Translation of the connect through PLAY physical activity intervention for underserved youth from in-person to virtual delivery: a feasibility study

Abstract

Background

Afterschool “aftercare” programs (ASPs) have been recognized as critical settings to promote youth adequate daily physical activity (PA). However, several social and contextual challenges, especially faced by ASPs serving under-resourced schools/communities, inhibit youth from meeting PA goals, with the COVID-19 pandemic only exacerbating these challenges. Connect through PLAY (CTPI) is a 16-week social-motivational PA intervention designed to increase PA in underserved youth (ages 9–16) by providing staff training and resources to overcome social-contextual challenges and integrate youth social-motivational needs into the PA programming of existing ASPs.

Purpose

This study aimed to evaluate the feasibility of translating the CTPI intervention into a virtual format during the onset of the COVID-19 pandemic. To date, we know little about whether establishing a positive social-motivational climate is possible through a virtual format.

Methods

The intervention included three components: (i) a novel PA curriculum, (ii) small group sessions, and (iii) staff health initiative. Youth and staff surveys were collected at baseline and endpoint to assess integration, acceptability, and potential effectiveness (longitudinal subsample n = 27 youth; 37% female; 36.1% Black/African American; M_age = 9.96 years).

Results

Paired sample t-tests indicated significant improvements in youth PA interest, cognitive engagement, regulatory motives, and PA participation, with medium to large effect sizes. Staff reported high acceptability and enthusiasm for continuing the intervention’s virtual activities.

Conclusion

Findings demonstrate that PA interventions focused on cultivating a positive social-motivational climate can be successfully adapted to virtual formats, providing valuable health promotion opportunities with greater reach to youth within under-resourced communities.

Implications.

• Practice: Virtual, social-motivational climate-based physical activity programs, could be a highly effective resource for schools and afterschool programs to support youth physical activity and health through improving capacity and reach to underserved communities.

• Policy: Policymakers focused on improving youth physical activity, health, and wellness should explore virtual school/afterschool-based interventions that are centered on addressing teacher/staff capacity needs and facilitating a positive social motivational climate that improves acceptability and effectiveness, and that can be sustainable and implemented wide scale.

• Research: Future studies using randomized controlled trail research designs that incorporate ecological momentary assessment and longitudinal psychometric network analysis are needed to strengthen the evidence base for virtual social-motivational physical activity interventions for youth.

Introduction

A substantial body of research has indicated that physical activity (PA) is essential when it comes to the health and well-being of children and adolescents and serves as a protective agent against the development of unhealthy body weight and subsequent risk for associated weight-related diseases [1, 2]. There is also substantial evidence that the importance of regular participation in PA for school-aged youth extends well beyond physical health and encompasses numerous facets of mental and psychosocial health [3], including cognitive development, behavioral responses, and psychosocial functioning [4]. Despite the many benefits of PA, the majority of children and adolescents in the United States (76%) fail to meet the recommendation of accumulating at least 60 min of moderate-to-vigorous daily PA [5]. Underserved youth, who have been shown in previous research to face multiple obstacles to PA access and opportunities resulting from their residence in under-resourced, low-income communities and racial-ethnic marginalization [6], are particularly vulnerable, with this demographic reporting the lowest levels of daily PA [7] and the highest incidence of obesity and associated illnesses [8]. The SARS-CoV-2 (COVID-19) outbreak, officially declared a pandemic on 11 March 2020, both highlighted and posed an additional set of challenges to youth PA accrual. To reduce viral transmission individuals were required to radically change their lifestyle, isolating at home, restricting outside exercise, coping with the temporary closure of schools. Consequently, the COVID-19 pandemic was found to further reduce opportunities for youth to be physically active [9] and the disproportionate effect of COVID-19 on vulnerable communities resulted in heightened physical and mental health disparities [10, 11]. These recent events compounded the already established susceptibility to long-term negative health outcomes due to a lack of PA prevalent among underserved youth. In particular, within the southeastern region of the country in which this study took place, this compounding vulnerability was most prominent among underserved youth within low-income and/or Black and African American communities.

Quality after-school programs (ASPs), whether in-person or remote, have been recognized as important sites that focus on promoting youth’s daily PA accrual [12–16], building quality and meaningful adult-youth connections [17], and integrating social and emotional learning skills which can ultimately enrich youth character development and motivation [18]. According to afterschool alliance [19], over 7.8 million children and adolescents in the United States participate in ASPs annually and ASPs have a significant reach to underserved populations of youth who are most in need of PA intervention. The growing body of evidence suggests that ASP staff can serve as influential role models and agents to supporting youth PA [12–17]. Specifically, ASP staff’s PA knowledge, value, motivation, and self-efficacy toward implementing a supportive social-motivational climate-based PA curriculum, as well as their ability to develop close social connections with youth, can be critical factors for youth engagement, PA accrual, and sustained behavioral change [12]. However, previous research has identified several barriers within ASPs, especially those serving under-resourced schools and communities, that inhibit staff from adequately meeting these goals, including minimal PA-based training, resources, or support, time constraints, antithetical cultural norms, disciplinary approaches that reduce PA, and large groups of participants with a diverse range of developmental needs [16, 20].

