Voll 2013.

Methods	Study design: cluster‐randomized controlled trial Study grouping: parallel group Study aim: "... to determine whether parental involvement in a physical activity intervention delivered to children in‐school could result in positive behavior change in parents, as measured by increased physical activity and reduced sedentary behavior" (quote) Study period: baseline data collection start: February 2012; post‐test assessment: March 2012 Total number of arms: 2 Description of intervention arms: 1. School‐based screen time tracking with family homework (child + caregiver); 2. School‐based screen time tracking (child only) Number of clusters per arm: not reported Average cluster size: 5.38 children Sample size justification and outcome used: not reported Unit of allocation: school Missing data handling: only participants who completed baseline and post‐test assessments were included in the analysis Reported limitations: 1. Small sample size as a result of difficulties in recruitment and attrition; 2. Failure to collect demographic information; 3. Self‐selected participation Randomization ratio and stratification: not reported Participant compensation or incentives: participating children were entered into a drawing with physical activity−related prizes (e.g. jump ropes, basketballs, volleyballs, frisbees). To thank caregivers for participation, drawings were held for a massage gift certificate and a trigger point foam roller
Participants	Baseline characteristics Child + caregiver arm (intervention group) Female (PROGRESS‐Plus): not reported Age in years (PROGRESS‐Plus): not reported Race/ethnicity/language/culture (PROGRESS‐Plus): not reported Place of residence (PROGRESS‐Plus): not reported Caregiver education (PROGRESS‐Plus): not reported Religion (PROGRESS‐Plus): not reported Household income/socioeconomic status (PROGRESS‐Plus): not reported Social capital (PROGRESS‐Plus): not reported Caregiver work hours and other characteristics that may indicate disadvantage (PROGRESS‐Plus): not reported Disability (PROGRESS‐Plus): not reported Sexual orientation (PROGRESS‐Plus): not reported Child weight status: not reported Child diet: not reported Child physical activity: total physical activity score, mean (SD): 2.4 (0.6) Caregiver weight status: not reported Caregiver diet: not reported Caregiver physical activity: total physical activity score, mean (SD): 5.3 (1.8) Caregiver civil status (PROGRESS‐Plus): not reported Child‐only arm (control group) Female (PROGRESS‐Plus): not reported Age in years (PROGRESS‐Plus): not reported Race/ethnicity/language/culture (PROGRESS‐Plus): not reported Place of residence (PROGRESS‐Plus): not reported Caregiver education (PROGRESS‐Plus): not reported Religion (PROGRESS‐Plus): not reported Household income/socioeconomic status (PROGRESS‐Plus): not reported Social capital (PROGRESS‐Plus): not reported Caregiver work hours and other characteristics that may indicate disadvantage (PROGRESS‐Plus): not reported Disability (PROGRESS‐Plus): not reported Sexual orientation (PROGRESS‐Plus): not reported Child weight status: not reported Child diet: not reported Child physical activity: total physical activity score, mean (SD): 3.3 (0.5) Caregiver weight status: not reported Caregiver diet: not reported Caregiver physical activity: total physical activity score, mean (SD): 7.0 (2.7) Caregiver civil status (PROGRESS‐Plus): not reported Although not reporting by intervention arm, study authors did indicate that across the 2 intervention arms, 81% (22/27) of participants were female Recruitment methods: names of elementary schools in the Waterloo Region School District were randomly selected for recruitment. School principals were the first point of contact by phone or email, and this was followed up with a package of study materials and documentation. If the principal declined participation or contact could not be established after 1.5 weeks, another school was selected and contacted. Eight schools agreed to participate. Some schools had more than 1 eligible class (n = 14 classes). The researcher visited each school to give students a 10‐minute presentation on the study and to distribute cover letters and consent forms Inclusion criteria: cluster: school located within the Waterloo Region District School Board; participant: child enrolled in fourth/fifth, fifth, or fifth/sixth grade with a caregiver with a working email address Exclusion criteria: not reported Age of participating children at baseline: fourth to sixth grade (estimated to be 8 to 12 years old) Total number randomized by relevant group: total across all study arms: n = 43; samples per arm were not reported and therefore were estimated: child + caregiver arm: n = 22; child‐only arm: n = 22 Baseline imbalances between relevant groups: no significant differences were reported, but study authors