Exploring the feasibility of a cluster pilot randomised control trial to improve children’s 24-hour movement behaviours and dietary intake: Happy homework

Figures & data

Figure 1. CONSORT flow diagram of the recruitment, adherence, and analysis process of pupils.

Note. SIMD = Scottish Index of Multiple Deprivation; BMI = body mass index; ST = screen time; DILQ = Day in the Life Questionnaire.

Table 1. Descriptive characteristics of participants.

		Intervention (n=40)	Control (n = 31)	Overall (n=71)
Age (years)		10.0 ± 0.3	10.6 ± 0.5	10.3 ± 0.5
BMI (kg/m^2)		18.13 ± 3.80	18.89 ± 3.02	18.46 ± 3.47
Sex, n (%)	Male	19 (47.5%)	13 (41.9%)	32 (45.1%)
	Female	21 (52.5%)	18 (58.1%)	39 (54.9%)
SIMD decile, n (%)	SIMD 1	5 (12.5%)	3 (9.7%)	8 (11.2%)
	SIMD 2	5 (12.5%)	3 (9.7%)	8 (11.2%)
	SIMD 3	1 (2.5%)	2 (6.5%)	3 (4.2%)
	SIMD 4	6 (15%)	6 (19.3%)	12 (16.9%)
	SIMD 5	1 (2.5%)	3 (9.7%)	4 (5.6%)
	SIMD 6	2 (5%)	4 (12.9%)	6 (8.5%)
	SIMD 7		4 (12.9%)	4 (5.6%)
	SIMD 8	16 (40%)	2 (6.5%)	18 (25.4%)
	SIMD 9	3 (7.5%)	4 (12.9%)	7 (9.9%)
	SIMD 10	1 (2.5%)		1 (1.4%)

SIMD: Scottish Index of Multiple Deprivation.

Table 2. Completion of HH activities based on teachers’ fidelity logbooks.

Weekly HH activities	Completion of weekly HH activities
	n (%)
Week 1 – Yoga	23 (Schaap et al., 2018)
Missing	2 (Okely et al., 2022)
Week 2 – Fitness and nutrition	16 (Migueles et al., 2019)
Missing	19 (Sharps & Robinson, 2015)
Week 3 – Dance and nutrition	16 (Migueles et al., 2019)
Missing	19 (Sharps & Robinson, 2015)
Week 4 – Walking	11 (Buchan et al., 2019)
Missing	19 (Sharps & Robinson, 2015)
Week 5 (Holiday week) – Games and colouring	11 (Buchan et al., 2019)
Missing	19 (Sharps & Robinson, 2015)
Week 6 (Holiday week) – Games and colouring	11 (Buchan et al., 2019)
Missing	19 (Sharps & Robinson, 2015)
Week 7 – Play	11 (Buchan et al., 2019)
Missing	19 (Sharps & Robinson, 2015)
Week 8 – Games and nutrition	13 (Kelley et al., 2003)
Missing	19 (Sharps & Robinson, 2015)

Note. Total no. of intervention pupils (n = 38).

Table 3. Teacher and pupils’ positive perceptions of happy homework.

Theme	Subtheme	Example quote
Teacher perceptions
Content	Useful and appropriate content
	Activities well-matched to curriculum	I was really keen to take part because when I looked at what the sort of activities … I though they well-matched the curriculum and the age and stage of the children so I thought they would enjoy doing it – Teacher 1
	Links HWB messages from school to home
	Challenges
	Enjoyable for the children
Preferred activities	Yoga	I actually liked all of them for different reasons. I’d say the week 1 yoga, that ties into things I was saying before that I was trying to do about more mindfulness or maybe more relaxing … - Teacher 1
	Dance
	Walking
	Workout week – spelling workout
Encouraging habitual activity	Liked the idea of puzzles instead of work over the Easter Holiday period.
	Hoped HH kept the children thinking of HWB whilst on Holiday
	Completed well over the Easter Holiday period.	They really quite liked the colouring in and that seemed to be quite well done … well some of them weren’t but you could tell most of them weren’t rushed – Teacher 2
	Could have been made optional for children who go on holiday over the Easter Holiday period
Implementation	Class got into routine	… we kinda worked that in with our usual homework and it was quite good just having that as my fourth task every week and the kids knew what was coming up – Teacher 1.
	Teacher enjoyed implementation
	Explained well for the children
	Homework was provided for the teacher
Teacher-pupil relationship	Making relationships stronger
	Encouraging pupils to be more active	I probably made more of a point of trying to encourage the children to do it which is obviously a good thing to be encouraging them to be as active as possible – Teacher 1
Pupil perceptions
Activities	Well planned
	Amount of homework given
	Preferred active tasks	I agree with everyone else the active ones make you more, want to go and be more active. The written ones, you’re just sitting down writing … - Girl 8

Note. HH = Happy Homework; HWB = health and wellbeing.

