Youth-centred participatory action approach towards co-created implementation of socially and physically activating environmental interventions in Africa and Europe: the YoPA project study protocol.

INTRODUCTION: The majority of adolescents do not meet guidelines for healthy behaviours, posing major risks for developing multiple non-communicable diseases. Unhealthy lifestyles seem more prevalent in urban than rural areas, with the neighbourhood environment as a mediating pathway. How to develop and implement sustainable and effective interventions focused on adolescent health and well-being in urban vulnerable life situations is a key challenge. This paper describes the protocol of a Youth-centred Participatory Action (YoPA) project aiming to tailor, implement, and evaluate social and physical environmental interventions. METHODS AND ANALYSIS: In diverse urban environments in Denmark, the Netherlands, Nigeria and South Africa, we will engage a dynamic group of 15-20 adolescents (12-19 years) growing up in vulnerable life situations and other key stakeholders (eg, policy makers, urban planners, community leaders) in local co-creation communities. Together with academic researchers and local stakeholders, adolescents will take a leading role in mapping the local system; tailoring; implementing and evaluating interventions during participatory meetings over the course of 3 years. YoPA applies a participatory mixed methods design guided by a novel Systems, User perspectives, Participatory co-creation process, Effects, Reach, Adoption, Implementation and Maintenance framework assessing: (i) the local systems, (ii) user perspectives, (iii) the participatory co-creation process, (iv) effects, (v) reach, (vi) adoption, (vii) implementation and (viii) maintenance of interventions. Through a realist evaluation, YoPA will explore why and how specific outcomes were reached (or not) in each setting (n=800-1000 adolescents in total). ETHICS AND DISSEMINATION: This study received approval from the ethics committees in Denmark, the Netherlands, Nigeria and South Africa and will be disseminated via various collaborative dissemination activities targeting multiple audiences. We will obtain informed consent from all participants. We envision that our YoPA co-creation approach will serve as a guide for participation of adolescents in vulnerable life situations in implementation of health promotion and urban planning in Europe, Africa and globally. TRIAL REGISTRATION NUMBER: NCT06181162.

Designing Activating Schoolyards: Seen from the Girls' Viewpoint.

Girls are typically less active in the schoolyard during recess than boys. It is therefore necessary to understand influences on girls' recess activity in schoolyards. The aim of this qualitative study was to investigate girls' perceptions of physical environmental factors influencing recess physical activity in re-designed schoolyards and to compare the perceptions of girls from different age groups. In 2018, 50 girls from five Danish schools were interviewed using photo-elicitation. The girls were from Grade 4 (n = 28, age 10-11) and Grade 6 (n = 22, age 12-13). Data were analysed using pen profiles constructed from verbatim transcripts. Ten factors emerged: variety, accessibility, size, designated spaces, greenery, playground markings, active play facilities, sports facilities, play equipment, and speakers. Play facilities (trampolines, obstacle courses, dancing and gymnastic appliances) were favoured over traditional sport facilities. Designated spaces, greenery and speakers were important for feeling comfortable within the schoolyard. Although similar factors were raised by the two age groups, some factors were perceived as enablers by the youngest and as barriers by the oldest girls, highlighting the complexity of designing schoolyards that cater to all ages. A greater understanding of how different designs and facilities may be perceived by girls of different ages is important for the design of future schoolyards.

Schoolyard upgrade in a randomized controlled study design-how are school interventions associated with adolescents' perception of opportunities and recess physical activity.

School recess physical activity is important for adolescent s health and development, and several studies have established evidence based on cross-sectional studies that it is influenced by the environment in the schoolyard. The aim of this study was to investigate the effect and variation across schools of a school-based intervention on students perceived opportunities for physical activity in the schoolyard, and to evaluate if an improved collective perception of opportunities was followed by an increase in PA during recess for the 13-15 year-old students. The intervention components included schoolyard renovation; mandatory outdoor recess; and increased adult supervision and support. Students collective perceptions were evaluated by a newly developed Schoolyard index (SYi) with seven items, and physical activity was objectively measured with accelerometer. We found variations in the change of student perceptions across the intervention schools, and that a one unit increase in the Schoolyard index (SYi) led to a 12% increase in recess PA. This study shows that adolescent PA during recess can be increased through a multicomponent intervention. The prospect for making an impact is low and according to the process analysis dependent on direct involvement; active and supportive adults; and varied, connected and well located facilities.