‘No one ever asked us’: a feasibility study assessing the co-creation of a physical activity programme with adolescent girls

Abstract

Background:

Globally, the poor activity level of adolescent girls is a public health concern. Little research has involved adolescents in the design of interventions. This study assessed the feasibility of involving girls in the co-creation of an activity programme.

Methods:

Thirty-one students (15–17 years old) were recruited from a post-primary school. The Behaviour Change Wheel guided intervention design, providing insights into participants’ capability, opportunity and motivation for change. Step counts and self-reported physical activity levels were recorded pre- and post-intervention. Feasibility benchmarks assessed recruitment, data collection, acceptability and adherence.

Results:

Activity and educational sessions were delivered for six weeks during physical education class. Average attendance was 87% (benchmark = 80%). Eligibility was 61% (benchmark = 60%). There was a 100% retention rate (benchmark = 90%). All participants (n = 31) completed baseline measures and 71% (n = 22) completed post-measures. 54% (n = 17) of students completed pedometer measurements, with 32% (n = 10) having complete data. Average daily steps were 13,121 pre-intervention and 14,128 post-intervention (p > 0.05). Data collection was feasible, receiving a mean score > 4/5 (benchmark > 3.5/5).

Conclusions:

The Behaviour Change Wheel can be used to co-create an activity programme with adolescent girls. Predetermined benchmarks, except for pedometer recordings, were reached or exceeded, providing evidence for the need of a randomised controlled trial to test effectiveness.

Keywords

physical activity physical education adolescent girls school-based intervention feasibility study

Background

Globally, adolescents don’t accumulate sufficient physical activity (PA) (1), with almost 95% of adolescent girls considered insufficiently active (1). The influences on PA during adolescence are multifactorial (2), and several barriers hinder participation, including feeling incompetent and disliking sport (3,4). Adolescent behaviours are predictive of adult behaviours; therefore promoting a healthy lifestyle at this stage is crucial to shape healthy adult behaviours (5).

Interventions to date aiming to improve PA levels of adolescent girls have demonstrated modest effects (5) and it is suggested this is partly due to the failure of the intervention to address participants’ needs (6). Exploring adolescent girls’ views of PA can produce vital information to guide intervention design (7). There have been some studies conducted which involved formative work to include participant perceptions in intervention design, such as the Trial of Activity for Adolescent Girls (TAAG) in the US and other studies conducted in Australia and the US (8 –10). However, there remains a paucity of research focusing on involving adolescent girls in programme design (11). Without the involvement of the youth’s voice, interventions may fail to accurately represent the needs of the participants (12). Therefore, this research aims to investigate the feasibility of involving adolescent girls in the design of a PA programme that they are involved in.

Recent systematic reviews and meta-analyses (5,13) have found that school-based PA interventions are more effective when based on a relevant theory. Many frameworks providing guidance on designing interventions exist. However, for this study, the Behaviour Change Wheel (14) (BCW), a synthesis of 19 frameworks for behaviour change, guided intervention design. The BCW provides insight into the motivations, capabilities and opportunities the participants perceive and how these relate to their behaviours (14).

As involving adolescent girls in PA programme design is a relatively unexplored area, it is vital to conduct a feasibility study to identify any key uncertainties before a full-scale trial (15,16). The aim of this study was to assess the feasibility of co-creating a PA intervention with adolescent girls, assessing recruitment, data collection, acceptability and adherence.

Methods

The reporting of this study followed the CONSORT statement (17) and the COREQ guidelines (18).

This study comprised two phases: formative research for intervention design and assessment of intervention practicability.

Participants

Participants (n = 31), approximately 15–17 years old, were recruited from a post-primary school using a convenience sample. Participants were approached in a face-to-face manner. The target group was insufficiently active girls (based on a PA questionnaire for adolescents (PAQ-A) (19) score of > 2.7 (20)). However, no interested participants were excluded. The majority of participants were inactive (80%, n = 25) with a mean PAQ-A score of 2.1 ± 0.3. Active participants (20%, n = 6) had a mean PAQ-A score of 2.9 ± 0.4, slightly above the threshold of > 2.7. A co-educational school was chosen, as in this setting females can be at a disadvantage when it comes to PA (21). This research aimed to provide opportunities for females to be active in a single-sex environment, which can be more beneficial (22).

Appropriate consent was sought before programme commencement.

