Built Environment and Active Transport to School (BEATS) Study

11 Pages·2016·1.14 MB·English

Open Access Protocol
Built Environment and Active Transport
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to School (BEATS) Study: protocol for a O
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cross-sectional study : firs
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Sandra Mandic,1 John Williams,2 Antoni Moore,3 Debbie Hopkins,4 a
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Charlotte Flaherty,5 Gordon Wilson,6 Enrique García Bengoechea,7 1
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John C Spence8 .1
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Tocite:MandicS, ABSTRACT p
Strengths and limitations of this study e
WilliamsJ,MooreA,etal. Introduction:Activetransporttoschool(ATS)isa n-2
BuiltEnvironmentandActive convenientwaytoincreasephysicalactivityand ▪ Study strengths include a large representative 01
TransporttoSchool(BEATS) 6
Study:protocolforacross- undertakeanenvironmentallysustainabletravel sample of adolescents and parents across one -0
sectionalstudy.BMJOpen practice.TheBuiltEnvironmentandActiveTransportto city with a heterogeneous physical environment, 11
2016;6:e011196. School(BEATS)StudyexaminesATSinadolescentsin data collection across the three seasons (fall, 19
6
doi:10.1136/bmjopen-2016- Dunedin,NewZealand,usingecologicalmodelsfor winter and spring) and objectively measured o
011196 activetransportthataccountforindividual,social, physicalactivityandbuiltenvironment. n 2
environmentalandpolicyfactors.Thestudyobjectives ▪ This study has achieved a 100% school recruit- 4 M
▸ Prepublicationhistoryfor areto:(1)understandthereasonsbehindadolescents mentrate. a
thispaperisavailableonline. andtheirparents’choiceoftransportmodetoschool; ▪ Study limitations include cross-sectional study y 2
Toviewthesefilesplease (2)examinetheinteractionbetweenthetransport design, self-reported travel data, data collection 01
visitthejournalonline choices,builtenvironment,physicalactivityandweight in one city and lack of information on transport 6. D
(http://dx.doi.org/10.1136/ statusinadolescents;and(3)identifypoliciesthat fromschool. o
bmjopen-2016-011196). promoteorhinderATSinadolescents. w
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Methods and analysis:Thestudywilluseamixed- lo
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RReecveisiveedd2199FeJbanruuaarryy22001166 methodapproachincorporatingbothquantitative INTRODUCTION ded
Accepted3March2016 (Insuforrvmeyast,ioanntShyrsotpeomm(eGtrIyS,)aacncaellyesroism,metearpsp,inGge)oganradphic Physical inactivity and sedentary lifestyles fro
among adolescents are global public health m
qualitativemethods(focusgroups,interviews)to h
gatherdatafromstudents,parents,teachersand problems. If feasible, active transport to ttp
schoolprincipals.Thecoredatawillinclude school (ATS) is a convenient way to integrate ://b
accelerometer-measuredphysicalactivity, physical activity (PA) into everyday life and m
anthropometry,GISmeasuresofthebuiltenvironment maintain or increase PA levels.1 2 ATS may jop
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andtheuseofmapsindicatingroutetoschool lead to healthy, environmentally sustainable n
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(students)/work(parents)andperceivedsafe/unsafe and economical travel practices over a life- m
areasalongtheroute.Toprovidecomprehensivedata time. Despite great variations in the preva- j.c
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forunderstandinghowtochangetheinfrastructureto lence of ATS between countries,3 the rates of m
supportATS,thestudywillalsoexamine ATS among adolescents have consistently on/
complementaryvariablessuchasindividual,familyand declined over the past decade in developed J
socialfactors,includingstudentandparental countries.4–8 anu
perceptionsofwalkingandcyclingtoschool,parental a
ppeerrcceeppttiioonnssooffdthifefenreenigthmbooudrehsooofdterannvsirpoonrmtteonts,crhoouotel, torRsecoefntArTevSiewinsidcehniltdifireendaarnadngeadooflepsrceednicts- ry 3, 2
toschool(students)/work(parents),perceptionsof including demographic characteristics, indi- 0
2
dreraivsionngs,ufosrecohfoionsfoinrmgaatipoanrtcicoumlamruscnhicoaotiloanntdecshtundoelongty, vsoidcuiaallaannddpfhamysiiclyalfaecntovirrso,nsmcheonotlalfafcatcotorsr,s.a9n–1d2 3 by
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andparentalphysicalactivityhabits,screentimeand Physical environment factors such as dis- u
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wreecirguhittmsetanttusra.tTeh(e12stsuedcyohnadsaraycshciehvoeodlsa).100%school tance, presence of walking paths and/or bike st. P
Fornumberedaffiliationssee Ethics and dissemination:Thestudyhasbeen luarnbeasn, faovramilaabnidlityroaodfsarfeectryehataivoenaalsigfanciifilictaienst, rote
endofarticle. approvedbytheUniversityofOtagoEthicsCommittee. impact on encouraging or hindering active cte
Theresultswillbeactivelydisseminatedthrough d
transport in youth.10 11 In contrast, land use b
Correspondenceto reportsandpresentationstostakeholders,symposiums y
DrSandraMandic; andscientificpublications. mix, residential density and intersection co
[email protected] density have not been consistently associated py
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MandicS,etal.BMJOpen2016;6:e011196.doi:10.1136/bmjopen-2016-011196 1
Open Access
with ATS in children and adolescents.12 Understanding has one of the highest rates of private vehicle ownership B
how these factors interact and influence transport per capita in the world.21 Finally, the climate/weather at MJ
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choices among adolescents in a local context will enable the south end of the South Island of New Zealand is
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the scientific community, policymakers, city planners very different from parts of the North Island of New en
and health promoters to address ATS barriers and Zealand and Australia. Thus, the interaction between : firs
reduce the reliance on motorised transport in this age climate/weather and the environment may have a differ- t p
group. ent impact on the ATS of adolescents. Therefore, under- ub
Most of the previous ATS studies in adolescents were standing of the local context through an ecological lis
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conducted in urban areas of the USA,13 14 Canada,15 approach examining multiple intersecting levels of influ- ed
Australia16 and Western Europe.17 18 Though some com- ence is essential for identifying effective intervention as
monalities may exist across high-income countries, strategiesto promote ATS. 10
reviews of the literature suggest that how the environ- The Built Environment and Active Transport to .1
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ment impacts physical activity and sedentary behaviour School (BEATS) Study will examine ATS among adoles- 6
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is not universal. The USA, Canada, Australia and cents on the South Island of New Zealand using eco- m
Western Europe have different urban layouts and social logical models for active transport10 22 which account jo
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norms compared to New Zealand. For instance, data for individual, social, environmental and policy factors. en
from 12 countries showed between-country variation in The study objectives are to: (1) understand the reasons -2
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residential density, intersection density, walkability index behind adolescents and their parents’ choice of trans- 16
and park density.19 Limited data from New Zealand port mode to school; (2) examine the interaction -01
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suggest that age, distance to school, number of vehicles between the transport choices, built environment, PA 1
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and screens at home, coeducational status of the school and weight status in adolescents; and (3) identify pol- 6