The challenges of the COVID-19 pandemic only further highlighted the challenges that ASP staff face in promoting PA opportunities for youth with lack of PA-based training and supports to manage the restrictions placed on interactive activities (e.g. inhibiting the use of shared equipment, requirements to socially distance and minimize any physical contact, the establishment of contained classrooms), and limitations on the admittance of outside active programming like karate and gymnastics into ASP sites (e.g. schools and community centers). In-person PA programs and interventions that typically supported staff implementation of PA were no longer allowable and/or applicable during and postpandemic due to these restrictions. These experiences during the pandemic brought to light the critical need for alternative cost-effective delivery methods of PA curricular and support systems that effectively achieve desired programmatic intervention outcomes across diverse settings and populations [21, 22]. In a recent scoping literature review study, Killian et al. identified 14 research studies that addressed the use of online and blended instruction in K-12 physical education (PE) [22]. The authors found that teaching and learning of online PE and online PA programs can be immensely beneficial to students positive physical/motor skill changes, motivational outcomes, and socio-relational learning in the absence of in-person instruction [22]. Another set of studies in virtual sport-based intervention programs indicated that implementing a virtual ASP curriculum can be promising for fostering both positive emotional responses and peer relationships [23]. However, in other studies, remote learning appeared less effective than in-person PE for achieving program goals with positive outcomes likely dependent on the quality of implementation and the degree to which this programming meets youth social developmental needs [16, 17, 24]. To date, we know little about whether the establishment of high-quality programming/intervention, that includes a positive social-motivational climate to support youth PA engagement, motivation, and social support, is possible through a virtual format. The current study aims to address this gap through testing the feasibility (i.e. integration, acceptability, and effectiveness potential) of implementing connect through PLAY (CTPI), a social-motivational climate-based ASP intervention to promote increased PA, through a virtual format. The development of school-based virtual implementation systems for promoting PA has significant implications in particular for supporting access/reach for underserved low-income and racial-ethnic minoritized youth (e.g. high stable attendance, minimal participation fees, equipment costs, or transportation requirements), and this was especially true during the COVID-19 pandemic for those who had higher rates of early return to in-person learning than youth from higher income/White communities due to greater challenges with internet access and reliability, lack of suitable devices, and other context-based or technology-based infrastructure issues that makes home-based virtual learning/intervention less feasible and effective [25].

The connect through PLAY intervention

The CTPI trial is a 16-week cluster-randomized controlled trial that builds upon the PA programming of already-established ASPs to promote increased PA in staff and underserved youth (9–16 years) by targeting youth social goals and developmental needs. Self-determination theory (SDT) [26] and achievement goal theory (AGT) [27] guided the conceptualization of the intervention which is centered on delivering positive PA experiences that encourage and maintain youth relatedness needs and an affiliation orientation toward PA (i.e. pursuing a PA competence that is defined by having positive social connections/experiences through PA), as well as fostering self-determined motivations and sustained increases in PA [12, 13].

The original trial is designed to address some of the challenges and barriers that staff face in implementing PA curricula [13]. Further, it provides staff with training, curriculum materials, and support for developing staff–youth and youth–peer relationships. The first of three core components of the intervention is the CTPI activities curriculum guide, which includes an extensive set of PA options that are designed to be implemented for at least 60 min (at least 2–3 activities each day) for at least three times per week and involve activities youth have never tried before and that emphasize positive social-emotional experiences and outcomes. The curriculum guide also includes a series of small group “connect the dots” sessions (30 min/once per week) that consist of interactive student-led discussions (e.g. stress management, healthy development) and team-building activities, which provide youth and staff guided opportunities to grow friendships, group cohesion, and staff connections. The second component of the intervention is the CTPI training manual for ASP staff, which is designed to promote sustained implementation of the curriculum guide. The training involves a series of sessions intended to develop strategies for establishing positive connections and group belonging within ASPs. It also provides staff detailed guidance for implementing the CTPI PA activities, including “recommended” PA practices and weekly schedules, instructions on how to set up the activity area and equipment and how to effectively communicate the goals and rules of each activity. The third component of the intervention is the Staff health initiative, which is an evidence-based SDT climate (autonomy and relatedness supports) and behavioral skills (self-monitoring, goal-setting, and social support) approach implemented weekly throughout the intervention that is aimed to promote improvements in the staff’s own PA value, efficacy, motivation, and behavioral change. This component aims to leverage ASP staff as both positive PA role models and agents of change for fostering youth PA behavioral change. A previous CTPI feasibility trial via “in-person” format demonstrated the adequate dose, fidelity, acceptability, and efficacy of changing social mechanisms within pre-existing ASPs to improve youth PA [see (12, 13, 28) for additional details about the intervention’s essential elements and research design].

