A Web-Based Physical Activity Promotion Intervention for Inactive Parent-Child Dyads : Protocol for a Randomized Controlled Trial

This is a sel -a chi ed e sion o an o iginal a icle. This e sion may di e om he o iginal in pagina ion and ypog aphic de ails. Au ho (s): Ti le: Yea : Ve sion: Copy igh : Righ s: Righ s u l: Please ci e he o iginal e sion: CC BY 4.0 h ps://c ea i ecommons.o g/licenses/by/4.0/ A Web-Based Physical Ac i i y P omo ion In e en ion o Inac i e Pa en -Child Dyads : P o ocol o a Randomized Con olled T ial ©Daniel Phipps, Weldon Thomas G een, Ree a Aho, Ee a Ke unen, S ua Biddle, Ky a Hamil on, A o Laukkanen, Kaisa Aunola, De win King Chan, Nelli Hankonen, Ma y Hassand a, Tommi Kä kkäinen, Vi pi-Liisa Kyky i, Juho Pole , Ryan Rhodes, Mon se C Ruiz, A ja Sääkslah i, Jeka e ina Schneide , Hanna-Ma i Toi onen, Ta u Lin unen, Ma in Hagge , Keegan Kni le. O iginally published in JMIR Resea ch P o ocols (h ps://www. esea chp o ocols.o g), 21.03.2024. Published e sion Phipps, Daniel; G een, Weldon Thomas; Aho, Ree a; Ke unen, Ee a; Biddle, S ua ; Hamil on, Ky a; Laukkanen, A o; Aunola, Kaisa; Chan, De win King; Hankonen, Nelli; Hassand a, Ma y; Kä kkäinen, Tommi; Kyky i, Vi pi-Liisa; Pole , Juho; Rhodes, Ryan; Ruiz, Mon se C; Sääkslah i, A ja; Schneide , Jeka e ina; Toi onen, Hanna-Ma i; Lin unen, Ta u; Hagge , Ma in; Kni le, Keegan Phipps, D., G een, W. T., Aho, R., Ke unen, E., Biddle, S., Hamil on, K., Laukkanen, A., Aunola, K., Chan, D. K., Hankonen, N., Hassand a, M., Kä kkäinen, T., Kyky i, V.-L., Pole , J., Rhodes, R., Ruiz, M. C., Sääkslah i, A., Schneide , J., Toi onen, H.-M., . . . Kni le, K. (2024). A Web-Based Physical Ac i i y P omo ion In e en ion o Inac i e Pa en -Child Dyads : P o ocol o a Randomized Con olled T ial. JMIR Resea ch P o ocols, 13, A icle e55960. h ps://doi.o g/10.2196/55960 2024 P o ocol A Web-Based Physical Ac i i y P omo ion In e en ion o Inac i e Pa en -Child Dyads: P o ocol o a Randomized Con olled T ial Daniel Phipps1,2, PhD; Weldon Thomas G een1, MSc; Ree a Aho1; Ee a Ke unen1, PhD; S ua Biddle1,3, PhD; Ky a Hamil on2,4, PhD; A o Laukkanen1, PhD; Kaisa Aunola5, PhD; De win King Chan6, PhD; Nelli Hankonen7, PhD; Ma y Hassand a8, PhD; Tommi Kä kkäinen5, PhD; Vi pi-Liisa Kyky i5, PhD; Juho Pole 1,5,9, PhD; Ryan Rhodes10, PhD; Mon se C Ruiz1, PhD; A ja Sääkslah i1, PhD; Jeka e ina Schneide 11, PhD; Hanna-Ma i Toi onen1, MSc; Ta u Lin unen1, PhD; Ma in Hagge 1,4,12, PhD; Keegan Kni le1, PhD 1Facul y o Spo and Heal h Sciences, Uni e si y o Jy äskylä, Jy äskylä, Finland 2School o Applied Psychology, G i i h Uni e si y, B isbane, Aus alia 3Cen e o Heal h Resea ch, Uni e si y o Sou he n Queensland, B isbane, Aus alia 4Heal h Sciences Resea ch Ins i u e, Uni e si y o Cali o nia - Me ced, Me ced, CA, Uni ed S a es 5Depa men o Psychology, Uni e si y o Jy äskylä, Jy äskylä, Finland 6Depa men o Ea ly Childhood Educa ion, Educa ion Uni e si y o Hong Kong, Hong Kong, China (Hong Kong) 7Facul y o Social Sciences, Tampe e Uni e si y, Tampe e, Finland 8Depa men o Physical Educa ion and Spo Science, Uni e si y o Thessaly, Thessaly, G eece 9Cen e o Excellence in Lea ning Dynamics and In e en ion Resea ch (In e Lea n), Uni e si y o Jy äskylä and Uni e si y o Tu ku, Jy äskylä, Finland 10School o Exe cise Science, Physical and Heal h Educa ion, Uni e si y o Vic o ia, Vic o ia, BC, Canada 11Cen e o Appea ance Resea ch, School o Social Sciences, Uni e si y o he Wes o England, B is ol, Uni ed Kingdom 12Depa men o Psychological Science, Uni e si y o Cali o nia - Me ced, Me ced, CA, Uni ed S a es Co esponding Au ho : Ma in Hagge , PhD Heal h Sciences Resea ch Ins i u e Uni e si y o Cali o nia - Me ced 5200 No h Lake Rd Me ced, CA, 95343 Uni ed S a es Phone: 1 (209) 228 4400 Email: [email p o ec ed] Abs ac Backg ound: Low le els o physical ac i i y a e associa ed wi h nume ous ad e se heal h ou comes, ye seden a y li es yles a e common among bo h child en and adul s. Physical ac i i y le els end o decline s eeply among child en aged be ween 8 and 12 yea s, e en hough child en’s beha io al pa e ns a e la gely go e ned by amilial s uc u es. Simila ly, pa en s’ac i i y le els ha e been gene ally epo ed as lowe han hose o nonpa en s o compa able age. Fo his eason, amily-based physical ac i i y p omo ion in e en ions a e a po en ially aluable and ela i ely unde esea ched me hod o mi iga ing physical ac i i y declines as child en de elop in o adolescen s and o inc easing physical ac i i y in pa en s. Objec i e: This s udy aims o assess he e icacy, easibili y, and accep abili y o a no el heo y-based web-based physical ac i i y p omo ion in e en ion among pa en -child