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and opportunity to socialise with friends influence the iciesthat promote or limit ATS inadolescents. n
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ATS of adolescents.20 Though some factors such as dis- Studyoverview: This observational cross-sectional study 4
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tance to school and parental safety concerns will be will use a mixed-method approach incorporating both a
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similar across countries, climate/weather and percep- quantitative (surveys, anthropometry, accelerometers, 2
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tions and features of the built environment are location- Geographic Information System (GIS) analysis, 1
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specific. In addition, social norms and policies can mapping) and qualitative methods (focus groups and . D
influence factors such as availability and use of public interviews) to gather data from students, parents, tea- o
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transportation, parental perceptions of safety, safety con- chersandschoolprincipals(figure1).Thecoredatawill nlo
scious parental practices, school zoning and reasons for include objective measures of PA (measured using accel- ad
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choosing a particular school. In particular, New Zealand erometers), anthropometry and the built environment d
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Figure1 TheBEATSStudy:conceptualframework,outcomemeasuresandassessmentprocedures.(ATS=activetransportto y
school;BEATS,BuiltEnvironmentandActiveTransporttoSchoolStudy;GIS=GeographicInformationSystemanalysis). rig
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2 MandicS,etal.BMJOpen2016;6:e011196.doi:10.1136/bmjopen-2016-011196
Open Access
(derivedthroughGISanalyticaltechniques),andtheuse school, two to four classes will be approached in years B
ofmapstocollectdataaboutroutetoschool(students)/ 9–13 (∼25 students per class x on average three classes MJ
work (parents) and perceived safe or unsafe areas along per school year×5 school years×12 schools=≈4000 stu- O
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the route. To provide comprehensive data for under- dents). Owing to logistic reasons, the sampling of classes n
standing how to change the infrastructure to support within the school will be left to the discretion of each : firs
ATS, the BEATS Study will also examine complementary school. t p
variables such as individual, social and policy factors, Using variance estimates calculated from data from ub
including student and parental perceptions of walking the Otago School Students Lifestyle Surveys (2009 and lis
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and cycling to school, parental perceptions of different 2011)20 in Dunedin schools (n=1458), 700 students per ed
modesoftransporttoschool,routetoschool(students)/ group would provide a statistical power of >0.90 at as
work (parents), reasons for choosing a particular school α=0.05 to detect a 10% difference in ATS use in boys 10
and student and parental weight status, PA habits, seden- versus girls,as well as differences in distance to school of .1
1
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tarybehavioursanddietaryhabits(studentsonly). 500m and differences in built environment variables 6
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between ATS and motorised transport users. Allowing m
for 30% non-response, a total of 2000 students will be jo
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METHODS ANDANALYSIS recruited. With an estimated recruitment rate of 50%, en
Study Design: The BEATS Study is based on multisector 4000 students will be invited to participate in the -2
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collaborations between secondary schools, the city 1
student survey. 6
council, the local communities and academia.23 The Procedures: Students will be recruited through their -01
study will be conducted in Dunedin, New Zealand 1
school. Packages with study information and consent 1
(population ∼120000). The BEATS Research Team is forms will be given to all invited students and their 96
multidisciplinary with expertise ranging from exercise parents at the school 1–3weeks prior to the scheduled on
science, behavioural medicine and health promotion to date(s) for data collection. The study will be advertised 24
geographic information science, statistics, consumer in the school’s newsletter. Information about the study Ma
behaviour and environmental sociology. Details on the y
will also be sent by email from the school principal to 2
development of research and community collaborations, 0
the students and parents. Each school will be provided 1
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planning and study implementation have been with prepaid envelopes containing relevant study infor- . D
described elsewhere.23 mation for those parents who do not have an email o
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The study will consist of six subprojects that examine address. Parents will have an option to sign their nlo
different components of the ecological models foractive consent either on paper or online. For adolescents ad
transport using quantitative (student surveyand parental e
under the age of 16years, parental opt-in or parental d
survey) and qualitative approaches (focus groups with opt-out consent will be used on the basis of the school’s fro
students, parents and teachers; school principal inter- m
views) (figure 1). Each substudy is described in more ptorefseigrenncteh.eAirlthcooungsehnsttuodnelnintse,wiellacahlsosthuadveenatnwoilpltiobne http
detailbelow.Datacollection startedin2014andwillcon- required to sign apaper version ofthe consent. ://b
tinue until 2017. m
Measures: Participants will complete an online survey
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(n=2000) and anthropometric measurements and will p
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Quantitativedata have an option to participate in PA assessment using n.b
BEATSstudent survey accelerometers (n=250) and/or one focus group (n=50) m
Purpose: The BEATS Student Survey examines adoles- (numbers indicate target sample sizes). Measures will j.co
cents’ transport to school habits, motivations and bar- include self-reported transport to school habits, percep- om/
riers for ATS, reasons for choosing a particular school, tions of ATS, self-reported healthy lifestyle habits, n
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perceptions of the neighbourhood environment, health anthropometry, school bag weight, accelerometer- a
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behaviours, weight status, perceptions of driving and the measured PA, perceived and objectively measured built u
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use of information communication technology. Specific environment characteristics and the route to school ry
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aims are to: (1) examine the interaction between the drawn on amap. , 2
transport choices, perceived (questionnaire) and object- Survey: Students will be surveyed once using a 30– 02
ive measures (GIS analysis) of the built environment, PA 40min questionnaire developed specifically for this 3 b
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and weight status in adolescents; (2) investigate the rela- study.Thequestionnairewillbedeliveredandcompleted g
tionship of the adolescents’ transport mode choice to online, during classroom time, with 3–5 research assis- ue
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the wider sociocultural, built environment and policy tants and a teacher present in the classroom. The ques- t. P
influences; and (3) compare motivations and barriers tionnaire will include questions on demographics, ro
