This research delves into the dynamics of active school transport (AST) by utilizing a two-stage co-design process and leveraging persuasive technology within a game for promoting AST called Battleship-AST. The primary aim of this research is to thoroughly investigate the two-stage game co-design process employed in creating a Battleship-AST game. Moreover, our research aims to evaluate participants’ perceptions regarding the motivating and engaging potential of the persuasive technology and gamification features embedded within the final iteration of the game. This evaluation aims to understand how these features influence participants’ motivation to increase their usage of AST through gameplay. In pursuit of these objectives, the research builds upon the existing Battleship-AST prototype and actively engages school children in a collaborative two-stage co-design process. Their valuable insights and preferences were harnessed in refining the game, which was subsequently tested during a tech event in Skellefteå, Sweden. The findings shed light on various aspects of the game’s impact, from its reception to the gamification features integrated within. Notably, the research highlights the positive impact of the co-design process, with increased motivation and engagement observed among the participants. Their involvement in shaping the game’s design resulted in a more engaging and enjoyable experience. The persuasive technology features, encompassing competition, collaboration, auditory cues, a virtual reward system, and an emphasis on similarity, played a pivotal role in sustaining engagement and motivating players. Elements such as rewards, leaderboard progression, and badges proved highly effective in encouraging continued participation and fostering a positive feedback loop. However, the study also identifies areas for potential improvement, including the need to measure real-life progress and refine the game’s levelling system. The research indicates that refining feedback mechanisms and tailoring game content to individual preferences could create an even more engaging experience. Additionally, long-term playtesting is proposed to assess the game’s extended impact. The findings offer promising avenues for enhancing motivation and engagement in AST, which can contribute to the promotion of healthier and more sustainable transportation choices among school children.

Background: A wide range of school interventions have been launched to increase childrens’ physical activity. Evaluation of the effectiveness of interventions requires suitable study designs and feasible quantitative evaluations relating to the school setting. The purpose of this study was to assess the evaluation design and methods for data collection, in order to make decisions about approaching forthcoming studies of the effectiveness of active school travel (AST) interventions.

Methods: Children from four Swedish schools in fifth grade (11–12 years old) participated in this non-randomized pilot study, two schools received an AST intervention and two schools were controls. The school-based AST intervention Sustainable Innovation for Children Transporting Actively (SICTA) was conducted by teachers in the classroom setting during four weeks. To assess feasibility of the evaluation design and methods for data collection a combination of quantitative and qualitative methods were applied, using participation- and response rates, a feasibility questionnaire and focus group interviews.

Results: Out of 25 potential schools, four schools accepted participation with explicit allocation requests preventing randomization. Out of 181 children, 107 children (59%) accepted participation. A total of 82% of the participating children reported active travel before the AST intervention, and 80% found reporting of daily school travels in the web-based survey to be easy. The children were in general positive about participating in the study and the methods for data collection were considered easy for the participating children to conduct and to blend well with usual school activities. There was an imbalance in reporting rates between intervention and control schools as well as a decrease in reporting rates during the study period.

Conclusions: Our results highlight the complexity and challenges in conducting controlled research among school children. Although children were positive about participation and found reporting to be easy, our results invoke the need to use alternative research designs and recruitment strategies that also attract children using non-active modes of travel when evaluating AST interventions in school contexts.

Emerging adulthood is a developmental stage influenced by the regularity of healthy behaviors. Gamification is the motivational strategy using virtual rewards and social comparison. This study aimed to explore the feasibility and proof of concept of utilizing digital badges, leaderboards, and quests as gamified learning in a health course. All data were collected using a pre/posttest format from first-year college students (n = 159; female = 42%). Employing a quasi-experimental design with the students in gamified/non-gamified conditions, Fitbit monitored physical activity (PA), and healthy eating (survey and diet recall) pre/post treatment. A covariance analysis demonstrated that gamification positively influenced students’ participation in light PA (p = .035, η2 = 0.03) and healthy eating (p = .008, η2 = 0.049) over the content matched control group. Integrating gamified elements into health education is feasible and advantageous to increase participation in activities such as walking and healthy eating.

Active school travel (AST) is an effective approach for increasing children’s physical activity and independent mobility, but policy supporting AST is lacking. This study aims to explore children’s experiences of AST to inform a policy recommendation. Photovoice methodology with a qualitative approach was applied, with children taking pictures on their way to school. This was followed by focus groups where the children explored their experiences of AST based on their photos. The data were analyzed using qualitative content analysis. The results show that the children valued independent mobility and wanted to be involved in decisions about their travels; they also expressed feelings of increased responsibility and personal growth as a consequence. Although the children recognized areas of improvement regarding infrastructure, especially regarding heavy traffic that jeopardized travel safety, they continued using AST. Finally, the children talked about the value of the health and environmental benefits of AST. Opportunities for friendship, play, and making decisions about their own time were highlighted as important incentives. The benefits from AST are many for children, as well as for society. The result has informed policy recommendations for AST, and the children’s input will be used to communicate the recommendations. Listening to the voices of children could be a steppingstone toward forming future healthy mobility initiatives. In that process, it is key to include children’s perspectives when formulating the AST policy for successful adoption and implementation.

Background

The COVID-19 pandemic negatively affected adolescents’ opportunities for physical activity in many countries.

Aim

To explore experiences and opportunities for physical activity among Swedish adolescents with different backgrounds, considering both the impact of the COVID-19 pandemic and broader influencing factors during and after this period.