dyads in Finland who do no mee physical ac i i y ecommenda ions a baseline. Me hods: Pa icipan s ( a ge N=254) will be ec ui ed om he gene al popula ion using a panel company and ad e isemen s on social media and andomly assigned o ei he an immedia e in e en ion g oup o a wai lis con ol g oup. The in e en ion consis s o 4 web-based g oup wo kshops o e he cou se o 10 weeks, web-based asks and esou ces, and a social suppo cha g oup. Da a on physical ac i i y beha io and cons uc s om he in eg a ed beha io change model will be collec ed h ough sel - epo su eys assessing physical ac i i y, au onomy suppo , au onomous mo i a ion, a i ude, subjec i e no m, pe cei ed beha io al con ol, in en ion, sel -moni o ing, habi , and accele ome e measu emen s a baseline, pos in e en ion, and 3 mon hs pos in e en ion. Exi in e iews wi h pa icipan s will assess he easibili y and accep abili y o he in e en ion p ocedu es. JMIR Res P o oc 2024 | ol. 13 | e55960 | p. 1h ps://www. esea chp o ocols.o g/2024/1/e55960 (page numbe no o ci a ion pu poses) Phipps e alJMIR RESEARCH PROTOCOLS XSL • FO Rende X Resul s: This s udy will e eal whe he he in e en ion changes leisu e- ime physical ac i i y among in e en ion pa icipan s ela i e o he con ol g oup and will examine he in e en ion’s e ec s on impo an heo e ical p edic o s o physical ac i i y. I will also yield da a ha can be used o e ine in e en ion ma e ials and in o m u he implemen a ion. T ial ec ui men commenced in Sep embe 2023, and da a collec ion should be comple ed by Decembe 2024. Conclusions: The planned in e en ion has po en ial implica ions o bo h heo y and p ac ice. P ac ically, he use o an en i ely web-based in e en ion may ha e scalable u u e uses o imp o ing physical ac i i y in 2 key popula ions, while also po en ially in o ming on he alue o dyadic, amily-based s a egies o encou aging an ac i e li es yle as an al e na i e o s a egies ha a ge ei he pa en s o child en independen ly. Fu he , by assessing change in psychological cons uc s alongside po en ial change in beha io , he in e en ion also allows o impo an es s o heo y ega ding which cons uc s a e mos linked o a o able beha io change ou comes. T ial Regis a ion: ClinicalT ials.go NCT06070038; h ps://clinical ials.go /s udy/NCT06070038 In e na ional Regis e ed Repo Iden i ie (IRRID): DERR1-10.2196/55960 (JMIR Res P o oc 2024;13:e55960) doi: 10.2196/55960 KEYWORDS dyadic beha io change; amily beha io change; in e en ion; physical ac i i y; heo y o planned beha io In oduc ion O e iew Low le els o physical ac i i y in adul and you h popula ions a e associa ed wi h an inc eased isk o physical and men al heal h condi ions and a educed quali y o li e. Con e sely, egula physical ac i i y pa icipa ion is associa ed wi h educed ch onic disease isk and be e psychological heal h and well-being [1]. Acco dingly, he Wo ld Heal h O ganiza ion has published e idence-based guideline le els o physical ac i i y equi ed o ealize hese heal h bene i s. The guidelines ecommend ha adul s aged be ween 18 and 64 yea s pa icipa e in a leas 75 minu es o igo ous physical ac i i y, 150 minu es o mode a e physical ac i i y, o an equi alen combina ion o bo h pe week, while child en aged be ween 7 and 17 yea s a e ecommended o pa icipa e in a leas 60 minu es o physical ac i i y pe day. S udies indica e ha mos people do no achie e hese guideline le els o physical ac i i y [2]. Fu he , s udies ha e obse ed a sha p d op in physical ac i i y pa icipa ion in child and adolescen popula ions, ollowed by gene ally low pa icipa ion le els in o and h oughou adul hood [3]. Gi en he s eep decline in ac i i y le els, as child en ansi ion in o adolescence, he de elopmen and implemen a ion o beha io al in e en ions o encou age an ac i e li es yle is a key a ge a ea o heal h p omo ion esea ch. One s a egy p oposed o enhance he e icacy o beha io change s a egies o child en’s ac i i y le els is o a ge he amily uni a he han child en hemsel es. Speci ically, pa en s o p e een child en e ain a s ong in luence on hei child’s beha io , bo h h ough hei own ac i i y le els [4,5] and h ough he oppo uni y o p o ide suppo o and os e mo i a ion owa d leisu e- ime physical ac i i y beha io s [6,7]. Fu he , e idence indica es ha child en likely in luence physical ac i i y beha io s and belie s in hei pa en s, as pa en s end o be less ac i e han nonpa en s [8], o en ci ing hei child en’s lack o mo i a ion o suppo as a ba ie o being physically ac i e [9]. This e idence o wi hin- amily e ec s indica es he po en ial u ili y o dyadic in e en ions o bo h pa en s and child en [10], using heo y-d i en, g oup-based beha io change s a egies o bols e social suppo , os e mo i a ion, and educe he pe cei ed ba ie s o beha io in bo h he pa en and child. Ye , despi e e idence o he po en ial u ili y o hese s a egies, ew physical ac i i y in e en ions ha e been applied o pa en -child dyads, and hose ha ha e end no o ha e a s ong basis in beha io al heo y and a e seldom e alua ed sys ema ically [11], inhibi ing meaning ul conclusions on hei e icacy. In esponse o he ela i e sca ci y o heo y-d i en, amily-based physical ac i i y in e en ion p og ams, we aim o de elop and es an in e en ion o p omo e physical ac i i y in low-ac i e pa en s and hei child en based on he in eg a ed beha io change model, an app oach ha ou lines he mul iple de e minan s and po en ial a ge s o in e en ion de i ed om mul iple heo e ical pe spec i es [12]. The In eg a ed Beha io Change Model The in eg a ed beha io change model d aws om se e al well-es ablished beha io al heo ies: sel -de e mina ion heo y [13], he heo y o planned beha io [14], he heal h ac ion p ocess app oach [15], and he e lec i e impulsi e model [16]. Cen al o he model is ha indi iduals’quali y o mo i a ion, which e lec s whe he hei beha io is consis en wi h he sel -endo sed easons, is highly in luen ial in indi iduals’ in en ions o pe o m physical ac i i y and physical ac i i y pa icipa ion. This p emise is de i ed om sel -de e mina ion heo y, which makes he dis inc ion be ween au onomous and con olled o ms o mo i a ion. Au onomous mo i a ion e lec s an indi idual’s pe o ming physical ac i i y consis en wi h hei own in e es s, choices, needs, and sense o pe sonal in ol emen [13,17]. By con as , con olled mo i a ion e lec s pe o ming ac i i ies o ex e nally e e enced easons, such as o ewa ds o ou o obliga ion o o he s. O c i ical impo ance when i comes o pe o ming physical ac i i y, indi iduals who pe o m physical ac i i ies o au onomous mo i es a e mo e likely o o m in en ions o pe o m physical ac i i y in he u u e and a e mo e likely o de elop ou ines and habi s, which can ansla e o long- e m physical ac i i y pe sis ence [18]. This is because hose ci ing au onomous easons o pe o ming physical ac i i y a e likely o pe sis because hei mo i a ion emana es om hemsel es, while hose whose mo i es a e con olled will only pe sis as long as he ex e nal con ingencies JMIR Res P o oc 2024 | ol. 13 | e55960 | p. 2h ps://www. esea chp o ocols.o g/2024/1/e55960 (page numbe no o ci a ion pu poses) Phipps e alJMIR RESEARCH PROTOCOLS XSL • FO Rende X (eg, ewa ds and demands om o he s) pe sis . A key enan o sel -de e mina ion heo y [17,19], is ha au onomous mo i a ion o physical ac i i y can be os e ed h ough he suppo o salien o he s, such as pa en s o eache s. Fo example, pa en s who display beha io s ha indica e suppo o child en’s au onomy and compe ence owa d physical ac i i y and demons a e a sense o uncondi ional ela edness wi h hei child en o physical ac i i ies, a e mo e likely o os e au onomous mo i es in hei child en owa d pe o ming physical ac i i y in he u u e [6,7,20]. As such, enabling pa en s o display au onomy-suppo i e beha io s wi h espec o p esen ing, discussing, and pe o ming physical ac i i y wi h hei child en is likely an impo an s a egy o p omo e physical ac i i y pa icipa ion in child en and may be pa icula ly aluable in amily-based in e en ions aimed a p omo ing physical ac i i y. I is also likely o be use ul in pa en -child dyads, whe e bo h pa en and child can be encou aged o display beha io s ha suppo each o he ’s au onomous mo i a ion. This is suppo ed in empi ical da a, whe e au onomy-suppo i e pa en ing has been associa ed wi h au onomous mo i a ion in child en as well as posi i e beha io al ou comes [21], including enhanced physical ac i i y [6]. The in eg a ed beha io change model also speci ies he p ocesses by which au onomous mo i a ion leads o in en ion owa d, and ac ual pa icipa ion in, physical ac i i y in he u u e. Speci ically, indi iduals who a e au onomously mo i a ed owa d a beha io a e p oposed o be mo e likely o o m adap i e belie s in a o o pe o ming ha beha io in he u u e [12,22-24] and, as a consequence, o m an in en ion o pe o m physical ac i i y in he u u e. Such belie s a e ep esen ed in he model by he belie -based a i ude, subjec i e no m, and pe cei ed beha io al con ol cons uc s om he heo y o planned beha io [14], a p o o ypical heo y ha iden i ies he an eceden s o in en ional beha io s such as physical ac i i y. The heo y s ipula es in en ion is he salien p edic o o subsequen beha io , and in en ions hemsel es a e a unc ion o a i udes (belie s abou he pe cei ed likely a ec i e o ins umen al ou comes o engaging in a beha io ), subjec i e no ms (belie s abou whe e impo an