for walking versus cycling to school. reasons for choosing a particular school, transport to te
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Participants: The BEATS Student Survey will recruit school habits, motivations and barriers to walking and te
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2000 students in school years 9–13 (age: 13–18years) cycling to school, perceived neighbourhood environ- b
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attending 1 of 12 secondary schools in Dunedin. Cluster ment, health behaviours, perceptions of driving and use c
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sampling will be undertaken using schools as sample of information communication technology. All questions y
units and classrooms within schools as clusters. In each havebeendevelopedforuseinschoolstudents,andmost rig
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MandicS,etal.BMJOpen2016;6:e011196.doi:10.1136/bmjopen-2016-011196 3
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have been validated and used successfully in similar Mapping a route to school: After completing the B
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populations. Home address will be collected to facilitate survey and anthropometry, students will be provided J
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calculationofdistancetoschool(usingGISanalysis)and with an A3 size map of the city with their school and city
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determine neighbourhood deprivation score as a surro- centre highlighted. Students will be asked to draw their n
gate for students’ socioeconomic status.24 Perceptions of route to school, indicate their mode of transport : firs
neighbourhood environment will be examined using a (including multimodal transport), mark the areas along t p
validated Neighbourhood Environment Walkability Scale the route where they feel safe or unsafe and comment ub
forYouth(NEWS-Y)(test–retestreliabilityinadolescents: on safety issues along the route. These paper maps will lis
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ICC range 0.56 to 0.87).25 Health behaviours will be be subsequently digitised through tracing the drawn ed
examined using questions from the Health Behaviour in route on a roads spatial data layer, using a GIS. This as
School Children survey (permission obtained) (moder- means that the recorded route will follow the surveyed 10
ate-to-vigorous PA question: ICC 0.77; vigorous PA ques- road network and will not be subject to the geometric .1
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tions: ICC 0.71 for frequency and ICC 0.73 for duration; irregularities associated with hand-drawing. Transport 6
test–retest reliability for television viewing and computer mode and safety attributes will be attached to the traced /bm
use: Spearman correlations 0.55 to 0.68;26 Food route lines where they occur. Map-measured routes have jo
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Frequency Questionnaire foradolescents: Spearman cor- been previously used as valid and were significantly dif- en
relationswiththe7-dayfooddiary−0.13to0.67).27 ferent from GIS-based network measurements,33 which -2
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Anthropometry assessment: Height and weight will be were also featured in this study. 6
measured atthe timeofthe surveyusingstandardproce- Geographic Information System Analysis: A built envir- -01
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dures with participants in school uniforms (without onment GIS analysis will be conducted for the home 1
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shoes, jackets and sweaters). Height will be measured and school neighbourhoods and route to school. 6
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using acustom-made portable stadiometerand recorded Objective measures of the built environment (distance n
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to the nearest 0.1cm. Weight will be measured using an from home to school, land mix use, residential density, 4
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electronic scale (A&D scale UC321, A&D Medical), intersection density and topography) and route to a
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recorded to the nearest 0.01kg and reduced by 0.5kg to school analysis (distance) will be derived through GIS 2
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account for clothing. Body mass index will be calculated analytical techniques using Esri ArcGIS V.10.2 Software. 1
as weight divided by height squared (kg(cid:1)m−2). Weight Distance from home to school will be calculated in two 6. D
status category will be determined using international ways: (1) actual route from home to school marked on a o
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age-specific and gender-specific cut-points.28 Waist cir- map, as previously described and (2) using the shortest nlo
cumferencewillbemeasuredusingametalmeasurement route on a topologically connected transport network, ad
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tape in standing position at the narrowest part of the based on geocoded home and school addresses. For the d
torso (above the umbilicus and below the xiphoid latter, distances will be calculated using the following fro
process). Students’ school bags will be weighed as well. steps: (1) geocoding home addresses to get address hm
Anthropometry measurements will be taken in a private, coordinates; (2) extracting school address points from ttp
screenedoffareaoftheclassroombytrainedresearchers. reference spatial data; (3) constructing an integrated ://b
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Accelerometer Assessment: One to three weeks after and connected road and track network; (4) attaching
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completing the online questionnaire, consenting adoles- the home and school point locations to this network; p
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cents will be instructed and shown at school how to and (5) using R scripting to calculate the shortest travel .b
attach and wear an accelerometer (ActiGraph, distance on the network for each study participant for m
GT3XPlus, Pensacola, Florida, USA). Participants will each route using the edges (roads, tracks) and nodes j.co
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wear an accelerometer above the right hip for at least (home, school and road/track intersection points) o/
12h per day for seven consecutive days. The valid wear forming the network. Such GIS-calculated distances n
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time criteria for wearing an accelerometer will be set as were found to be statistically similar to distances mea- a
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at least 5days, for a minimum of 10h per day.29 30 To sured from Global Positioning System (GPS) data col- u
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promote compliance, participants will be given a log to lected on the home-to-school route.34 ry
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record the times and reasons for taking the accelerom- The intersection density will be calculated as a count , 2
eter off during the day and will receive emails, phone of intersections along the route using the route and 02
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calls or text reminders. After 7days, participants will junction data derived from the connected transport b
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return their accelerometer at their school. Activity network. A 100m buffer zone based on the routewill be g
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counts will be stored in 10s and 30s interval counts to used to obtain a count of the junctions on or near the e
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detect short bursts of vigorous PA.31 Data with 10s inter- route. The land use mix variable along the school routes t. P