Purpose of the present study

Guided by SDT and AGT, we aimed to deliver a virtual format of the CTPI to continue facilitating PA promotion within underserved ASPs (defined by at least 50% of school enrollment on free or reduced meals and 50% of youth of a racial-ethnically marginalized group) by addressing the acute challenges posed by the COVID-19 pandemic and the pervasive challenges and limitations in staff/program capacity faced by ASPs more broadly. Examination of the feasibility of the virtual delivery of the program, including the integration and acceptability (i.e. the ease of program implementation, the likelihood that staff will use the intervention in the future, perceptions of value/effectiveness and enjoyment), and effectiveness potential (i.e. changes in targeted PA social mechanisms and PA engagement) is warranted to support broader implementation of CTPI that would enhance accessibility, reach, and impact on youth engagement in PA [29]. This provides a compelling rationale for the development and implementation of our study. The present research focuses on the translation of the CTPI from an in-person format to a virtual format during the COVID-19 outbreak. The virtual delivery version of the CTPI was designed to be deliverable on a web-based platform and to meet the new restrictions placed on the ASP PA curriculum due to the pandemic (i.e. social distancing, no shared equipment). In this adaptation, content, structure, and essential elements of the intervention were preserved so that one could target the same social mechanisms and aims (i.e. improving youth PA motivation and daily PA accrual) as the larger “in-person” efficacy trial. As this new version of the intervention program was designed and implemented for the first time, the feasibility of its virtual delivery was paramount to ensure the translation of demonstrable benefits of CTPI into ASPs through this new approach and can be used to inform planning/development of larger future virtual-based PA interventions for underserved youth that can achieve greater reach. The purpose of this study, therefore, aimed to examine the feasibility of the virtual CTPI intervention during the COVID-19 pandemic. Specifically, this study assessed the integration and acceptability of the virtual delivery format by measuring youth and staff perceived enjoyment, utility (benefit/importance), and practicality/sustainability (ability and willingness to continue playing/implementing CTPI activities) of the intervention and the effectiveness potential of the virtual delivery of CTPI on improving targeted PA social mechanisms (i.e. PA motivation, perceived efficacy, value/importance of PA, interest/affect, social support) and increasing youth PA engagement from baseline to post-intervention.

Methods

Research design

A descriptive, repeated measures research design was used to examine prepost intervention differences in self-reported acceptability and efficacy for youth and staff at two ASPs serving underserved youth using weekly acceptability surveys administered to both youth and staff throughout the 16-week virtual intervention and self-report surveys administered at baseline and post-intervention.

Participants

Data were collected from two ASPs that serve underserved youth in a rural-suburban area of the southeastern United States between September 2020 and April 2021. The two sites were recruited within the network of boys and girls club community partners that are involved with the larger (in-person) CTPI trial. To ensure recruited ASPs represent underserved communities, inclusion criteria required that only schools/ASPs whose student enrollment is composed of at least 50% of youth from low-income households, defined by free/reduced lunch status, and at least 50% of enrolled youth identify as a racial/ethnic minority. Given the southeastern region of the country in which these data were collected, racial/ethnic minority populations predominantly include youth who identify as Black and/or Hispanic, with small percentages of youth identifying as Pacific Islander and Asian. Among the two schools who participated in the study, the student population of one school consisted of 100% of youth from low income households and 51% of racial-ethnic minority status (33% of youth identified as Black or African American; 18% Hispanic) and the second school consisted of 62% of youth from low-income households and 79% of minority status (67% of youth identified as Black or African American; 10% Hispanic). Both youth and staff at the ASPs participated in the study. There were 38 youth who completed the baseline survey (n = 34% female; 34.2% Black/African American; M_age = 9.84 years) and 53 youth who completed the endpoint survey (n = 43% female; 52.8% Black/African American; M_age = 10.04 years). Over 50% of the sample (n = 27; 37% female; 36.1% Black/African American; M_age = 9.96 years) completed both baseline and endpoint surveys, and these responses will be used to examine preliminary effects of the intervention on targeted psychosocial, motivational, and behavioral outcomes. All youth ages 9–16 that were enrolled in the study and participated in the weekly CTPI activities were asked to complete acceptability surveys. In addition, there were nine ASP staff members (89% Black/African American; M_age = 28.4, SD = 3.1) who completed the baseline and endpoint surveys. All participation in the study was voluntary, and those invited to participate had the right to decline with no negative consequences. The study protocol was approved by the Institutional Review Board (IRB) and the study was conducted in accordance with the ethical standards of the American Psychological Association.