o he s in one’s li e would wan hem o engage in a beha io o no ), and pe cei ed beha io al con ol (belie s abou whe he engaging in a beha io is unde one’s own con ol o wi hin hei abili ies). Resea ch has demons a ed ha hese belie s end o be eliably ela ed o physical ac i i y in en ions and pa icipa ion, signaling hei po en ial as modi iable cons uc s ha could be a ge ed in in e en ion s a egies aimed a p omo ing posi i e in en ions owa d, and ac ual pa icipa ion in, physical ac i i y. Acco dingly, in e en ions based on he heo y and a ge ing he belie -based cons uc s ha e shown e icacy in changing in en ions and beha io [25]. Fo example, in e en ions p esen ing pe suasi e messages ha highligh he ad an ages o beha io and downplay he disad an ages, a ge ing a i ude change, o p omp ing p ac ice ha assis s indi iduals in success ully mas e ing he a ge beha io and o e coming obs acles, a ge ing pe cei ed beha io con ol change, ha e been shown o be e ec i e in p omo ing in en ion and beha io change in physical ac i i y con ex s [26]. While he e is e idence o he u ili y o in e en ions based on he ecommenda ions o sel -de e mina ion heo y (eg, use o s a egies like os e ing au onomy suppo in in luen ial o he s) o he heo y o planned beha io (eg, p o iding pe suasi e communica ions a ge ing belie change), he in eg a ed beha io change model also acknowledges ha hese s a egies a e o en mo e e icacious in changing mo i a ion o in en ion han changing beha io [27]. Recognizing he sho all in he associa ion be ween mo i a ion and beha io , such as ela i ely modes in en ion-beha io ela ions obse ed in physical ac i i y [28-32], o he s a egies ha bols e in en ions may be use ul. Fo example, esea che s adop ing ac ion con ol amewo ks ha e sugges ed ha le e aging [28,33] in e en ion s a egies such as planning and sel -moni o ing may s eng hen he in en ion-beha io ela ionship and inc ease he likelihood ha indi iduals ac on hei good in en ions when pe o ming physical ac i i y [15,34]. S udy O e iew Objec i es Gi en he need o in e en ions o help child en main ain physical ac i i y le els as hey ansi ion in o adolescence and o help pa en s become mo e physically ac i e, ou g oup used he in eg a ed model as a s a ing poin o de elop a no el, emo ely deli e ed dyadic physical ac i i y p omo ion in e en ion. By applying he in eg a ed beha io change model o a pa en -child in e en ion, we aim o use and s eng hen wi hin- amily dynamics o os e au onomous mo i a ion and encou age physical ac i i y in bo h pa en s and p e een child en. In his p o ocol, we desc ibe a planned andomized con olled ial o es ing he e ec s o his in e en ion in a sample o insu icien ly ac i e Finnish-speaking pa en s and child en. Me hods T ial Design The ial will adop a andomized wai lis con ol design in which pa en -child dyads a e he uni o andomiza ion. Families will be andomized on sign-up o ei he an in e en ion g oup ha ecei es he in e en ion immedia ely a e baseline da a collec ion o o a wai lis con ol g oup ha will ecei e he in e en ion a e all ou come da a ha e been collec ed. Pa icipan Rec ui men and Eligibili y Pa en -child dyads will be ec ui ed om he gene al Finnish popula ion h ough di ec con ac wi h a panel company, h ough social media ad e isemen s, and h ough pos s on pa en ing discussion boa ds and o ums. Indi iduals who esponded o he ad e isemen s we e di ec ed o a sc eening su ey hos ed on he Web opol pla o m. To be eligible o inclusion, dyads mus consis o a pa en o gua dian aged >18 yea s and a child aged 8-12 yea s, and bo h dyad membe s need o be conside ed seden a y. Pa en s a e conside ed seden a y i hey we e no ac i e o a leas 30 minu es a day on 5 o mo e days in he pas week, and child en a e conside ed seden a y i hey we e no ac i e o a leas 60 minu es pe day in he pas week. Dyads will be excluded i ei he he pa en o child epo ed ha ing a medical condi ion o inju y likely o p e en hem om sa ely engaging in physical ac i i y. People mee ing he inclusion c i e ia can con inue in he Web opol su ey o ead in o ma ion JMIR Res P o oc 2024 | ol. 13 | e55960 | p. 3h ps://www. esea chp o ocols.o g/2024/1/e55960 (page numbe no o ci a ion pu poses) Phipps e alJMIR RESEARCH PROTOCOLS XSL • FO Rende X abou he ial and a e hen o e ed he oppo uni y o p o ide hei con ac de ails o op -in o he ial. Powe Analysis The p ojec ed sample size was es ima ed om a s a is ical powe analysis conduc ed using G*Powe ( e sion 3.1; Hein ich-Heine-Uni e si ä Düsseldo ). The analysis assumed a small o medium e ec size (Cohen =0.235) o he in e en ion on ou p ima y ou come a iable, leisu e ime physical ac i i y, calcula ed om an a e age o e ec sizes om me