Lugares y actividades dentro de la escuela

Prior to the main study, the AOR study questionnaire database was piloted at the leisure centres with previous AOR participants. This was done to receive general feedback regarding language, presentation, and time taken to complete (≈20 minutes), as fitness professionals have one hour to complete the induction process including the study questionnaires. Modifications were then made to the questionnaire, e.g. drop-down menu selections and colour-coding for different sections on the IT database were added, a hard copy of the questionnaire was presented for clarity, and an additional question requesting participant consent and the researcher‟s contact details were added. Additionally, visits were made to gain additional awareness and understanding of resources at the leisure centres, develop a relationship with AOR co-ordinators, and to offer specific up- skilling training on the AOR effectiveness questionnaire. After receiving feedback from the participants and leisure centre staff, the IT questionnaire template was prepared on an Excel spreadsheet and all leisure centre staff were trained

Data was collected at induction and 3, 6, and 12 months after AOR completion to measure the effectiveness of PA behaviour change in the short and long term (NICE, 2006a).

2.6.2.1 Induction and exit.

Data regarding participants‟ sex, age, ethnicity, and reason for referral were collected on the referral form completed by the health professional. The leisure providers collected induction and exit data via the AOR study database. Because different resources were available at the independent leisure centres, some preferred to input data directly onto an IT database in the presence of the participant, while others preferred to note the data on paper and the data were then centrally loaded on the database by a co-ordinator.

Hard copies of AOR referral forms, AOR induction/exit data, and attendance per participant data were emailed to the PCT quarterly by leisure providers (Quarter 3: October 2009–December 2009, Quarter 4: January 2010–March 2010,

Quarter 1: April 2010–June 2010, Quarter 2: July 2010–September 2010 and October 2010–December 2010 and January 2011–March 2011 for exit data only).

The total number of inducted participants for the study was 2228 and 626 attended their exit interview at 12 weeks after induction with the leisure provider.

2.6.2.2 Six- and twelve-month follow-up.

Follow-up questionnaires (See Appendix B.2), at 6 and 12 months after exit, were sent to participants that had given their consent at their induction, except for October and November 2009 referrals that received their 6-month follow-up questionnaire at 8 months once the ethical approval for the study had been granted. Thank you letters (Appendix B.3) were sent to participants once the 6- month questionnaires were returned to acknowledge the time/information given and to encourage participation at 12 months. A total of 307 six-month follow-up questionnaires and 242 twelve-month questionnaires were received.

2.6.3 Measuring PA.

Self-reported measures of PA levels were collected to determine the

effectiveness of the AOR scheme in this study. Using a comprehensive decision matrix from the Medical Research Council (2010), the total PA level was

assessed to evaluate if it was in line with the CMO‟s recommendation. The

intensity, duration, and type of PA were additional elements that were studied to better understand the behaviour change, if any, that had occurred. Importantly, in light of factors such as the high number of participants, relatively low budget, intention to have low participant burden, complexity of data analysis, and

feasibility (i.e. suitable for elderly participants), self-reporting questionnaire was considered the favourable method for measuring PA levels.

There is a wide range of PA measuring tools and methods: self-reporting questions, activity log, pedometer, accelerometer, and heart rate monitors. Macfarlane et al. (2006) discussed the challenges arising because of differences in the cut-off points for different methods of measuring PA and the consequent

lack of convergent validity. Further details of PA measures can be found in Chapter 4, Section 4.1, 4.2 and 4.3 of this thesis. The validity and repeatability of self-reporting PA can be compared to objective measures such as heart rate (using heart rate monitors) and acceleration (using accelerometers) to enhance confidence levels of the outcomes of the more subjective methods (i.e. IPAQ; Craig et al., 2003). The IPAQ, which has been reliability- and validity-tested in 12 countries (Spearman‟s ρ clustered around 0.8 and criterion validity mean ρ of 0.30), is a self-reporting questionnaire used to measure vigorous, moderate, and walking activity in the last seven days of the programme (Craig et al., 2003). The IPAQ is recommended as a research tool for measuring PA levels (Craig et

al., 2003). Hence, the IPAQ was adopted for Study 1. According to Bull (2005a),

the IPAQ short form takes between 3 and 4 minutes to administer and the IPAQ long form, between 15 and 20 minutes (number of questions: N = 4 [short form] and N = 27 [long form], both self-administered).

Considering the fact that fitness professionals who were administer the

questionnaire would not have prior knowledge of the IPAQ and one hour is the allocated consultation time for recording baseline measures and conducting the leisure centre induction programme, the IPAQ short form (Appendix B.4, 2001) was selected because it was considered both less daunting and a more practical option to include in the evaluation by the fitness professionals. It is possible to obtain a continuous measure of categorical indicators of PA from the IPAQ forms, e.g. Metabolic (MET) minutes/week is the continuous measure of energy yielded weighted by type of activity (Anon., 2005). The MET compendium (Ainsworth et

al., 2000) was referenced by the landmark report recommending at least 30

minutes/week of PA (Pate et al., 1995) as a reference for moderate-intensity activities.