Recruitment materials

Both focus groups suggested that PLAN-A recruitment materials should highlight how their participation in the project would (1) help their peers; (2) improve their own (and PS) skills and knowledge; and (3) increase their potential to influence their peers and have their voice heard. These themes should be reflected on the PLAN-A website and a video would be a good method of communication for girls their age. Both focus groups recommended that recruitment materials provided an insight into the PA training activities. Certificates, endorsements in records of achievement and/or PLAN-A-branded clothing were not viewed as suitable incentives to participate.

Intervention content

Recruitment materials

Suggested revisions to the recruitment materials included having less text and more pictures, emphasising the fun side and benefits of the training, giving further details of what the PS training would entail and reiterating that PSs did not have to be good at sport. Participants selected a favourite logo and guided the colour and the tag line ‘peer-power active girls’.

Intervention content

Participant recruitment and retention

The number and percentage of participants who opted out of the study was recorded in addition to the number of girls attending peer nomination, the number of girls invited to be a PS and the percentage of girls who consented.

Peer supporter training attendance and adverse events

Trainers recorded the attendance of girls at each day of the PS training and reasons for absence. Trainers recorded adverse events and reported them to the research team.

Trainer questionnaire

Trainers completed an evaluation questionnaire following delivery of the PS training (see Appendix 2). The measures were adapted from a similar questionnaire used in the AHEAD study.⁴⁰ Achievement of PS training objectives was assessed through trainers’ perceptions that the training achieved key objectives of increasing PS knowledge, interpersonal skills, communication skills and confidence to be a PS using a four-point scale (0 = ‘not well at all’ to 3 = ‘very well’). Perception of the PS response to training was measured using four items (engagement, involvement, enjoyment and interest) and scored from 0 (‘not at all’) to 3 (‘very’). The training arrangements (e.g. suitability of training space) were rated on a five-point scale (0 = ‘poor’ to 4 = ‘excellent’).

Peer supporter questionnaire

Peer supporters completed an evaluation questionnaire at the end of the training (see Appendix 3) that assessed enjoyment, views on training content and logistics and perceived trainer autonomy support. Enjoyment of the training was rated using a five-point scale (1 = ‘not at all’ to 5 = ‘a lot’) and open text responses. Ten items assessed PSs’ views on the content and logistics of the training (e.g. ‘I understand my role as a PS’, ‘the length of the training was about right’) using a scale ranging from 0 (‘disagree a lot’) to 4 (‘agree a lot’). The Sport Climate Questionnaire⁵³ measured PSs’ perceptions that trainers were autonomy supportive with five items (e.g. the PLAN-A trainers provided me with choices and options) anchored by responses ranging from 0 (‘disagree a lot’) to 4 (‘agree a lot’). The mean of the five items was derived to produce an autonomy support score for each training pair.

Observation of the pilot peer supporter training

A researcher who worked on the AHEAD study, and was familiar with the PS training approach, observed the PS training to assess fidelity. An observation form (see Appendix 4) was developed to record the timing of training components and to record whether or not individual activity objectives were met (0 = objective fulfilled ‘not at all’ to 3 = objective fulfilled ‘lots’). PS engagement was estimated from 0 (‘not at all’) to 3 (‘very’) for each activity. Notes documenting the extent to which trainers’ delivery style was need-supportive, elements that worked and those that did not were made.

Peer supporter focus groups

Focus groups with PSs (n = 10) were conducted at two time points: (1) the day after the second day of PS training (‘post training’) and (2) approximately 5 weeks after training (‘during intervention’). At both time points, PSs were divided into two groups of five. The post-training focus group guide focused on identifying improvements and participants’ experiences of the training and views on trainers. The during-intervention focus group guide examined the girls’ experiences of being a PS, feelings of preparedness, what actions they had taken, what had/had not worked and what their Year 8 peers thought of their role. Focus groups ranged from 25 to 30 minutes in duration.

