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ST U D Y P R O T O C O L Open Access
Monitoring activities of teenagers to comprehend
their habits: study protocol for a mixed-methods
cohort study
Mathieu Bélanger
1,2,3*
, Isabelle Caissie
1
, Jacinthe Beauchamp
1
, Jennifer O’Loughlin
4,5,6
, Catherine Sabiston
7
and Michelina Mancuso
8
Abstract
Background: Efforts to increase physical activity in youth need to consider which activities are most likely to be
sustained over time in order to promote lifelong participation in physical activity. The Monitoring Activities of
Teenagers to Comprehend their Habits (MATCH) study is a prospective cohort study that uses quantitative and
qualitative methods to develop new knowledge on the sustainability of specific physical activities.
Methods/design: Eight hundred and forty-three grade 5 and 6 students recruited from 17 elementary schools in
New Brunswick, Canada, are followed-up three times per year. At each survey cycle, participants complete self-report
questionnaires in their classroom under the supervision of trained data collectors. A sub-sample of 24 physically active
students is interviewed annually using a semi-structured interview protocol. Parents (or guardians) complete telephone
administered questionnaires every two years, and a health and wellness school audit is completed for each school.
Discussion: MATCH will provide a description of the patterns of participation in specific physical activities in youth,
and enable identification of the determinants of maintenance, decline, and uptake of participation in each activity.
These data will inform the development of interventions that take into account which activities are the most likely to
be maintained and why activities are maintained or dropped.
Keywords: Physical activity, Sport, Youth, Behavior, Adolescents, Mixed methods, Cohort
Background
In Canada, physical inactivity is the most prevalent pre-
ventable risk factor for chronic disease and mortality in
youth and across the lifespan [1,2]. A recent objective
assessment of physical activity in a representative sample
of Canadians aged 6 to 19 years indicated that only 9%
of boys and 4% of girls engaged in the recommended
60 minutes of moderate-to-vigorous physical activity per
day [3]. The burden of chronic disease will likely increase
given that low levels of physical activity in youth is a
strong predictor of a sedentary lifestyle in adulthood [4].
Physical inactivity in youth increases the risk of cardio-
vascular disease [5,6], diabetes [7], low bone mineral
density [8,9], slower cognitive development [10-12], anx-
iety and depression [13], and obesity [14,15]. Physical ac-
tivity and sports provide opportunitie s for developing
competence, experiencing achievement, developing iden-
tities, forming positive relationships, learning to respect
others, and enhancing a sense of community, while phys-
ical inactivity may result in suboptimal psychological and
social growth [3]. Enrolment in physical activity programs
is associated with improved social and communication
skills, heighted motivation, lower rates of deviant behav-
iours, and better academic achievement [16].
Declines in physical activity during adolescence are
characterized by marked changes in the range of physical
activities in which youth engage [17]. The popularity of
nearly all types of physic al activity declines during ado-
lescence [18] and the number of different activities in
which adolescents engage also decreases with age [17,19].
With the possible exceptions of active transportation (i.e.,
* Correspondence: mathieu.f.belanger@usherbrooke.ca
1
Centre de formation médicale du Nouveau-Brunswick, Pavillon
J.-Raymond-Frenette, 15, rue des Aboiteaux, Moncton, NB, Canada E1A 3E9
2
Department of family medicine, Université de Sherbrooke, Sherbrooke,
Canada
Full list of author information is available at the end of the article
© 2013 Bélanger et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Bélanger et al. BMC Public Health 2013, 13:649
http://www.biomedcentral.com/1471-2458/13/649
walking, bicycling to and from school) and household
chores, few young people maintain involvement in specific
types of physical activity during adolescence [20-26].
Other reports indicate that the relative contribution of
different types of physical activity changes with age. For
example, although participation in both organized and
non-organized physical activity decreases during adoles-
cence [27-29], there are steeper declines in organized
physical activity especially in girls [30]. Similarly, high
drop-out rates from sports are reported from childhood
to adolescence [18] and from adolescence to adulthood
[22,31,32]. Some activities are en gaged in almost exclu-
sively by some age groups [31].Skipping rope, playing
tag, and using playgrounds are popular among children
[24,25], whereas adults engage in physical conditioning
and occupational physical activity [31]. Participation in
specific physical activities in adulthood is nevertheless
more likely among individuals who engaged in the activ-
ity durin g adolescence [22].