Formative research phase

The BCW guided the intervention design (23). In the hub of the BCW is the COM-B system, suggesting an individual’s motivations, capabilities and opportunities are related to their behaviour (23). The BCW and the COM-B system systematically guided the intervention design, selecting the most appropriate intervention functions and behaviour change techniques (BCTs) necessary to reach the target behaviour (23).

The eight steps of intervention design as outlined in the BCW guide (23) were followed, beginning at step 4 as steps 1–3 have been established in literature. Students completed a COM-B 23-item self-evaluation questionnaire assessing their capability, opportunity and motivation relating to their PA behaviours (14).

The areas of capability, opportunity and motivation that participants identified as being most important for their behaviour change in the COM-B questionnaire (Table 2) were explored further during the focus groups. Two focus groups lasting 30 minutes were held with approximately eight students in each. The female researcher, who had previous focus group experience, facilitated the discussion using a semi-structured guide. Focus groups were transcribed verbatim using pseudonyms to protect participant identity. The data were coded by the researcher and analysed using directed content qualitative analysis (24), mapping the data onto the COM-B frame.

Using both the questionnaire data and the focus group results, intervention functions were identified (step 5). The BCW outlines which intervention functions are appropriate to address the COM-B areas identified (14). Using the APEASE criteria (assessing affordability, practicality, cost-effectiveness, acceptability, safety and equity) (23), intervention functions were selected. Step 6 was not relevant for this study. BCTs designed to serve the chosen intervention functions were then selected (step 7). Frequently used BCTs were chosen from a possible 94 options (25). Finally, an appropriate mode of delivery was chosen (23).

The completion of these eight steps provided an outline for a six-week intervention to address areas of the COM-B system identified by participants (Table 1). Intervention content, including PA and educational components, was designed using direct suggestions from participants discussed in the focus groups.

Table 1.

Weekly schedule of activities including BCTs and intervention functions.

	Intervention function	BCTs	Content – school based	Content – home based
Week 1	Education Training	Demonstration of the behaviour Instruction on how to perform a behaviour Feedback on the behaviour Information about health consequences Goal setting	Theory: benefits of PA Practical: aerobics Set SMART goal (specific, measurable, attainable, realistic, timed). Weekly SMART goals will be set in school to be completed at home.	Record daily steps Plan PA sessions Follow SMART goal
Week 2	Enablement Modelling Training	Goal setting Action planning Habit formation Demonstration of the behaviour Instructions on how to perform a behaviour Feedback on the behaviour	Theory: planning for PA Practical: kickboxing Set Week 2 SMART goal	Record daily steps Plan to exercise with a friend Follow SMART goal
Week 3	Education Enablement Coercion	Self-monitoring of behaviour Biofeedback Monitoring of emotional consequences	Theory: nutrition and fuelling your body for exercise Practical: yoga Set Week 3 SMART goal	Monitor how you feel after exercise in your PA diary Record daily steps Follow SMART goal Commitment to activity: this week I will…
Week 4	Education Training Enablement Incentivisation	Self-monitoring of behaviour Monitoring of emotional consequences Feedback on behaviour Demonstration of the behaviour	Theory: time management Practical: pilates Set Week 4 SMART goal	Monitor how you feel after exercise in your PA diary Record daily steps Follow SMART goal Identify time management strategies to fit in PA
Week 5	Education Training Persuasion	Credible source Biofeedback Instruction on how to perform a behaviour	Theory: PA promotion strategies Practical: HIIT training (high-intensity interval training) Set Week 5 SMART goal	Identify your PA female role model Record daily steps Follow SMART goal Include at least 1 at-home HIIT session
Week 6	Education Enablement	Instruction on how to perform a behaviour Monitoring of emotional consequences Goal setting	Theory: review of what has been covered + planning for summer months Practical: fun team games	Plan for the summer – how will you continue your new PA habits?

Measures

Feasibility benchmarks

Feasibility benchmarks were defined to assess recruitment, data collection, acceptability and adherence.

Recruitment was assessed via recruitment records. A predefined eligibility rate of 60% was deemed feasible (8).

Acceptability of measures (pedometers, questionnaires, focus groups) was assessed via a questionnaire using a 5-point Likert scale. A score of 1 indicated low acceptability and a score of 5 indicated high acceptability. A predefined mean score of ⩾ 3.5/5 for positive statements and ⩽ 1.5/5 for negative statements was deemed feasible (26,27).