Trainer interviews

Both trainers were interviewed separately (interview lengths were 63 and 52 minutes) by Kathryn Banfield. The trainer interview guide considered both the train the trainers workshop and the delivery of the PS training, including the content and logistics of training, what worked/what did not, potential changes and how to engage the PSs. Interviews and focus groups were recorded using an encrypted digital recorder (Olympus DS-3500; Olympus, KeyMed House, Southend-on-Sea, UK), then transcribed verbatim and anonymised.

Intervention materials

All training and intervention materials, including the session plans and trainers’ guide, were seen as useful and clear. One trainer felt that the session plans presented too much information for use in the training (see Chapter 2, Peer supporter training, Logistics and resources).

Structure and venue

Trainers felt that there was insufficient training time for them to understand the content of the activities and allow them to ‘sink in’ (Trainer 1) and that the training was carried out too far ahead of the PS training delivery. Both trainers suggested lengthening the training to allow more time to practise each activity rather than just talk through them. The venue was considered satisfactory, but too small:

I think you could have done more learning by practise, by doing, because then you actually fully understand what the exercise is and how it works and what you’re trying to get from it.

Trainer 1

The training was well received, with clear information delivered with sufficient depth. Trainer 2 felt that there could have been more detail on the background of the project that they could disseminate to PSs:

If you went through it [background information] a little bit more, I think when we then said it to the girls I think it might have flowed a lot better rather than just saying, ‘OK, that’s that.’ It might have been nice to go in depth.

Trainer 2

Feelings of preparedness

Both trainers felt insufficiently prepared to deliver the PS training based on the train the trainers event alone. One trainer revisited the content in their own time, the other wanted to but did not have time:

There maybe needs to be another couple of hours added on, to maybe 2 top-up days, just to really go through it . . . I don’t think I was prepared enough in terms of knowing each activity off by heart.

Trainer 2

In response to this, the week before delivery of the PS training, a half-day meeting was held to allow trainers to prepare. The trainers found the extra meeting useful and the timing, structure and content of the 3-day train the trainers event was revised in light of these findings.

Attendance

Attendance was 91% (n = 10) at both training days; one girl did not attend because of a disagreement with another PS outside the PLAN-A training.

Logistics and resources

The PS training space and venue were rated ‘adequate’ by both trainers (Figure 4) and PSs (see Figure 7). This was largely because of its small size and lack of break-out space. This led to an environment in which it was difficult to concentrate. The observer also felt that the layout of the room (including a lack of tables) led to a very informal learning environment. Trainers and PSs rated the refreshments for the training highly (see Figures 4 and 7).

FIGURE 4

Trainer ratings of PS training arrangements.

FIGURE 7

Peer supporter ratings of pilot training content.

The training manual and resources were considered to be ‘very good’ and ‘good’, respectively, by the trainers (see Figure 4). Trainers agreed that the session plans were helpful and clear, but suggested condensing the quantity of information to make delivery easier:

There’s too much going on on the page . . . I don’t think you can take that in and use that as a thing to use in the classroom, for me.

Trainer 1

As a result, cue cards were developed that allowed the trainers to write their own notes about each activity to use in the PS training.

The girls found the PS booklets to be a helpful prompt of key information and good to show others what they did. They suggested that the booklet should be used more for reference by PSs rather than using it to write in during the training:

If you were to forget something, then you have a booklet to look back on. I feel maybe instead of copying it down you could have it written on the board and already written in the booklet.

Post-training focus group 2

The PSs felt that the PS diaries were a good idea; however, during the intervention the girls reported not using them because they forgot about them or did not want to record conversations:

I just don’t need it. I just can’t be bothered with it.

During-intervention focus group 2

Fidelity to the session plans

Given the time constraints, on day 1 two activities were not delivered: the ‘thought shower: why be active?’ (10 minutes in duration) and ‘post box’ (10 minutes in duration) activities. On day 2, the ‘relaxation activity’ (5 minutes in duration) was excluded.

