Start small and let it build; a mixed-method evaluation of a school-based physical activity program, Kilometre Club.

BACKGROUND: Despite the benefits of physical activity, there is minimal research focusing on factors that influence real-world school-based physical activity programs. Kilometre (KM) Club is an Australian grassroots program which aims to increase physical activity in students through the completion of an outside walk or run at school. This small-scale pilot evaluation aimed to examine families, teachers and principals' perceptions of the benefits, enablers and barriers of KM Club. It also aimed to examine the effects of KM Club on student's physical activity levels during the school day. METHODS: Four regional New South Wales (NSW) primary schools participated in this study. 26 families, four teachers, and two principals from School A, C, B and D completed semi-structured interviews to understand their perceptions of KM Club. 21 students completed emotional state-scales to understand their emotions when participating in KM Club. 141 students from Schools B, C and D participated in step-count measures using accelerometers. RESULTS: Families, teachers and principals reported a range of benefits such as improved social connectedness, wellbeing, home and classroom behaviours, participation in sport and fitness levels. Enablers consisted of champion engagement, incentives, versatile facilities and integration with other school activities. Identified barriers included the weather and environment, program timing and health issues. Most students reported that participating in KM Club made them feel proud, confident and fantastic. School B reported a significant increase in students' daily step counts on KM Club days compared to non-KM Club days (+ 15%; p = 0.001), while School C reported no significant changes (-5%; p = 0.26). School D reported a significant increase in the number of daily steps taken by KM Club participants compared with non-KM club participants (+ 10%; p = 0.024). CONCLUSION: There is no one-size-fits-all approach to implementing school-based physical activity initiatives. However, it appears that flexible and adaptable factors are important to the successful implementation of school-based programs, such as KM Club. This study revealed a variety of self-reported health, wellbeing and educational benefits for students, as well as an increase in student's physical activity levels at 2 of the 3 schools participating in the quantitative data collection. This pilot evaluation may help to inform future design, implementation and scale-up of KM Club and school-based health promotion programs, potentially improving child health, wellbeing and educational outcomes. TRIAL REGISTRATION: (LNR223 - LNR/19/NCC/45).

Substance Use and Sex Index (SUSI): First stage development of an assessment tool to measure behaviour change in sexualised drug use for substance use treatment studies.

BACKGROUND: Existing tools for measuring blood-borne virus (BBV) and sexually transmitted infection (STI) transmission risk behaviours in substance use interventions have limited capacity to assess risk behaviours across varied social, cultural and epidemiological contexts; have not evolved alongside HIV treatment and prevention innovations; or accounted for sexual contexts of drug use including among a range of lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ) sub-communities. The Substance Use and Sex Index (SUSI) is a new brief, simple tool being developed to assess change in HIV and STI risk behaviours for substance use treatment studies. METHODS: A 26-item questionnaire was piloted online among community volunteers (n = 199). Concurrent and predictive validity were assessed against risk-taking (RT-18) and STI testing items (Gay Community Periodic Surveys). RESULTS: The developed scale comprised nine items measuring: condomless penile (anal or vaginal) sex, unprotected oral sex, shared toy use, bloodplay, chemsex (consumption of drugs for the facilitation of sex), trading sex for drugs, being 'too out of it' to protect self, injecting risk and group sex. Factor-analytic approaches demonstrated that items met good fit criteria for a single scale. Significant, moderate magnitude, positive relationships were identified between total SUSI score and both RT-18 risk-taking and recent STI testing. Qualitative feedback underscored the importance of culturally-embedded question formulation. CONCLUSION: The results support the conceptual basis for the instrument, highlighting the need for further scale content refinement to validate the tool and examine sensitivity to change. SUSI is a step towards improving outcome measurement of HIV/BBV/STI transmission risk behaviours in substance use treatment studies with greater inclusiveness of experiences across different population groups.

A managed alcohol program in Sydney, Australia: Acceptability, cost-savings and non-beverage alcohol use.

INTRODUCTION AND AIMS: Managed alcohol programs (MAPs) are a novel harm reduction intervention for people who experience long-term homelessness and severe long-term alcohol dependence. MAPs provide regulated amounts of alcohol onsite under supervision. Preliminary international evidence suggests that MAPs are associated with improvements such as reduced non-beverage alcohol consumption and decreases in some alcohol-related harms. There are currently no MAPs in Australia. We aimed to assess the feasibility of a MAP in inner-Sydney. DESIGN AND METHODS: A survey among eligible homeless alcohol-dependent residents of an inner-Sydney short-stay alcohol withdrawal service occurred in 2014 to assess acceptability. Administrative data were analysed to ascertain estimates of cost-savings for a MAP based in Sydney. RESULTS: Fifty-one eligible participants were surveyed. More than one-quarter (28%) reported consumption of non-beverage alcohol. A residential model received greatest support (76%); the majority (75%) of participants indicated a willingness to pay at least 25% of their income to utilise a MAP. Hospital and crisis accommodation cost-savings were conservatively estimated at AUD$926 483.40 and AUD$347 574.00, respectively per year for a 15-person residential MAP. DISCUSSION AND CONCLUSIONS: Our findings demonstrate the acceptability of a MAP in Sydney among a target population sample, with the implementation of a residential MAP likely to produce significant cost-savings. A trial of a Sydney MAP evaluating the impact on health and social outcomes, including a comprehensive economic evaluation, is strongly recommended.