Acceptability was assessed via attendance and a side-by-side matrix. A pre-defined attendance rate of 80% was deemed feasible (28). A side-by-side matrix assessed importance of programme content etc. versus satisfaction levels of this aspect. A mean score of ⩾ 3.5/5 was deemed acceptable (26,27).

Adherence was assessed using the retention rate and the number of participants who completed both measures. A retention rate of 90% was deemed feasible (29) and a 60% completion rate for both measures was deemed feasible (8).

PA and ‘enjoyment’

Participants completed the PAQ-A questionnaire to assess PA levels (19) and the ‘Physical Activity Enjoyment Scale’ (PACES) at baseline and post-measures, which is a valid measure of PA enjoyment among adolescent girls (30).

Pedometers were worn for seven consecutive days at baseline and post-intervention, which is a sufficient period to estimate habitual behaviour without burdening participants (31). Participants received instructions for wearing their pedometer and a record sheet to log non-wear times.

Analysis

Pedometer and questionnaire data were managed using Excel. Mean steps per day for pre- and post-measurements were calculated. Participant summary scores for the PAQ-A and PACES were calculated using the relevant scoring protocols (19,30). A paired t-test was used to compare mean scores at pre- and post-measures. 100% (n = 31) and 71% (n = 22) completed the PAQ-A and PACES at baseline and post-measures respectively. 32% (n = 10) of participants had full sets of pedometer data.

Qualitative data from focus groups were analysed thematically allowing for the identification of recurring themes (32). The qualitative data analysis software NVivo 10 was used to manage the focus group data (33). A thematic network was created by first generating a list of codes of any potential themes or patterns. These codes then formed the initial basic themes within the data. Categories of basic themes were then grouped together, resulting in organising themes. Global themes were created by combining organising themes to encapsulate the principle metaphors in the text as a whole (34). Similar procedures adopted during pre-intervention focus groups were used during post-discussions.

Results

Phase 1 results

Behavioural diagnosis

Participants are identified by pseudonyms (e.g. P1) and focus groups are labelled as FG1 and FG2. Participants discussed their capability to be active. Acquiring physical skills and physical stamina was important for behaviour change. Some students felt incapable of being active, due to poor skills and instructions. Girls spoke of an Ultimate frisbee PE class, and how they felt they lacked the skills needed to participate:

They didn’t show us how to throw it [the frisbee], they just expected us to know how to do it (FG1; P3).

Students also discussed barriers to exercising outside of school:

When I go to the gym I use machines, I feel like I’m not doing anything properly and people are judging you (FG1, P3).

Students also felt they were limited by their own lack of knowledge:

We don’t know what else we can do apart from sports (FG2, P4).

Within psychological capability, students identified mental stamina and needing an ability to overcome mental obstacles. During focus group discussions, overcoming mental obstacles was discussed:

When I run, my mind says, ‘I can’t do it’. I would like that to be ‘you can do it’ (FG1, P4).

Other students agreed, saying:

Yeah, if you’re on a treadmill 15 minutes feels like two hours! (FG1, P1).

When considering physical opportunity, time was the most prominent factor. Students noted how study takes priority over exercise:

We’ll be in school all day then study after school (FG2, P3).

These concerns particularly pertained to preparing for State Examinations. Participants also discussed social opportunity, noting having people around was motivating. Students felt cautious about participating alone but found enjoyment in exercising with others:

It’s fun with someone with you and time goes quicker (FG1, P4).

When discussing motivation, participants identified needing to ‘feel they wanted to do it’. Students discussed their lack of motivation, and felt the gender roles evident in PA contributed to this:

Girls aren’t really taught that they should want to do it [be physically active] (FG2, P3).

When discussing reflective motivation, specifically developing habits of being active, students suggested the following:

I tho follow (FG1, P2).

The development of a structured plan would allow them to work towards goals.

Findings from the COM-B 23 questionnaire can be found in Table 2.

Table 2.

Results from the COM-B questionnaire.