Table 4. Negative perceptions and barriers teachers and pupils perceived regarding happy homework.

Theme	Subtheme	Example quote
Teacher perceptions
General homework	Completion of general homework is not a priority to the school or teachers
	Unsure of the benefits of homework
	Completion of homework is dependent upon children’s circumstances
	Health and wellbeing homework isn’t given the same importance as other curriculum areas.	So, no, I would say they put more importance on their traditional homework they would get like your spelling words, your maths … your calculations’ - Teacher 1
Completion of HH activities	Higher completion rates in early weeks
	Novelty wore off	I feel like the participation kinda tailed off. They were quite enthusiastic at the start but its similar with most things, they get used to it and the novelty wears off – Teacher 2
	A lot of paper – environmentally friendly
Barriers to completion of HH	Parent attitudes
	Clubs	In this class, I do have a lot of children … go to the after-school clubs like the netball and the football. In fact, I have one girl who, on a Thursday night, goes to three different things so she’s very busy. So, some of them when I was coming back saying “have you got it? Have you handed it in?” some of them were saying ‘I was at this club this night and I couldn’t do it – Teacher 1
	Holidays
	Home-life
HH was not age-appropriate	Games	Some of the games I think were maybe a wee bit young. Obviously, you weren’t meant to know that, but they were maybe a bit young for the kids we had – Teacher 2
HH provided extra work	Extra work for teachers
	Time consuming for parents	I think it’s quite time consuming for the parents as well because they’re just looking to make their life easy … a lot of them are working full-time, you know both parents, so it’s all about making it quite easy for them.- Teacher 2
HH stickers	Clashing views (class-by-class basis)
	Enthusiastic initially	Initially, they seemed quite enthusiastic about the stickers but then it kinda tailed off. But then, maybe the aged range they’re at, the stickers aren’t the same novelty for them – Teacher 2
	Not an enticement
Pupil perceptions
Barriers	Lifestyle and family events	Like some people might have like a really serious sport they do and they’re training like every day of the week for like 4 hours or something so like when you come back it’s like “right I have to do it now” – Girl 6
	Clubs
	Time-consuming
	Parent employment

Table 5. Pupils perceived autonomy in happy homework.

Theme	Sub-theme	Example quote
Options in Happy Homework	Days	I don’t know if this makes sense but one night, I got in really late and I had to do Happy Homework and I was like to my mum “I have to do it” and she was like “don’t do it just now” and I was like’ no I have to’. And when I thought about it more, I thought I’d just leave it till tomorrow and my mum was fine with that… – Girl 1
	Time	I like the ones that provided you with an option because if there was one you didn’t really want to do at the time, they you could have like the option to do another one so then if you, then when you want to do the other one you can do the other one as well – Boy 6
	Activities – choice	I prefer the ones like options. Em, so you have like more options you don’t just need to do that it gives you like more opportunity to do that… if you had one option and you didn’t like it you have one option you have to do but you might not like it a lot or as much. But if you have 2 options then you’ve got that one option you can go to say I really like that, or I don’t like that. So, if you do more than 2 options, maybe like 4 or 5 options, you could do, it would make … if you liked all of them you might decide “aw I want to do all of them” so you might be more active that night if you’ve got, if you don’t do as much sports you could be like aw ill just do this one. It might not be as much but its more active you could do all of them if you wanted to be more active – Girl 6
	Activities – prescriptive	I think in some of the activities there is a choice between some and then in others like, it will tell you to go do this or that, like it was a set activity for some of them you had to do which would be good in some ways. Like some of them would be really good but some would be like not challenging but like made you have to go out your way to do it, and not like quick…- Girl 6
Pressure to complete Happy Homework	No pressure
	Pressure from teacher	When the teacher didn’t get a lot in, she got quite annoyed, and we felt pressured to do it – Boy 1
	Competing interests/activities	After sport … like if you have a club on. If it’s like late on like 7 or 8 your mum or dads like it’s a school night get to bed. And you’re like having to do it. So, if there’s more options you could be like that one’s going to be quicker, I could do that one – Boy 7

Table 6. Pupils perceived competence in happy homework.

