Abstract:
Physical inactivity is on the increase among Nigerian adolescents and it remains a key risk factor for noncommunicable diseases. Although multi-level, school-based intervention may offer opportunities for promoting Physical Activity (PA), its effects have not been well investigated. This study was conducted to evaluate the effects of a 12-week multi-level intervention on the PA behaviours of adolescents in secondary schools, Oyo State.
A cluster randomised experimental design was adopted with measurements at baseline and post-intervention. Ibadan North-west and Ogbomosho North Local Government Areas (LGAs) were randomly selected and allocated to the Experimental Group (EG) and Control Group (CG) respectively. Twenty-two of the 72 schools in both LGAs were randomly selected. A total of 1,318 respondents (EG= 666; CG= 652) participated in the baseline assessments and 995 (EG =493; CG=502) did so at post-evaluation. A pre-tested, self-administered questionnaire, comprising a10-point knowledge, 90-point attitude, 50-point self-efficacy and 5-point Self-reported PA (SPA) scales was used for data collection. Knowledge Score (KS), Self-Efficacy Score (SES) and Attitude Score (AS) were dichotomised into “poor” and “good”, using 50th percentile as the cut-off. The SPA score was categorised as low (<1 to ≤1.9), moderate (>1.9 to ≤3.9) and vigorous (>3.9). Seven key informant interviews and six focus group discussions were held with principals and teachers, respectively. Baseline findings guided the design and implementation of the intervention which comprised the following: dialogue meetings with officials of the Ministry of Education and school authorities; health education and medical screening for teachers; teacher-led sessions on PA, and provision of educational and sporting materials for students in EG. Quantitative data were analysed using descriptive statistics, Student's t-test, Chi-square and mixed-effects linear regression. Level of significance was α0.05. Qualitative data were analysed using thematic approach.
Ages in EG and CG were 13.4±2.1 and 14.3±1.9 years, respectively. Baseline KS increased significantly from 8.4±1.3 to 8.7±1.2 in the EG but decreased slightly in the CG (8.6±1.1 to 8.5±1.3). Attitude score increased significantly from 65.3±13.4 to 69.3±11.3 in EG but decreased among the CG (66.7±11.2 to 64.3±12.4), while SES increased from 39.6±7.2 to 40.5±6.7 in EG but decreased in CG (39.6±6.4 to 39.4±6.1). At baseline, the moderate and vigorous SPA levels of the EG were 72.2% and 1.7% respectively; among the CG, the proportions were 72.9% and 0.8%, respectively. This increased significantly post-intervention to 89.2% and 3.7% in EG and 88.8% and 1.0% in CG. Exposure to intervention (β=0.10, CI=0.01-0.18), having a positive attitude (β=0.11;CI=0.06-0.15) and high self-efficacy (β=0.16, CI=0.11-0.21) were positively associated with increased SPA score at post-evaluation, while being a female (β= -0.22; CI= -0.27- -0.17) and being in the 15-19 years age range (β = -0.13; CI=-0.19-0.08) were negatively associated. Qualitative data revealed inconsistent PA policy implementation due to inadequate human, sporting resources and facilities and increasing time-demand for academic activities.
School-based multi-level intervention could improve adolescents’ attitude, self-efficacy and physical activity behaviours. It is therefore recommended for adoption and scale-up in schools in the study location.