COM-B component	List of possibly relevant factors	N = 31	%
Capability
Physical	Have more physical stamina	17	54
	Have more physical strength	18	58
	Have better physical skills	17	54
	Overcome physical limitations	9	29
Psychological	Have more mental strength	14	45
	Know more about why it is important	6	19
	Overcome mental obstacles	19	61
	Know more about how to do it	12	38
	Have better mental skills	9	29
	Have more mental stamina	17	54
Opportunity
Physical	Have more time to do it	23	74
	Have it more easily accessible	14	45
	Have the necessary materials	11	35
	Have more money	9	29
Social	Have more people around me doing it	10	32
	Have more triggers to prompt me	8	25
	Have more support from others	7	22
Motivation
Automatic	Feel that I want to do it enough	22	71
	Feel that I need to do it enough	10	32
Reflective	Develop a habit of doing it	20	64
	Believe that it would be a good thing to do	15	48
	Develop better plans for doing it	17	54

Definitions (14): physical capability: physical skills, strength or stamina; psychological capability: knowledge or psychological skills, strength or stamina to engage in the necessary mental processes; physical opportunity: opportunity afforded by the environment involving time, resources, location, cues, physical ‘affordance’; social opportunity: opportunity afforded by interpersonal influences, social cues and cultural norms that influence the way we think about things, such as the words and concepts that make up our language; automatic motivation: automatic processes involving emotional reactions, desires (wants and needs), impulses, inhibitions, drive states and reflex responses; reflective motivation: reflective processes involving plans (self-conscious intentions) and evaluations (beliefs about what is good and bad).

Intervention functions

The behavioural diagnoses arising from the COM-B questionnaire and focus groups were combined to design a six-week intervention.

All nine intervention functions were considered. However, restriction and environmental restructuring were excluded due to impracticality. Intervention functions and BCTs used can be seen in Table 1 (25).

PA programme

Students participated in weekly 90-minute PA and educational sessions during PE for six weeks. Students tracked their steps using a pedometer, working to meet individualised incremental step goals. Students also kept a PA diary, monitoring steps and weekly goals. Using pedometers in conjunction with a PA diary makes them an effective way of improving PA levels (35).

Phase two results

Feasibility benchmarks

Recruitment was feasible, exceeding the predetermined 60% benchmark, with 80% (n = 25) of participants scoring ⩽ 2.7 in the PAQ-A.

Acceptability rates were high. The average attendance was 87.16%, exceeding the 80% target, except for the last week of school. Each aspect of the side-by-side matrix scored greater than 3.5/5 for satisfaction levels, exceeding the benchmark.

Using pedometers motivated students to be active. One student commented she ‘didn’t realise how lazy I was until I put it on’ (FG1, P4). Others agreed, stating that comparing steps with peers was motivating. However, recording steps was a burden, and students desired a device that could synchronise with their phones.

Students also enjoyed using PA diaries and found it supportive to share goals with others, as articulated by one student:

Who cares if you make goals… but if you’ve told someone you can’t get away with not doing it (FG1, P5).

Students were encouraged to write down how they felt after exercise, which proved to be effective in increasing motivation to exercise:

When I could see that I was writing down that I felt better, it made it a bit easier (FG2, P5).

Using diaries also enabled students to overcome mental obstacles:

After school the last thing I want to do is go for a run, but when you look back and see I did it yesterday and I felt great after (FG2, P2).

The study had a 100% retention rate, exceeding the 90% benchmark. All participants (n = 31) completed baseline questionnaires and 71% (n = 22) completed the post-assessments, exceeding the 60% benchmark. All students invited to participate in focus groups agreed, exceeding the 60% benchmark. Use of pedometers to measure step count did not meet the benchmark of 60%, with 32% of students with full sets of data.

The average scores assessing acceptability of the measures exceeded the predetermined benchmarks, with each item scoring ⩾ 3.5/5 and ⩽ 1.5/5 for positive and negative statements respectively.

PA

Mean PAQ-A score pre- (n = 31) and post-intervention (n = 22) was 2.39 ± 0.51 and 2.51 ± 0.45 respectively. There was no difference in PAQ-A scores from pre- to post intervention (p > 0.05).

Full pedometer data were received from 10 participants. Mean steps per day pre- and post-intervention were 13,121 ± 4,883 and 14,128 ± 5,637 respectively (n = 10). No other pedometer data were recorded or returned to the researcher.

The mean PACES score pre-intervention (n = 31) was 64.4 ± 7.21 and post-intervention (n = 22) was 65.4 ± 9.02 (p > 0.05).

Student perceptions

Focus groups post-intervention were used to gain an understanding of the participants’ perceptions of the intervention. Two themes emerged: programme novelty and unleashing potential.