Procedures

The virtual CTPI was administered within the two ASPs, 3 days a week for 16 weeks. All participating youth and staff completed informed consent and assent forms prior to data collection. Youth and staff were asked to complete short surveys at baseline and endpoint which included self-reported measures to assess integration and acceptability of CTPI in the ASP and effectiveness potential of the virtual intervention program and obtain demographic information. Staff were also asked to complete a school technology equipment needs assessment at baseline and any identified technology equipment needed for the intervention that was unavailable in the school was provided by the research team. An intervention team member visited each school prior to the intervention to help set up and train staff on all technology equipment and provided an initial consultation on the implementation of intervention components.

Virtual (connect through PLAY) intervention

The virtual delivery of the intervention included all three key components of the larger CTPI curriculum: A novel PA curriculum that supported teamwork and social connection/cohesion (60 min, 3/week); small group, “connect the dots” sessions (30 min/week) that involved interactive student-led discussions centered on empowering youth to engage in their own healthy behaviors and support their peers in being healthy; and a staff health initiative that promoted improvements in the staff’s own PA value, efficacy, motivation, and behavior. Each component was adapted to fit an online delivery format and to meet school-mandated safety parameters stemming from the pandemic. In particular, we developed a large set of new PA games for the PA component that addressed current and potentially future requirements to be socially distanced, wear masks, and to avoid sharing any equipment or allow for outside visitors. The CTPI research team identified and presented several viable online platform options to each ASP site that ensured safety, privacy, easy access for youth and staff in the program, and “friendly” usability; all programs opted to use the Google platform (Google, LLC; e.g. Google Classroom, Google Meet) for intervention delivery. An orientation to the platform was provided to all ASP staff, that also included tutorials on how to access and engage with all intervention materials. However, this platform was already used by both school districts, and thus, ASP staff and youth were quite familiar and comfortable with navigating the platform for the intervention.

Video sessions throughout the intervention were conducted with our CTPI research team to record training tutorials for youth (e.g. dance steps), implementation tutorials for staff (e.g. a stepwise tutorial on how to run the small group session about teamwork), and related group-based activity videos to demonstrate the new PA games (e.g. an array of new dances, circuit trainings, no-equipment games, PA challenges for youth and staff, yoga, mindfulness and breathing exercises). All units of the staff health initiative curriculum were also developed into interactive videos that helped build staff knowledge and motivation for healthy behaviors and set up tasks/goals to be accomplished by staff each week (e.g. activity challenge, step goal).

Each week, a set of six to nine PA (Videos 2–3 each day for 3 days) and an accompanying tutorial to each video on how to set up and play the games were posted on the Google Classroom for ASP staff to post and implement with their students. At a regularly scheduled time during one program day each week, the CTPI intervention team would set up a live stream with the program site through Google Meet where the research team was able to connect with the youth in the program and facilitate a number of the activities assigned for that week over a large projector screen and where students had the opportunity to demonstrate for the CTPI staff the fun new activities and skills that they learned that week from the CTPI curriculum. Each week, a small group “connect the dots” activity and accompanying tutorial video were also posted to the Google classroom for staff to review. A separate live-streamed small group session was scheduled weekly in which the CTPI curriculum specialist prompted students to work together, brainstorm, create, and share their thoughts and projects with one another, ASP staff, and the CTPI curriculum specialist. Units were centered on developing skills for “positive and effective teamwork,” “understanding and managing goals,” “mindfulness and emotional management,” and “social expression, empowerment, and development.” Lastly, staff health initiative videos and accompanying goal worksheets for each health unit were posted for ASP staff to complete each and a weekly staff health promotion meeting was scheduled with the CTPI staff health clinician to review the unit and discuss accomplishments as well as barriers and possible solutions for reaching weekly health goals (see Table 1 for curriculum units).

Table 1.

Descriptive statistics of staff health initiative acceptability assessment

	Staff health initiative acceptability questions (mean/SD)
	Q1: This week’s staff health activities were easy to integrate into my daily life	Q2: This week’s staff health activities have helped me improve my daily health habits
Staff health units
Goal setting	3.50/0.53	3.63/0.52
Engagement	3.71/0.76	3.71/0.49
Mindfulness	4.13/0.83	4.13/0.64
Nutrition	3.88/0.64	4.00/0.76
Sustainability	3.86/0.69	3.86/0.69
Overall mean	3.82/0.69	3.87/0.62

Measures

To assess acceptability of the CTPI, short surveys were administered weekly. To measure feasibility of the virtual intervention for on youth social mechanisms and obtain demographic information a different set of self-report surveys were administered at baseline and endpoint. Both the baseline and endpoint survey and weekly acceptability survey were collected through a web-based platform (i.e. SurveyMonkey; SurveyMonkey LLC, Palo Alto, California, USA).

