The Effect of a School-Based Intervention on Physical Activity and Well-Being: a Non-Randomised Controlled Trial with Children of Low Socio-Economic Status
Shannon et al. Sports Medicine - Open
The Effect of a School-Based Intervention on Physical Activity and Well-Being: a Non-Randomised Controlled Trial with Children of Low Socio-Economic Status
Stephen Shannon 0
Deirdre Brennan 0
Donncha Hanna 2
Zoe Younger 2
Jessica Hassan 0
Gavin Breslin 0 1
0 Sport and Exercise Sciences Research Institute, Ulster University , Jordanstown BT37 OQB , Northern Ireland
1 The Bamford Centre for Mental Health and Well-being , Belfast BT15 1ED , Northern Ireland
2 School of Psychology, Queen's University Belfast , Belfast BT9 5BN , Northern Ireland
Background: Self-determination theory (SDT) has been used to predict children's physical activity and well-being. However, few school-based SDT intervention studies have been conducted, and no research exists with children of low socio-economic status (SES). Therefore, SDT-derived needs-supportive teaching techniques informed the design and analyses of the Healthy Choices Programme (HCP). The aim was to determine if the HCP could enhance moderate-to-vigorous physical activity (MVPA) and well-being among children of low SES through increasing autonomy-support, needs satisfaction and intrinsic motivation. Method: A mixed factorial two (group) × two (time) wait-list controlled trial was conducted and reported using the TREND guidelines. A total of 155 children (56% females; intervention n = 84, control n = 71) took part and completed measures at baseline (week 0) and post-intervention (week 11). The effect of the intervention on MVPA (model 1) and well-being (model 2) was tested through serial mediation models with three mediators (i.e. autonomy-support, needs satisfaction and intrinsic motivation). Results: In comparison to the control group, the intervention was related to increases in MVPA (β = .45) and autonomy-support (β = .17). In model 1, analyses revealed partial mediation of the MVPA change through autonomy-support (β = .14), intrinsic motivation (β = .51) and all three SDT mediators in sequence (total r2 = .34). In model 2, well-being was indirectly enhanced through autonomy-support (β = .38) and autonomy-support and needs satisfaction in sequence (total r2 = .21). Conclusions: The HCP enhanced MVPA and well-being by engendering a needs-supportive physical activity environment. The scientific and practical contribution of this study was the application of SDT in all aspects of the HCP intervention's design and analyses. Practitioners may consider integrating SDT principles, as implemented in the HCP, for health promotion. Trial Registration: This study is registered on Research Registry (number researchregistry2852).
Health promotion; Behaviour change; Needs satisfaction; Motivation; Physical education
A self-determination theory-based intervention had
a positive impact on children’s moderate-to-vigorous
physical activity and well-being.
Well-being and physical activity were enhanced through
the children perceiving greater autonomy-support from
their teachers, psychological needs satisfaction and
Practitioners may consider supporting children’s
psychological needs in the physical activity environment
through provision of activity choice, open-ended
questions, and positive constructive feedback.
Well-being is a key indicator of health and refers to an
individual’s optimal psychological functioning [
Globally, approximately 80% of school youth do not meet
the World Health Organization’s (WHO)
moderate-tovigorous physical activity (MVPA) guidelines for health
], with similar figures (i.e. 82%) reported among Irish
children of low socio-economic status (SES) [
adverse health effects of physical inactivity are well
], and given studies [
] show that childhood
physical activity behaviours track into adulthood, these
low figures are of public health concern. Hence,
evidencebased physical activity interventions are needed and
specifically with children of low socio-economic status
(SES) who are at even increased risk of reduced health
and well-being compared to the general population [
Theory-based physical activity interventions can highlight
the psychological and social processes that underlie children’s
health and behaviour change [
]. While many school-based
physical activity interventions have adopted a theory in their
design, few studies have included theoretical constructs
related to psychological needs and motivation in their analyses
]. As such, there remains limited information on the
psychosocial mechanisms responsible for improving children’s
physical activity levels and well-being [
]. To advance
physical activity and well-being promotion it has been
proposed that psychosocial variables be included in all aspects
of the design and analyses of interventions [
To explore behaviour change processes, researchers have
applied constructs from self-determination theory (SDT)
]. Collectively, sub-theories within SDT specify that the
satisfaction of humans’ psychological needs for competence
(i.e. a sense of effectiveness within environment), autonomy
(i.e. volitional behaviour) and relatedness (i.e.