Programme novelty

Students discussed the novelty of the programme and activities provided. The programme allowed students to participate in PA away from males:

I didn’t dread coming because the boys weren’t there (FG1, P5).

Participants also enjoyed the activities:

It was something different, not just the stuff we always do in PE (FG1, P3).

The exposure to new activities provided alternative forms of PA to the participants. Several of the participants had never experienced yoga, and one student commented on the benefits of this:

None of us have really done it [the activities], so we’re all on the same page (FG2, P4).

Students also enjoyed having ownership of the programme. Providing autonomy within activities increased accountability for participation:

Like they [the activities] were things that we suggested them so we couldn’t not do it (FG2, P3).

Unleashing potential

Participation in this programme also led to a realisation of other PA opportunities available. Girls discussed how, prior to this programme, sport and PA were synonymous:

I always just associated physical activity with games from PE (FG2, P5).

Other students further illustrated their lack of awareness of their PA opportunities:

When you said on the first day that walking was physical activity, I just never considered it (FG1, P2).

Students noted they felt more capable of being active, gaining an awareness of the possibilities available:

Now I feel like I know there is other things to do apart from play sport (FG1, P3).

Discussion

The aim of this study was to assess the feasibility of co-creating a PA programme with teenage girls using guidance from the BCW (14). Both intervention content and study procedures were feasible as demonstrated by successful recruitment, retention, adherence and acceptability. The use of focus groups provided girls with autonomy and ownership of the programme and is therefore a key element of the intervention design. A future randomised controlled trial (RCT) would include the intervention functions and BCTs used in this study as they were selected as a result of the behavioural diagnosis. However, the exact content and activities provided would depend on the interests of the girls involved in the study. Some possible changes that may occur in an RCT based on feedback from the participants include a longer programme duration and better links with other subjects, particularly for the education component. Within this study, girls felt the educational component would be better suited to a classroom setting and suggested the involvement of other teachers to deliver this component, moving towards a more whole-school approach.

While unintended, this intervention was delivered during regular PE time. Previous research has identified that many girls fail to participate in school PE (36,37), often citing feelings of self-consciousness as a barrier to participation, particularly in front of males (38). These findings were reflected in this study, with girls in the focus groups noting that they would not participate in a programme outside of PE for fear of ridicule from peers. Single-sex environments have been shown to be more beneficial for females (21), and this intervention provided an opportunity for girls to be active away from their male counterparts. Another important element of this intervention was the autonomy and ownership given to students in the programme design, resulting in increased accountability for their participation. Research has shown that girls often disengage from PE due to the activities provided, with team sports dominating the curriculum (39,40). While it may not be possible for PE teachers to conduct a behavioural analysis as was done in this study, it would be possible for them to include the opinions of students in the selection of activities during PE. This could be facilitated through discussions or questionnaires at the beginning of the year or by creating shared expectations and plans for the yearly PE curriculum. Providing girls with more choice and a variety of activities may lead to increased participation levels in PE class. The results of this study demonstrate that it is feasible to co-create a PA programme with adolescent girls and similar approaches could be adapted by researchers and teachers aiming to increase the PA levels of this cohort.

Within this study, the one procedure which was not acceptable was the use of pedometers, with only 10 students having full sets of data. Allowing girls to choose the evaluation methods used is an important consideration for the intervention moving forward. In recent years there has been a surge in the number of people using wearable wrist-worn devices to monitor and track their PA levels. While the idea of using these consumer wearables has grown in popularity, it is important to ensure valid and reliable devices are chosen for use within research (41). It is also important to consider the feasibility and cost-effectiveness of using such trackers in a school setting. A possible solution to this measurement issue is to use the pedometers in conjunction with an app on a smartphone. However, monitoring and tracking methods of PA should be agreed upon with the participants to ensure it is acceptable.

Lessons to be learned from this study include the importance of formative research in intervention design and the importance of providing autonomy to participants. As previously mentioned, girls’ disengagement in PE and PA often comes from a dislike of activities on offer; therefore, providing a choice of activities is imperative in increasing participation rates. Researchers looking to develop similar interventions should focus on creating multi-component programmes and identifying an appropriate theory to underpin the study, as a recent meta-analysis by Owen et al. (42) found these interventions to be more effective at increasing PA. The methods for monitoring PA should also be considered for future studies, ensuring the method chosen is acceptable to the participants.