Theme	Subtheme	Example quote
Capability	Capable	Em, I felt quite capable. Like your mum and dad might say aw you done that wrong but you’re kinda in a smaller group, so I felt more capable – Girl 3
	Balanced level of difficulty	Yeah. I don’t want to say it was easy. Sometimes it was challenging but sometimes it was easy … I found the written ones easy, like relatively easy, but the like most of the active ones like the em, the alphabet exercise like I have quite a, like 7 letters in my name so that’s a lot of exercise – Boy 6
Happy Homework challenges	Fun
	Aimed at younger population
	Good idea
	Competitiveness	I mean it wasn’t, it didn’t have to be that challenging like cause you kinda wanna win. The plank one was quiet, it was like a fun challenge if you know what I mean – Girl 6
Overcome Happy Homework challenges	Read over it – understand more	Cause the one that was like the sugar one, like the teaspoon. At first, we didn’t really understand how much it was and what it was and sometimes some packets might not say like the certain amount on it. So, it’s hard to like, it was like your favourite snacks to have, but some of your favourite snacks might not have it so it’s good to see you’re looking to see what ones are good for you. At first, we didn’t really get it but after you done it, after you thought about it and read the question more it was getting more clear – Girl 6
	Determined to try my best
Sense of accomplishment	Proud
	Special occasions
	Completed all 8 weeks
	New skills	I have like accomplished some skills that I wasn’t able to do before like … – Girl 6
	Interest in new activities	I wasn’t really calm before, and I wasn’t really into yoga. But now I’ve tried it I actually quite like it – Girl 3
	Fun to complete compared to maths
	Made sure went back to compete all activities	That I had finished them. I missed one week because I wasn’t in school, I was away somewhere but obviously I couldn’t hand it in but after the last week I just did that because I would’ve felt like I just left that one – Boy 6

Table 7. Pupils perceived relatedness: physical activity participation and interactions during happy homework.

Theme	Subtheme	Example quote
Participate in PA with most	Siblings
	Cousins	Most of the time I’ll just do it with … em, my cousins, and em, I don’t go to any clubs anymore. I used to go to loads but now I don’t – Girl 1
	Pet	This sounds really really strange, but em, my aunties dog … he loves to chase after his ball and he loves to have a race because he’s really fast because he’s a cocker spaniel and its really fun because you’ll just run with him and he will give you this wee grin when you run past and he’s got the ball and he will look up at you – Girl 2
	Friends
	Dad	Eh my dad … he’s quite active and he’s the only person in my family that comes cycling or running … I’m not entirely sure [why] … probably because we can go a lot longer distance that if I was just with my friends – Boy 1
	Mum	My mum because usually she drags me out of bed to go a run … because usually my friends don’t want to come out to play. They just video-chat me. They are more social – Girl 4
Parent/family participant in Happy Homework	Mum (majority)	Yeah … usually my mum would work from home, but my dad doesn’t work from home at all … [Inaudible] – Boy 3
	Dad	My mum helped me with the last couple, but my dad did the yoga one, but he couldn’t do it and he fell flat on his face [laughing] – Girl 3
	Siblings
	Gran
	Cousins
Experience of family participation in Happy Homework	Seeing parents active	It was good, it was the first time I’ve ever saw either of my parents do the plank … I liked doing it – Boy
	Competitiveness	With your parents it’s making you more competitive to beat them. Em, and then it’s like fun because you’re having that time with them. So, it’s fun to have more time doing stuff – Girl 6
	Fun
	Sometimes not enough people to play games
	Took parent away from technology	Yeah, because my dad’s always on his phone. He practically doesn’t do anything with me so … he does the homework with me. Usually, daily he’s on his phone and never really speaks to me. So, with the happy homework he actually does it with me and its better – Girl 4
	Brought family together	It was kinda like fun and happy cause like, my parents are like divorced and he came to do the homework with me because I asked him, so I was kinda happy … yeah … happy because I like finally saw my mum and dad like together so like it was nice – Girl 4

Table 8. Pupil perceived relatedness: perceived level of support during Happy Homework and parent–child relationship after Happy Homework.