belongingness) are essential for optimal motivation, health behaviour
and well-being. In support of SDT hypotheses, children’s
physical activity has consistently been predicted by
autonomous motivation , and in some cases, well-being has
been predicted by physical activity contexts that satisfy
children’s psychological needs [
]. However, SDT has
received limited application in school-based intervention
The aim of SDT-informed interventions is to engender
needs-supportive social conditions wherein
enhancement of physical activity and well-being is realised
indirectly through needs-support and satisfaction, and
autonomous motivation [
] (see SDT model for
health interventions ). One validated SDT-informed
intervention technique is needs-supportive teaching
techniques utilised by intervention deliverers (e.g. school
teachers) who can be trained to offer participants
physical activity choices (i.e. autonomy support), provide
positive instructional feedback (i.e. competence support)
and develop a supportive relationship (i.e. relatedness
]. In five school-based intervention studies,
participants have been receptive to such techniques by
reporting enhanced perceptions of needs-support [
]. However, all but one [
] of those studies was
with pre-adolescent children (6–12 years), and none
were from areas of low SES––a group at risk for reduced
]. Furthermore, existing studies have either
excluded the well-being [
] or needs satisfaction
 components of SDT in their model. Considering the
evidence collectively, it is unclear if needs-supportive
techniques can exert an influence on each variable on
SDT’s causal chain (i.e. autonomy-support, needs
satisfaction, motivational regulation) and whether facilitation
of those processes predict improved physical activity and
well-being among children of low SES.
In response to the outlined limitations, a 10-week
intervention called the Healthy Choices Programme
(HCP) was developed for 8–9-year-old children of low
SES. The programme’s content, delivery and analyses
were consistent with SDT hypotheses [
intervention sought to enhance children’s physical activity and
well-being through providing needs-supportive teacher
training to the delivering sport student volunteers and
classroom teachers. The aim was to determine the effect
of the HCP through modelling a process that linked
autonomy-support, needs satisfaction and intrinsic
motivation with physical activity and well-being.
The first hypothesis was that the HCP would increase
the intervention group’s perceptions of
autonomysupport from their teachers in comparison to a control
group (hypothesis 1 (H1)). The second (H2) and third
(H3) hypotheses were that intervention group’s needs
satisfaction and intrinsic motivation would increase
through the mediation of autonomy support. Lastly,
hypotheses four (H4) and five (H5) were that the
intervention would, respectively, indirectly enhance MVPA and
well-being, through the autonomy support, needs
satisfaction and intrinsic motivation sequential pathway [
Design, Inclusion Criteria, Recruitment Setting and
The reporting of the HCP adhered to the Transparent
Reporting of Evaluations with Non-Randomised Designs
(TREND) statement [
] and was registered on Research
Registry (trial number 2852). Following approval from
Ulster University’s Research Ethics Committee, two
schools from Northern Ireland (NI) were identified for a
2 (groups) × 2 (time-points) wait-list controlled trial.
This entailed purposively selecting the intervention and
control groups and staggering the delivery of the HCP
across two school semesters whilst collecting data at the
same time ([
] see Fig. 4). To reduce the potential for
contamination, the control school Principal delayed
announcement of the HCP until the following school
semester, and both schools were unaware of their school’s
data being compared during the intervention.
An inclusion criterion was based on the Multiple
Deprivation Measure in Northern Ireland [
index has seven domains of socio-economic deprivation
including income, services and crime. Having identified
schools of low SES on the measure, two schools with
likewise demographics (i.e. mixed gender, urban, size)
were approached for recruitment. Both school Principals
agreed and invited all Primary five pupils to participate.
Participant assent and parental consent were gained
prior to conducting the research.
A group of trained researchers conducted baseline
(week 0) and post-intervention (week 11) measurements
(discussed below) with the pupils under quiet classroom
conditions. The classroom teacher was present at all
The HCP was delivered for 2 h and 15 min each week
during school curriculum time for a 10-week period (i.e.
22.5 h of instruction in total). The intervention was in
addition to general physical education classes and
included (i) weekly hour-long practical sessions delivered
by a trained sport student volunteer in tandem with,
and under the supervision of classroom teacher and (ii)
a ‘Daily Mile’ that involved the classroom teacher
leading a 15-min walk every school day. SDT [
several aspects of the programme described below.
The weekly sessions consisted of a series of active
discussions and physical tasks that contained messages
around the health benefits of physical activity. The
student volunteers received a teaching resource detailing
language and techniques consistent with
needssupportive tenets in SDT [
], e.g. ‘acknowledge the
activities were challenging and congratulate the children
for trying their best’. Likewise, the classroom teachers
also received a teaching resource including the above
language and walking activities that would facilitate
autonomy-choice for the children. For example, the
‘mirror image’ activity entailed walking partners completing
the Daily Mile in tandem with a choice to mirror each
Student volunteers completed a two-day SDT training
programme. The training was focused on facilitating the
student volunteers’ understanding of a needs-supportive
instructional style [
]. Their training included a
discussion regarding the students’ experiences of Duda’s [
empowering vs disempowering climate and a video
evaluation of an authoritative-command vs
autonomysupportive teaching style using a rater proforma (see Fig. 1).