val counts will be analysed using MeterPlus software will be calculated as the mean land use mix entropy35 ro
using Evenson cut-points.32 Variables will include using the Dunedin City Council reference data (value te
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average moderate-to-vigorous physical activity and seden- range between 0 (the land use mix along the route is of te
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tary times (daily, weekday and weekend), 1 hour before a single class) and 1 (the land use mix along the route b
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school (8:00 to 9:00), 1h after school (15:00 to 16:00), is evenly distributed among all land use classes)). The c
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and lateafter-school hours (16:00 to20:00). topography of each route will be represented by the y
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4 MandicS,etal.BMJOpen2016;6:e011196.doi:10.1136/bmjopen-2016-011196
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altitude difference and total altitude gain variables, cal- inferences in the light of the limitations acknowledged B
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culated inconjunction with digital elevation data. above. J
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Analysis: Data analysis will include descriptive statistics, From the parents who consent to participate in the
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examination of the normal distribution of data (the physical activity study, a subsample of 250 parents (equal n
Ssphoanpdirion-gWihlkistotegsrtaman)danvdisuthale ihnospmeocgtieonneitoyfotfhevarcioanrrcee- gcoenndtaecrterdeptroesceonntafitriomn)thweiilrl ibneterraenstdoanmdlywsiellliencgtendessantdo : first p
(Levene’s test). Generalised linear mixed effects models wear an accelerometer for 7days. Approximately 30 ub
will be used to investigate relationships at the individual, parents will be purposefully recruited for focus groups lis
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social and environmental levels and to take account of to provide a broad representation of participants based ed
the cluster sampling scheme. Binary variables (eg, on a number of sociodemographic, attitudinal and as
walking to school or not) will be modelled with logistic behavioural characteristics relevant to the topic under 10
regression and ordinal variables (eg, frequency of consideration. .1
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walking to school on a semantic frequency scale) with Procedures: Recruitment of parents for the BEATS 6
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proportional odds regression, accounting for the cluster Parental Survey will take place using the following proce- m
sampling scheme.Analyses will be conducted with R and dures: (1) advertising in the school’s newsletters; (2) jo
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SPSS Statistical Package V.22.0. giving the BEATS parental pamphlet to students at en
school to take home; and (3) two email/mail invitation -2
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BEATSparental survey messages sent from the school principal to the parents 16
Purpose: The BEATS Parental Survey will examine paren- at their school. The BEATS parental pamphlet and -01
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talperceptionsofdifferenttransportmodestoschool,par- email from the school principal to parents will include 1
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entalmotivationsandbarriersforATS,parentalpasttravel brief information about student and parental surveys, a 6
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toschoolhabits,perceptionsofthebuiltenvironmentand sign-up sheet for parents, relevant links to the BEATS n
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safetyoftheroutetoschool,physicalactivityhabits,health Study website for further information about the BEATS 4
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behaviours,weightstatusandroutetoworkandtheirrela- Parental Survey, downloading study information sheets a
tionship to ATS habits in adolescents. Specific aims are: and consent forms, and signing consentonline. y 2
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(1) to explore the parental social and cultural environ- Invited parents will be given 1month to respond to 1
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mentinrelationshiptoATShabitsoftheirchildren;(2)to the invitation to participate in the BEATS Parental . D
compare parental and adolescents’ perceptions of the Survey. Only one parent per household will be included o
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builtenvironment,andespeciallysafetyforATSand(3)to in the data analysis. Multiple parents per household will nlo
compareparentalandadolescents’physicalactivityhabits, be determined from a combination of home address ad
and motivations for and barriers to ATS (in conjunction data, child’s school, child’s school year and parent’s ed
withtheBEATSStudentSurvey). gender. The second parent from the same household fro
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Participants: Parent participants will be recruited will be removed from the analysis. However, separated h
through 12 secondary schools in Dunedin (1000 parents parents (from different households) will be included in ttp
for the parental survey (80–100 parents per school); 250 the analysis. ://b
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parents for physical activity monitoring; and 30 parents Measures: Parent participants will complete an online
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for focus groups). We will approach parents of students surveyandwillalsohaveanoption toparticipateinphys- p
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in four classes in years 9–13 in each school (∼25 stu- ical activity assessment (using accelerometers) with n.b
dents per class×4 classes per school year×5 school anthropometric measurements and/oronefocus group. m
years×12 schools=≈6000 parents). With an expected par- Questionnaire: Parents will be surveyed once using a j.co
ticipation rate of 15–20% (an average parental participa- questionnaire developed specifically for this study. om/
tion rate in school-initiated surveys in Dunedin Participants will have a choice of completing the survey n
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secondary schools), we will recruit 1000 parents to com- online (Qualitrics software) or on a paper copy mailed a
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plete the survey (80–100 parents per school). In the to them. This approach will not disadvantage parents of u
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case of lower participation rate, the participating schools families with a lower socioeconomic status or families ry
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will be asked to sendthe study information toall parents with limited or no computer and internet access at , 2
at their school (by email or post). The study will be home. The parents will complete the 25–30min ques- 02
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advertised through social media such as Facebook, local tionnaire in theirown spare time. The questionnairewill b
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community newspapers as well as poster advertising in include questions on demographics (including self- g
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workplaces, local community and sporting centres. reported height and weight), transport to school habits e
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Owing to complexity of the overall BEATS Study, the of theirchildren, perceptions of walking, cycling, driving t. P
student and parental components will be planned as dis- and bussing to school, safety of child’s route to school, ro
tinct research projects. Therefore, parents will be able to perceived neighbourhood environment, PA habits, trans- te
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participate irrespective of their child’s participation. port to work details and perceptions of driving. Parental te
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This approach will be a limitation to the creation of barriers to walking and cycling to school will be exam- b
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parent–child dyads for the purpose of the analysis. ined using previously validated instruments (internal c
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Therefore, we will use child-level and parent-level data consistency 0.71–0.86; ICC 0.74–0.81)36 37 and will be py
to make comparisons, when appropriate, and make supplemented with specific questions (eg, parental rig
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MandicS,etal.BMJOpen2016;6:e011196.doi:10.1136/bmjopen-2016-011196 5
Open Access
attitude towards cycle skills training and assessment of Parental Survey. With expected participation rates of B
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needs for a bike libraryor cycle skills training for adoles- 15% to 20%, 1000 parents will be recruited. Assuming J
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cents). Perceptions of the neighbourhood environment that the relationship between parental attitudes and
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will be examined using a validated parent version of the child PA42 and between parental PA and child PA43 is en
NYoeuigthhb(oNuErWhoSo-Yd) (Etenstv–irroentemsternetliabWilaitlkyaibnilpitayrenStcsaolef adfoor- sdmyaadlls w(ril=l0b.1e5sutoffic0i.e2n5t),toadesatemcptlre≥0o.f1534w7ithpaαr=e0n.0t–5chanildd : first p
lescents: ICC range 0.61 to 0.78).25 Parental self- β=0.80. Using the same α and β, 394 dyads will be suffi- ub
reported PA habits will be assessed using questions from cient to detect a small effect size using analysis of vari- lis
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the International Physical Activity Questionnaire ance (ANOVA). Therefore, we will aim for at least 400 ed
(I-PAQ) Long Form (test–retest reliability with median dyads in our sample. A sample size of 250 parents in the as
ICCof ∼80)38 and brief measuresof PA.39 40 PA substudy will be sufficient to detect medium effect 10
Parental Physical Activity Assessment: Within 2weeks sizesforcomparisonbetween the groups using ANOVA. .1
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of completing the questionnaire, consenting parents will Analysis: Data analysis will include descriptive statistics, 6
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attend a 20min appointment to set up an accelerometer examination of the normal distribution of data (the m
(ActiGraph, GT3XPlus, Pensacola, Florida, USA) and Shapiro-Wilk test and visual inspection of the corre- jo
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obtain anthropometry measurements (height, weight sponding histogram) and the homogeneity of variance en
and waist circumference assessed using standard proce- (Levene’s test)). Generalised linear mixed-effects -2
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dures described above). During the study appointment, models will be used to examine parental attitudes 6
participants will be instructed and shown how to attach towards ATS, their perceptions of the built environment -01
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and wear an accelerometer. The appointments will be (especially safety for cycling to school) and objective 1
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set up at one of the designated locations throughout the measures of the built environment as correlates of ATS 6
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city. To facilitate recruitment, participants will be able to in adolescents. Data analysis will take into account the n
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choose a location and time that is most convenient for cluster sampling scheme. Bivariate correlations and 4
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them. Anthropometry measurements will be taken in a ANOVA will be used to examine relationships and a
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private room by a trained researcher. Participants will compareparental weight statusand PAwithparental atti- 2
wear an accelerometer above the right hip for at least tudes towards ATS and adolescents’ PA, weight status 01
6
12h per day for seven consecutive days. The valid wear and transport to school habits and to compare parental . D
time criteria for wearing an accelerometer will be set for and adolescents’motivations and barrierstoATS. o
w
at least 5days, for a minimum of 10h per day. To As described previously, 6000 parents will be invited to nlo
promote wearing an accelerometer, participants will be participate in the BEATS Parental Survey. With expected ad
given a log to record the times and reasons for taking participation rates of 15–20%, ∼1000 parents will be ed
the accelerometers off during the day and will receive enrolled in the study with at least 400 parent-child dyads fro
m
emails, phone calls or text reminders. After 7days, parti- and parents inthe PAsubstudy. h
cipants will return their accelerometer or mail it using a ttp
prepaid envelope. Data will be analysed using MeterPlus Qualitativedata ://b
softwareusing the threshold criteriaforadults.41 BEATSfocus groups with students,parents and teachers m
jo
GIS analysis: Objective measures of the built environ- Purpose: Focus groups will be conducted with groups of p
e
ment (distance to workplace and child’s school, land students, parents and teachers to explore their percep- n.b
mix use, residential density, intersection densityand top- tions of active transport, transport to school, transport m
ography) and route to work analysis (distance, route modes, motivations and barriers to travel behaviour and j.co
proximity to child’s/children’s school(s)) will be derived modalchoice, adolescents’ internet use and use of infor- om/
through GIS analytical techniques using Esri ArcGIS mation communication technologies (table 1). The n
J
10.2 Software and code written in R, using the same focus groups will provide qualitative empirical data to a
n
methods described above for the student study. complement the quantitative survey data, offering an u
a
Distances (home to child’s school, home to parental opportunity to delve into the meanings, perceptions and ry
3
workplace and child’s school to parental workplace) will interpretations ofthe participants.44 , 2
be calculated on the topologically connected transport Participants: Student participants will be recruited 02
3
network, based on geocoded work addresses, as well as from the Student Survey sample. To account for discrete b
home and children’s school addresses. The intersection school contexts, all 12 participating schools will be y g
u
density will be calculated as described for the student offeredtheopportunitytoparticipateinonefocusgroup e
s
study. The land use mix variable along the school routes of 8–10 students with equal gender and age representa- t. P
was calculated as the mean land use mix entropy,35 tion. Parent participants will be recruited through adver- ro
using the Dunedin City Council reference data (as tisements at schools, workplaces, local community and te
c
described above). The topography of each route will sporting centres. Six to eight parental focus groups will te
d
again be evaluated through the altitude difference and be conducted, with 4–10 participants per focus group b
y
total altitude gain variables. and up to 30 participants recruited. Teacher participants c
o
p
Sample size calculation: As described above, 6000 will be recruited through participating schools. Four to y
parents will be invited to participate in the BEATS six teachers’ focus groups will be conducted with four to rig
h
t.