Integration and acceptability assessment

During one of the regularly scheduled virtual intervention periods each week, surveys were administered to investigate youth perceptions of each novel PA game and small group activities, using four questions: (i) How much did you like (insert the activity name) this week; (ii) would you like to do the (insert activity) again?; (iii) Do you think it was beneficial to students to have a small group discussion/activity on (weekly topic), and; (iv) how important do you think it is to think about ways to (insert weekly topic), with a response scale of 1 (not at all) to 5 (very much/beneficial/important). All staff of each ASP were also asked to complete surveys about their perceptions of the acceptability of the PA and small group curriculum for youth (i.e. how much did the students in your program like the (insert activity) this week?; is this an activity that you think you will do again with students in the program?), and the staff health initiative curriculum for staff (i.e. goal setting, engagement, nutrition, and sustainability) that asked staff to rate on a 1 (strongly disagree) to 5 (strongly agree) whether this week’s staff health activities were… “easy to integrate into my daily life,” and “have helped me improve my daily health habits.” All acceptability and feasibility questions were derived from Sekhon et al.’s theoretical framework of acceptability [30] and other feasibility frameworks [31] and have been used in several large study’s with same-aged youth and adults in underserved communities within the southeastern United States [12, 28, 32].

Effectiveness potential: PA social mechanisms and engagement

The social support and exercise survey [33] was used to measure youth perceived changes in ASP staff’s social support for youth PA [reliability coefficients range from 0.71 to 0.82; 5-point scale: 1 = none (receive support), 5 = very often (receive support)]. The intrinsic interest and regulatory motives scale [34] was used to measure youth PA interest, PA cognitions (i.e. perceived efficacy and value/importance of PA), and PA regulatory motives [reliability coefficients range from 0.78 to 0.87; 5-point scale: 1 = never (does not enjoy), 5 = always] with higher mean scores across scale items indicating youth greater intrinsic enjoyment and degree of affective engagement in exercise. Additionally, PA participation frequency was measured using the item “In the last 7 days how often were you very active (playing hard, running, jumping, and throwing) for a total of at least 60 min per day?” (1 = never; 5 = always—all 7 days; item derived/modified from Johnston, O’Malley, Schulenberg, Bachman, Miech, and Patrick, Monitoring the Future, Institute for Social Research, University of Michigan). For youth survey data, the mean of student responses was calculated for each component at baseline and endpoint.

Statistical analysis

G*Power software [35] was used to conduct a power analysis to verify legitimacy of the estimated sample size of 27. In a G*Power t test, the difference between two dependent means (matched pairs) was used as the statistical test, with an effect size set to 0.05, and statistical power set to 0.80 [36]. A high statistical power means that the results are likely valid; as the power increases, the probability of making a type II error decreases [36]. The G*Power result showed a sample size of 27 is needed to reach an adequate statistical power of 0.80.

All statistical analyses were conducted using IBM SPSS (version 25.0; IBM Corp., Armonk, NY). To answer the research questions, first, a descriptive analysis was conducted to show the percentage of youth’s responses on major survey questions. Then, a paired sample t-test was conducted to determine whether there were significant changes from baseline to endpoint in targeted social, cognitive, and behavioral health outcomes including youth PA interest, PA cognitions, PA regulatory motives, PA social support, PA participation (yes/no), and PA frequency. The statistical significance threshold was set at P < 0.05.

Results

Demographics

Chi-squared analyses were used to examine any differences between the longitudinal subsample (n = 27) and the full sample (n = 64). Comparisons showed that there were no differences in gender [χ² (1, 53) = 0.319, P = 0.57] and age [χ² (6, 53) = 5.83, P = 0.44], but there were significant differences in race and ethnicity [χ² (2, 53) = 12.96, P = 0.002]. Compared to the full sample (n = 27), there were fewer Black/African American youth who completed both baseline and endpoint surveys. This disparity was not the result of greater dropout among Black youth but rather due to Black youth (n = 17) returning to in-person learning and joining the ASP/CTPI later into the year, on average, compared to White students in the schools in which the intervention was implemented (and did not complete baseline measures). Chi-squared analyses were also used to examine whether there were any potential differences between the subsample of youth with complete baseline and endpoint data, compared to those with data only at a single data point. Results showed that there were no differences in PA interest [χ² (8, 38) = 12.75, P = 0.12], PA cognitions [χ² (8, 38) = 5.38, P = 0.25], PA regulatory motives [χ² (8, 38) = 12.34, P = 0.26], social support [χ² (8, 38) = 14.85, P = 0.32], or PA participation [χ² (8, 38) = 10.21, P = 0.25].

Descriptive analysis

Since there was no significant difference between the subsample of youth with complete data and the full sample, descriptive analyses were conducted by using the responses of the full sample (n = 64). The descriptive results showed the percentage of youth’s answers to the major survey questions. For PA participation, compared to baseline, the number of youth who reported that they were “quite often” or “always” very active in the past 7 days at the endpoint increased from 47.4% to 77.3%.