The students were then presented with vignettes in
which children were in need of competence or
autonomy-support and were required to produce
needs-supportive techniques to enhance engagement.
Finally, the students completed a peer-teaching
quality assessment of a Healthy Choices Programme
session and were assessed in line with an adapted
version of Reeve et al.’s [
] teacher observation
sheet (see Fig. 2). In the case where improvement
was recommended, the student volunteer was asked
to reassess their understanding of the aims of the
HCP and to engage the vignettes they encountered
The classroom teachers completed a one-day training
event in which they were guided on an
autonomysupportive teaching style during the Daily Mile and
supervision of the weekly sessions. To link an
autonomy-supportive teaching style with relevant
teaching practices in the Northern Ireland Key Stage Two
], ‘active learning’ techniques were used.
Active learning entails creating a learner-centred
environment, in which the children are encouraged to
participate in the direction of a lesson through questions,
activity choice and feedback [
]. The teachers were
asked to develop active learning techniques they could
utilise throughout the weekly sessions and Daily Mile (e.
g. use of questions, positive feedback, allowing the
students to choose content).
In addition, to enhance the children’s relatedness
support, parents and/or guardians participated in an insight
afternoon. Through consultation, it was decided to update
the parents on the HCP through information flyers and
videos uploaded to the school’s online ‘parent space’.
Objective MVPA during school days (i.e. Monday to Friday)
and school hours (i.e. 9 am–3 pm, see [
] for time
category classification) was measured using Actigraph
accelerometers (GT3X and GT1M, Pensacola). The
accelerometers were fitted onto the children’s waists with an
elasticated belt and positioned on the midaxillary line above
the right hip. The devices recorded data in 5 s epochs, a
valid capturing period for 8–9-year-old children’s
]. Wells et al.’s [
] wear-time criterion was
applied, including at least 8 h wear per-day for a minimum
of three weekdays. Children meeting the criteria at both
time-points were selected as the ‘valid sample’. Time spent
in health-enhancing MVPA intensities [
] were calculated
using Evenson cut points [
] deemed the most valid and
reliable for 8–9-year-old children [
counts of < 20 min of consecutive zeroes, or > 15,000 were
removed, as they are considered biologically implausible
]. For analyses, one variable reflecting the children’s
average school-day MVPA was created.
Well-being was measured using the 7-day recall
Kidscreen-27 questionnaire [
]. Kidscreen-27 has
demonstrated excellent psychometric properties with
children aged 8–18 [
] and was recently validated with
Irish children of low SES [
]. Kidscreen-27 assesses
seven physical, social and psychological well-being
], and for analyses, a single variable
reflecting the total of the 27-items was created.
To assess the degree to which the children felt their
teachers supported their need for autonomy, a modified
version of Standage, Duda and Ntoumanis’s [
Education (PE)-adapted Learning Climate Questionnaire
was employed. As the HCP involved physical activity
outside of PE (i.e. through the Daily Mile and weekly
sessions), the items were modified to reflect
autonomysupport during physical activity classes. The scale
included six items and responses preceded with the stem:
‘In physical activity classes my teacher…’, and were
scored using a 7-point Likert scale ranging from
‘strongly disagree’ to ‘strongly agree’. A confirmatory
factor analysis (CFA) revealed support for a single latent
factor (χ2 = 13.961 (9) p = .124; CFI = .947; TLI = .912;
RMSEA = .063). A scale total was created for analyses.
Children’s perceptions of psychological needs
satisfaction (i.e. autonomy, competence and social relatedness)
in the context of physical activity were assessed using an
age-appropriate questionnaire [
]. The questionnaire
included 18 items scored a 5-point Likert scale ranging
from ‘not like me at all’ to ‘really like me’ and
encompassed three 6-item subscales for autonomy, competence
and relatedness. After the omission of the two negatively
worded items (item 4 autonomy, and item 12
competence), a CFA within the sample revealed a good-fitting
three-factor model with covariance paths between the
latent variables (χ2 = 152.789 (99) p = .000; CFI = .920;
TLI = .903; RMSEA = .065). A total needs satisfaction
variable was created for analyses.
Four dimensions of SDT’s motivation continuum were
measured using an age-appropriate questionnaire [
The questionnaire included 12 items encompassing four
3-item motivation subscales (i.e. intrinsic motivation,
identified regulation, introjected regulation and external
regulation) answered on a 5-point likert scale ranging
from ‘not like me at all’ to ‘really like me’. A four-factor
model consisting of two latent co-varying factors (i.e.
identified with intrinsic motivation and introjected
regulation with external regulation) yielded an unacceptable fit.
However, correlating three items (i.e. item in 1 intrinsic
motivation with item 2, and 10 in identified regulation;
and item 11 in introjected regulation with item 12 external
regulation) theoretically aligned with Ryan and Deci’s [
conception of autonomous and controlled motivation in
SDT, subsequently yielded an acceptable fit (χ2 = 81.982
(45), p = .001; CFI = .937; TLI = .907; RMSEA = .077). Scale
totals for each dimension were created.