6 MandicS,etal.BMJOpen2016;6:e011196.doi:10.1136/bmjopen-2016-011196
Open Access
B
Table1 ThemesforBEATSStudyfocusgroupsandinterviews M
J
Focusgroups/interviewthemes O
p
Studentfocusgroup ▸ Currenttravelpractices en
▸▸▸ DBPearirrvcreieerpsrstiootfoncsaulorterfertnnratantpisvrapecoptritrcaemcstoicdeess : first pu
b
▸ Stereotypesofpeoplewhousedifferenttransportmodes lis
▸ Perceptionsofthelocalenvironment he
▸ Parentalrolesondeterminingtransportmodes d a
▸ Theroleofteachers s 1
Parentalfocusgroup ▸ Currenttravelpatternsandsocialpressures 0
▸ Personaltransporttoschoolexperiences .11
3
▸ PerceptionsofhealthbenefitsofATS 6
▸ Relationshipsbetweentravelandindependence /bm
▸ Builtenvironmentintheschoolneighbourhood jo
p
▸ Perceptionsofthesafetyofstudents’routestoschool e
n
Teachers’focusgroup ▸ Personaltransportpracticesandnorms -2
0
▸ Builtenvironmentathomeandatwork 1
6
▸ Perceptionsoftransportmodes -0
▸ Perceptionsofstudents’transporttoschool 11
1
▸ Theroleoftheteacherinencouragingactivetransport 9
6
▸ Roadsafety o
n
Schoolprincipalinterview ▸ Schoolpolicyforactivetransporttoschool 2
▸ Perceptionsoftransportmodes 4 M
▸ Healthandsafetyliabilities a
y
▸ Schoolroadsafetyprocedures,educationandmessages 2
▸ Infrastructureandthebuiltenvironment 01
6
. D
o
w
n
lo
a
sixteacherspersessionandupto24participants.Sample researchers will provide support and assistance to the d
e
size for student, parental and teachers’ focus groups will lead researcher, and take notes on key issues arising d
bedeterminedbyredundancyandsaturation.4546 through the session. fro
m
Procedures: The focus group session will last up to 1 The lead researcher will be responsible for identifying h
hour, and be conducted at a time suitable for each and mitigatinganyriskswhichcould affectthe outcomes ttp
group of participants. For students and teachers, the of the research. Potential risks include: (1) potential ://b
m
focus group will take place in a quiet and private loca- power dynamics within the student focus group session jo
p
tion at each school. For parental focus groups, a neutral since all focus group participants will be known to one e
n
and mutually convenient location will be used. Drinks another as students from the same school and a mix of .b
m
and snack food will be provided for the participants to age groups; (2) domination over a conversation in par- j.c
create a more relaxed environment and foster a positive ental focus group (to be minimised byallowing onlyone o
m
environment in which the participants feel free to speak parent per family to participate in anyone focus group); o/
at ease and without judgement. Participants will be and (3) potential power dynamics in teachers’ focus n J
advised that they do not need to answer anyof the ques- group resulting from different roles at the school or per- an
u
tions should they not wish to do so. They will be reas- sonal relationships that could affect the ability of partici- a
ry
sured that their responses will be anonymised in any pantsto speakopenly. 3
subsequent reporting of the empirical material. Measures: Focus group themes for students, parents , 2
0
Participants will also be encouraged to keep the content and teachers arelisted intable 1. 2
3
of the focus group discussion between themselves. Analysis: Focus group sessions will be digitally audio b
y
Sessions will end with an opportunity to ask questions recorded, fully transcribed and analysed using NVivo10 g
u
and discuss ATS-related issues not covered by the focus qualitative analysis software. Detailed notes taken by e
s
group questions. researchers during and immediately after each focus t. P
The focus groups will be facilitated by up to three group will allow the incorporation and development of ro
te
researchers. The lead researcher (DH) will direct the lines of enquiry for subsequent focus groups. This is due c
te
session, ask the questions according to the semistruc- to the highly dynamic and interactive nature of qualita- d
tured interview question matrix (table 1) and develop tive data generation and analysis.47–49 Thematic analysis by
dialogue between the focus group participants, ensuring will be used to search for emergent themes.50 This co
p
that all participants’ voices are being heard. Additional approach is popular in qualitative research, with the y
rig
h
t.