Methods

Data was collected through focus group interviews (n = 13) with 86 students and analysed using content analysis.

Results

Although many adolescents managed to remain physically active during the COVID-19 pandemic, socioeconomic differences affected opportunities for participation in organized sports and activities, as well as perceptions of community safety. Findings also highlighted the important role of schools and the influence of gender and performance norms on physical activity, as well as young girls’ desire for “safe spaces” to focus on their training and development.

Conclusion

The COVID-19 pandemic disrupted routines, prompting adaptations and exposing various barriers. Social belonging, socioeconomic background, and prevailing norms significantly influenced activity levels, while the balance between independence and safety emerged as a key factor. Moving forward, we recommend investing in community safety, youth sports, and supportive school policies that challenge gender and performance norms, particularly in socioeconomically disadvantaged areas.

The societal gains from increased physical activity among children are substantial. This study aims to contribute with knowledge about how the benefits of increased physical activity are valued by the Swedish general public. The methodological approach is a contingent valuation survey (n = 768), which allows to capture values associated with increased physical activity that extend beyond the health domain. To our knowledge, this is the first study using a contingent valuation approach to assess the comprehensive benefits of promoting physical activity. Although almost all respondents support the idea to promote active school transport in general, slightly more than half the sample reject the idea to contribute financially, while almost half the sample state a positive willingness to pay (WTP), and only approximately 10% state a positive WTP without uncertainty. The average WTP a lump sum for the intervention is estimated to lie between SEK64-185 (approximately 6–19 Euros). Higher WTP correlates with income, perceptions that lack of physical activity as a serious problem, and regular exercise engagement. Due to limited access to cost data, a full economic evaluation is not possible. Nevertheless, even using lower-bound WTP (uncertain = 0), aggregate benefits exceed teacher‐time costs, which are expected to constitute the most important part of intervention costs. Policymakers are recommended to implement low-cost interventions to increase physical activity of children, for instance by promoting the use of active school transport.

Background: Healthy lifestyle behaviors in pregnancy are important for maternal and offspring health. Mobile health (mHealth) tools have potential to provide support for lifestyle behaviors at scale but such tools are commonly developed only in native languages, limiting reach in migrant populations. 

Objectives: This qualitative study, in two of the largest migrant populations in Sweden (Arabic- and Somali-speaking women), aimed to explore (a) perceptions and needs of knowledge and support related to pregnancy and lifestyle behaviors and (b) needs of and attitudes towards a pregnancy app and how features and content in the app can be adapted to support healthier lifestyle behaviors in migrant women.

Method: Individual semi-structured interviews were conducted with Arabic (n = 10) and Somali-speaking women (n = 9). Data was analyzed using content analysis (inductive latent approach).

Results: Arabic- and Somali-speaking women described an increased need of knowledge regarding pregnancy and lifestyle behaviors. The social environment could both motivate behavior change and be a source of misinformation. Women expressed great trust in maternity healthcare but requested more information related to lifestyle behaviors. A pregnancy app was perceived as a helpful tool to support healthy lifestyle behaviors. Mere translations were suggested to be valuable, however, audio- and video-format to deliver content and inclusion of women's partners in the app were described as desirable adaptations.

Conclusion: Our findings can guide maternity healthcare on what support migrant women need and inform future development of mHealth tools for pregnant migrant populations. Future research should disentangle the degree of cultural adaptations required for mHealth lifestyle interventions provided by healthcare.

Background: Over the last decades, the prevalence of AST has decreased significantly. Barriers to active school transport (AST) have been extensively examined in the literature, while psychosocial factors that facilitate AST have received less attention. To our best knowledge, there are currently no reviews on this subject. Therefore, the objective of this review was to scope the literature and identify published research about psychosocial factors related to AST.

Methods: Systematic searches conducted in PubMed, Web of Science, TRID, Scopus, and ERIC resulted in a total of 1933 publications, and 77 of them were considered eligible for this review.

Results: The results of the included articles were categorised into four psychosocial factors: confidence in ability, attitudes, social support, and social norms, which were all generally positively related to AST, with a few exceptions.

Conclusion: The findings of this review indicate that these psychosocial factors may be important to consider when developing interventions and highlight that both children and parents should be involved in the process. This knowledge can serve as a valuable guide for developing interventions to promote AST. However, the evidence base supporting these psychosocial factors requires further investigation to fully understand how and when to incorporate them to maximise AST efficacy.

Background

There is a growing need to invest in interventions that promote physical activity, such as active school transportation. Ideally, these interventions should be school-based to reach as many children as possible. However, school personnel have a heavy workload, and interventions must be feasible and sustainable. This study aims to explore the feasibility of a school-based intervention from the school personnel's perspective and increase knowledge about what makes an intervention in a school context feasible.

Methods

A qualitative design was applied with individual interviews with 19 participants, including principals, teachers, project coordinators, one school nurse, and one operation manager. The data were analyzed with qualitative content analysis.

Results

The result were formulated into one main theme “Crossing the threshold – enter and you might feel at home” and three subthemes “Flexibility for integration in the school context”, “Sensing meaningfulness is essential for being worth the effort” and “A supportive design to enhance enthusiasm”. These themes indicate that schools have a heavy workload and that there is a threshold for schools to invest time and effort into health promoting intervention. Flexibility, meaningfulness, and support were thus crucial elements for making an intervention in the school context feasible.

Conclusion

The results of this study outline a promising strategy to meet the needs of school personnel and can serve as a valuable guide for further research concerning school-based interventions aiming to promote health.