Testing the effectiveness and implementation at scale of TransformUs program on physical activity and sitting time in Australian Secondary Schools.

INTERVENTION: TransformUs is a school‐based intervention targeting reducing sedentary behaviour and increasing physical activity that will be rolled out across Australian secondary schools. Overall duration of the intervention is 6 months i.e., the follow‐up evaluation will be at 6 months for both the Effectiveness Trial and Implementation Trial. The effectiveness and implementation trials will run parallel to one another. Schools can only be involved in one trial, not both. Frequency and duration of each strategy will vary between the schools, teachers and students. Each of these components will include a repertoire of activities that teachers could choose and implement differently across the day. However, we are expecting that: ‐ Active breaks are short (up to 2‐minutes) activities that interrupt prolonged periods (e.g., 20‐30 minutes) of sitting in class. They can be incorporated into any class lesson. At least one active break should be planned for and delivered in each core lesson. For example: Active bingo, active grammar, chair yoga). ‐ Active lessons are longer sessions (e.g., 30 minutes) directly linked to the curriculum and involve integrating movement into the student learning experience. For example: times table teams (Maths), relay story (English). ‐ Active recreation (active play and recreation activities, before school, during school [recess and lunch included], after school) will depend on the length of each school breaks. Organised or non‐organised activities frequency and length will also depend on the students likes, for example: Organised lunchtime Sports/activities could include Activity incursion: circus skills; Cross year level: Sports/activities (e.g. Basketball, Soccer, Netball); Year level activity: Activity (e.g. Ultimate frisbee, Dodge ball, CONDITION: Public Health ‐ Health promotion/education Sedentary behaviour in adolescents ;Physical activity in adolescents; ; Sedentary behaviour in adolescents ; Physical activity in adolescents PRIMARY OUTCOME: Waist circumference; Will be assessed using a flexible steel tape at the umbilicus by trained staff. Two measurements will be taken, where a discrepancy of >0.5 cm is apparent, a third measurement was taken and the average of each was used.; [Baseline ‐ 2022‐2023; T2 ‐ 2022‐2023 (6 months after baseline)] Physical activity; Students will wear the ActiGraph GT9X accelerometers on their non‐dominant wrist for 24 hours for eight days at each of the measurement points. Time spent on physical activity at light, moderate and vigorous intensity will be extracted. [Baseline ‐ 2022‐2023 ; T2 ‐ 2022‐2023 (6 months after baseline)] Sedentary time; Students will wear the ActiGraph GT9X accelerometers on their non‐dominant wrist for 24 hours for eight days at each of the measurement points. Time spent in sedentary time will be obtained.; [Baseline ‐ 2022‐2023; T2 ‐ 2022‐2023 (6 months after baseline)] SECONDARY OUTCOME: Adolescents’ activity levels in different areas ; Will be assessed using SOPLAY (System for Observing Play and Leisure Activity in Youth) to observe and record adolescents’ activity levels in different areas of the school grounds during recess and lunchtime. SOPLAY uses momentary time sampling techniques to record the activity level (i.e., sedentary, walking, very active) of each individual within a pre‐determined target area.[Baseline ‐ 2022‐2023 ; T2 ‐ 2022‐2023 (6 months after baseline)] Insulin ; Markers of cardiometabolic heath will be assessed utilising a dry blood spot analysis technique (finger prick blood spot test). ; ; *This will be an elective add on for students. A tiered consent process will be used to determine this subsample. ; [Baseline ‐ 2022‐2023 ; T2 ‐ 2022‐2023 (6 months after baseline)] LDL‐cholesterol ; Markers of cardiometabolic heath will be assessed utilising a dry blood spot analysis technique (finger prick blood spot test). ; ; *This will be an elective add on for students. A tiered consent process will be used to determine this subsample. ; [Baseline ‐ 2022‐2023 ; T2 ‐ 2022‐2023 (6 months after baseline)] Self‐reported physical activity ; Will be assessed using validated questions that will be included on the survey via REDCap. ; [Baseline ‐ 2022‐2023 ; T2 ‐ 2022‐2023 (6 months after baseline)] Triglycerides ; Markers of cardiometabolic heath will be assessed utilising a dry blood spot analysis technique (finger prick blood spot test). ; ; *This will be an elective add on for students. A tiered consent process will be used to determine this subsample. ; [Baseline ‐ 2022‐2023 ; T2 ‐ 2022‐2023 (6 months after baseline)] Blood pressure (BP) ; Will be measure using a blood pressure monitor (e.g., Mobil‐O‐Graph 24h PWA). Systolic and diastolic BP measurements will be taken three times on the participant’s right arm. The first measure will be performed after five minutes of seated rest with the remaining two measurements taken at 1‐min intervals. The three BP measurements will be averaged for a final value. ; ; *This will be an elective add on for students. A tiered consent process will be used to determine this subsample. [Baseline ‐2022‐2023 ; T2 ‐ 2022‐2023 (6 months after baseline)] Class engagement ; Will be assessed using validated questions that will be included on the survey via REDCap. ; [Baseline ‐ 2022‐2023 ; T2 ‐ 2022‐2023 (6 months after baseline)] Pubertal status ; Will be assessed using Tanner staging (Sexual Maturity Rating) to assess secondary sex characteristics during puberty. This will be included in the student survey.