Systematic reviews have identified factors that are ro-
bustly associated with physical activity [33-35]. However,
other than gender differences whereby boys prefer com-
petitive sports [20,21,36-38] and accumulate more vigor-
ous physical activity than girls (who accumulate more
moderate physical activity [20,21] and prefer non-
competitive individual sports [37]), little is known about
the determinants of participating in specific physical activ-
ities. Moreover, in-depth understanding of why adoles-
cents discontinue, maintain or initiate physical activity
participation is lacking.
Whereas qualitative studies provide rich descriptive in-
formation on how various factors influence behavioral
patterns, few qualitative studies explore reasons for par-
ticipation in physical activity during adolescence. Extant
qualitative studies show that common reasons for taking
part in physical activity include enjoyment, social inter-
action and weight management, whereas lacking confi-
dence and ability are barriers [39-42]. A qualitative study
that explored differences between phy sical activity main-
tainers and decliners [43] suggested that decliners
reported negative social interactions, unsupportive social
environments and feeling insufficiently competent as
factors related to declines in physical activity. In con-
trast, maintenance of physical activity was associated
with recognition of health benefits of physical activity,
relatedness to others, and perceiving the environment as
supportive of physical activity. Insights on factors ex-
plaining differences in patterns of physical activity par-
ticipation during adolescence from both prospective
qualitative and quantitative data are needed.
Monitoring Activities of Teenagers to Comprehend
their Habits (MATCH) is a prospective mixed-methods
study aimed at identifying and better understanding the
determinant s of discontinuing or sustaining participation
in specific physical activities during adolescence. The ob-
jectives are: 1) to better understand the physical activity-
related experiences of participants in various types of
physical activity, including individual activities, team-
based activities, organised activities, and non-organised
activities; 2) to develop better understanding of the
process of maintaining adequate physical activity levels
during the transition from childhood to adolescence; 3)
to develop better understanding of the process of de clin-
ing physical activity levels during the transit ion from
childhood to adolescence; 4) to identify determinants of
maintaining, discontinuing, or taking up participation in
different types of physical activity from childhood to
adolescence; and 5) to assess how changes in correlates
relate to changes in participation in different types of
physical activity.
Methods/design
Design and conceptual framework
MATCH is a prospe ctive cohort study that uses quanti-
tative and qualitative methods to develop new know-
ledge on the natural course and determinants of physical
activity in youth. The M ATCH study is grounded in the
Self-Determination Theory (SDT) which enables better
understanding of what motivates people to engage in,
and maintain, certain types of physical activity. This in
turn will help inform the design of intervent ions tailored
to individual needs. SDT is founded on the notion that
individuals behave according to interactions between ex-
trinsic forces, intrinsic motives and essential needs [44].
An integral component of SDT is the underlying theory
of Basic Psychological Needs, which assumes that a per-
son maintains optimal functioning in contexts that sup-
port three basic psychological needs: competence,
autonomy and relatedness [45,46]. Specifically, mainten-
ance of participation in a physical activity is achieved
when an individual feels that he or she masters the activ-
ity (competence), when the activity is undertaken by
choice (autonomy), and when a meaningful connection
is established with people through participation in the
activity (relatedness). Chaos Theory is also incorporated in
components of MATCH because random external events
(i.e., loss of a friend, a public announcement, a conversa-
tion) may trigger at least short-term behavior change [47].
Chaos Theory supports investigating the influence of un-
planned or uncontrolled factors that lead to sudden
changes in physical activity. MATCH received Ethics
Approval from the Comité d’Éthique de la Recherche du
Centre Hospitalier de l’Université de Sherbrooke.
Study population
Nineteen schools were initially recruited from across the
province of New Brunswick, Canada to participate in
MATCH. However two schools were subsequently
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excluded because of a low return rate of consent forms.
