‘Kids Just Wanna Have Fun’ Phenomenological Insights Into Changing Physical Activity Behaviour Dr Paul Chadwick Consultant Clinical and Health Psychologist Senior Teaching Fellow, UCL Centre for Behaviour Change Clinical Lead for Psychology, Camden Integrated Practice Unit for Diabetes Clinical

Centre for Behaviour Change Developing interdisciplinary thinking and collaboration Translating academic expertise to address social issues and improve human wellbeing

Innovation [in-uh-vey-shuh n] 1.something new or different introduced: numerous innovations in the high- school curriculum. 2.the act of innovating; introduction of new things or methods.innovating

Proposition Scientifically derived theories of behaviour and behaviour change are the ‘thing’ that can be used to drive innovation in physical activity interventions.

I am taking as given…. That children are not nearly active enough for their current and future health and wellbeing. That being physically active is a good thing. That appropriate physical activity has a range of positive impacts on physical and psychological health. That there are benefits to being more physically active, regardless of whether your BMI changes as a result.

What are the forces shaping the behaviour you want to change? What are the intervention techniques available to modify those forces? The Behaviour Change Wheel

Systematic literature review identified 19 existing frameworks Synthesis into a new framework Model of behaviour at the hub of a wheel Synthesis of existing frameworks: 9 intervention functions each include one or more behaviour change techniques 7 policy categories that could enable or support these interventions to occur Michie et al (2011) The Behaviour Change Wheel: a new method for characterising and designing behaviour change interventions, Implementation Science.

The COM-B system: Behaviour occurs as an interaction between three necessary conditions Michie et al (2011) Implementation Science

Defining Capability Psychological Capability Any mental process or skill that is required for the person to perform the behaviour e.g. memory, attention & decision making abilities, knowledge Physical Capability Any set of physical actions that requires an ability or proficiency learned through practice e.g. taking blood, administering injections, manual handling, driving, sequence of movements etc Capability An individual’s psychological & physical capacity to engage in the activity concerned

Capability: Physical Acquisition of the developmentally appropriate motor skills necessary for physical activity. Lack of basic fundamental movement skills means that engagement is often unrewarding. Poor cardiovascular fitness means that physical activity can be painful and ‘hard work’.

Capability: Psychological Developmentally appropriate awareness of: What physical activity and sedentary behaviour is. The benefits of physical activity. The costs of sedentary behaviour. Physical activity and sedentary behaviour targets. KNOWLEDGE Ability to monitor and set SMART goals for self/ relevant to physical activity and sedentary behaviour. SELF-REGULATION The ability to play Abilities relating to participation in group activities (e.g. turn taking, communication). INTERPERSONAL Parenting skills to encourage physically active and reduce sedentary behaviour.

Opportunity The external social & physical factors that make wanted behaviours more likely to happen & the unwanted behaviours less likely to happen Physical Opportunity Anything in the physical environment that discourages or encourages the performance of the behaviour e.g. prompts, availability of services, the structure of the physical space in which the behaviour is to be performed Social Opportunity Influences that come from friends, family, colleagues & other influential people that support the doing or not doing of a behaviour either by provision of direct support or by influencing the way people think or feel about a behaviour Opportunity

Physical Opportunity Objects / Services / Location Equipment (e.g swimming, pedometers) ‘Safe’ spaces to engage in PA Size/Weight appropriate activities. Social Opportunity Prompts Cues and reminders to be active. Removal of triggers for sedentary behaviour. Space and Time Dedicated time for PA. Simplifying life. Peer Pressure / Norms Exposure to active peers increases PA. Exposure to inactive peers increases sedentary behaviour. Credible Models Moves from parental influence to peer influence across development. Culture Is there a concept of ‘activity for health and/or wellbeing’?

Motivation The sum total of internal influences that energise and directs behaviour: a moment-by- moment property which is shaped by different systems of influence: physiological, impulses and inhibitions, motives, beliefs, and identity. Reflective People’s values and beliefs about what is important (good and bad), conscious intentions, decisions and plans. Automatic Emotional responses, desires and habits resulting from associative learning and physiological states. Motivation

Motivation and physical activity in deconditioned overweight children Reflective: It is not important It is not something I am good at Automatic It hurts It makes me feel bad

MEND Programme Treatment and secondary prevention programme for overweight and obese children. Parent and child attend twice weekly sessions for 12 weeks. Curriculum includes: –Education about: Impact of excess body weight on health Nutrition Physical activity –Parenting skills training –Behaviour change techniques –Participation in structured physical activity sessions specifically graded for range of abilities. Aim of physical activity curriculum: to provide overweight children with the opportunity to engage in physical activity in such a way as to lead to positive change in the child’s relationship with their bodies and physical activity.