a-analyses o sel -de e mina ion heo y–based in e en ions (Hedges g=0.45 [35]) and in e en ions a ge ing sel -e icacy (Cohen d=0.48 [36]), wi h α se a .05 and s a is ical powe se a .80 e eal a p ojec ed o al sample size o 178 pa icipan s. We also assumed a p ojec ed 30% a i ion a e in pa icipan s h ough he s udy based on simila ials [37], esul ing in a sample o 254 pa icipan s (ie, 127 dyads) o be ec ui ed a baseline. S udy P ocedu es All ec ui men ma e ials will be deli e ed in a web-based o ma wi h a URL o wa ding pa icipan s o a sc eening and in o med consen su ey hos ed on he Web opol pla o m. Fi s , pa en s will be p esen ed wi h an eligibili y ques ionnai e o assess whe he hey and hei child en making e e ence o hemsel es and hei leas ac i e child aged be ween 8 and 12 yea s, mee he inclusion c i e ia. Eligible pa en s will hen be p esen ed wi h in o ma ion abou he s udy and an in o med consen o m. Pa en s who p o ide in o med consen o pa icipa e in he s udy will be p omp ed o p o ide hei name, con ac de ails, and he name o hei leas ac i e child, aged be ween 8 and 12 yea s, and will be en olled in he s udy. A e en olling in he ial, dyads will be assigned by compu e ized andom-digi gene a ion o 1 o 2 g oups: an immedia e in e en ion g oup ha ecei es he in e en ion immedia ely a e baseline da a collec ion, o a wai lis con ol g oup ha will ecei e he in e en ion a e all ou come da a ha e been collec ed. Pa icipan s in bo h g oups will be asked o p o ide ou come da a immedia ely a e andomiza ion, 3 mon hs la e , and 6 mon hs la e . Ou come da a will be collec ed h ough web-based su eys hos ed on he Web opol pla o m and h ough physical ac i i y measu emen de ices mailed o pa icipan s’ homes. Fo web-based su eys, pa en s will be emailed 2 sepa a e URLs: 1 o hemsel es and 1 o hei child. Pa en s will be ins uc ed ha hey may help hei child unde s and he su ey i ems bu should a oid in luencing hei child’s answe s o he ques ionnai e. Pa icipan s in he immedia e in e en ion g oup will ecei e he in e en ion be ween he baseline and 3-mon h da a collec ion poin s, while pa icipan s in he wai lis con ol g oup will ecei e he in e en ion a e all da a collec ion has been comple ed. While da a a e planned o be collec ed a baseline, 3 mon hs, and 6 mon hs, he ial includes a s opping ule, such ha 6-mon h ollow-up da a will no be collec ed i he e is no e ec o he in e en ion on he p ima y ou come (ie, leisu e ime physical ac i i y) a he 3-mon h ollow-up. The ial design low diag am is p esen ed in Figu e 1. JMIR Res P o oc 2024 | ol. 13 | e55960 | p. 4h ps://www. esea chp o ocols.o g/2024/1/e55960 (page numbe no o ci a ion pu poses) Phipps e alJMIR RESEARCH PROTOCOLS XSL • FO Rende X Figu e 1. A lowcha o en ollmen and da a collec ion o he P oAc ial. In e en ion Immedia e In e en ion G oup The in e en ion consis s o 4 web-based sessions hos ed h ough a ideocon e encing pla o m (Zoom Inc) and acili a ed by 1 o 2 membe s o he esea ch eam. The 4 sessions will be deli e ed in weeks 1, 3, 5, and 8 o he p og am. Summa ies o each session, including he a ge cons uc s and beha io change echniques used in each session, a e p esen ed in Table 1. The i s session will in ol e only pa en s and will las 90 minu es. I ocuses on ins uc ing pa en s in he use o au onomy-suppo ing pa en ing beha io s. The emaining 3 sessions will in ol e bo h pa en s and child en and will las 45 minu es. Session 2 p omp s a discussion o he bene i s o an ac i e li es yle, including enjoymen and impo ance, and ge s pa icipan s o se indi idual and join physical ac i i y- ela ed goals. Session 3 eaches pa icipan s how o make ac ion plans and coping plans (ie, p oblem-sol ing) when pu suing physical ac i i y goals. Session 4 co e s social no ms ela ed o physical ac i i y, has pa icipan s speci y hei iden i y ela ed o physical ac i i y, and p omp s social suppo s a egies wi hin each dyad. JMIR Res P o oc 2024 | ol. 13 | e55960 | p. 5h ps://www. esea chp o ocols.o g/2024/1/e55960 (page numbe no o ci a ion pu poses) Phipps e alJMIR RESEARCH PROTOCOLS XSL • FO Rende X Table 1. Con en and a ge s o each in e en ion session in he P oAc ial. Beha io change echniques p eceded by an “M” a e d awn om he Mo i a ion and Beha io Change Techniques [38]. Beha io change echniques p eceded by a “T” a e d awn om he Beha io Change Taxonomy e sion 1 [39]. Beha io change echniquesTa ge cons uc sSession Au onomy suppo i e pa en ing Session 1: 90 minu es and pa en s only •M3. Use non-con olling, in o ma ional language •M5. P o ide a meaning ul a ionale •M6. P o ide choice •M7. Encou age he pe son o expe imen and sel -ini ia e he beha io •M10. Show uncondi ional ega d •M12. Use empa hic lis ening •M16. Cla i y expec a ions •T1.1 Goal se ing yeah •T1.4 Ac ion planning •T4.1 Ins uc ion on how o pe o m he beha io •T4.2 In o ma ion abou an eceden s •T5.3 In o ma ion abou social and en i onmen al consequences •T5.6 In o ma ion abou emo ional consequences •T8.1 Beha io al p ac ice/ ehea sal •T16.3 Vica ious consequences A i udeSession 2: 45 minu es, pa en s, and child en •M4. Explo e li e aspi a ions and alues •M6. P o ide choice •M7. Encou age he pe son o expe imen and sel -ini ia e he beha io •M16. Cla i y expec a ions •M17. Assis in se ing op imal challenge •M19 Help de elop a clea and conc e e plan o ac ion •M20 P omo e sel -moni o ing •T1.1 Goal Se ing (beha io ) •T1.3. Goal Se ing (ou come) •T1.5 Re iew beha io goal(s) •T1.6 Disc epancy be ween cu en beha io and goal •T2.3 P omp sel -moni o ing o beha io •T4.1 Ins uc ion on how o pe o m he beha io •T5.6 In o ma ion abou emo ional consequences •T15.3 Focus on pas success Pe cei ed beha io al con ol and sel - egula- ion Session 3: 45 minu es, pa en s, and child en •M15. Add ess obs acles o change •M19. Help de elop a clea and conc e e plan o ac ion •M20. P omo e sel -moni o ing •M21. Explo e ways o dealing wi h p essu e •T1.2 P oblem-sol ing •T1.5 Re iew beha io al goals •T1.6. Disc epancy be ween cu en beha io and goal •T2.2 Feedback on beha io •T8.7 G aded Tasks •T15.1 Ve bal pe suasion abou capabili y •T15.3 Focus on pas success. Subjec i e No m and pe cei ed au onomy suppo Session 4: 45 minu es, pa en s, and child en •M2 P omp iden i ica ion o sou ces o p essu e o beha io change •M8. Acknowledge and espec pe spec i es and eelings •M9. Encou age asking o ques ions •M14. P omp iden i ica ion and seek a ailable social suppo •T1.1 Goal Se ing (beha io ) •T1.3 Goal Se ing (ou come) •T1.4 Ac ion planning •T1.5 Re iew beha io al goals •T1.7 Re iew Ou come Goals •T3.2 Social Suppo (P ac ical) •T3.3 Social Suppo (Emo ional) •T6.2 Social compa ison •T6.3 In o ma ion on o he s’app o al. •T13.1 Iden i ica ion o sel as ole model •T13.5 Iden i y associa ed wi h changed beha io In addi ion o he web-based sessions, pa icipan s will ha e access o a websi e ha includes ma e ials ha suppo he con en o each session. This includes wo kshee s, slide decks and eco ded e sions o he sessions, a menu o physical ac i i ies sui able o pa en s and child en, and u he p ac ice ma e ials. JMIR Res P o oc 2024 | ol. 13 | e55960 | p. 6h ps://www. esea chp o ocols.o g/2024/1/e55960 (page numbe no o ci a ion pu poses) Phipps e alJMIR RESEARCH PROTOCOLS XSL • FO Rende X Be ween sessions, pa icipan s will ecei e SMS ex messages ha ask hem o p o ide w i en eedback on hei p og ess; o e ad ice, sugges ions, o eminde s; o p omp e lec ion on hei mo i es o physical ac i i y. Pa en pa icipan s will also be g an ed access o a mode a ed web-based cha o um (Wha sApp g oup [Me a Facebook, Inc]) in which pa en s can sha e hei expe iences wi h he sessions and p o ide and ecei e social suppo om o he pa icipa ing pa en s. In e en ion ma e ials a e a ailable on he in e ne [40]. Wai lis Con ol G oup Pa icipan s assigned o he wai lis con ol g oup will comple e he same da a collec ion p ocedu es as he immedia e in e en ion g oup bu will no be equi ed o unde ake any al e na i e in e en ion asks du ing he da a collec ion pe iod. A e he da a collec ion pe iod, pa icipan s in he wai lis con ol g oup will be in i ed o ecei e he in e en ion and accompanying ma e ials. Ou comes O e iew Measu es o psychological cons uc s will be assessed using mul i-i em scaled su ey measu es, while leisu e- ime physical ac i i y is o be assessed using sel - epo ed su eys and obse a ionally h ough accele ome e measu emen s. All i ems we e ansla ed in o Finnish by na i e speake s and pilo ed on a sample o 8- o 12-yea -old Finnish child en and hei pa en s. Full measu es a e a ailable on he in e ne [40]. P ima y Ou comes (Physical Ac i i y and Seden a y Time) Sel - epo ed physical ac i i y and ime spen in seden a y ac i i ies o bo h pa en s and child en will be assessed using he Godin-Shepa d leisu e ime exe cise ques ionnai e [41], whe e pa icipan s will be equi ed o epo he numbe o occasions hey engaged in ligh , mode a e, and igo ous physical ac i i y o 15 minu es o longe . Seden a y ime will be measu ed using 2 i ems pe pa icipan , a ge ing weekdays and weekend days sepa a ely (eg, “In he pas 7 days, how much ime did you spend si ing du ing a ypical weekday a e school o weekend day?”) [42]. I ems a e sco ed on a sliding scale om “no ime” upwa ds in inc emen s o hal an hou . Seconda y Ou comes De ice-Measu ed Physical Ac i i y Physical ac i i y will also be assessed using a