Schools recruited were selected to include a mix of
French and English language schools from high, mod er-
ate, and low socioeconomic neighbourhoods, situated in
rural and urban areas. Students were recruited within
the 17 study schools from September 2011 to January
2012. Information packages were sent to the parents of
all children in Grade 5 and 6 (10-12 years old), which
provided detailed information on the MATCH study ob-
jectives and methods, as well as a consent form for par-
ents and students to complete and return to the school.
A total of 802 eligible students were recruited in the first
year of data collection, for a response proportion of 51%.
Contact information for parents or guardians of 490 of
these 802 participants were obtained from schools. At
least three attempts to contact each parent were made
between August 2012 and February 2013. A total of 253
parents were contacted, of whom 246 (97%) agreed to
respond to a telephone-admi nistered questionnaire.
For the qualitative component of the study, a purposely-
selected sample of participants was selected from among
those categorized, after four survey cycles, as most physic-
ally active (we ascertained that four questionnaires were
needed to appropriately assess types of activities usually
practiced). Six participants were recruited to represent
each of the following categories of physical activity partici-
pation: involved primarily in a) team activities; b) individ-
ual activities; c) organised activities; and d) non-organised
activities, for a total of 12 boys and 12 girls. Although
overlap occurs among the types of physical activity prac-
ticed by different groups, the decision to recruit based on
this categorisation was motivated by the intention to in-
clude participants with a wide variety of behavioral pat-
terns and not to obtain four mutually exclusive groups.
This way, we maximize our ability to develop an under-
standing of experiences of participation in different types
of physical activities.
Quantitative data collection
Participants provide data three times each year until the
end of grade 12 when they graduate from high school,
for a total of up to 24 survey cycles per participant.
Three survey cycles per year permit investigation of sea-
sonal variation in activity levels and types of activity
practiced [48]. At each survey cycle, participants
complete self-report questionnaires in their classroom
under the supervision of trained data collectors. Class-
room visits in the first survey cycle took approximately
45-60 minutes and subsequent visits take approximately
20-30 minutes (stu dents need less instructions). All data
collection visits are scheduled at the convenience of
teachers.
Data are collected from parents (or guardians) every
two years a telephone-administered questionnaires.
During the first year that schools participate in the
study, a designated person within each scho ol completes
a questionnaire in consultation with other staff, which
collects data on the school environment. Responses are
verified on-site by a research assistant.
Student questionnaire
The student questionnaire uses a checklist of 36 activ-
ities to collect data on the types of physical activity in
which participants engaged over the past four months.
The checklist inc orporates all of the commonly prac-
ticed activities by youth in this region [49] and all activ-
ities included in other similar and validated physical
activity checklists [50-52]. Participants report the fre-
quency of participation in each activity, where the activ-
ity took place (school, home or neighborhood, indoor
arena or gym, outdoor field, other), and with whom (by
myself, organized group or team, siblings, friends, par-
ents) activities were engaged in [24]. Pilot-testing of the
questionnaire in English and French followe d by discus-
sions with 12 Grade 5 and 6 students indicated that chil-
dren have no difficulty understanding and answering the
questions.
Physical activity level is estimated using a simple 2-
item questionnaire developed for use among youth [53].
This questionnaire has demonstrated test-retest reliabil-
ity (r = 0.77) and it correlated significantly with acceler-
ometer data (r = 0.40; this criterion validity index is as
good as or better than other physical activity question-
naires) [53].
Basic Psychological Needs are measured in three ques-
tionnaires: (i) perceived competence is assessed with the
6-item subscale from the Intrinsic Motivation Inventory
[54], (ii) perceived autonomy is assessed in the seven
items from the autonomy subscale of the Basic Psycho-
logical Needs in Life Scale [55,56], an d (iii) perceived re-
latedness is assessed with the Relatedness to Others in
Physical Activity Scale [57]. Each of these scales has in-
ternal consistency reliability coefficients (Cronbach’s
alpha) of 0.70 to 0.92 and is associated with physical ac-
tivity [54-57]. Motives for physical activity is measured
with the Motivations for Physical Activities Measure-
Revised, a 30-item questionnaire that reflects five gen-
eral motives for physical activity participation including
enjoyment, competence, appearance, fitness and social
interaction [58]. Enjoyme nt and competence are mea-
sures of intrinsic motives, whereas appearance, fitness
and social are indicators of extrinsic motives [58]. The
questionnaire has been used successfully to document a
relationship between different types of motives for phys-
ical activity and long-term adherence to two specific types
of physical activity (Tae Kwon Do and Aerobics) [58].
