Alison M. Gallagher’s research while affiliated with University of Ulster and other places

Background Physical inactivity in adolescents is a major public health issue. Schools are important settings for physical activity interventions. The WISH Study was a peer-led, school-based walking intervention that aimed to increase physical activity levels of adolescent girls. This study uses the RE-AIM Framework to present the process evaluation of the WISH Study with a focus on factors that affected participation, motivation, and enjoyment of the intervention. Methods Pupils (n589 12–14 years) were recruited from 18 schools in the border region of Ireland and Northern Ireland. In intervention schools (n9), older pupils (15–18 years) were trained as walk leaders and led pupils (12–14 years) in brisk walks (10–15 min) during the school day, across the school year (2021-22). Questionnaires to measure self-efficacy for walking and physical activity, health-related quality of life and reasons for engaging in physical activity were administered throughout the intervention. At the end of the intervention focus groups were held with pupils, and interviews conducted with teachers and walk leaders. Attendance at walks was monitored by walk leaders. Quantitative data were analysed descriptively, and qualitative analysis was undertaken using thematic analysis. Themes were reported under RE-AIM indicators (reach, effectiveness, adoption, implementation, and maintenance). Results Pupils in the intervention schools (n286) were representative of adolescent girls in Northern Ireland and Ireland, in terms of their activity level. At baseline, 15% of these pupils met the recommended physical activity guidelines of 60 min moderate-vigorous physical activity per day, as measured by accelerometers. The total number of walks reported per school ranged from 2 to 104 across intervention schools. One quarter of pupils (n74, 26%) never attended a walk and 15% (n23) of walk leaders did not lead a walk. Pupils and walk leaders self-reported improvements in their physical health, mental well-being, and social relationships, and walk leaders reported gaining transferrable skills. Implementation was aided by school support in some schools, although barriers such as COVID-19, lack of time, harsh weather, inadequate facilities for indoor walks, and walk leader availability, were identified. Staff engagement was a key driver for the maintenance of walks. Conclusions Despite a promising feasibility study and a comprehensive walk leader training programme, the extent to which the intervention was adopted and implemented varied, suggesting future school-based physical activity interventions need to consider individual school contexts to ensure intervention fidelity. Trial registration ISRCTN 12847782

Background Gaining excessive weight during pregnancy has been linked with adverse effects including increased risk of caesarean delivery and postpartum weight retention. Despite these recognised risks, currently no UK/Ireland gestational weight gain (GWG) guidelines exist, women are not routinely weighed throughout pregnancy and consequently, women’s understanding of the importance of weight management during, and post-pregnancy remains poor. The present study explored factors influencing weight change during and post-pregnancy and identified potential opportunities that could help women manage weight during these periods. Methods Women aged 18–45 years-old who had an uncomplicated pregnancy within the last 3 years were invited to complete an online questionnaire (n = 108) regarding their experience of changes in body weight during and post-pregnancy. Follow on focus groups (n = 13 women) were conducted online within the same population to delve deeper into the topic, the sessions were recorded, transcribed verbatim and data subjected to directive content analysis based on the socio-ecological model. Results Respondents reported in the online questionnaire, they did not receive enough information around weight management during (81.5%) and post-pregnancy (86.1%). Focus group qualitative data identified barriers to managing weight at each level of the ecological model, at the intrapersonal (e.g., changes in diet), interpersonal (e.g., conflicting advice), environment and society (e.g., COVID-19 pandemic), and institutional and policy (e.g., system failing) levels. Potential strategies to help manage weight were also identified, at the intrapersonal (e.g., need for further information), interpersonal (e.g., support groups), environment and society (e.g., messaging), and institutional and policy (e.g., further follow-up care) levels. Conclusions Mothers report receiving insufficient information around weight management, with barriers identified at each level of the ecological model. Highlighting that support and change is needed on multiple levels both during and post-pregnancy, with potential strategies identified, which could potentially inform future studies.