Raw data from each individual questionnaire was
manually inputted into SPSS (Version 22; IBM Corp., NY).
Ten percent of questionnaires were checked as a quality
assurance procedure. The expectation maximisation
algorithm was conducted on each independent scale to
estimate missing data after Little’s Missing Completely
at Random test confirmed that the data was missing at
random on both time-points (p > .05).
Two models subscribing to Fortier, Duda, Guerin and
] SDT model for health interventions were
specified. The aim of testing the models was to determine
if changes in the children’s perceptions of
autonomysupport (from teachers) would indirectly affect changes
on the primary outcomes of MVPA (model 1) and
wellbeing (model 2) through needs satisfaction and intrinsic
motivation (see Fig. 3).
The independent variable (X) was coded as a
dichotomous variable (control = 0 and intervention = 1).
Difference scores were created by subtracting
postintervention scores from baseline. MVPA and well-being
were coded as dependent variables (Y). Mediator 1 (M1)
refers to autonomy-support, mediator 2 (M2) as needs
satisfaction, and mediator 3 (M3) as intrinsic motivation.
Intrinsic motivation was selected as M3 because it is
assumed and has been empirically found to yield the most
adaptive outcomes in terms of increasing MVPA in
] and well-being [
] (see Additional file 1
wherein identified regulation, introjected regulation and
external regulation were selected as M3).
The procedures described by Hayes [
] were used,
testing one direct effect between X on Y (cCË ) and seven
singular or serial indirect effects between X on Y
through M1, M2 and M3. Hayes’ model also examines
three direct and three indirect effects between X on the
three mediators. The results can confirm if the effect of
X (intervention) on Y (outcomes) is either (i) not
significant, (ii) fully explained by the mediators (i.e. full
mediation), (iii) partially explained through the mediators (i.e.
partial mediation) or (iv) indirectly explained through
the mediators (i.e. indirect effects) [
Two figures were produced specifying beta (β)
coefficient values for each direct path and r2 values related to
the proportion of total variance predicted in model 1
and model 2. A table was created to detail the
completely standardised effect sizes and confidence
intervals for each of the seven indirect effects of the
intervention on the dependent variables. If confidence
intervals did not cross zero, the indirect relationship was
interpreted as statistically significant [
]. For improved
accuracy, the models were tested with 5000 bootstrap
]. Analyses were conducted using Hayes’ [
PROCESS macro for SPSS (Version 22; IBM Corp, NY).
The recruitment dates, sample characteristics, flow of
participants and attrition rates through each stage of the
study are presented in Fig. 4. The total sample size was
155 children, comprising 72 boys and 82 girls with a
mean age of 8.7 years (SD = .50). The intervention group
included 84 (54.2%) children, and the control group
included 71 (45.8%). Table 1 details the mean and standard
deviation scores for each outcome variable at baseline
and post-intervention. On average, a 10% attrition rate
was found at baseline and 7% at post-intervention.
Model 1: MVPA
The results of model 1 confirmed that taking part in the
HCP significantly and directly enhanced MVPA (β = .45,
p = .005) and autonomy-support (M1; β = .17, p = .003).
The intervention group’s mean minutes of MVPA
increased from 21.06 (SD 6.24) at baseline to 24.91 (SD
7.48) at post-intervention, while the control group’s
post-intervention mean minutes (M 23.48, SD 7.14)
decreased in comparison to their baseline (M 19.50, SD
8.20; see Table 1).
When exploring the direct and indirect effects of the
intervention on M1, M2 and M3, the results revealed
that the direct effect of the intervention on M1 did not
in turn influence M2 and M3. However, this was not the
case for model 2 (see below), suggesting the null effects
were attributable to the reduced sample size in model 1
(n = 62) because of non-compliance with accelerometer
The intervention indirectly enhanced MVPA through
singular mediation of autonomy-support (M1; β = .14,
95% CI [.010 to .158], p < .05), and intrinsic motivation
(M3; β = .51, 95% CI’s [.000 to .134], p = .04). The
intervention also indirectly enhanced MVPA through serial
mediation of M1 (autonomy support), M2 (needs
satisfaction) and M3 (intrinsic motivation) (95% CI [.000
to .023], p < .05). In comparison to the variance
predicted for the intervention’s direct effect on MVPA alone
(r2 = .20), factoring in M1, M2 and M3 resulted in a
greater predicted MVPA variance (p = .001, r2 = .34).
Once controlling for SDT mediators, the direct effect of
intervention on MVPA remained, concluding partial
mediation (see Fig. 5 for a visual description of model 1
and Table 2 for values for each path).
Model 2: Well-Being
The results of model 2 confirmed that on its own, the
intervention did not directly enhance well-being (r2 = .05, p = .42).