Theme	Subtheme	Example quote
Supported/cared for	Encouraged to complete activities	Yeah, I felt supported. When they did have the time to come over and help me, they were telling me like, say it was the plank one, they would tell me that I could do it and I was able to do it – Girl 8
	Parent wanted to join in
	Usually hates homework – felt happy spending time with family	Yeah, because like they support you on your homework. Usually, I don’t want to do homework but when I had to do that, when I was doing it with them, I felt happy … because usually I hate homework … . because I spent time with my family and stuff like that – Girl 4
	Helping to complete activities
	Boost of confidence	I remember like for a couple of weeks i’d just be doing it myself because my mum and dad had to work but then they had like time to do one with me, so I wasn’t by myself doing it. My mum and dad were doing it. So, it wasn’t just me doing it this time. And they helped me do it… and then like when you’re doing a plank and them supporting you yeah like that. It boosts your confidence – Boy 6
Relationship after Happy Homework	The same
	Spend more time together now	We got closer … because we were spending more time together … my dad comes out the back with me to play football … yeah, because he used to say he didn’t have any time – Boy 4
	Participate in sports together now	Em, yeah because when it was all done and stuff like that, they wanted to do more sports with me and stuff like that – Girl 4
	Fall out over losing	It makes you angry when you lose to your parents. It makes you fall out [laughing] – Boy 7
	Get along better	Well, me and my dad kinda get competitive with each other. So, if I won against him, he would always want to have a re-match or something like that. But yeah, in the end if he won, he’d be happy. But like it kinda depends how it goes. Like if he wins, he will be really happy, but he won’t let go of it. But then it would kinda improve after it because we became like … just like we kinda got along a wee bit better – Girl 7

Table 9. Key recommendations to improve happy homework.

Theme	Subtheme	Example quote
Teacher recommendations
Everyday approach – normal		The only thing I can really think of is … trying to make it a bit more, as part of their normal day. Things they might be doing kinda anyway. Em, I know that would probably be really hard to think of things like that. But the walking one was a really good example of that because they would be building that into their day anyway. And if they weren’t, they might not see it as too onerous to try and to try and do. - Teacher 1
Streamline implementation	Signing in one place	You had them signing it Monday, Wednesday, Friday. I get that, but maybe just one day for the parents to sign it like on a Thursday just to say this is when it’s done … obviously, with health and wellbeing you’re trying to get them to do it on a daily basis but even if that is the case, they’re still only getting it signed on the Thursday night – Teacher 3
	Hand out once a week	Em, based on what we do with homework, we would give it out once a week and it would be expected, say you hand it out on Monday and collect in on Friday. Because generally speaking the homework we do is out on Monday in on a Friday. Um, so with the wee kinda activities Monday, Wednesday, Friday, rather than on Friday morning like “you need to sign, you need to sign” like, wee things … - Teacher 3
	Holiday challenges instead of homework	Even a challenge instead of actual homework. You know so, “your challenge this holiday weekend is to … ” and then a generic be active for 15 mins and get it signed off – Teacher 3
Teachers	Research team could work more closely with classroom teachers on content planning	The only thing I would say is it might be worth em, depending on what age range your targeting at, so maybe you could discuss with us, with teachers or whatever, think about the level of certain things so like the games and things like that. Upper school and lower school will be interested in completely different things. Em, so that’s an option if it’s going to be games they want to play, we could maybe have some ideas of the activities they could do – Teacher 2.
	Rewards specific to school	So yeah, probably finding on a school-by-school basis what they’re reward systems like and behaviour systems – Teacher 1
Continue promoting it		Gee-wiz … em … I don’t know. Em … I think it is just constantly flogging at it. I don’t know. I think nowadays everyone just accepts everything to be done for them. So how will you manage to get people to recognise they need to take responsibility for their own development and their own health and wellbeing? Rather than it being something that is handed out to them. But I think you’re kinda battling against the tide with it – Teacher 3
Incorporate equipment		I know that in P6 we do “bikeability”, so I don’t know if anything involving bikes but then you have the whole equity thing if not everyone has a bike so there’s issues like that – Teacher 1
Pupil recommendations
Increase autonomy support	Some activities – go out and play (less structured)
	Any days (less structured)	I just feel like if we didn’t have days when we had to do it, em, it would be a little bit better – Girl 1
	More options – activities	After sport … like if you have a club on. If it’s like late on like 7 or 8 your mum or dads like it’s a school night get to bed. And you’re like having to do it. So, if there’s more options you could be like that one’s going to be quicker, I could do that one – Boy 7
Increase autonomy in ways to completion Happy Homework activities	Ways to prove you have completed the activities	I think we should have to like to do something to show that we’ve done it. I know that like, I only got my mum to sign it once I done it but some people just go their mum to sign it so oh yeah I’ve done it … yeah to make people want to do it because they’re so to their electronics or like if they’ve got a phone you could say like call a friend or text a friend to go out and play for 15 minutes. So, say you called, say I called Anna, you could write like who did you go out with, who did you call, and then at school the next day, when you’ve told to prove you could ask Anna, did Zara actually call you – Girl 7
	Digitally (computer-based)