COM-B Elements of MEND Physical Activity Curriculum Knowledge of PA and its importance Parenting skills specifically targeted to change PA and SB Training in self-regulation skills for PA Group PA Programme Developmentally appropriate exercise Emphasis on ‘safe space’ to exercise Environmental restructure Mandatory participation in PA MEND groups form their own norms supporting PA Community linkage Parental Modelling

A Phenomenological Analysis of Young Peoples Experience of the MEND Programme Research question What do children say about their experiences of the MEND programme, a year since completion? Methodology Interpretative Phenomenological Analysis (IPA); qualitative methodology which aims to describe the lived experience of an event or circumstance. Appropriate for: Generating hypotheses about under-researched areas. Developing a richer account of a phenomenon.

Interview Schedule  Could you describe what MEND is in your own words? (What is it about/for?)  What was MEND like for you? (Most important things about MEND for you?)  How did it come about that you went along to MEND? (Whose idea? How did you feel?)  Could you tell me what it was like going along to MEND? (What did you like/not like/find difficult? What were the other people in the group like? What was it like for your family/friends?)  Looking back at MEND, what do you think about it? (Its influence/not? Any before/after comparisons?)  How did you think about yourself/your body before / during / since MEND (words to describe, thoughts, feelings)?  If you had to summarise your journey through the MEND programme (before/during/after MEND), what would you say?  Are there any other things that you haven’t told me about MEND that you think are important?

What do they remember? Very little about the nutrition education (note this does not mean that it was ineffective!) Physical activity sessions were referenced by all participants as the main point of recollection. All participants referenced initial anxiety about the idea of being physically active in the MEND programme. The strongest theme in participants recollection of their experience of physical activity was…

Fun! [I used to] think that exercise [was]… sort of like a torture. But when I went [to MEND] I find it nice and fun and I just thought exercise was basically just going with the flow. It may seem hard at the beginning, but if you just get along with it and don’t really think about how tired you get you just think about how much fun you’re having, it’ll be very easy for you. [MEND] was all fun…not worrying at all.

Csíkszentmihályi’s (1990) model of ‘flow’ Flow: ‘the mental state of operation in which a person performing an activity is fully immersed in a feeling of energized focus, full involvement, and enjoyment in the process of the activity’ COM-B: Motivation People do things that make them feel good!

Fun was associated with ‘connectedness’! If there’s one person, you can play a small game, the more people there are you can play better games…it’s a fun programme where you do games in unity and have lots of fun games…by myself, all of the things that I’m doing would actually be much more fun with more people…I really find it much more fun with more people. I met most of my friends so that’s what I liked about [MEND] the most, ‘cause it’s not as fun when you’re not with anybody like anybody you know...when you know someone you’re not alone exactly…[when my friends weren’t in] I was mostly alone, and that’s what kind of stopped my confidence a little bit.

Implications Physical activity can often be the ‘Cinderella’ ingredient in Lifestyle Weight Management Programmes –It is not necessary to directly provide PA to achieve clinically significant reductions in weight status. –Direct provision of PA alone is insufficient to produce clinically significant reductions in weight status. –Extra cost for no additional benefit in a KPI-driven world. Children’s experience and voices are a much-neglected source of evidence in our understanding of how to develop effective weight management services. The children in this study spontaneously referenced their experience of directly provided PA as being the most memorable and positive aspect of a multi-component weight management intervention. Their accounts of PA were consistent with the development of intrinsic motivation for physical activity, which has been identified as a major determinant of physical activity behaviour (Deci and Ryan, 2000). Direct provision of PA within multi-component weight management interventions have the potential to set the seeds for a positive lifelong relationship with physical activity.

Physical Literacy “Physical literacy can be described as the motivation, confidence, physical competence, knowledge and understanding to value and take responsibility for engagement in physical activities for life.” Whitehead (2014) What are the conditions necessary for physical literacy to develop?

Innovation through synthesis of what is already known Skills Confidence Lots of opportunity Physical Literacy (Start Young, Stay Active, 2014) Knowledge of PA and its importance Parenting skills specifically targeted to change PA and SB Training in self-regulation skills for PA Group PA Programme Developmentally appropriate exercise Emphasis on ‘safe space’ to exercise Environmental restructure Mandatory participation in PA MEND groups form their own norms supporting PA Community linkage Parental Modelling Applying behaviour change methodology is a reliable route to innovation!

Thank you for listening! E: T: