Challenges and barriers in conducting school-based physical activity research: A narrative review

ABSTRACT

Physical activity (PA) is associated with numerous mental and physical health benefits. But it has been observed that young people and children frequently participate in low levels of PA, which is especially noticeable when they progress from primary to secondary school. Thus, in order to improve physical health among school-going children, different schools should put in place school-based PA intervention programs. The researchers designing PA intervention protocols for school children encounter various challenges during implementation; hence, this narrative review determines the challenges and barriers faced by the researchers during data collection on PA of school-going adolescent children. The review highlighted the challenges encountered during implementation of school-based PA and fitness among school children. The key issues mentioned in the review involved problems related to communication with schools, recruitment of participants along with the informed consent, implementation and data collection, environment of school, and barriers to PA in school. The documentation of these difficulties can help advance knowledge of the researchers and their efficacy, which will finally result in the development of strengthened and close relationships with school-based educational institutions, leading to implementation of intervention protocols and enhancing physical fitness in school children.

Introduction

Physical activity (PA) offers several health benefits to young people, and the routines they establish around PA are likely to last into adulthood.[1] Youth should participate in PA of moderate-to-vigorous intensity (MVPA) for at least 60 minutes a day, as per widely accepted public health recommendations. However, research shows that the majority of children do not follow these guidelines, with 80% of 13- to 15-year-olds globally not engaging in enough PA.[1,2]

Young people and children frequently participate in low levels of PA[1], and PA participation reduces as children progress from primary (ages 4–11) to secondary (ages 11–16) education.[3] According to recent global surveillance data, 81% of youth (ages 11–17) do not participate in the recommended 60 minutes per day of moderate-to-vigorous PA (MVPA).[4] As children and adolescents spend maximum amount of their time in school, it provides an excellent setting for involvement in PA programs and allows for the collection of substantial amounts of data.[5]

According to recent research, PA programs in schools had little to no impact on the children who participated regularly.[6,7] However, the World Health Organization (WHO) recommended that schools create PA opportunities and programming and provide suitable and safe areas that encourage PA participation.[8] Since schools offer so many opportunities to promote PA throughout the school week, including before- and after- physical education classes, school programs, classroom-based PA, active school travel, and recess programming, they are thought to be the perfect place to encourage children for PA.[9,10] Hence, this narrative review determines the challenges faced by the researchers during data collection on PA and fitness of school-going adolescent children and demonstrates practical strategies to overcome the challenges, consequently enhancing the research process for primary care physicians and general care providers.

Review

Challenges during communication with schools

Promotion of PA interventions which are school-based has the potential to decrease chronic disease in the population as children and adolescents spend maximum amount of their time traveling to and from school, and almost all children in many countries attend school until they reach adolescence.[8] School-based interventions present a significant chance to enhance the understanding of the prevention of noncommunicable diseases and to give students the chance to engage in PA before, during, and after school hours, which may help them adopt healthier behaviors that they can carry into adulthood.[11]

Thus, the challenges that can be faced by the author’s undertaking school-based PA interventions may involve permission from the school authorities and no response to the emails. Additionally, some of the schools have their own protocol; so, to avoid the disturbance in the academic schedule, the permission may not be granted. Most of the schools can deny the permission for conducting the project in their school as the principal had to take the permission from the management and consequently would have to look after for all the aspects of the project for students’ safety concern. Researchers should not undervalue the benefits or drawbacks of communication with participating schools on the research project. The difference between acquiring data without any issues and gathering none at all can be attributed to effective and transparent communication with the staff at the school.

The strategies that can be implemented to overcome these challenges involve providing detailed information about the intervention protocol to the management authorities of the schools for the purpose of permission along with demonstration of the exercises included in the intervention protocol for safety concerns of the children. Additionally, elaborating the benefits and impact of PA in children which will enhance their health-related quality of life can be beneficial in obtaining the permission from the school authorities.

Recruitment and informed consent

Students who want to achieve their academic, emotional, and social objectives in the school system encounter many challenges. In fact, some advised that in order to assist students’ academic and social-behavioral development, educators should value the relationships children experience within their family, neighborhood, and community. School-based health promotion initiatives that are built on collaborations between community and school officials are one strategy to assist students’ healthy development. In reality, extramural research funding is frequently needed to assist the implementation and assessment of these programs. Getting parental approval is a major barrier when performing research on children.