Integration and acceptability

Most youth (80.8%) liked doing the intervention activities in their ASP. Also, the majority of youth (76.9%) reported they would like to continue to do some of the intervention activities in their ASP in the future. The small group acceptability assessment also indicated acceptability of the small group activities. Based on the scale of 1 (not at all) to 5 (very beneficial), on average, youth reported that they think it was “beneficial” (M = 4.6) to have a small group discussion incorporating deep breathing, teamwork, gratitude, and role modeling. Also, based on the scale 1 (not at all important) to 5 (very important), on average, youth reported that they think it is “important” (M = 4.6) to think about ways they can work together as a team with others.

Staff acceptability assessment also indicated acceptability of the virtual intervention’s activities for each week. Based on the scale of 1 (not at all) to 5 (super fun), on average, staff reported that youth in their program thought the CTPI activity each week is “super fun” (M = 4.1). In addition, based on the scale of 1 (no, never) to 5 (yes, for sure), on average, staff reported that they will “yes, for sure” (M = 4.41) do the CTPI activity again with the youth in the program. Staff health initiative acceptability assessment indicated acceptability of health activities for each unit. The descriptive statistics of staff health acceptability assessment are included in Table 1.

Effectiveness potential

A paired sample t-test was conducted to assess youth’s improvements in targeted social, cognitive, and behavioral health outcomes from baseline to endpoint. A paired sample t test showed that there was significant improvement in youth’s PA interest, PA cognition, PA regulatory motives, and PA participation from pre- to postsurvey (P < 0.05). Table 2 presents the paired sample t-test results. Additionally, effect sizes were calculated using Cohen’s d, with PA interest (0.49), PA cognitions (0.47), and PA regulatory motives (0.47) interpreted as being medium, and PA participation (0.87) interpreted as being large.

Table 2.

A paired sample t-test result

	Mean difference	SD	t	df	Significance (two-tailed)	Cohen’s d	95% CI
							Low	Upper
PA interest	−0.29	0.68	−2.21	25	0.04	0.49	−0.57	−0.02
PA cognitions	−0.54	1.20	−2.36	27	0.03	0.47	−1.00	−0.07
PA regulatory motives	−0.42	1.00	−2.20	27	0.04	0.47	−0.80	−0.03
Social support	0.01	1.17	0.04	25	0.97	0.01	−0.46	0.28
PA participation	−0.75	1.13	−3.52	27	0.00	0.87	−1.19	−0.31

Discussion

While limitations of virtual formats persist, this study demonstrates the possibility for well-designed interventions to effectively promote youth PA and psychological well-being, and to do so even under challenging conditions, such as those experienced during the COVID-19 pandemic. The purpose of this study was to examine the feasibility of the virtual CTPI intervention during the COVID-19 pandemic. The findings suggest that PA interventions centered on facilitating a positive PA social-motivational climate can be effectively translated into valuable virtual learning experiences and health promotion for youth. Specifically, the results highlight promising outcomes, particularly in PA participation and social-motivational factors related to PA engagement, and these outcomes are analogous to those found in our in-person CTPI trials [12–15, 28]. Youth found the small group social activities and the structured PA activities, such as dance, socially based circuit training, and novel active games were engaging and beneficial, with a vast majority (over 75%) expressing a desire to continue these activities in the future. Staff also reported acceptability and enthusiasm for continued implementation of the virtual intervention’s activities. Analyses assessing effectiveness potential among the longitudinal subsample indicated significant improvements in youth PA interest, cognition, regulatory motives, and PA participation, with medium to large effect sizes observed.

Implications

The results demonstrated several notable outcomes. First, findings highlight how the provision of PA capacity and resources to ASP staff and teachers who typically do not receive substantial training in PA/health promotion [16, 37, 38] can have critical positive impact on youth health behaviors. In particular, findings demonstrate how the provision of CTPI’s easy-to-use, developmentally appropriate online training and support tools/resources can support ASP staff and teachers effectively establish a positive social-motivational climate that promotes increased youth PA engagement and motivation (i.e. interest, cognition, and regulatory motives). Novel to the CTPI intervention, resources were provided to support staff in improving their PA, health, and wellness. Initial staff acceptability assessments, based on responses to two key questions, indicated positive feedback. Staff were asked to rate their agreement with the statements, “this week’s health activities were easy to integrate into my daily life” and “this week’s health activities have helped me improve my daily health habits,” using a scale ranging from “strongly disagree” to “strongly agree.” Responses showed that the majority of participants agreed or strongly agreed with both statements, highlighting the intervention’s feasibility and its perceived impact on promoting healthier daily routines. Together, the PA implementation tools, and staff health promotion resources aim to leverage ASP staff as both positive PA role models and key agents of change for youth behavior change [13].

