar with the performance criteria for each specific RT skill (i.e., Squat, Push-ups, Lunge, Overhead Press, Suspended row, front support with chest touches). in the MY TECHNIQUE screen, students can see an overview of their six skills and current scores (rated with help from a peer, teacher, or can self-assess using the video). Upper body and torso muscular endurance will be assessed using the validated 90° push-up and plank tests, respectively. All the above mentioned measures will be assessed as a composite secondary outcome.

Timepoint [4]

During the 8-week intervention period, after completing of each practical RT session of the RT for Teens program.

Secondary outcome [5]

Cost: We will conduct a within-trial economic evaluation, from the perspective of the Education Sector, assessing cost-effectiveness of the RT for Teens program across the three trial arms.

Costs comprise intervention and implementation costs (not evaluation costs); the latter varies in intensity between trial arms. The opportunity cost of teacher, and other staff, time will also be costed at pro-rata salary levels for intervention and implementation activities. An incremental cost-effectiveness ratio (ICER) will assess the additional costs and additional effectiveness between trial arms. A probability sensitivity analysis will assess statistical uncertainty in the ICER, and a value of information analysis will assess the value of undertaking future research to further optimise implementation. A budget impact analysis will then estimate the total financial impact for the NSW DoE and Ministry of Health (MoH) from investing in the most cost-effective implementation model for scale-up across Australia. Central to our proposal is generating data to guide policy makers’ future decisions. To estimate RT for Teens value we will compare the incremental cost per participant with benefit achieved at the participant level across each group.

Timepoint [5]

After all participating schools have implemented the intervention.

Secondary outcome [6]

Acceptability: Perceptions among the delivery team that a given intervention is agreeable, palatable, or satisfactory.
This outcome will be assessed via an online questionnaire for the teachers who delivered the RT for Teens program.
Items from a validated questionnaire will be used, designed to assess the Acceptability of Intervention Measure (AIM) (Weiner et al., 2017).

Weiner, B. J., Lewis, C. C., Stanick, C., Powell, B. J., Dorsey, C. N., Clary, A. S., ... & Halko, H. (2017). Psychometric assessment of three newly developed implementation outcome measures. Implementation Science, 12(1), 1-12.

Timepoint [6]

6-month and 18-month follow-up (post-intervention commencement).

Secondary outcome [7]

Adaptability: Extent to which an intervention can be adapted, tailored, refined, or reinvented to meet local needs.
This outcome will be assessed via an online questionnaire for the teachers who delivered the RT for Teens program.
Items from the validated Program Sustainability Assessment Tool (PSAT) questionnaire will be used (Hall et al., 2021).

H Hall, A., Shoesmith, A., Shelton, R. C., Lane, C., Wolfenden, L., & Nathan, N. (2021). Adaptation and Validation of the Program Sustainability Assessment Tool (PSAT) for Use in the Elementary School Setting. International journal of environmental research and public health, 18(21), 11414.

Timepoint [7]

6-month and 18-month follow-up (post-intervention commencement).

Secondary outcome [8]

Feasibility: Perceptions among the delivery team that an intervention can be successfully used or carried out within a given organization or setting.
This outcome will be assessed via an online questionnaire for the teachers who delivered the RT for Teens program.
Items from a validated questionnaire will be used, designed to assess the Feasibility of Intervention Measure (FIM) (Weiner et al., 2017).

Weiner, B. J., Lewis, C. C., Stanick, C., Powell, B. J., Dorsey, C. N., Clary, A. S., ... & Halko, H. (2017). Psychometric assessment of three newly developed implementation outcome measures. Implementation Science, 12(1), 1-12.

Timepoint [8]