Active transportation is determined by asking youth
how they usually get to and from school (actively,
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inactively or mixed) [59]. The core questionnaire also
collects data on age, sex, school-based physical activities
[59], sedentary behaviors [60,61], perceived physical ac-
tivity of others, weight regulating behaviors [62], sleep
patterns [63], pubertal stage [64,65], and unplanned
events that may have influenced physical activity partici-
pation such as parental divorce, sickness in the family,
difficulties at school, etc. Data on dietary habits are col-
lected once a year, using items from the 2010 National
Youth Physical Activity and Nutrition survey [66].
Parent questionnaire
Parents provide data on their own level of participation
in physical activity in a telephone-administered ques-
tionnaire [67]. They also report on their participation in
specific phy sical activities [67], and they provide data on
family structure, socioeconomic level, and neighbour-
hood attributes [68].
Student and parent questionnaires were developed in
English and translated into French if validated transla-
tions were not already available. The translation was
undertaken by a bilingual kinesiologist whose mother
tongue is French, with emphasis on conceptual rather
than literal translations, and on clear and concise formu-
lation. Three bilingual research team members reviewed
and edited the translation for consistency with the English
version. The French items were then back-translated
by an independent individual whose mother tongue is
English. The initial and final English versions where
then compared to confirm consistency.
School questionnaire
The school questionnaire includes data on facilities
available for physical activity inside schools, school yards
and in the schoo l neighborhood. Data are also collected
on whether students have access to schools facilities dur-
ing non-instructional times throughout the school day, if
activities are offered to them when they remain indoors
due to inclement weather during non- instructional time,
and if students have access to school facilities outside
school hours. We also collect information on frequency
and duration of Physical Education classes, and school
policies related to physical activity and nutrition (adapted
from [69] and [70]). Data collected in this school question-
naire has a high level of validity (% agreement with
consensus-based opinion among school staff is perfect
for >75 of items), test-retest reliability (exact agreement
for 79.4% of items), and inter-judge reliability (77.3% of
items have shown exact agreement between raters) [71].
Qualitative data collection
The annual individual qua litative interviews with a sub-
sample of 24 participants take place in a private room
provided by schools. A phenomenological approach,
which is particularly useful for understanding experi-
ences of individuals and gaining insight into their moti-
vations and actions, is used in the qualitative component
of this study [72]. The phenomena under study include
participation in specific types of physical activity, main-
tenance of physical activity, and decline in level of phys-
ical activity. Consistent with standard phenomenological
methodology, our design involves multiple face-to-face
interviews [73,74]. Participants are interviewed individu-
ally on a yearly basis to describe the evolution of their
physical activity-related experiences as it relates to i) the
type of physical activity they take part into as well as ii)
maintenance or decline in participation in physical activ-
ity. The first interview serves as a baseline from which
individual profiles will thereafter be built using data
from follow up interviews. The interviews are audio-
recorded and transcribed verbatim.
Although phenomenological research often begins
from a perspective free from hypotheses or preconcep-
tions [75], mor e recent viewpoin ts suggest that it is im-
possible to begin withou t preconceptions or bias and
therefore emphasize that res earchers should state their
initial theoretical basis [76,77]. Therefore, the semi-
structured interview guide (used as a flexible template
rather than a rigid list of questions [78]) aims at gather-
ing data on part icipants’ general experience s with phys-
ical activity and physical activity-related feelings of
competence, relatedness with others, and autonomy
(Ba sic Psychological Needs component of the SDT). In-
terviewers are also trained to examine the occurrence of
random external triggers if marked changes in patterns
of physical activity are noted.
In addition to the 24 participants above, we will invite
participants with low physical activity in the first two
years of study who subsequently become physically ac-
tive for interviews that explore circumstances that led to
this (sudden) change. Participants in these interviews
will be met only once. These interviews could take place
in year 3-6, depending on when sudden increases
are noted. This will be of particular use to investigate
the extent to which “chaotic events” influence increases
in physical activi ty. Interviews will continue until data
saturation is reached. All interviews will be recorded and
transcribed.