Strengths and limitations

The co-creation of this programme between the researcher and students, underpinned by the BCW, is a strength. Involving the participants in the design of the content provided them with ownership and autonomy. However, the researcher’s involvement in the evaluation is a potential limitation. Future studies should use different methods of monitoring PA that are acceptable to adolescent girls.

Conclusion

It is feasible to involve adolescent girls in the co-creation of a PA programme under the guidance of the BCW. This study makes an important contribution to existing evidence on the development of theory-driven school-based public health interventions.

Footnotes

Declaration of conflicting interest

The authors declare that there is no conflict of interest.

Funding

Méabh Corr is supported by a Doctoral Studentship from Mary Immaculate College. The funders played no role in the study.

ORCID iD

Meabh Corr

References

Hallal

Andersen

Bull

Guthold

Haskell

Ekelund

. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012; 380: 247–257.

Barr-Anderson

Neumark-Sztainer

Schmitz

Ward

Conway

Pratt

, et al. But I like PE: factors associated with enjoyment of physical education class in middle school girls. Res Q Exerc Sport. 2008; 79: 18–27.

Woods

Tannehill

Quinlan

Moyna

Walsh

. The Children’s Sport Participation and Physical Activity study (CSPPA). Dublin, Ireland: School of Health and Human Performance, Dublin City University and the Irish Sports Council; 2010.

Rees

Kavanagh

Harden

Shepherd

Brunton

Oliver

, et al. Young people and physical activity: a systematic review matching their views to effective interventions. Health Educ Res. 2006; 21: 806–825.

Pearson

Braithwaite

Biddle

SJH

. The effectiveness of interventions to increase physical activity among adolescent girls: a meta-analysis. Acad Pediatr. 2015; 15: 9–18.

Corder

Atkin

Ekelund

van Sluijs

. What do adolescents want in order to become more active? BMC Public Health. 2013; 13: 718.

Murillo Pardo

Camacho-Minano

Generelo Lanaspa

Julian Clemente

Novais

Maia Santos

. Data for action: the use of formative research to design a school-based intervention programme to increase physical activity in adolescents. Glob Health Promot. 2015; 22: 45–54.

Dudley

Okely

Pearson

Peat

. Engaging adolescent girls from linguistically diverse and low income backgrounds in school sport: a pilot randomised controlled trial. J Sci Med Sport. 2010; 13: 217–224.

Okely

Cotton

Lubans

Morgan

Puglisi

Miller

, et al. A school-based intervention to promote physical activity among adolescent girls: rationale, design, and baseline data from the Girls in Sport group randomised controlled trial. BMC Public Health. 2011; 11: 658.

10.

Gittelsohn

Steckler

Johnson

Pratt

Grieser

Pickrel

, et al. Formative research in school and community-based health programs and studies: ‘state of the art’ and the TAAG approach. Health Educ Behav. 2006; 33: 25–39.

11.

Enright

O’Sullivan

. ‘Can I do it in my pyjamas?’ Negotiating a physical education curriculum with teenage girls. Eur Phys Educ Rev. 2010; 16: 203–222.

12.

Jacquez

Vaughn

Wagner

. Youth as partners, participants or passive recipients: a review of children and adolescents in community-based participatory research (CBPR). Am J Community Psychol. 2012; 51: 176–189.

13.

Owen

Curry

Kerner

Newson

Fairclough

. The effectiveness of school-based physical activity interventions for adolescent girls: a systematic review and meta-analysis. Prev Med. 2017; 105: 237–249.

14.

Michie

Van Stralen

West

. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011; 6: 42.

15.

Craig

Dieppe

Macintyre

Michie

Nazareth

Petticrew

, et al. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008; 337: a1655.

16.

Hubbard

O’Carroll

Munro

Mutrie

Haw

Mason

, et al. The feasibility and acceptability of trial procedures for a pragmatic randomised controlled trial of a structured physical activity intervention for people diagnosed with colorectal cancer: findings from a pilot trial of cardiac rehabilitation versus usual care (no rehabilitation) with an embedded qualitative study. Pilot Feasibility Stud. 2016; 2: 51.

17.

Eldridge

Chan

Campbell

Bond

Hopewell

Thabane

, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot Feasibility Stud. 2016; 2: 64.

18.

Tong

Sainsbury

Craig

. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007; 19: 349–357.

19.

