An empowerment-based school physical activity intervention with adolescents in a disadvantaged community: A transformative mixed methods investigation

Abstract: It is important for the health of adolescents to engage in regular physical activity. The majority of adolescents do not, however, engage in sufficient physical activity to meet contemporary guidelines, and adolescents of low socioeconomic status appear to be less physically active compared to adolescents of high socioeconomic status. As such, the overall aim of this thesis is twofold. First, the thesis aims to gain insight into adolescents’, from a multicultural community of low socioeconomic status, views on physical activity. Second, the thesis aims to describe and problematize the development and implementation of an empowerment-based school intervention, in a Swedish multicultural community of low socioeconomic status, and to evaluate the effects of the intervention focusing on basic needs satisfaction, motivation, and objectively measured physical activity. This compilation thesis is based on four papers and is written within the ‘How-to-Act?’-project which has its starting point in a two-year empowerment-based school intervention. For the purpose of the ‘How-to-Act?’-project, one intervention school (n=54 7th graders) and two control schools (n=60 7th graders), situated in a multicultural area of low socioeconomic status in Gothenburg, were recruited. For paper I and II, focus group interviews were conducted with adolescents (n=53) in the intervention school, before implementation of the intervention, to illuminate what they convey concerning factors that facilitate respectively undermine their physical activity. Paper III describes and problematizes the development and implementation of the empowerment-based school intervention, which was continuously developed and implemented through cooperation and shared decision making, focusing on physical activity. For paper IV physical activity was measured with accelerometers and basic needs satisfaction and motivation through questionnaires at baseline (7th grade), midpoint (8th grade), and endpoint (9th grade), to evaluate the effects of the intervention. On the one hand, the adolescents’ voices illuminated that, within their environment, it is difficult to establish healthy physical activity habits. More specifically, the adolescents expressed a profound awareness of tempting screen-based activities as undermining their physical activity, and several stereotypical gender norms were highlighted as undermining the girls’ physical activity. On the other hand, the adolescents mentioned that they enjoyed engaging in physical activity. According to the adolescents, enjoyment related to physical activity was promoted through variation and options, experiencing and developing physical skills, and the presence of peers. The adolescents also suggested that social support facilitated their physical activity, and proposed some ideas on how the school could become more supportive of their physical activity. Through the empowerment-based school intervention, the adolescents were offered opportunities to engage in a variety of physical activities and to assess and critically reflect upon health-related information and recommendations. Further, the intervention involved the adolescents in the decision-making process and thus, arguably, facilitated participation and empowerment. Nonetheless, the development and implementation of the intervention led to a number of ethical dilemmas that required cautious consideration. During the course of the two-year intervention, there was a credible decrease in controlled motivation, autonomous motivation, and moderate-to-vigorous physical activity. There were no credible effects of the intervention on controlled motivation, autonomous motivation, or moderate-to-vigorous physical activity. Future school-based physical activity interventions, in multicultural areas of low socioeconomic status, are recommended to include multidimensional intervention approaches across contexts to counteract the decline in physical activity during adolescence and to achieve lasting change in adolescents’ physical activity.