ACTIVE (Active Communities Through Individual Vouchers – Evaluation)

Lead investigator
Professor Sinead Brophy

Co-Contributors: Jemma Hawkins, Suzanne Audrey, Gareth Stratton, Charlotte Todd, Danielle Christian, Sarah McCoubrey

Many teenagers, have very low activity levels, placing them at higher risk of future cardiovascular disease, cancer and obesity. However, effective and sustainable interventions to address this issue are lacking. This proposal builds upon promising pilot work involving physical activity vouchers for teenagers in a deprived area of South Wales. The pilot study showed a reduction in a number of barriers to activity and was successful in engaging girls and changing attitudes to activity, resulting in improved activity levels. The proposed study aims to expand the pilot study and incorporate additional advocacy and peer mentor aspects to promote sustainability.

Aims & objectives
(1) To examine evidence of effect of a multi-component intervention in improving activity levels, cardiovascular fitness and health (2) To explore engagement with the scheme, particularly among high-risk groups and examine what works for whom and why (including mediating effects of intervention components) (3) To examine evidence of effect in sustained local investment in implementing recommendations of young people in promoting physical activity.
Study design

Vouchers: Vouchers worth £20 will be given once per month for 12 months to all children aged 13-14 in 4 secondary schools in Swansea with high percentages of children receiving free school meals. The vouchers can be used to pay for existing activities (such as attending the water park, indoor skateboarding centre or other activity providers), attract existing activities to the area (grouping together to bring a coach or teacher to run sessions in local centres), start new activities (pay parent or other provider to start sessions in new activity such as street dancing, kickboxing and others) and buy equipment (roller blades, bikes). All vouchers are numbered and marked with the individual’s name and require a signature by the child and the activity provider with details of the activity or equipment purchased.

Peer mentor scheme and Advocacy Meetings: 5 pupils from each school (identified as influential and respected by peers) will be given training and skills to become peer mentors. They will be given skills to motivate and increase confidence among their peers to be active and also attend meetings with local politicians and businesses to promote sustainable investment in the provision of physical activities within their communities.   Peer mentoring has been successfully used in preventing smoking in this age group [6] and has recently been associated with significant improvements in school day physical activity levels and aerobic fitness in 9-13 year olds in America [7]. In addition, two pupils from each school will be selected to meet with local government agencies and commercial providers of activity. This will involve discussion of their needs, barriers to activity and changes that could improve activity for teenagers and improve uptake of facilities provided.  This has potential to improve support regarding activity for teenagers in the community and develop facilities among activity providers.

Promoting investment: Teenagers will be trained in making short films with a handheld camera about why activity is important to them, barriers to being active and recommendations to improve activity for children and young people. The films will be posted on you-tube, presented at local research meetings and submitted to national conferences and meetings, promoted in the media (TV and radio), and presented to local government and commercial agencies (council, public health department, education authority, commercial investors, bus companies).

Support worker: A support worker will help raise awareness of teenagers as to what is available in the area and encourage them to design their own new activities or attract new coaches to the area. The support worker will liaise with local and commercial activity providers and children to help develop sustainable methods of investing their vouchers.

Comparison: two schools in Cardiff (outside the intervention regions) will be selected to measure activity and engagement in activities over the same time period.  It was felt that activity vouchers could change the area for all young people and that contamination of schools in the local area would be a very high possibility. Therefore, comparison schools would need to be outside the intervention areas.

Measures of effect:

Aim (1): Change in health and fitness:

·      Total activity (accelerometer assessed) fitness (shuttle run), cardiovascular health (blood pressure, time to resting heart rate) will all be measured before and after intervention and in comparison schools.

·      General health will be assessed using linkage to routine data to examine number of visits to GP’s practices in the 12 month period before the intervention and after the intervention in participant and children from comparison area. Linkage will be performed within CIPHer a new centre of excellence in health research linking routine data (

Aim (2):  Examining engagement and what works for whom and why:

·      Activities and hours active per week before and after the intervention compared to comparison schools will be measured using a physical activity questionnaire.  Number of vouchers used by whom and where will also be examined.

·      Weight and height measurements will be undertaken for the purpose of exploring engagement with the scheme by BMI

·      Routine data (National Child Health Dataset, GP records, educational records) will be used to examine demographic profile of participants by voucher use. For example, number of vouchers used associated with retrospective data on birth weight, gender, early life growth curves, contact with GP, educational achievement at Key stage 1 and 2 ,and prospective data such as educational achievement Key stage 3 (is voucher use associated with future educational achievement) will be linked to be reported after key stage 4 assessment.

·      Qualitative reports of engagement in activity and barriers and facilitators before and after the intervention. Focus groups and interviews with children, teachers and support workers will explore which aspects of the scheme work or do not work for different teenagers and why.

 Aim (3): Impact and sustainability:

·      Number views of you-tube movies, number of meetings in which movies are presented (conferences, local meetings with council and potential funders)

·      Number of meetings between teenagers and key stakeholders

·      Agreements and commitments to move investment into areas which are recommended by the young people (Qualitative interviews).

·      Audit of activities available before and after intervention and in comparison area and number of new activities set up. Follow of activities available will be performed at 3 months and 12 months post-intervention.

·      User assessed success evaluated by interviews with young people before and after the intervention.

Further information & publications
Start date
January 2015
End date
December 2016

British Medical Association