However, when factoring in the mediators, the intervention
indirectly and significantly enhanced well-being (r2 = .21, p
= .001), through a combination of singular and serial indirect
mechanisms outlined below.
When exploring the direct and indirect effects of the
intervention on M1, M2 and M3, the results were
consistent with Deci and Ryan’s (2000) assumptions. The
direct effect of the intervention on autonomy-support
(M1, β = .17, p < .04) resulted in an indirect effect of the
intervention on needs satisfaction (M2, β = .43, 95% CI
[.186 to .685], p = .001). Further, and in relation to the
sample size reference above for model 1, the increased
sample size in model 2 (n = 132) resulted in an indirect
effect of the intervention on M3 (β = .11, 95% CI [.066
to .165], p = .001) through M2.
The intervention indirectly enhanced well-being
through autonomy-support (M1, β = .38, 95% CI [.004
to .104], p = .01) and through autonomy-support and
needs satisfaction in serial (β = .15, 95% CI [.003 to
.054], p < .05). There was no significant indirect effect
of the intervention through the autonomy support,
needs satisfaction and intrinsic motivation sequence
(see Table 2 for values for each path and Fig. 6 for a
visual model depiction).
This was the first study to apply SDT in the design and
analyses of a school-based intervention aimed at
enhancing MVPA and well-being among children of low SES.
The HCP was designed to enhance children’s
perceptions of autonomy-support, needs satisfaction and
intrinsic motivation through training sport student volunteers
and classroom teachers to utilise needs-supportive
teaching principles. The research aim was to test the
effect of the HCP on the children’s MVPA and well-being
through Fortier et al.’s [
] SDT model for health
interventions. The results highlighted a number of
psychosocial processes that underlie the mechanisms of
MVPA and well-being promotion [
]. In support of H1, the
intervention group perceived more support for their need
for autonomy than the control group from baseline to
postintervention. Exploring the residual causal sequence
revealed that the intervention indirectly enhanced MVPA
through partial mediation of autonomy-support, needs
satisfaction and intrinsic motivation and indirectly
enhanced well-being through autonomy-support and needs
satisfaction. These findings indicate that needs-supportive
physical activity environments can facilitate positive
motivational states, MVPA behaviour and well-being [
Ways to advance SDT in health promotion are now
By training teachers to offer physical activity choice,
participatory learning, positive constructive feedback
and meaningful rationale during the Daily Mile and
supervision weekly sessions, the children’s need for
autonomy was enhanced. This finding corroborates Ryan
and Deci’s [
] description of needs-supportive social
environments and aligns with studies in the PE context
18, 19, 38
] wherein pupils have been receptive to their
teacher’s modified instructional style. In accordance with
SDT hypotheses, in model 2, the direct effect of the
intervention on autonomy-support exerted indirect
effects on needs satisfaction and intrinsic motivation,
confirming hypotheses 2 (H2) and 3 (H3). Support for
H2 and H3 provide confirmatory evidence of the
mediating role of autonomy-support described in SDT [
which the children’s school environment facilitated
psychological needs satisfaction and intrinsic motivation
for physical activity [
]. As such, our findings are
consistent with the trans-contextual model of motivation
], suggesting that autonomy-support from teachers
can transfer its effects to general physical activity
In comparison to the control group, the intervention
group increased their total and MVPA during school
days from baseline to post-intervention (i.e. 4.49 min
improvement). Whilst regular MVPA is essential for
children’s health [
], many school teachers indicate time
as a barrier for behaviour change [
]. This study
highlighted that integrating basic, time-efficient, and
physical activities into the school day can have a
meaningful impact on children’s behaviour change, suggesting
that educators consider completing curriculum-based
activities with physical activity [
]. Moreover, the
psychosocial processes reported for these effects can inform
future health promotion efforts. Consistent with SDT,
the MVPA variance was explained through partial
mediation of autonomy-support, needs satisfaction and
intrinsic motivation (H4). Support for H4 provides
evidence congruent with a meta-analysis of 46 studies
], suggesting that pre-adolescent children’s physical
activity can be enhanced and is most strongly regulated
through autonomous intrinsic motivational states rather
than extrinsic motives. However, there was a degree of
variance unexplained by SDT constructs in model 1. The
lack of full mediation through SDT mediators is
unsurprising given that the Integrated Behaviour Change
], among other dual-process models [
denotes unconscious psychological processes beyond
intentional motivations that provide schema for
children’s physical activity (e.g. affective responses, see [
for a review). Future research may consider testing SDT
alongside assumptions within or alongside validated
dual-process models [
] to improve the prediction
and enhancement of physical activity behaviours in
The HCP did not exert a significant direct effect on
well-being, supporting conclusions in a recent systematic
review of school-based physical activity interventions
] and randomised controlled trial designed to
increase well-being [
]. However, the HCP had an
indirect effect on well-being through
autonomysupport and needs satisfaction, confirming H5. This
finding, coupled with the results of a school-based
screen-time intervention incorporating SDT [
supports the conceptualisation of well-being from a
eudemonic perspective [
], in which well-being is realised
through the social environment providing support for
one’s psychological needs [
Furthermore, the indirect effect of the intervention on
well-being through autonomy-support and needs
satisfaction reinforces previous research that documented a
positive correlation between needs satisfaction during
physical activity and well-being [
], indicating that
needs satisfaction at a domain level (i.e. physical activity)
may transfer its effects to well-being at a global
day-today level. In addition, while previous research  has
reported a direct unidimensional relationship between
physical activity and well-being, the indirect effects
found in the present study suggest a more nuanced
]. The psychosocial explanation that physical
activity contexts provide an opportunity for social
belongingness (i.e. relatedness), environmental mastery (i.e.
competence) and volition (i.e. autonomy) was evidenced
to facilitate well-being among children of low SES.
When aiming to enhance well-being through physical
activity, researchers and practitioners may consider
modifying the social climate through offering
psychological needs-support rather than just the behaviour
Generalisability and Limitations
The design of this study was specific to children in the
school setting. Therefore, adaptation and use of
needssupportive techniques for other populations (e.g. adults)
and contexts (e.g. online) may refer to a recent review on
needs-supportive physical activity communication [
While the authors followed available methodological
] by maintaining communication with the
delivering teachers and student volunteers, including
revisiting the aims of the SDT principles applied [
], there was
a lack of empirical fidelity data upon which to conclude
on the efficacy of the study fidelity. We refer the reader to
a recent theoretical fidelity evaluation study of a likewise
SDT programme [
] for addressing such issues in future
work. Moreover, it was not possible to conduct a
followup to test whether the effects reported maintained
longitudinally a recognised limitation of the waiting list design
]. While all efforts were ensured to reduce the potential
for contamination, the design of this study would have
been improved through a clustered randomised control
trial design comprising additional participants.
A key strength of the current study was the design,
application and analyses of SDT-informed needs-supportive
teaching techniques. This study demonstrated that the HCP
enhanced MVPA partially through increasing the children’s
perceptions of autonomy-support, needs satisfaction and
intrinsic motivation. Well-being was also indirectly enhanced
through improvements in autonomy-support and needs
ta > ep iab tc 04 to
T M > va ffEe [95%
re 1 d r .0
t > n
en 3 e
tam >M en rab tc C −[0 .t0o
rTe 2M epd iav ffEe [95% .0
satisfaction. The indirect effects of the HCP highlighted
motivational and needs-supportive mechanisms underpinning
children’s MVPA participation and well-being. As such, the
practical implications of this study can guide researchers and
practitioners towards modifying the social environment in
which physical activity is experienced through utilising
needs-supportive teaching principles [
]. To build on the
findings from this research, further work may consider
conducting a clustered RCT incorporating the recommended
methodologies to explore if such changes can be maintained
longitudinally. Such work could examine the influence of
needs-support provided to the children by their teachers,
student volunteers and parents, who all contributed to the
intervention. Overall, the HCP is a theory-driven study that
can advance health promotion in the school setting.
Additional file 1: Serial mediation models treating identified regulation,
introjected regulation and extrinsic motivation as mediator 3 (M3).
(DOCX 30 kb)
HCP: Healthy Choices ProgrammePEPhysical education; WHO: World Health
OrganizationMVPAModerate-to-vigorous physical activitySESSocio-economic
The authors acknowledged the children and schools who participated in the
study. This research was funded by the Ulster University’s PhD challenge
fund. The authors would like to thank the schools and student volunteers
who participated in the programme.
This research was supported by the Ulster University’s PhD challenge fund.
Availability of Data and Materials
The data for this study is stored by the lead and final authors.
SS, GB and DB designed the study. SS, ZY and JH collected and managed
the data input. SS and DH analysed the data. All authors contributed to the
final draft of the article.
Ethics Approval and Consent to Participate
Informed consent and assent was sought prior to this study. Ethical approval
was granted by the Ulster University, in which we adhere to the Declaration
of Helsinki throughout all ethical procedures.
Consent for Publication
The Ulster University approved this study for publication.
Stephen Shannon, Gavin Breslin, Donncha Hanna, Zoe Younger, Deirdre
Brennan and Jessica Hassan declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
1. Deci EL , Ryan RM . Hedonia, eudaimonia, and well-being: an introduction . J Happiness Stud . 2008 ; 9 : 1 - 11 .
2. Sallis JF , Bull F , Guthold R , et al. Progress in physical activity over the Olympic quadrennium . Lancet . 2016 ; 388 : 1325 - 36 .