Optimal gestational weight gain (GWG) during pregnancy is required for healthy foetal growth, however excessive GWG has been linked with adverse effects including increased risk of caesarean delivery and postpartum weight retention ⁽¹⁾ . Currently no UK GWG guidelines exist, and women are not routinely weighed throughout pregnancy; consequently, women’s understanding of GWG remains poor ⁽²⁾ . The aim of this study was to explore factors influencing weight change during and post-pregnancy, plus identify potential opportunities that could help women manage weight during this period. Women aged 18-45 years-old who had a full-term, singleton, uncomplicated pregnancy within the last 3 years were recruited from mother and toddler groups, advertising on social media platforms and a university-wide email sent to staff and students. 108 eligible women completed the online questionnaire, between April and June 2023, on their experience regarding changes in body weight during and post-pregnancy. Follow on focus groups were then conducted within the same population. 4 focus groups with 2-5 participants per group and a 1-2-1 interview (n = 13 participants) were conducted online between September and October 2023, using a semi-structured topic guide. Discussions ranged between 32 to 90 minutes (average 59 minutes), were audio recorded, transcribed verbatim and thematically analysed ⁽³⁾ using NVivo12 software, with each theme being assigned to one level of the ecological model ⁽⁴⁾ . Ethical approval was granted by Ulster University’s Research Ethics Committee. Respondents reported in the online questionnaire, they did not receive enough information around weight management during (81.5%) and post-pregnancy (86.1%). Barriers to managing weight during and post-pregnancy were identified at each level of the ecological model. At the intrapersonal level (n = 4 themes), namely: changes in diet (convenience foods/ snacks), priorities (priority on the baby), lack of knowledge (not aware of adverse effects) barriers to physical activity (tired). At the interpersonal level (n = 3 themes), namely: lack of time (parity, working mum), conflicting advice (friends and family), lack of support (lack of support at appointments). At the environment and society level (n = 3 themes), namely: COVID-19 pandemic (amenities closed), location (rural communities), societal expectations. At the institutional and policy level (n = 1 theme), namely: system failing (lack of follow-up care). Potential strategies to help manage weight were also identified, at the intrapersonal level (n = 1 theme), namely: need for further information (components of GWG), interpersonal level (n = 1 theme), namely: support groups. At the environment and society level (n = 1 theme), namely: messaging (realistic expectations), institutional and policy level (n = 2 themes), namely: regular weighing, and further follow-up care. In conclusion, mothers report receiving insufficient information around weight management, with barriers identified at each level of the ecological model highlighting that support is needed on multiple levels during and post-pregnancy, with potential strategies identified to assist mothers which informs future studies.

School food has a major influence on children’s diet quality and has the potential to reduce diet inequalities and non-communicable disease risk. Funded by the UK Prevention Research Partnership (UKRI), we have established a UK school food system network. The overarching aim was to build a community to work towards a more health promoting food and nutrition system in UK schools. The network has brought together a team from a range of disciplines, while inclusion of non-academic users and other stakeholders, such as pupils and parents, has allowed the co-development of research priorities and questions. This network has used a combination of workshops, working groups and pump-priming projects to explore the school food system, as well as creating a systems map of the UK school food system, and conducting network analysis of the newly established network. Through understanding the current food system and building network expertise, we hope to advance research and policy around food in schools. Further funding has been achieved based on these findings, working in partnership with policy makers and schools, whilst a Nutrition Society Special Interest Group has been established to ensure maximum engagement and future sustainability of the network. This review will describe the key findings and progress to date based on the work of the network, as well as a summary of the current literature, identification of knowledge gaps and areas of debate, according to key elements of the school food system.

Purpose Levels of physical inactivity in children remains a serious public health concern. The school and home setting provide a promising environment to support children’s physical activity (PA). Understanding the factors that influence PA in childhood is key in the development of effective strategies for increasing activity levels and overcoming barriers in primary school aged children. Nevertheless, there is limited evidence in relation to parents’ and teachers’ perceptions of children’s PA behaviour both at school and in the home environment. Thus, the present study aims to explore the current views, barriers, and facilitators to PA in parents and teachers of children (aged 7-9 years) to inform the design of the Children - Sit Less, Move More (C-SLAMM) intervention. Methods In total, twelve semi-structured telephone interviews were conducted with primary schoolteachers (n = 6) and with the parents (n = 6) of primary school aged children. All data were audio-recorded, transcribed verbatim and analysed using thematic analysis. Results Analyses revealed an understanding of the relationship between children’s PA and health, however the knowledge and perceptions of PA varied. Participants’ felt PA was important but believed several factors impacted children’s ability to be active. Three main themes emerged from the study, reflecting parents’ and teachers’ perspectives on promoting primary school children’s PA at school and at home: (1) knowledge and perception of PA, (2) barriers and facilitators to an active lifestyle, and (3) parent and teacher acceptability and feasibility of the proposed intervention. Findings suggest that the most significant barriers to promoting PA among primary school children include a lack of space, uneven distribution of PA equipment and limited access to play and sporting facilities and suggest opportunities for overcoming these barriers as a way of increasing children’s PA at school. Lack of teacher and parental support were highlighted as key barriers for intervention delivery. Implications for intervention development and future directions were also considered. Conclusions Findings from this work highlight that a one-size-fits-all approach may not be applicable when designing a school-based PA intervention, as some degree of flexibility is required. Funding Source Northern Ireland Chest Heart and Stroke