hip-wo n iaxial accele ome e (Hookie AM20; T axmee L d). Each dyad will be mailed 2 accele ome e s, de ailed ins uc ions on wea ing he de ice, and a dia y o eco ding when hey wo e he accele ome e , how hey commu ed o school o wo k, and any e en s ha may ha e inhibi ed accu a e da a (eg, missed days and exe cise done wi hou he de ice). Raw da a om accele ome e s will be p ocessed using he GGIR package in R so wa e (R Founda ion o S a is ical Compu ing) [43], wi h ou come sco es p o ided as he amoun o ime spen engaged in seden a y beha io , ligh physical ac i i y, mode a e physical ac i i y, and igo ous physical ac i i y. Au onomy-Suppo i e Pa en ing Au onomy-suppo i e pa en ing p ac ices will be assessed using a 4-i em ques ionnai e based on measu es used in a p e ious s udy [44], wi h esponses p o ided on 5-poin scales (1=s ongly disag ee o 5=s ongly ag ee). Pe cei ed Au onomy Suppo Pe cei ed au onomy suppo will be assessed using he pe cei ed au onomy suppo scale o exe cise se ings [45]. Fo child en, he scale e e s o au onomy suppo om pa en s, while o pa en s, he scale makes e e ence o au onomy suppo ecei ed om amily. All i ems a e sco ed on a 5-poin Like scale (1=s ongly disag ee o 5=s ongly ag ee). Au onomous and Con olled Mo i a ion Au onomous and con olled mo i a ion o bo h pa en s and child en is assessed using 4 i ems each [46], wi h esponses p o ided on 5-poin scales (1=s ongly disag ee o 5=s ongly ag ee). A i ude A i ude owa d engaging in physical ac i i y is assessed using 3 i ems wi h a common s em [44,47], wi h esponses p o ided on a 5-poin seman ic di e en ial scale (eg, unenjoyable [1] o enjoyable [5]). Subjec i e No ms Subjec i e no ms in pa en s a e assessed using 3 i ems e e ing o impo an o he s [44,47]. Child en answe ed simila i ems, bu in speci ic e e ence o amily and iends sepa a ely. All i ems a e sco ed on a 5-poin Like scale (1=s ongly disag ee o 5=s ongly ag ee). Pe cei ed Beha io al Con ol Pe cei ed beha io al con ol is assessed in bo h pa en s and child en using 2 i ems [44,47], wi h esponses p o ided on 5-poin scales (1=s ongly disag ee o 5=s ongly ag ee). In en ion In en ion o engage in leisu e ime physical ac i i y is assessed in bo h pa en s and child en h ough 3 i ems [44,47], wi h esponses p o ided on 5-poin scales (1=s ongly disag ee o 5=s ongly ag ee). Sel -Moni o ing Sel -moni o ing owa d physical ac i i y is assessed using 2 i ems [44,48], each sco ed on a 5-poin Like scale (1=s ongly disag ee o 5=s ongly ag ee). Habi Habi s a e assessed using he 4-i em au oma ici y subscale o he sel - epo ed habi index [49,50], wi h esponses p o ided on 5-poin scales (1=s ongly disag ee o 5=s ongly ag ee). Accep abili y Fo pa icipan s in he immedia e in e en ion g oup, he pos in e en ion (3 mon hs) web-based ques ionnai e will include su ey i ems assessing he accessibili y and easibili y o in e en ion p ocedu es. Pa icipan s will also be in i ed o a end a 45-minu e web-based exi in e iew o explo e JMIR Res P o oc 2024 | ol. 13 | e55960 | p. 7h ps://www. esea chp o ocols.o g/2024/1/e55960 (page numbe no o ci a ion pu poses) Phipps e alJMIR RESEARCH PROTOCOLS XSL • FO Rende X pa icipan pe cep ions o he in e en ion con en and possible imp o emen s o u u e implemen a ion. Da a Analysis Hypo heses will be es ed using R so wa e. All analyses will ini ially be pe o med as in en ion- o- ea , and pe -p o ocol analyses will also be unde aken o compa ison. Pa e ns o missing da a will be explo ed using he Li le missing comple ely a andom es . Missing da a in he inal analysis will be in e ed using ull-in o ma ion maximum likelihood analysis. We will es he e icacy o he in e en ion on ou p ima y ou come, sel - epo ed leisu e- ime physical ac i i y, using an i e a i e se ies o gene alized linea models. Independen a iables will include ime, in e en ion condi ion, demog aphic co a ia es (eg, s a da e, gende , and age), deli e y g oup clus e ing, wi hin-dyad clus e ing, and pe son-in e en ion heo y i PΔ [51]. Each a iable g oup will be added in a subsequen i e a ion o he model, and model i s a is ics will be examined a each i e a ion. This p ocess will be epea ed o each seconda y ou come a iable (pe cei ed au onomy suppo , au onomous mo i a ion, a i ude, subjec i e no m, pe cei ed beha io al con ol, ac ion planning, coping planning, sel -moni o ing, and beha io al au oma ici y). We also in end o assess he e ec o heo y-based media o s on change in physical ac i i y using a pa h model. Speci ically, we aim o assess whe he he e ec s o in e en ion condi ions on change sco es in physical ac i i y ou comes (bo h p ima y and seconda y) a e media ed by change sco es in each o he psychological