Effectiveness of a school-community linked program on physical activity levels and health-related quality of life for adolescent girls

Background: This study evaluated the effectiveness of a school-community program on Health-Related Quality of Life (HRQoL; the primary outcome), physical activity (PA), and potential mediators of PA among adolescent girls living in low-socioeconomic rural/regional settings. Method: The study was a cluster-randomized controlled trial. Twelve communities with the requisite sports clubs and facilities were paired according to relevant criteria; one of each pair was randomly assigned to the intervention or control condition. Eight schools per condition were randomly selected from these communities and the intervention was conducted over one school year (2011). Female students in grades 7-9 in intervention schools participated in two 6-session PA units - a sport unit (football or tennis) and a recreational unit (leisure centre-based). These were incorporated into physical education (PE) curriculum and linked to PA opportunities for participation outside school. Students were surveyed at baseline and endpoint, self-reporting impact on primary and secondary outcome measures (HRQoL, PA) and PA mediators (e.g. self-efficacy). Linear mixed models for two-group (intervention, control) and three-group (completers, non-completers, control) analyses were conducted with baseline value, age and BMI as covariates, group as a fixed effect and school as random cluster effect. Results: Participants completing baseline and endpoint measures included: 358 intervention (baseline response rate 33.7%, retention rate 61.3%) and 256 control (14.1% and 84.0%). Adjustment for age and BMI made no substantive difference to outcomes, and there were no cluster effects. For HRQoL, after adjustment for baseline scores, the intervention group showed significantly higher scores on all three PedsQL scores (physical functioning: M +/- SE = 83.9 +/- 0.7, p = .005; psychosocial: 79.9 +/- 0.8, p = .001; total score: 81.3 +/- 0.7, p = .001) than the control group (80.9 +/- 0.8; 76.1 +/- 0.9 and 77.8 +/- 0.8). The three-group analysis found intervention non-completers had significantly higher PedsQL scores (84.0 +/- 0.8, p = .021; 80.4 +/- 0.9, p = .003; 81.7 +/- 0.8, p = .002;) than controls (80.9 +/- 0.8, 76.1 +/- 0.9 and 77.8 +/- 0.8). There were no significant differences for any PA measure. Intervention completers had significantly higher scores than non-completers and controls for some mediator variables (e.g. self-efficacy, behavioural control). Conclusion: Positive outcomes were achieved from a modest school-community linked intervention. The school component contributed to maintaining HRQoL; students who completed the community component derived a range of intra-personal and inter-personal benefits.