MandicS,etal.BMJOpen2016;6:e011196.doi:10.1136/bmjopen-2016-011196 7
Open Access
search for themes equating to the use of variables in Analysis: The interview sessions will be digitally audio B
M
quantitative research.51 Themes emerge as a result of recorded, fully transcribed and analysed by NVivo10 J
both inductive and deductive reasoning, drawing qualitative analysis software. In line with Basit,53 analysis O
p
together field-generatedthemesand theover-riding con- and interpretation will begin during the interview en
ceAptfutearlufrpalmoaedwionrgk.t5h1e transcriptions to the NVivo10 soft- plyrsoisceasns,danwdritceo-unpti,nause‘tahrdoyungahmtirca,nisnctruipittiivoen,afnodrmcarelaatnivae- : first p
ware, a liberal coding approach will be used to explore process of inductive reasoning, thinking and theoriz- ub
the empirical material, to identify similarities, differ- ing’.53 Thus, the identification of themes from the lis
h
ences, patterns and structures in the text.52 53 Following empirical material will begin during the interview ed
this, an interpretivist approach to analysis will be used to process. The formal analysis will take place using the as
get a greater depth of understanding. This reading of same analytical process used for the focus group 10
the material will consider the survey findings and draw sessions. .1
1
3
parallels across the different research methods. One 6
researcher (DH) will code the material. Coded material Mixed-methods design /bm
will be shared with other researchers and triangulated The approach to data integration will be one of conver- jo
p
with the focus group session notes. Triangulation (eg, of gent parallel or ‘concurrent triangulation’.55 The empir- en
researchers, methods, informants) can limit methodo- ical material from the quantitative and qualitative -2
0
1
logical and personal biases, thereby increasing the trust- strands of this research will be equal, and will be used to 6
worthiness of the research findings.54 Trustworthiness is ‘more accurately define relationships among variables of -01
thought to be achieved through the credibility, transfer- interest’.56 Thus, neither quantitative nor qualitative 11
9
ability, dependability and confirmability of the data will be considered to be ‘truer’, or given more 6
o
research.46 Trustworthiness is a qualitative standard weight, than the other. Through this approach, findings n
2
similar to that of generalisability and objectivity in quan- are understood as evidence that can be either narrative 4
titative approaches.46 or numeric, to examine the same phenomenon, namely Ma
Active Transport to School. Specifically, consistent with y 2
the notion of ‘parallel-datasets’ forwarded by Creswell 01
6
BEATSschoolprincipal interviews and Plano Clark,57 both methods will be used to address . D
Purpose: The school principal interviews will explore complementary aspects of the same phenomenon, and o
w
school principals’ perceptions of ATS, school neighbour- integration of qualitative and quantitative data will take nlo
hood environment, school’s policies for ATS, road safety place in the interpretation/discussion phase. To this ad
e
procedures around the school and personal travel end, both sources of datawill be analysed separately and d
habits. convergences and divergences in the findings will subse- fro
Participants: Principals of all 12 participating schools quently be identified in the context of side-by-side com- hm
will be invited to participate. Either the school principal parison and reported, and interpretations will be ttp
or deputy principal will be eligible to participate in this provided. ://b
m
interview.
jo
Procedures: A 60min semistructured interview will be Strengths and limitations p
e
conducted at the school and attended by two research- The BEATS Study will extend current national58 59 and n.b
ers. The lead researcher will direct the interviewand ask international projects60 examining the association of the m
the questions according to the interview question built and social environments and health in adolescents. j.co
matrix. The same researcher will lead all school princi- The review by Adams et al19 shows that between-country om/
pal interviews for consistency. The second researcher variation exists in how the primary indicators of walkabil- n
will provide assistance to the first researcher and take ity related to active transport. The cross-sectional study Ja
n
notes on the conversation arising through the session. described in this article is being conducted in a country u
a
Before the session, participants will provide written with one of the highest per capita levels of car owner- ry
3
consentandbereassuredthattheirresponses(including ship in the world, with narrow roads and in a city with , 2
identifiable comments about their particular school) cool and wet weather. These are all factors that may 02
will be anonymised in any subsequent reporting of the influence the physical activity and transit decisions of 3 b
y
empirical material. parents and children. Thus, New Zealand and the cityof g
u
Measures: The school principal interviews will involve Dunedin in particular, provide a unique context to e
s
an open-ended questioning technique. The general line examine the correlates of active transport. t. P
of questioning will include gaining information about The strengths of this study include a 100% school ro
school policy for ATS and school-specific concerns recruitment rate,alarge representativesample ofadoles- te
c
relatedtoATS(table1).Sincethe interview will besemi- cents and parents across one city with a heterogeneous te
d
structured in nature, there will be a loose line of ques- physical environment, comprehensive examination of b
y
tioning that will be developed prior to the interview personal, social, environmental and policy correlates of c
o
(table 1), as well as flexibility to develop specific themes ATS, datacollection acrossthe three seasons (fall, winter py
ofinterest toeach school principal. and spring) and objectively measured physical activity rig
h
t.
