Physiotherapy - Theses
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ItemThe Circus Project: Co-designing a circus-based intervention to enhance physical activity participation for preschool-aged children born preterm( 2023-08)Preschool-aged children (three-five years) born preterm (<37weeks' gestation) participate in less physical activity compared with term-born peers. Physical activity is essential for all children, as it facilitates the development of motor skills, as well as maintaining and improving skeletal and cardiovascular health. However, for children born preterm, who are at greater risk of long-term developmental impairments, adequate physical activity is likely to have an even greater role. Although physical activity participation interventions do exist, few target children born preterm at the preschool age, and there is limited evidence of collaboration with parents and other key stakeholders. Engaging stakeholders in co-design of interventions is likely to increase the relevance to the end user, and therefore result in increased uptake of healthcare initiatives. Furthermore, children are more likely to engage in an intervention when it is enjoyable, unique, and delivered in a naturalistic leisure setting. The purpose of this thesis was to develop a circus-based intervention in collaboration with key stakeholders to increase participation in physical activity for children born preterm. This was achieved through five iterative studies using an action research framework. A scoping review of the literature (Study 1) explored what was known from published and grey literature about the use of circus activities as a health intervention for children and young people. Fifty-seven of 897 sources of evidence were included, which described 42 unique interventions. The review found emerging evidence of positive health outcomes resulting from circus activities used in general populations and those with defined biopsychosocial challenges (such as cerebral palsy and autism). The review also highlighted opportunities to strengthen the evidence base such as focusing on detailed reporting of intervention elements (such as the use of the TIDieR checklist), increasing research in preschool-aged children, and focusing therapeutic interventions on specific groups of participants with demonstrated need (rather than the general population). A sequential mixed-methods study (Study 2) explored the experiences and needs of key stakeholders (parents of preschool-aged children born extremely preterm (<28 weeks' gestation), clinicians, and circus coaches) in engaging children born preterm in recreational physical activity. Barriers, facilitators, and strategies were identified in the survey (n = 217) and interview (n = 43) results, which had implications for the development of a circus-based physical activity intervention. These included the importance of coaches' specific knowledge and understanding of the preterm experience, programs incorporating holistic outcomes rather than purely physical development, the role of geographical location and cost as key considerations, and the involvement of clinicians in program design, but not delivery. A novel co-design process (P-POD) was then developed to facilitate an authentic transition to an online environment (Study 3). This process was used to co-design the circus-based physical activity intervention with ten key stakeholders, incorporating the findings from the previous studies (Study 4). The resulting intervention was titled CirqAll: Preschool Circus for Premmies and was reported according to the TIDieR checklist. The novel co-design process was evaluated using an explanatory mixed-methods design. Anonymous surveys completed by the co-design participants revealed that P-POD adhered to the guiding principles of co-design and stakeholder involvement. Themes developed from interview data described participants' experiences of the supportive online culture, room for healthy debate, power-sharing, and multiple definitions of success within the process. Finally, a feasibility study using a case series design (Study 5) evaluated the recruitment capability, acceptability and implementation fidelity of the first part of the 3-part co-designed intervention (CirqAll: professional development for circus coaches (CirqAll:PD)). Furthermore, limited efficacy testing was conducted on outcomes of interest including knowledge, skills, and confidence. Results indicated that CirqAll:PD was feasible with some modifications required to reduce attrition prior to larger-scale testing. Furthermore, coaches who completed CirqAll:PD (n = 27) showed improvements in knowledge, skills, and confidence in working with children born preterm from baseline to post-intervention, with improvements retained at three-months. Overall, this thesis developed and evaluated both a novel approach to co-designing paediatric interventions with key stakeholders, and a circus-based physical activity intervention. Findings from this thesis can be used to co-design future interventions, as well as provide a solid foundation for further development and testing of an intervention that may improve physical activity participation for preschool-aged children born preterm.