3. Breslin G , Fitzpatrick B , Brennan D , et al. Physical activity and wellbeing of 8-9 year old children from social disadvantage: an all-Ireland approach to health . Ment Health and Phys Act . 2017 ;(13): 9 - 14 .
4. Kjønniksen L , Torsheim T , Wold B . Tracking of leisure-time physical activity during adolescence and young adulthood: a 10-year longitudinal study . Int J Behav Nutr Phys Act . 2008 ; 5 : 69 .
5. Ball K. Traversing myths and mountains: addressing socioeconomic inequities in the promotion of nutrition and physical activity behaviours . Int J Behav Nutr Phys Act . 2015 ; 12 : 142 .
6. Michie S , Carey R , Johnston M , et al. From theory-inspired to theory-based interventions: linking behaviour change techniques to their mechanisms of action . Euro Health Psychol . 2016 ; 18 : 395 .
7. Lubans D , Richards J , Hillman C , et al. Physical activity for cognitive and mental health in youth: a systematic review of mechanisms . Pediatrics . 2016 ; 138 https://doi.org/10.1542/peds. 2016 . 1642 . Epub 2016 Aug 19
8. Van Sluijs EM , Kriemler S. Reflections on physical activity intervention research in young people-dos, don'ts, and critical thoughts . Int J Behav Nutr Phys Act . 2016 ; 13 : 25 .
9. Ryan RM , Deci EL . Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being . Am Psychol . 2000 ; 55 : 68 .
10. Ryan RM , Deci EL . Self-determination theory: basic psychological needs in motivation, development, and wellness . Guilford Publications 2017 .
11. Fortier MS , Duda JL , Guerin E , et al. Promoting physical activity: development and testing of self-determination theory-based interventions . Int J Behav Nutr Phys Act . 2012 ; 9 : 20 .
12. Owen KB , Smith J , Lubans DR , et al. Self-determined motivation and physical activity in children and adolescents: a systematic review and metaanalysis . Prev Med . 2014 ; 67 : 270 - 9 .
13. Standage M , Gillison FB , Ntoumanis N , et al. Predicting students' physical activity and health-related well-being: a prospective cross-domain investigation of motivation across school physical education and exercise settings . J Sport Exer Psych . 2012 ; 34 : 37 - 60 .
14. Breslin G , Shannon S , Fitzpatrick B , et al. Physical activity, well-being and needs satisfaction in eight and nine-year-old children from areas of socioeconomic disadvantage . Child Care Pract . 2017 ; 23 ( 3 ): 275 - 91 .
15. Quaresma A , Palmeira A , Martins S , et al. Effect of a school-based intervention on physical activity and quality of life through serial mediation of social support and exercise motivation: the PESSOA program . Health Educ Res . 2014 ; 29 : 906 - 17 .
16. Reeve J , Jang H , Carrell D , et al. Enhancing students' engagement by increasing teachers' autonomy support . Motiv Emotion . 2004 ; 28 : 147 - 69 .
17. González-Cutre D , Ferriz R , Beltrán-Carrillo VJ , et al. Promotion of autonomy for participation in physical activity: a study based on the trans-contextual model of motivation . Educ Psychol . 2014 ; 34 : 367 - 84 .
18. González-Cutre D , Sierra AC , Beltrán-Carrillo VJ , et al. A school-based motivational intervention to promote physical activity from a selfdetermination theory perspective . J Educ Res . 2016 ; 111 ( 3 ): 320 - 30 .
19. Chatzisarantis NL , Hagger MS . Effects of an intervention based on selfdetermination theory on self-reported leisure-time physical activity participation . Psychol Health . 2009 ; 24 : 29 - 48 .
20. Tessier D , Sarrazin P , Ntoumanis N. The effect of an intervention to improve newly qualified teachers' interpersonal style, students motivation and psychological need satisfaction in sport-based physical education . Contemp Educ Psychol . 2010 ; 35 : 242 - 53 .
21. Des Jarlais DC , Lyles C , Crepaz N , et al. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement . Am J Public Health . 2004 ; 94 : 361 - 6 .
22. Hughes JP . Stepped wedge design . In: Wiley Encyclopedia of Clinical Trials; 2008 .
23. Northern Ireland Research and Statistics Agency. Research Agency. Northern Ireland Multiple Deprivation Measure 2017 . 2012 . p. 2010 . Available at: http://niopa.qub.ac.uk/bitstream/NIOPA/4648/1/NIMDM2017-UES.pdf.
24. Duda JL . The conceptual and empirical foundations of empowering coaching™: setting the stage for the PAPA project . Int J Sport Exer Psychol . 2013 ; 11 : 311 - 8 .
25. Council for the Curriculum, Examinations and Assessment. Key Stage Two curriculum . Available at: http://ccea.org.uk/curriculum/overview. Accessed 27 Apr 2017 .