Table 10. Changes in outcome measures from pre- to post-intervention.

					The effect of intervention group on post-test scores (after controlling for pre-test scores, SIMD, and BMI-Z Score)
	Control (mean, SD)		Intervention (mean, SD)		$\mathit{\beta }$ (Standardised regression coefficient)	Standard Error	Two-tailed P Value	Confidence interval levels (M, 95%CI)
Outcome	Pre	Post	Pre	Post
ActiGraph GT3X+
AvAcc (mg)	42.62 (11.17)	45.22 (13.88)	41.50 (10.88)	43.98 (15.92)	0.00	0.08	0.98	−0.13	0.13
IG	−1.03 (0.13)	−1.02 (0.17)	−1.05 (0.13)	−1.05 (0.16)	−0.03	0.08	0.76	−0.16	0.12
MVPA (min.d^−1)	55.66 (20.36)	61.87 (28.16)	53.09 (19.33)	58.05 (29.73)	−0.01	0.08	0.87	−0.14	0.12
M60 (mg)	197.05 (58.35)	209.29 (83.82)	195.80 (64.78)	213.71 (104.16)	0.04	0.07	0.57	−0.08	0.15
M30 (mg)	337.78 (125.71)	351.24 (156.80)	322.82 (124.69)	348.31 (183.01)	0.04	0.08	0.58	−0.08	0.17
ActivPAL
Sitting time (hrs/day)	8.70 (.84)	8.63 (0.70)	9.13 (0.84)	8.71 (0.89)	0.01	0.19	0.98	−0.30	0.31
Standing time (hrs/day)	2.81 (0.69)	3.01 (0.56)	2.60 (0.63)	2.82 (0.44)^a*	−0.04	0.16	0.82	−0.31	0.23
Stepping time (hrs/day)	2.28 (0.57)	2.20 (0.26)	2.14 (1.47)	2.44 (0.22)	0.32^b**	0.09	0.00	0.17	0.48
Sit-to-stand transitions	85.51 (20.17)	92.47 (14.71)^a*	88.63 (20.17)	82.97 (14.71)^a*	−0.35^b**	0.11	0.00	−0.52	−0.17
Sit 60 mins plus (hrs/day)	1.15 (0.52)	0.83 (0.91)^a*	1.27 (0.69)	1.18 (0.51)	0.31^b*	0.14	0.03	0.08	0.54
Sleep Duration (hrs/day)	10.16 (0.52)	9.92 (0.51)	9.90 (0.80)	10.04 (0.64)	0.27^b*	0.11	0.02	0.09	0.45
Questionnaires
Weekly Screen time (hr/week)	28.45 (19.48)	33.55 (16.48)^a*	41.51 (32.13)	34.76 (19.67)	−0.03	−0.13	0.85	−0.24	0.19
DILQ	1.83 (1.44)	1.28(1.49)^a**	1.54 (1.42)	1.54 (1.44)	0.14^b**	0.051	0.01	0.06	0.24

Note. BMI = Body Mass Index; AvAcc = Average Acceleration; IG = Intensity Gradient; MVPA = Moderate-to-vigorous physical activity; DILQ = Day in the Life Questionnaire. β Effect size weak (<0.2), medium (0.2–0.5) strong (≥0.5).

^aSignificant differences between pre and post scores whilst controlling nested nature of the data ^a*(P < 0.05) ^a**(P < 0.001).

^bSignificant effect of group on post test scores whilst controlling for pre-test scores, BMI, SIMD and nested nature of the data ^b*(P < 0.05) ^b**(P < 0.001).

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