The parents and community may misunderstand research studies, and low levels of involvement may lessen the benefits of these efforts and jeopardize the external validity of numerous potentially effective PA programs of intervention that are performed in school. High participation rates are necessary to avoid sample bias and increase the representativeness of prevention and intervention research.[12] Additionally, to create acceptable, practical, and affordable strategies to encourage open communication between students, parents, teachers, and researchers, it is essential for educators and researchers to collaborate.

In research studies, for making children to cooperate and participate, Institutional Review Boards typically require formal consent from parents or guardians; however, occasionally, this requirement of informed consent is waived. In addition, most school districts have to authorize research projects that have a school-based component for which passive or active parental consent is required. A consent form must be signed by parents to permit their child to get involved in research that uses active consent methods. If parents do not permit their child for the research study by indicating the same on consent forms or if they forget to return the consent form consisting of their child’s participation preference, the forms are considered as “Parental refusals”.[13] Researchers simply ask parents to respond if they do not want their child to be engaged in the study if they use passive consent, also referred to as notification methods. In passive consent processes, it is assumed that the lack of a parental reaction signifies the child’s assent to participate in the study. Passive consent methods raise concerns regarding potential violations of parents’ rights as they may not have gotten adequate notification about the study.[12] For example, if a child loses or misplaces a consent form, the researcher will presume that the parent approved the child’s participation, even though the parent was not aware of the study’s purpose.

In any research study, obtaining informed consent and recruiting participants can be challenging and time-consuming. This is particularly important in educational settings where access to schools and subsequent agreement from parents/caregivers can provide numerous challenges for an outside researcher.[14] The first obstacle for researchers may be acquiring gatekeeper permission and/or teachers’ willingness to take part in a research project at the school level. In some previous research, issues with school principals getting changed were also faced by the researchers as a new permission with their sign is considered for continuation of the project. When conducting research on PA, it can be helpful for researchers to first interact with school sport partnerships (SSPs) or other similar working groups.[15] In conclusion, recruitment of parental consent is difficult as child assent needs the supervision from their parents. Even though schools give their consent, parental consent is necessary. So, to find the solution for this, the class teacher of the respective standards should be informed for that respective class about the nature of study and its implementation; then in the parents–teachers meeting, all the parents should be given the details regarding the intervention protocol along with the benefits associated with the school-based PA intervention program and consequently recruit the consent forms for their child. Furthermore, in order to obtain informed permission, which can be highly informative for attending parents, project meetings between the researcher or study team and parents may be beneficial. Parents may have the chance to ask the researcher (s) questions during these meetings. All the collected forms with or without consent should be kept with the class teacher for the purpose of the record.

Implementation and data collection

A team of researchers and assistance is frequently needed for school-based PA research in order to gather the necessary data in the allocated amount of time. It can be difficult for the primary researcher to get this kind of support, but using qualified undergraduate students might be helpful. In a recent study, undergraduate students in their final year participated in a mentored peer-led PA intervention in which some assisted with data collecting, while others implemented the intervention.[16] Although gathering qualitative data can take a long period, it is crucial to not hasten the process. To acquire a deeper understanding, it is critical to establish rapport with participants at the initiation of the program. Students should receive training before initiation of data collection takes place to equip to the skills that are required. Since most students will already be familiar with the fundamentals of the techniques, training can concentrate on improving the consistency of the measurement procedures. Undergraduate student involvement can result in low reliability, poor attendance, and a variety of practical issues (studies, sports, or part-time employment commitments). As a result, linking studies to dissertations of final year can boost student enthusiasm and dedication and motivate them to attend data collection sessions in order to complete the study requirements.

In order to collect PA data, school officials must provide significant organizational input, and participating instructors must sacrifice curricular time, which has historically been noted to be scarce in an overcrowded curriculum for data collecting.[17,18,19] It is important that educational institutions feel valued and acknowledged for the time they have sacrificed. To guarantee this, researchers should stay in touch with schools even after data collection is over as cutting off after data collection with the schools and participants can damage relationships. Research conducted in schools needs to be collaborative, and giving schools feedback can help school employees understand the results of their time and work. Data from research may be used to determine areas where students’ health and well-being, as well as PA levels, should be enhanced. As a result, educational institutions have the chance to launch novel initiatives or guidelines that show how they have responded to the implications of the study. The framework for inspection focuses on care, training, and education quality. In the examination domain of personal development, learners should be able to preserve their physical and mental well-being. This can be shown by their participation in the PA data that are gathered and PA research. In all, this can make the research process and information more valuable to school administrators.