The allocated time and observed delivery time for each activity are shown in Appendix 5. On day 1, three out of nine activities before lunch took more time than allocated to deliver (e.g. ‘what do we know already?’). Lunch was slightly longer than scheduled, which resulted in activities after lunch being excluded or shortened. On day 2, activities before and immediately after lunch were an average of 12 minutes longer than scheduled, again leading to activities in the afternoon being given less time. Qualitative findings supported the observations: trainers felt that there was too much content to deliver and a lack of time for discussion. As a result, both trainers suggested that the training should be extended and more time should be added for discussion:

It’s too much in 2 days . . . I think it would have been nice to spread it over 3 days if you keep the activities, have a bit longer for each of them.

Trainer 2

The observer recorded that trainers added in active games to energise girls when necessary. Despite intending to benefit the girls, these contributed to the drift from the schedule. In addition, the observer noted that trainers could have shortened some sessions that were longer than intended:

Too long was given for discussions amongst small groups/activities . . . The girls would then talk about ‘off task’ things . . . time could have been used better.

Observation note

The extent to which PS training objectives were met is reported in Table 3. For timetabled sessions that comprised more than one distinct activity, the mean objective fulfilment is reported. Seven activities (41.18%) across both days were not rated. The mean rating for activities was 3.00, suggesting that objectives were achieved. However, fulfilment of objectives was lower (1.00) for activities at the end of day 2.

TABLE 3

Fulfilment of pilot PS training activity objectives

Both trainers felt they successfully enhanced PSs’ knowledge about PA, communication skills, interpersonal skills and understanding of their PS role (Figure 5). The objective to enhance PSs’ confidence to spread informal messages among their peers was not met well (1.5 ± 0.71); this supports PSs’ reported low confidence in this area (see Peer supporters’ experience of training).

FIGURE 5

Trainer-rated achievement of pilot PS training objectives.

The qualitative data gave insight into why some objectives were not achieved fully, including losing focus because of activities over-running (and other activities being rushed), omitting key activities and trainers not being clear on general group rules:

When it came to the core message of it and becoming a PS, I think we did not do enough because we physically did not have enough time.

Trainer 2

Peer supporters’ experience of training

Peer supporters’ engagement with training was high on day 1 and slightly less so on day 2 (Table 4). A need to maintain engagement in the ‘communication skills’ and ‘finishing up’ activities was identified.

TABLE 4

Observed PS engagement per pilot activity section

Figure 6 shows that the trainers felt the PSs were very involved throughout the training. They perceived the PSs to be somewhat engaged and interested. PSs wanted to discuss topics and ask questions throughout:

FIGURE 6

Trainers’ ratings of PSs’ responses to the pilot training.

Every time we did something they wanted to talk about it. They were quite chatty and so they wanted to talk about things.

Trainer 1

That was quite good because you had to debate your point. That was quite good.

Post-training focus group 1

Girls were particularly engaged in activities that they could relate to and that involved being active:

It worked well because the video is so powerful. It was a ‘visual’ and some of them probably can relate to that . . . that’s why, because they can relate to those questions.

Trainer 2

However, although most activities were rated as highly engaging, there was evidence of some boredom, fatigue and distraction because of the ineffective timings of activities (i.e. rushing activities at the end of day 2), overuse of writing rather than more physical tasks and a disagreement between PSs on day 2:

Some silly[ness], some look bored [afternoon] day 2? Lethargic.

Observation notes

Some became distracted or I saw it in their face. OK, they might be looking but I could see they’re still not there.

Trainer 2

I just think there could have been more activities. . . . We probably learn more by doing stuff than writing because I think we get a bit bored writing.

Post-training focus group 1

Enjoyment over the 2-day training was moderate to high and was marginally higher on day 2 (3.80 ± 0.79) than on day 1 (3.30 ± 0.68). Open-ended responses revealed that all girls enjoyed the ‘listening train’ activity most and 60% felt they were good at role-play tasks. Activities that were more active and involved discussion and debate were also enjoyed, which supported trainers’ perceived drivers of engagement (see above):

I liked the big discussion we had about fitness between boys and girls and self-confidence. I liked that big debate.