[Baseline ‐ 2022‐2023 ; T2 ‐ 2022‐2023 (6 months after baseline)] Classroom observations on‐task behaviour ; Will be assessed by research staff observing students on the following behaviours: Focused on‐task (e.g., reading, writing, asking/answering questions); Passive off‐task (e.g., not focused, daydreaming, starring, drinking water); Off‐task (e.g., not focused walking around, playing with irrelevant objects, fidgeting); Absent (e.g., went to the toilet). This data will be collected via REDCap. These outcomes will be assessed as a composite outcome. [Baseline ‐ 2022‐2023 ; T2 ‐ 2022‐2023 (6 months after baseline)] Environmental changes ; The newly developed School Physical Activity Environments (SPACES) Audit Tool will be used to evaluate the outdoor grounds and the immediate surrounding area of each school. ; [Baseline ‐ 2022‐2023 ; T2 ‐ 2022‐2023 (6 months after baseline)] Glucose ; Markers of cardiometabolic heath will be assessed utilising a dry blood spot analysis technique (finger prick blood spot test). ; ; *This will be an elective add on for students. A tiered consent process will be used to determine this subsample. ; [Baseline ‐ 2022‐2023 ; T2 ‐ 2022‐2023 (6 months after baseline)] HDL‐cholesterol ; Markers of cardiometabolic heath will be assessed utilising a dry blood spot analysis technique (finger prick blood spot test). ; ; *This will be an elective add on for students. A tiered consent process will be used to determine this subsample. ; [Baseline ‐ 2022‐2023 ; T2 ‐ 2022‐2023 (6 months after baseline)] 25‐hydroxyvitamin D ; Markers of cardiometabolic heath will be assessed utilising a dry blood spot analysis technique (finger prick blood spot test). ; ; *This will be an elective add on for students. A tiered consent process will be used to determine this subsample. ; [Baseline ‐ 2022‐2023 ; ‐ Baseline ‐2022‐2023 ; ‐ T2 ‐ 2022‐2023 (6 months after baseline) ; EMAs: ; ‐ 3 times per term for up to 6 terms ; Interviews: ; T2 ‐ 2022‐2023 (6 months after baseline)] Implementation e.g., organisational readiness, organisational climate, decision to register, Intention to implement, current teaching practices, process evaluation measures, frequency of intervention delivery ; Will be assessed using existing validated and reliable measures in the survey (REDCap), Ecological Momentary Assessment (via SMS, 3 times per term for up to 6 terms) and audio‐recorded interviews (30 min, one on one interviews with a subsample of teachers after the intervention. A subsample of consenting teachers will be invited to participate at random. These outcomes will be assessed as a composite outcome.[School staff surveys: ; ‐ 6 months after recruitment] Musculoskeletal health ; To assess the location of any musculoskeletal discomfort, the modified Nordic Musculoskeletal Questionnaire will be used. Participants will be asked to report (in the student survey) if, during classroom lessons over the last seven days, they had experienced any muscle, joint or bone discomfort.[Baseline ‐ 2022‐2023 ; T2 ‐ 2022‐2023 (6 months after baseline)] PRIMARY OUTCOME ; Body mass Index (BMI) ; Adolescents’ stature will be measured to the nearest 0.1 cm using portable stadiometers, and body mass will be measured to the nearest 0.05 kg using portable calibrated electronic scales. BMI (kg/m2) will be calculated based on stature and body mass ; [Baseline ‐ 2022‐2023 ; T2 ‐ 2022‐2023 (6 months after baseline)] INCLUSION CRITERIA: IMPLEMENTATION TRIAL •As this is a real‐world trial, all Australian secondary schools and school staff are eligible to register. •TransformUs will be available to all secondary school staff in Australia, however, the research component will only be offered to secondary staff at Government and Independent schools (*). In 2020 there were 113,084 secondary school staff at Government and Independent schools across the country (ABS, 2020). Based on uptake of the TransformUs Primary program (ACTRN12617000204347), it is likely that no more than 5% of eligible staff will participate, which equates to approx. n=5654 staff. Only teachers registered to TransformUs who work in Government/Independent schools will be invited to take part in the research (surveys, EMAs and interviews). Based on response rates from TransformUs Primary, this is likely to be no more than 40% of registrants. *Note: ethical approval will be sought from each State/Territory’s equivalent