In turn, findings from the feasibility assessment of this virtual format centered on supporting staff in engaging youth in a high-quality positive PA social motivational climate within ASPs were encouraging. There were high acceptability rates from youth with most youth (80.8%) reporting enjoyment in the intervention activities, and 76.9% expressing interest in continuing these activities in the future. Small group discussions were particularly well-received, with youth rating them as beneficial and important for team building. Staff also reported high levels of acceptability and satisfaction, with an average rating of 4.1 out of 5 for the CTPI activities being “super fun.” Indicators of acceptability of the intervention components were comparable to our in-person feasibility trial which used the same questionnaires/scales, with responses ranging, on average, from 4.25 to 5.00 [28]. Findings also highlighted the social motivational and behavioral effectiveness potential of the CTPI virtual program. There were substantial increases in youth PA participation, with the percentage of youth reporting being “quite often” or “always” very active rising from 47.4% at baseline to 77.3% at the endpoint. This significant improvement suggests that the virtual intervention was successful in motivating youth to remain physically active, even during pandemic-related restrictions. Data from the longitudinal subsample also highlighted the intervention’s potential for improving youth PA-related psychological well-being with observed increases in PA interest, PA-related cognitions, and PA regulatory motives, further supporting the intervention’s feasibility and effectiveness in diverse domains.

Second, the current intervention, grounded in SDT [26] and AGT [27], appears to have been effectively translated to a virtual format. Within the framework of SDT, the intervention addressed the three core psychological needs including autonomy, competence, and relatedness [12, 13, 26]. The intervention activities allowed youth to choose among different physical activities, supporting autonomy and fostering a sense of ownership over their participation. By implementing a structured curriculum of incrementally more challenging (scaffolded) PA options, the program provided opportunities for youth to experience success and skill development, thus enhancing their sense of competence. Furthermore, the small group discussions and team-based games helped establish a strong sense of relatedness, creating a supportive social climate that is central to sustaining motivation [26]. These elements collectively contributed to internalizing motivation, leading to improved PA participation even under challenging circumstances. In fact, changes in PA in this study, albeit self-report, are reflective of observed changes in PA participation reported in our previous studies [12, 14, 15] as were changes from baseline to postintervention in youth intrinsic and regulatory motivations [14, 15]. Similarly, the intervention design aligned with key principles of AGT by fostering a positive social motivational climate [27]. The focus was on emphasizing competence through social relationships, group belonging, and staff/teacher acceptance, rather than physical/sport competition or social comparison. The significant improvements in PA interest, cognition, and regulatory motives, which are comparable to changing intrinsic and regulatory motivational trajectories observed in the in-person CTPI trial [14, 15], suggest that the core social-motivational mechanisms underlying both SDT and AGT were preserved and effectively adapted to the virtual environment. These findings indicate the adaptability of these theoretical frameworks to different delivery formats, including online interventions, highlighting their potential to promote PA and psychological well-being in low-income underserved communities and racial-ethnically marginalized youth populations.

Lastly, the curriculum and infrastructure development of the virtual CTPI was adopted from the in-person CTPI trial, which was carefully designed with our community partners to address the strengths, barriers, and specific needs of under-resourced schools and communities to promote youth motivation and engagement in PA and overall wellness [12–16, 28]. While a larger effectiveness trial is needed to determine if effects are sustained over time, the results from this feasibility trial suggest that the virtual CTPI, which provides “adoptable” developmentally appropriate MVPA-promotion strategies that require minimal equipment and program capacity (e.g. staff supports and training tools, easy-to-implement “curriculum” focused on a positive climate with choice and youth input, equipment, staff health initiative, etc.) to pre-existing under-resourced ASPs, may be an effective strategy for improving MVPA of underserved youth who have traditionally been more difficult to reach and treat. In addition, during the COVID-19 pandemic, it was important for us to maintain focus on integrating CTPI programming within pre-existing schools and ASPs as youth began moving back toward in-person learning, and to not rely on home-based delivery systems which posed additional challenges for many underserved communities who were more likely to face barriers related to technology infrastructure [25].

While the school-based virtual system addressed pressing needs driven by the pandemic, and brought PA and health-promotion supports to underserved youth who had earlier returns to in-person learning, it also highlighted ways in which virtual delivery systems meet a critical need that has implications for the future of PA-based interventions for youth. Moving toward the virtual delivery of interventions within schools/ASPs supports the provision of alternative, more cost-effective delivery methods of PA curricular and support systems that reduce burden on school infrastructure and teachers’ time, improves reach, feasibility, and adoptability, and can achieve desired programmatic intervention outcomes within hard-to-reach underserved communities [39, 40].