26. Breslin G , Brennan D , Rafferty R , et al. The effect of a healthy lifestyle programme on 8-9 year olds from social disadvantage . Arch Dis Child . 2012 ; 97 : 618 - 24 . https://doi.org/10.1136/archdischild-2011- 301108 . [doi].
27. Trost SG , Loprinzi PD , Moore R , et al. Comparison of accelerometer cut points for predicting activity intensity in youth . Med Sci Sports Exerc . 2011 ; 43 : 1360 - 8 . https://doi.org/10.1249/MSS.0b013e318206476e.
28. Wells SL , Kipping RR , Jago R , et al. Characteristics associated with requested and required accelerometer wear in children . BMJ Open . 2013 ; 3:e003402 . https://doi.org/10.1136/bmjopen-2013-003402.
29. Evenson KR , Catellier DJ , Gill K , et al. Calibration of two objective measures of physical activity for children . J Sports Sci . 2008 ; 26 : 1557 - 65 .
30. Ravens-Sieberer U , Erhart M , Gosch A , et al. Mental health of children and adolescents in 12 European countries-results from the European KIDSCREEN study . Clin Psychol Psychother . 2008 ; 15 : 154 - 63 .
31. Shannon S , Breslin G , Fitzpatrick B , et al. Testing the psychometric properties of Kidscreen-27 with Irish children of low socio-economic status . Qual Life Res . 2016 ; 26 ( 4 ): 1081 - 89 .
32. Standage M , Duda JL , Ntoumanis N. A test of self-determination theory in school physical education . Br J Educ Psychol . 2005 ; 75 : 411 - 33 .
33. Sebire SJ , Jago R , Fox KR , et al. Testing a self-determination theory model of children's physical activity motivation: a cross-sectional study . Int J Behav Nutr Phys Act . 2013 ; 10 : 111 .
34. Hayes AF . Beyond Baron and Kenny: statistical mediation analysis in the new millennium . Commun Monogr . 2009 ; 76 : 408 - 20 .
35. Hayes AF . Introduction to mediation, moderation, and conditional process analysis: a regression-based approach . New York: Guilford Press; 2013 .
36. Field A . Discovering statistics using IBM SPSS statistics: sage 2013 .
37. Hayes AF . The PROCESS macro for SPSS and SAS . Retrieved. 2015 ; 12 : 2015 .
38. González-Cutre D , Sierra AC , Beltrán-Carrillo VJ , Peláez-Pérez M , Cervelló E. A school-based motivational intervention to promote physical activity from a self-determination theory perspective . J Educ Res . 2018 ; 111 ( 3 ): 320 - 30 .
39. Wallhead TL , Hagger M , Smith DT . Sport education and extracurricular sport participation: an examination using the trans-contextual model of motivation. Res Q Exerc Sport . 2010 ; 81 : 442 - 55 .
40. Kelly MP , Barker M. Why is changing health-related behaviour so difficult? Public Health . 2016 ; 3 ( 136 ): 109 - 16 .
41. Hagger MS , Chatzisarantis NL . An integrated behavior change model for physical activity . Exerc Sport Sci Rev . 2014 ; 42 : 62 - 9 . https://doi.org/10.1249/ JES.0000000000000008.
42. Brand R , Ekkekakis P. Affective-reflective theory of physical inactivity and exercise . German J Exer Sport Res . 2017 ; 48 ( 1 ): 48 - 58 .
43. Rafferty R , Breslin G , Brennan D , et al. A systematic review of school-based physical activity interventions on children's wellbeing . Int Rev Sport Exerc Psychol . 2016 ; 9 : 215 - 30 .
44. Tymms PB , Curtis SE , Routen AC , et al. Clustered randomised controlled trial of two education interventions designed to increase physical activity and well-being of secondary school students: the MOVE project . BMJ Open . 2016 ; 6:e009318 . https://doi.org/10.1136/bmjopen-2015- 009318 . [doi]
45. Lubans DR , Smith JJ , Morgan PJ , et al. Mediators of psychological well-being in adolescent boys . J Adolesc Health . 2016 ; 58 : 230 - 6 .
46. Reeve J . Understanding motivation and emotion . United States of America: Wiley; 2014 .
47. Muros JJ , Pérez FS , Ortega FZ , et al. The association between healthy lifestyle behaviors and health-related quality of life among adolescents . J Pediatr . 2017 ; 93 ( 4 ): 406 - 12 .
48. Ntoumanis N , Quested E , Reeve J , et al. Need supportive communication: implications for motivation in sport, exercise, and physical activity, Persuasion and communication in sport, exercise, and physical activity . Abingdon: Routledge; 2017 .
49. Sebire SJ , Kesten JM , Edwards MJ , May T , Banfield K , Tomkinson K , et al. Using self-determination theory to promote adolescent girls' physical activity: exploring the theoretical fidelity of the Bristol girls dance project . Psychol Sport Exerc . 2016 ; 24 ( 4 ): 100 - 10 .