Kowalski

Crocker

Donen

. The Physical Activity Questionnaire for Older Children (PAQ-C) and Adolescents (PAQ-A) Manual. Saskatoon: University of Saskatchewan; 2004.

20.

Voss

Ogunleye

Sandercock

. Physical Activity Questionnaire for children and adolescents: English norms and cut-off points. Pediatr Int. 2013; 55: 498–507.

21.

Kane

M.J

LaVoi

Wiese-Bjornstal

Duncan

Nichols

Pettee

Ainsworth

The 2007 Tucker Center research report, developing physically active girls: an evidence-based multidisciplinary approach. Minneapolis, MN: University of Minnesota; 2007.

22.

Bender

Litfin

. The effects of gender grouping on female students’ participation in physical education. Master of Arts in Education Action Research Papers. Paper 96. St. Catherine University; 2015.

23.

Michie

Atkins

West

. The behaviour change wheel: a guide to designing interventions. London: Silverback Publishing; 2014.

24.

Hsieh

H-F

Shannon

. Three approaches to qualitative content analysis. Qual Health Res. 2005; 15: 1277–1288.

25.

Michie

Richardson

Johnston

Abraham

Francis

Hardeman

, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013; 46: 81–95.

26.

Casey

Harvey

Telford

Eime

Mooney

Payne

. Effectiveness of a school-community linked program on physical activity levels and health-related quality of life for adolescent girls. BMC Public Health. 2014; 14: 649.

27.

Barnes

Plotnikoff

Collins

Morgan

. Feasibility and preliminary efficacy of the MADE4Life program: a pilot randomized controlled trial. J Phys Act Health. 2015; 12: 1378–1393.

28.

Kelty

Morgan

Lubans

. Efficacy and feasibility of the ‘Girls’ Recreational Activity Support Program Using Information Technology’: a pilot randomised controlled trial. 2012; Adv Physiol Educ, 2: 10-6.

29.

Okely

Lubans

Morgan

Cotton

Peralta

Miller

, et al. Promoting physical activity among adolescent girls: the Girls in Sport group randomized trial. Int J Behav Nutr Phys Act. 2017; 14: 81.

30.

Motl

Dishman

Saunders

Dowda

Felton

Pate

. Measuring enjoyment of physical activity in adolescent girls. Am J Prev Med. 2001; 21: 110–117.

31.

Clemes

Biddle

. The use of pedometers for monitoring physical activity in children and adolescents: measurement considerations. J Phys Act Health. 2013; 10: 249–262.

32.

Braun

Clarke

. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3: 77–101.

33.

QIP Ltd. NVivo Qualitative Data Analysis. Version 10. Software; 2012.

34.

Attride-Stirling

. Thematic networks: an analytic tool for qualitative research. Qual Res. 2001; 1: 385–405.

35.

Tudor-Locke

. Taking steps toward increased physical activity: using pedometers to measure and motivate. President’s Council Phys Fitness Sports Res Digest. 2002; 3: 1–8.

36.

Brooks

Magnusson

. Taking part counts: adolescents’ experiences of the transition from inactivity to active participation in school-based physical education. Health Educ Res. 2006; 21: 872–883.

37.

Mitchell

Gray

Inchley

. ‘This choice thing really works …’ Changes in experiences and engagement of adolescent girls in physical education classes, during a school-based physical activity programme. Phys Educ Sport Pedagogy. 2015; 20: 593–611.

38.

Biddle

Whitehead

O’Donovan

Nevill

. Correlates of participation in physical activity for adolescent girls: a systematic review of recent literature. J Phys Act Health. 2005; 2: 423–434.

39.

Brooks

Magnusson

. Physical activity as leisure: the meaning of physical activity for the health and well-being of adolescent women. Health Care Women Int. 2007; 28: 69–87.

40.

Flintoff

Scraton

. Stepping into active leisure? Young women’s perceptions of active lifestyles and their experiences of school physical education. Sport Educ Soc. 2001; 6: 5–21.

41.

Evenson

Goto

Furberg

. Systematic review of the validity and reliability of consumer-wearable activity trackers. Int J Behav Nutr Phys Act. 2015; 12: 159.

42.

Owen

Curry

Kerner

Newson

Fairclough

. The effectiveness of school-based physical activity interventions for adolescent girls: a systematic review and meta-analysis. Prev Med. 2017; 105: 237–249.