cons uc s a ge ed by he in e en ion (ie, pe cei ed au onomy suppo , au onomous mo i a ion, a i ude, subjec i e no m, pe cei ed beha io al con ol, ac ion planning, coping planning, sel -moni o ing, and beha io al au oma ici y). E hical Conside a ions All s udy p ocedu es ha e been app o ed by he Uni e si y o Jy äskylä Human Sciences E hics Commi ee (s a emen numbe 806/13.00.04.00/2023). All pa en s in e es ed in pa icipa ing in he s udy will be p esen ed wi h de ailed in o ma ion abou he in e en ion, po en ial isks o pa icipan s, he igh o wi hd aw, and da a secu i y a angemen s. Pa en s will ha e he chance o ead his in o ma ion and ask ques ions o he esea ch eam be o e p o iding hei in o med consen o pa icipa e. Da a will be s o ed on secu e cloud-based se e s hos ed by he Uni e si y o Jy äskylä consis en wi h ou da a a chi ing and s o age managemen plan, complian wi h uni e si y guidelines. A he conclusion o da a collec ion, pa icipan s’ physical ac i i y and da a on psychological measu es a each measu emen poin will be ma ched using pseudonymized codes and deiden i ied o he g ea es ex en possible. Pa icipan s will no be o e ed any inancial o o he compensa ion o hei pa icipa ion. Resul s The p ojec eam ecei ed inal no i ica ion o esea ch unding app o al o he cu en p ojec om he Finnish Minis y o Educa ion and Cul u e, Spo Science Funds, in Ma ch 2022 (PROJECT 350904), and he ial has been p e egis e ed on ClinicalT ials.go (ID 806/13.00.04.00/2023). En ollmen in o he ial commenced on Sep embe 20, 2023. En ollmen is scheduled o con inue un il Ma ch 2024, wi h he inal collec ion o ollow-up da a scheduled o Decembe 2024. We expec ha he esea ch will p o ide aluable o ma i e e idence o he e icacy o a heo y-d i en amily-based physical ac i i y in e en ion s a egy. Fu he , as he p oposed ial includes open ma e ials and es s o he heo y-d i en mechanis ic e ec s ha may encou age beha io change, his esea ch may also se e as a aluable s epping s one o he de elopmen o mo e la ge-scale, low-cos in e en ions o amily beha io change. Discussion O e iew This p o ocol p esen s a andomized con olled ial aiming o inc ease physical ac i i y le els in inac i e pa en -child dyads wi hin Finland, based on he in eg a ed beha io change model. We hypo hesize in his p o ocol ha bo h pa en s and child en will show inc eased le els o physical ac i i y, ou p ima y ou come a iable, bo h a he immedia e and 3-mon h pos in e en ion s age, ela i e o a wai lis con ol g oup. Fu he , we hypo hesize we will obse e simila changes in he ial’s seconda y ou comes, he psychological cons uc s o he in eg a ed beha io change model (ie, au onomy suppo , au onomous mo i a ion, a i ude, subjec i e no m, pe cei ed beha io al con ol, sel -moni o ing, in en ions, and habi ), in he in e en ion g oup ela i e o he wai lis con ol g oup. Po en ial Findings and Implica ions Child en ansi ioning in o adolescence ha e shown a sha p decline in ac i i y le els [3], while pa en s a e gene ally less ac i e han simila adul s wi hou child en [8]. Thus, bo h popula ions indi idually ep esen aluable a ge s o in e en ion. Recognizing his, go e nmen s and heal h depa men s ha e ecommended beha io al in e en ions o p omo e physical ac i i y pa icipa ion in bo h g oups. Howe e , beyond s a egies o in luence physical ac i i y in ei he child en o pa en s sepa a ely, esea ch indica es ha pa en s and child en likely ha e a no ewo hy in luence on each o he ’s physical ac i i y beha io s and belie s [6,7,9]. Thus, he deli e y o in e en ions in amily con ex s, such as pa en -child dyads, ep esen s a po en ially highly aluable s a egy o p omo e physical ac i i y pa icipa ion in bo h popula ions. This is suppo ed o a deg ee in me a-analysis, as dyadic in e en ions encou aging an ac i e li es yle demons a ed sligh ly la ge e ec s han hose a ge ing indi iduals [10]. Ye , such in e en ions emain ela i ely a e compa ed o mo e adi ional, indi idual- a ge ed p og ams, pa icula ly hose ha a e based on beha io al heo y which may con ibu e o hei e icacy and ele ance o heal h sciences o e all [10]. This s udy es s a heo y-based amily beha io al in e en ion aimed a p omo ing change in physical ac i i y pa icipa ion in pa en -child dyads. The in e en ion aims o os e au onomous mo i a ion, enhance social suppo , and educe pe cei ed ba ie s o exe cise in an a mosphe e ha is accep ing and open. The in e en ion will make a unique con ibu ion o p ac ice and heo y. Gi en he low le els o physical ac i i y JMIR Res P o oc 2024 | ol. 13 | e55960 | p. 8h ps://www. esea chp o ocols.o g/2024/1/e55960 (page numbe no o ci a ion pu poses) Phipps e alJMIR RESEARCH PROTOCOLS XSL • FO Rende X