Limitations
The study schools for MATCH represent a convenience
sample. However, the schools were selected specifically
to represent a mix of schools from low, middle, and
higher socioeconomic status in a variety of urban, subur-
ban, and rural settings in French and English regions of
New Brunswick. Further, it is unlikely that the determi-
nants of the maintenance or discontinuation of physical
activity differ markedly between youth populations in
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Canada. It is possible that repeated data collection using
the same questionnaire could sensitize participants to
motives for maintaining or not participating in physical
activity. This is partly why (in addition to cost, feasibility,
and seasonality) we limited data collection to every 4
th
month, rather than monthly or more frequently. Given
the young age of participants, it is also possible that they
experience difficulty expressing their feelings during
the qualitative interviews. Our team includes researchers
experienced in conducing in-depth interviews with this
age group and has developed strategies to ease this
process.
Discussion
The MATCH study provides the infrastructure for a re-
search program that will generate better understanding
of how physical activity participation evolves during
childhood and adolescence. Recruiting grade 5 and 6
students and following them throughout adolescence is
motivated by the finding that, for most people, peak
physical activity level occurs between grade 5-7 [79], and
then declines markedly from grade 8-11 [20,21,80-82].
The MATCH study will provide a detailed assessment of
the natural history of physical activity participation in a
period characterised by important changes in behaviour,
growth, and puberty. No study has yet provided such de-
tailed prospective data. Moreover, although the determi-
nants of youth engaging in specific types of physical
activities may vary, few investigations distinguish be-
tween types of physical activity. MATCH will enable in-
vestigating processes of sustaining, interrupting, or
initiating participation in a wide variety of different
physical activities. Particularly, although some studies
have shown strong relationships between different types
of physical activity motives and basic psychological
needs and physical activity, MATCH has the capacity to
tease out why such factors are important for some
people, and if this changes over time and for different
types of physical activities. In addition, the mixed
methods approach enables investigation according to
various theoretical frameworks. We will quantify the im-
portance of se veral potential determ inants of participa-
tion and develop in-depth understanding of how these
determinant s arise and co-occur. This combination of
approaches will allow gaining insight s into processes and
events that lead to behavioural changes while also enab-
ling unexpected questions to occur. All of this will guide
the development of better interventions aimed at in-
creasing and sustaining participation in physical activity
among youth.
Abbreviations
SDT: Self-Determination Theory; MATCH: Monitoring Activities of Teenagers
to Comprehend their Habits.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
MB conceptualized the study and its design. JB, JOL, MM and CS contributed
to the conception of the study and study design. IC and MB organize and
coordinate the data collection process. MB and IC drafted the first version of
this manuscript. All authors reviewed the manuscript for intellectual content
and approved it for publication.
Acknowledgements
The MATCH project is supported by the New Brunswick Health Research
Foundation and by the Social Sciences and Humanities Research Council
and Sport Canada through the joint Sport Participation Research Initiative.
JOL holds a Canada Research Chair in the Early Determinants of Adult
Chronic Disease.
Author details
1
Centre de formation médicale du Nouveau-Brunswick, Pavillon
J.-Raymond-Frenette, 15, rue des Aboiteaux, Moncton, NB, Canada E1A 3E9.
2
Department of family medicine, Université de Sherbrooke, Sherbrooke,
Canada.
3
Research Centre, Vitalité Health Network, Moncton, Canada.
4
Department of social and preventive medicine, Université de Montréal,
Montreal, Canada.
5
Centre de recherche du Centre Hospitalier de l’Université
de Montréal, Montreal, Canada.
6
Institut national de santé publique du
Québec, Montreal, Canada.
7
Faculty of Kinesiology and Physical Education,
University of Toronto, Toronto, Canada.
8
New Brunswick Health Council,
Moncton, Canada.
Received: 28 June 2013 Accepted: 8 July 2013
Published: 12 July 2013
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doi:10.1186/1471-2458-13-649
Cite this article as: Bélanger et al.: Monitoring activities of teenagers to
comprehend their habits: study protocol for a mixed-methods cohort
study. BMC Public Health 2013 13:649.
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