School environment

The most common issue involved when organizing school-based intervention programs can be finding an appropriate location. In order to facilitate confidential discussions, this must guarantee that participants are at ease in a natural setting. Focus groups could be held in the common area between classrooms as one strategy to employ in a primary school. This enables the teachers to view the sessions, whereas the participants feel that their intervention protocol and data are confidential. Additionally, background noise and distraction may result from staff and/or children moving throughout the school; it is unlikely to cause major disruptions over an extended period of time. In a secondary school, finding suitable areas can be more challenging, but requesting access to the dining hall or an empty classroom can be taken into consideration for study purpose. Focus groups can also be held in any corner of the sports hall if a team of data collectors is present.[15]

Additional research staff can help facilitate the procedure by ensuring that participants wait a suitable distance apart in order to prevent crowding. If working alone, it could be beneficial to seek a teaching assistant or teacher for help with organizing the procedure. For example, for fitness testing, employing the 20 m shuttle test can be difficult as it is necessary to find a suitable location ahead of the data collecting day and make sure it is free for the usage. Since indoor rooms might not give enough space, outdoor spaces frequently offer a more favorable atmosphere for these studies. Because in primary schools the indoor space is usually multipurpose and used for events like big group meetings and assemblies, access might be challenging. The weather and the duration of school breaks and schedules of lunch may affect the use of outdoor areas for the study intervention. If we are aware that outdoor space is necessary, we should think about scheduling a backup date with the school early on to minimize disruptions caused by inclement weather and a shortage of interior space.

There are certain restrictions in comparison to high-income nations, such as limited resources.[20] Because of scarcity in resources, there may not be any teachers available to train the participants or there may be insufficient teachers to adequately serve the population of the students. In terms of financial resources, there may not be enough money, facilities, equipment, or room for PA that could lead to a variety of activities.[20] Thus, school environment can be one of the barriers for the researchers in terms of space available for the performance of the PA intervention, distractions associated with staff and/or children moving throughout the school, weather conditions, duration of school breaks, and scarcity of resources. Therefore, to overcome these barriers, prior discussion regarding scheduling the PA intervention should be considered with the school.

Barriers to physical activity in school

The main obstacle affecting school-based PA is considered to conflict with academic studies, where children and adolescents complained about not having enough time for PA because they were spending most of their time on homework due to academic load.[20,21] Furthermore, research findings indicate that principals of the schools may not possess a comprehensive understanding of the physical education program at their schools. Consequently, enhancing the principal’s knowledge could play a crucial role in addressing some teacher perspectives regarding challenges to high-quality programming.[22] Similarly, some of the class teachers along with physical education teachers cannot be enthusiastic enough for incorporation of school-based PA programs as they were found to be more concerned about academic profiles of the student participants. Thus, the challenge more commonly encountered in terms of PA is academic load due to the increased competition in various fields, because of which children get insufficient time for PA for which the researchers can have discussion about various aspects of PA with parents, teachers, and principals for providing school-based PA intervention protocols.

Moreover, an important barrier that can be considered was COVID-19 as many participants must have demonstrated irregularity in attendance, because of which their school-based PA intervention must have compromised. Furthermore, the guidelines implemented for COVID-19 must have limited the involvement of students in school-based PA, which involved wearing of masks and social distancing.[23] A comparable study conducted by Fegert et al.[24] found that the COVID-19 policy was a significant barrier to PA involvement because of enforced restrictions involving a 2 m physical distance and limitations on sporting activities, social and communal events, and playground and park use. Additionally, all scheduled after-school programs were canceled, and as a result, the children and adolescents had to abide by rules regarding behavioral restrictions, PA limitations, and physical distancing.[4,25] Other factors influencing PA participation can include insufficient energy, extrinsic illness, and poor social support.[26]

Conclusion

The review highlighted the challenges encountered during implementation of school-based PA among school children. The key issues mentioned in the review involved problems related to communication with schools, recruitment of participants along with the informed consent, implementation and data collection, environment of school, and barriers to PA in school, which will benefit researchers, postgraduate, and undergraduate students. However, it is necessary to develop strong relation for researchers with the school physical education teachers along with the participants and PE teachers should be fully compliant with the PA intervention protocol incorporated by the study researchers as they helped facilitate and manage any issues that arise. The documentation of these challenges can help in advancing knowledge and efficacy of the researchers, which will consequently result in the development of closer and strengthened relations with school-based educational institutions, leading to implementation of intervention protocols and enhancing physical fitness in school children and furthermore demystifying the research process for primary care physicians and general care providers.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.