Translation to future intervention

Most effective digital PA interventions prior to the COVID-19 pandemic incorporated face-to-face components and asynchronous programming, such as active video games [41, 42]. The pandemic increased attention to the development and implementation of online synchronous PA programs for youth and/or their key socializers (i.e. parents, ASP staff, and teachers) to promote youth PA, with mixed results reported among these studies. Tripicchio et al. examined a digitally enhanced, home-based PA intervention for high-risk middle school youth (63 youth across 54 families) that included home deliveries of activity kits, asynchronous sport and exercise videos posted on a private YouTube channel, and supportive text messages from health coaches. Results showed self-reported increases in youth PA self-efficacy and participation and most parents (95.1%), and youth (83.8%) expressed interest in participating again in the future [43]. Similarly, Whalen et al. investigated the HealthyKidsQuarantined project, which provided virtual PA, PE, and nutrition education curricula and resources to elementary and middle schools and showed significant engagement (21 300 views/downloads from schools and 9800 social media views/downloads) with teachers, students, and families expressing appreciation for the supportive health resource [44]. In contrast, Onadeko et al. conducted a cross-sectional study comparing in-person and remote formats of implementing the NFL Play 60 FitnessGram project, designed to improve youth health and wellness through NFL PLAY 60 incentives, an app, and online modules focusing on social-emotional well-being, nutrition, and PA activities, and found that remote learning appeared less effective than in-person PE for achieving program goals [24].

Thus, while this burgeoning area of virtual youth health promotion is promising, challenges remain in assessing the full impact of virtual PA intervention, particularly with regard to data collection and process evaluation. To advance research in this area, future studies could benefit from incorporating ecological momentary assessment (EMA) and longitudinal psychometric network analysis [45]. EMA, with its real-time data collection feature, would allow researchers to capture fluctuations in youth PA levels and social-motivational factors during and immediately after intervention activities to limit bias [46]. This approach would provide detailed insights into the intervention and contextual factors influencing youth engagement and psychological responses to virtual programs. Additionally, longitudinal psychometric network analysis could explore the dynamic relationships among EMA data of motivation, self-efficacy, and emotional well-being throughout the intervention [47]. By mapping the evolving connections between these constructs, researchers could identify key psychological drivers and barriers that contribute to sustained PA participation and improved well-being. Together, these novel methodologies would complement traditional evaluation techniques, offering a deeper understanding of the mechanisms underpinning virtual PA interventions and informing the design of future programs to optimize their positive impact on youth physical and psychological health. Additionally, these approaches shift away from a “one-size-fits-all” model by empowering youth, their teachers, ASP staff, parents, and influential peers to exercise autonomy and make choices while fostering social opportunities and providing guidance that supports mastery and sustained engagement in PA. Simultaneously, it offers researchers, practitioners, and youth advocates valuable insights to optimize PA participation by identifying and implementing activity types that are most effective for specific youth, tailored to their social networks, the time of day, and the broader social context.

Limitations

While the findings of this study are promising, several limitations should be acknowledged. First, the study relied on a relatively small sample size, which may limit the generalizability of the results. Although efforts were made to recruit a diverse participant pool, the study was confined to specific ASPs, potentially restricting its broader applicability. Second, data collection during the COVID-19 pandemic presented unique challenges, including interruptions to program implementation during afterschool hours. These disruptions may have influenced both the consistency and quality of engagement with intervention activities. Third, given the unprecedented circumstances of the pandemic, the study did not include a control group. Future studies should address these limitations by incorporating larger, randomized controlled trail research design to strengthen the evidence base for virtual social-motivational based PA interventions.

Conclusions

The 16-week, ASP staff-based, digitally enhanced PA intervention was designed in response to COVID-19 and delivered to youth living in under resourced communities between September 2020 and April 2021. The CTPI intervention demonstrated that virtual, social-motivational climate-based PA programs could effectively support youth physical and mental health. By leveraging social-motivational frameworks and incorporating dynamic, interactive activities, the program achieved substantial improvements in PA participation and PA-related social motivational engagement and ASP staff and youth found it important, useful, and sustainable. These findings highlight the potential of virtual PA interventions to address health disparities, particularly in underserved communities, and underscore the importance of innovative, adaptable approaches in promoting youth well-being.

Funding Source

Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health under Award Number R21HD077357 (Zarrett, PI) and the National Institute of Nursing Research of the National Institutes of Health under Award Number 1R01NR017619-01 (Zarrett, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Conflicts of Interest

The authors declare that they have no conflict of interest.

Human Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Transparency Statement

Analytic Plan Pre-Registration: This study was not formally registered and the analysis plan was not formally preregistered. However, the larger randomized-controlled trial that was translated into this virtual format is registered. Materials Availability: Materials used to conduct the study may be available by contacting the corresponding author.

Data Availability

A copy of survey instrument questions will be provided upon request to the corresponding author. Participant data are not publicly available due to human subject research protections, but qualified academic researchers may send data/analytic code requests to the corresponding author for review. All use of data would be subject to confidentiality and data-use agreements.