note higher levels of physical activity in the child‐only arm Total number analyzed by relevant group: child physical activity score (child + caregiver arm: n = 11; child‐only arm: n = 5); caregiver physical activity score (child + caregiver arm: n = 12; child‐only arm: n = 6) Attrition by relevant group: attrition rates by intervention arm were not reported and cannot be calculated because study authors did not report the number of children by intervention arm at baseline Description of sample for baseline characteristics reported above: child physical activity score: those who completed measures at baseline and post‐test assessments (child + caregiver arm: n = 11; child‐only arm: n = 5); caregiver physical activity score: those who completed measures at baseline and post‐test assessments (child + caregiver arm: n = 12; child‐only arm: n = 6)
Interventions	Intervention characteristics Child + caregiver arm (intervention group) Brief name/description (TIDieR #1): Turnoff Week Challenge tracking plus homework assignments to complete with a caregiver Focus of intervention: physical activity Behavior change techniques: in addition to the child‐only intervention, the following techniques were applied separately or differently in the child + caregiver arm: "goals and planning," "feedback and monitoring," "social support," "shaping knowledge," "natural consequences," "repetition and substitution," "identity," "self‐belief" Why: rationale, theory, or goal (TIDieR #2): although parents play an important role in shaping children's behaviors, less is known regarding how children might influence parents' behaviors. According to the study author: "school‐based health promotion interventions that include parental involvement may influence parental behavior via two mechanisms: 1) passive diffusion of the intervention and 2) children's ability to directly influence their parents' behavior." This study sought to examine this "spread of effects" phenomenon by involving parents in a school‐based "screen‐free week" intervention. The design of this intervention arm was informed by 4 key theories: social cognitive theory, socioecological model, value expectancy model, theory of planned behavior How, where, and when and how much (TIDieR #6 to 8): in addition to the child‐only arm, caregivers were asked to complete 2 online homework assignments with their child during the 1‐week intervention. Each assignment required approximately 5 to 10 minutes Who: providers (TIDieR #5): same as child‐only arm Economic variables and resources required for replication: not reported Strategies to address disadvantage: not reported Subgroups: not reported Assessment time points: baseline, 2 weeks (end of intervention) Co‐interventions: not reported What: materials and procedures (TIDieR #3 to 4): in addition to the child‐only arm, caregiver‐child dyads were asked to complete 2 homework assignments together online. The first homework assignment included information on the benefits of physical activity and guidance on goal‐setting (S.M.A.R.T. goals), and encouraged parents and children to set 3 activity goals for the week. As part of the second homework assignment, parents and children were asked to complete a 5‐minute fitness activity together and to reflect on this experience. Homework assignments were evaluated simply as completed or not completed Tailoring (TIDieR #9): not reported Modifications (TIDieR #10): not reported How well: planned and actual (TIDieR #11 to 12): not reported Sensitivity analyses: not reported Child‐only arm (control group) Brief name/description (TIDieR #1): Turnoff Week Challenge tracking Focus of intervention: physical activity Behavior change techniques: "feedback and monitoring," "repetition and substitution" Why: rationale, theory, or goal (TIDieR #2): school‐based interventions "represent a viable way to reach children and increase their physical activity" (quote). Screen‐free initiatives are a promising intervention approach, but formal evaluations among children are lacking. As such, the present study utilized a school‐based "screen‐free week approach" to promote positive behavior change. The study author noted that the Turnoff Week Challenge and tracker form were informed by the theory of planned behavior and also reported that the purpose of the challenge and the form in the context of this study was to attract participation How, where, and when and how much (TIDieR #6 to 8): children filled out their Turnoff Week Tracker form daily in class. The form required 1 to 2 minutes to complete. The intervention lasted 1 week Who: providers (TIDieR #5): researcher, but daily tracking was facilitated by classroom teachers Economic variables and resources required for replication: not reported Strategies to address disadvantage: not reported Subgroups: not reported Assessment time points: baseline, 2 weeks (end of intervention) Co‐interventions: not reported What: materials and procedures (TIDieR #3 to 4): children were instructed to avoid the following screen‐related sedentary behaviors: 1. Using their computers for leisure activities (e.g. online games), 2. Watching TV, and 3. Playing video games. Children were simultaneously encouraged to be physically active for at least 60 minutes each day. Suggestions for physical activity included walking, chores, playing tag, and structured exercise (e.g. sports). Each day, children were asked to record their screen time and level of physical activity using a "challenge tracker form." Children were instructed to return these forms to their teacher after 1 week Tailoring (TIDieR #9): not reported Modifications (TIDieR #10): not reported How well: planned and actual (TIDieR #11 to 12): not reported Sensitivity analyses: not reported
Outcomes	The following instruments were used to measure outcomes relevant to this review at baseline and at 2 weeks (end of intervention) Children's physical activity levels: Physical Activity Questionnaire for Older Children (PAQ‐C); study authors reported high internal consistency Data for total physical activity score are available for end of intervention Caregivers' physical activity levels: Rapid Assessment of Physical Activity questionnaire (RAPA); study authors reported high validity and reliability Data for total physical activity score are available for end of intervention
Identification	Study name: Determining the "Spread of Effects" of Physical Activity Interventions From Children to Parents/Guardians Country: Canada Setting: primary schools in Waterloo Region, Ontario, Canada Types of reports: Masters thesis Comments: used 1 report only: Voll 2013 Author's name: Jess Voll Email: jess@greo.ca Conflicts of interest: not reported Sponsorship source: not reported
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation	Low risk	Quote: "each classroom (or school, if more than one class per school wished to participate) was randomly assigned to the treatment or control group using random number generation in Microsoft Excel" (p 47)
Allocation concealment	Unclear risk	Judgment comment: methods used to conceal the allocation sequence were not described
Blinding of participants and personnel All outcomes	Low risk	Judgment comment: participating parents and children were informed that they would be assigned to 1 of 2 groups; however, the true purpose of the study was concealed until after the intervention. Although outcome data were collected via self‐report, concealment of the study hypothesis may have helped to minimize bias
Blinding of outcome assessment All outcomes	Unclear risk	Judgment comment: no information on blinding of outcome assessors was provided. Because all data were self‐reported by study participants, outcomes may or may not have been influenced by lack of blinding
Incomplete outcome data All outcomes	High risk	Judgment comment: attrition rates by intervention arm were not reported and could not be calculated because the study author did not report the number of children by intervention arm at baseline. Overall, no data were available for 37.2% (16/43) of caregiver‐child dyads; this includes 15 dyads that provided no data and 1 dyad that withdrew data after they were informed of the true intent of the study. Matched baseline and post‐test data were not available for 62.8% (27/43) of children and 58.1% (25/43) of caregivers
Selective reporting	Unclear risk	Judgment comment: the trial was not registered and no protocol was cited that could be retrieved. Physical activity scores for both children and caregivers were reported in a format that could be entered into meta‐analysis
Recruitment bias	Unclear risk	Judgment comment: it is unclear whether randomization occurred before or after recruitment. However, wording provided in the cover letter to caregivers suggests that they may not have been made aware of assignment before consenting to take part in the study
Baseline imbalance	Unclear risk	Judgment comment: study authors did not report on similarities and differences between intervention arms or clusters
Loss of clusters	High risk	Judgment comment: study authors did not report on whether any clusters were lost. However, given the very small number of participants and the high level of attrition and missing data, it is likely that clusters were lost
Incorrect analysis	High risk	Judgment comment: study authors did not report adjusting for clustering in the analysis and did not report intraclass correlation coefficients (ICCs)
Comparability with individually randomized trials	Unclear risk	Judgment comment: information was insufficient to permit judgment
Other sources of bias	High risk	Judgment comment: study authors noted that some clusters (i.e. classrooms) had 1 or 2 study participants