Post-training focus group 2

Peer supporters believed that the training helped them understand their role; they enjoyed the games and learnt something new (Figure 7). Eighty per cent reported five different facts they learnt about PA in free text. The PSs felt prepared to support their friends by enhancing their knowledge, confidence and ability to empathise with others:

It does actually work, that you feel like you can go out and talk to people about it. It’s not just something that you do and then you forget about it.

Post-training focus group 1

Like, if one of your friends has an insecurity, you know how to understand them and how to talk to them about it.

Post-training focus group 1

Trainers expressed concerns about the PSs’ ability to be realistic about how to peer support. This was also reflected in observation notes that questioned how empowered the girls were to make changes at school. Similarly, 60% of PSs suggested that more time could be devoted to practising being a PS, which would further enhance their confidence to be a PS (see Figure 7). Some PSs were unsure of how to use the facts they had learnt or how to start a conversation with their peers:

It feels like if we have all these facts – like, you can’t just casually slip a fact into, like, a conversation that you’re having with someone.

During-intervention focus group 2

Peer supporters thought that including more activities that focus on building confidence would improve the training:

Respondent 1:

Like with the confidence, we didn’t go a lot over how to be confident.

Respondent 2:

Yeah, because that’s like a major thing. If you’re going to help someone else you need to be confident in yourself as well.

Post-training focus group 1

Need-supportiveness of trainers and perceptions of need-support

On average, PSs reported relatively high levels of trainer autonomy support (3.42 ± 0.47; range 2.80–4.00) and thought that trainers were helpful (3.80 ± 0.42) and friendly (4.00 ± 0.00). Similarly, the observation documented that the trainers circulated among the girls, interacted with them and helped them with their tasks. The girls respected the trainers, commenting that they were different from teachers, made the training fun, were trusted, not boring and ‘understood us more than actual teachers’:

If you said something to them, you really felt you could trust them. They were just very friendly and stuff.

Post-training focus group 2

Autonomy support

Trainers provided autonomy by giving PSs choice within a structure of clear instructions and the opportunity to lead discussions and express their opinions:

They gave us lots of choices. They kind of said what to do but then they were giving you choices of how to do it, which was better than everybody saying, ‘you’ve got to do it like this’.

Post-training focus group 1

Trainers empathised with the PSs, and when the training required concentration or when engagement was low, they responded by incorporating elements that they felt the girls enjoyed:

In the lunchtimes, they were desperate to move. We were getting the tennis balls out and [Trainer 2] got some tunes on and was getting them dancing.

Trainer 1

What girls did to peer support

The PSs reported engaging in little peer-supporting activity. Efforts to peer support included suggesting active travel and leading by example:

We went to the gym last year just before the end of term, and, we kind of spoke to everyone about it, like a few of our friends. And then they invited a few of their friends to go.

During-intervention focus group 1

One of my friends, we were, coming back from town or something. She was like, ‘Oh, no, I’ll get my mum to pick us up.’ I was like, ‘Why can’t we walk, to get some exercise?’

During-intervention focus group 2

PSs felt that they encouraged their peers to walk more or go to the gym:

And [girl name] and [girl name] house are, like, an hour away from each other, and we walked, like, all the way.

During-intervention focus group 2

There were a number of instances of PSs talking to family or non-female Year 8 peers:

I had a conversation with this year seven, who was in my tutor [group].

During-intervention focus group 1

Challenges of being a peer supporter

The main challenges and reasons many girls did little peer supporting was that they lacked confidence in approaching peers and encouraging them to be active, particularly peers whom they did not know:

A bit awkward if I just went up to someone and told their friends. It would be a bit weird to just come up to her in person.

During-intervention focus group 1

Despite the PS training dedicating sessions to the when, where and how of starting conversations and overcoming challenges, a barrier to PS activity was knowing how and when to start a conversation. Participants suggested including more activities in the training to support this:

You might have told us, like, how to start the conversation or something. Because, in a conversation, we don’t really – it doesn’t really bring it up that much.

During-intervention focus group 2

Participants also reported that many of their friends are already active:

Most of the girls in our class are already really active, so it’s kind of not really.

During-intervention focus group 2