Identifying local authority need for, and uptake of, school-based physical activity interventions in England – a cluster analysis using routine data

ABSTRACT

BackgroundSchools in England need effective, simple interventions to address shortfalls in children’s physical activity. Areas in England where physical activity is low among children may particularly benefit from school-based physical activity interventions. Further, stark geographical inequalities for children’s physical activity exist and have widened during Covid-19 lockdowns. The Daily Mile (TDM) is a school-based running programme that has been widely adopted across England. However, there is limited evidence of its equitability and whether it reaches children in most need. We aimed to i) identify local authorities in England with the highest need for children’s physical activity promotion and ii) determine whether TDM reaches schools in areas of high need.MethodsThis was a cross-sectional study linking routinely collected data from a range of sources including the Active Lives Surveys and national datasets. Characteristics of need were identified following a literature review to identify determinants of children’s physical activity. Our assessment of local authority ‘need’ included measures of children and adult’s physical activity and excess weight, children’s mental health needs, access and utilisation of outdoor space for exercise, and deprivation. We grouped local authorities using a hierarchical cluster analysis. The optimal number of clusters for our data was three clusters. We estimated the association between ‘need’ and registration to TDM with a Poisson regression.ResultsWe identified three distinct clusters of need for children’s physical activity interventions representing 4.5 million primary school children. High-need, medium- need, and low- need local authorities included 24%, 56% and 20% of 123 upper-tier English local authorities respectively. Schools in local authorities of high-need were more likely to be registered to TDM (IRR 1.25, 95%CI1.12–1.39) compared with schools in low-need local authorities, where registration to TDM ranged from one in five schools in the low-need cluster to one in four in the high-need cluster.ConclusionOur study suggests that TDM is an equitable intervention reaching schools in areas with the highest need. Areas of highest need are concentrated in particular areas in England, for example the North East. Matching public health interventions to the needs of the population is more efficient and equitable than blanket policies directed at whole populations. This identification of clusters of local authorities that share patterns of need may guide shared learning between local authorities that share similar challenges and contextual features.