Introduction Globally, 81% of children fail to meet physical activity (PA) guidelines and the causes of such inactivity are complex and multifactorial. Parents can influence the PA levels of their children through modelling, co-participation, encouragement and family support. A meta-analysis by Brown et al (2016) showed family-based PA interventions to be effective. However, there are many perceived barriers to family PA and it is accepted that there is a persistent socioeconomic gap in PA. Socioeconomic status is an important determinant of health and can influence attitudes, experiences, behaviours, and exposure to health risk factors. PA is positively associated with socioeconomic status and recent research indicates that children from the least affluent families are less likely to meet PA guidelines in comparison to children from the most affluent families (44% vs 55% meeting PA guidelines respectively). To support families to address these inequalities and improve population health, an understanding of the costs associated with family-based PA interventions is required. Therefore, the aim of this scoping review is to provide a comprehensive overview of health economic evaluations of family-based PA interventions. Methods This scoping review protocol will be registered with the Open Science Framework and will be conducted according to the Arksey and O’Malley framework for scoping reviews. Electronic databases (Ovid MEDLINE, Embase, Web of Science, PubMed, Cochrane Library, and Scopus) will be searched from inception. Reference lists of eligible studies and relevant systematic reviews will be searched for potentially eligible studies. Included studies will be those that recruited a family unit, delivered an intervention that included a component of PA (e.g. exercise, sport, play), examined the effect on PA and reported on the economic costs. The titles and abstracts of potentially relevant articles will be screened independently by two reviewers and data from eligible studies extracted using Covidence software. Data will be charted and the results summarised. Conclusions This scoping review will provide an understanding of the costs associated with family-based PA interventions, information that will be important for the development of evidence-based interventions and for future policy and commissioning.

We acknowledge an error in the BMI data in our publication [...]

Background Physical inactivity in adolescents is a major public health issue. Schools are important settings for physical activity interventions. The WISH Study was a peer-led, school-based walking intervention that aimed to increase physical activity levels of adolescent girls. This study uses the RE-AIM Framework to present the process evaluation of the WISH Study with a focus on factors that affected participation, motivation, and enjoyment of the intervention. Methods Pupils (n589 12–14 years) were recruited from 18 schools in the border region of Ireland and Northern Ireland. In intervention schools (n9), older pupils (15–18 years) were trained as walk leaders and led pupils (12–14 years) in brisk walks (10–15 minutes) during the school day, across the school year (2021-22). Questionnaires were administered throughout the intervention, and at the end of the intervention focus groups were held with pupils, and interviews conducted with teachers and walk leaders. Attendance at walks was monitored by walk leaders. Quantitative data were analysed descriptively, and qualitative analysis was undertaken using thematic analysis. Themes were reported under RE-AIM indicators (reach, effectiveness, adoption, implementation, and maintenance). Results Participating pupils (n286) were representative of adolescent girls in Northern Ireland and Ireland, with 15% of pupils, achieving recommended physical activity guidelines (60 mins moderate-vigorous physical activity per day) at baseline. The total number of walks reported per school ranged from 2-104 across intervention schools. One quarter of pupils (n74, 26%) never attended a walk and 15% (n23) of walk leaders did not lead a walk. Pupils and walk leaders self-reported improvements in their physical health, mental well-being, and social relationships, and walk leaders reported gaining transferrable skills. Implementation was aided by school support in some schools, although barriers such as COVID-19, lack of time, harsh weather, inadequate facilities for indoor walks, and walk leader availability, were identified. Staff engagement was a key driver for the maintenance of walks. Conclusions Despite a promising feasibility study and a comprehensive walk leader training programme, the extent to which the intervention was adopted and implemented varied, suggesting future school-based physical activity interventions need to consider individual school contexts to ensure intervention fidelity. Trial registration : ISRCTN 12847782