8 MandicS,etal.BMJOpen2016;6:e011196.doi:10.1136/bmjopen-2016-011196
Open Access
and built environment. The large study sample will In summary, the BEATS Study will provide timely and B
M
enable comparison of student and parental barriers and highly relevant information to understand individual, J
facilitators for ATS across neighbourhoods stratified by social, environmental and policy factors that influence O
p
e
socioeconomicstatusandwalkability,using bothperceived ATS within the New Zealand context. The results will n
and objective measures of the built environment. In add- provide valuable information for the schools, city coun- : firs
ition, data from students and parental surveys will allow cils, transport agencies and land planners and help t p
examination and comparison of correlates of walking and inform future changes to the built environment, school ub
cycling to school from parental and adolescents’ perspec- policy development and city policy development. The lis
h
tives. Therefore, the BEATS Study will provide relevant results will also inform health promotion efforts and ed
and timely data to examine correlates of ATS at all levels shape future interventions to promote ATS in New as
of the ecological frameworks used inthis study (figure 1). Zealand adolescents and advance further the scientific 10
Study limitations include cross-sectional study design, self- knowledge in this field. .1
1
3
reported travel data, data collection in one city and lack 6
/b
ofinformationontransportfromschool. Authoraffiliations m
1ActiveLivingLaboratory,SchoolofPhysicalEducation,SportandExercise jo
p
Sciences,UniversityofOtago,Dunedin,NewZealand e
n
2DepartmentofMarketing,UniversityofOtago,Dunedin,NewZealand -2
3SchoolofSurveying,UniversityofOtago,Dunedin,NewZealand 01
ETHICSANDDISSEMINATION 4CenterforSustainability,UniversityofOtago,Dunedin,NewZealand 6-0
All participants will sign their own consent. Parents will 5DunedinCityCouncil,Dunedin,NewZealand 1
1
have an option to sign their consent either on paper 6DunedinSecondarySchools’Partnership,Dunedin,NewZealand 1
9
7DepartmentofFamilyMedicine,ParticipatoryResearchatMcGill,McGill 6
oprareonntlainle.opFto-irnadoorlepscaerenntstaulnodpetr-otuhte caogneseonft1w6iylleabrse, U8Fnaicvuelrtsyitoy,fMPhoynstirceaall,EQduuceabteioc,nCaanndadRaecreation,UniversityofAlberta, on 2
used on the basis of the school’s preference. Although Edmonton,Alberta,Canada 4 M
students will also have an option to sign their consent a
y
online, each student will be required to sign a paper Acknowledgements TheBEATSStudyisacollaborationbetweenthe 2
version of the consent. The results will be actively dis- DunedinSecondarySchools’Partnership,DunedinCityCounciland 01
6
seminated through reports and presentations to stake- UniversityofOtago.Theauthorswouldliketoacknowledgethe . D
membersoftheBEATSStudyAdvisoryBoard(MrAndrewLonie,Mrs o
holders, individual reports to each participating school, RuthZeinert,DrTaraDuncan,DrSusanSandretto,DrJanet w
n
organisation of the symposiums for the local commu- Stephenson),researchpersonnel(studycoordinatorsAshleyMountfort, lo
nity, scientific conference presentations and research EmilyBrookandLeianaSloane,researchassistants,researchstudents ad
e
publications.23 In addition, the results will be dissemi- andvolunteers)andallparticipatingschools,students,parents,teachers d
nated through social media such as Facebook, profiled andschoolprincipals. fro
m
on our research laboratory website and the BEATS Contributors SMistheprincipalinvestigatorwhoconceptualisedtheoverall h
Study website, and presentations at health promotion study,establishedresearchcollaborationsandledtheprojectimplementation. ttp
forums. Allauthorscontributedtothedesignofthestudyandquestionnaires.SM, ://b
JW,AM,EGBandJCSobtainedresearchfunding.JWwasresponsiblefor m
The BEATS Study will provide comprehensive baseline statisticalanalysis.DHledthequalitativeresearchdesign,datacollectionand jo
p
data to evaluate school-based interventions in Dunedin analysis.AMwasresponsibleforGeographicInformationSystemsdata e
n
(eg, Cycle Skills Training and Bike Library in South analysis.GWassistedwiththerecruitmentofschools.SMdraftedthis .b
manuscript.Allauthorsrevisedandapprovedthefinalversionofthe m
Dunedin). In the long run, data collected as a part of manuscript. j.c
the study will form comprehensive baseline data for a o
m
npaatruenratlalexppeercreimpteionntstoofexthame ibnueiltcheannvgireosnimnesntutdaenndt AaTndS FZueanldainndgETmheisrgwinogrkRwesaesasrcuhpeproFrtiersdtbGyratnhte(H1e4a/5lt6h5R),esNeaatirocnhaCloHuenacrtilofNew on/
FoundationofNewZealand(1602and1615),LotteryHealthResearchGrant J
as a result of on-road and off-road cycle infrastructure a
(Applic341129),UniversityofOtagoResearchGrant(UORG2014)and n
construction in several Dunedin neighbourhoods (2014– DunedinCityCouncil.Thefundingbodiesdidnothavearoleinthedesign ua
2017). Taken together, these findings will provide ofthestudyandcollection,analysis,datainterpretationorwritingofthis ry 3
important information for designing future school-wide, manuscript. , 2
0
neighbourhood-wide and city-wide interventions to Competinginterests Nonedeclared. 2
3
encourage active transport among adolescents and use Patientconsent Obtained. by
active transport as a means of increasing physical activity g
inthisagegroup.TheBEATSStudyfindings willberele- Ethicsapproval UniversityofOtagoEthicsCommittee(referencenumber13/ ue
203;19July2013). s
vant to the local context and practices due to inclusion t. P
of decisionmakers and other knowledge users on the Provenanceandpeerreview Notcommissioned;externallypeerreviewed. ro
research team and a strong commitment to knowledge OpenAccess ThisisanOpenAccessarticledistributedinaccordancewith tec
theCreativeCommonsAttributionNonCommercial(CCBY-NC4.0)license, te
exchange and mobilisation. The comprehensiveness of d
tkhneowstlueddygewiallncdonutnridbeurtsetatnodtihnegaodfvafanccteomrsetnhtaotfinscflieunetnificec wcthohemicomhriegpriecnriaamllliwyts,oaornkthdieslricpsertonopsdeeristlyhtreicbiirtuedtdee,rairvneadmtivtihxe,ewaudosarekpstis,obnnuoidnldi-fcfueoprmeonmntetthercirsmiawls.,oSprekreo:nvohidntte-pd:// by co
p
ATS inadolescents. creativecommons.org/licenses/by-nc/4.0/ y
rig
h
t.
MandicS,etal.BMJOpen2016;6:e011196.doi:10.1136/bmjopen-2016-011196 9
Open Access
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