Examination of Happy Homework 2.0 on 24-hour Movement Behaviours in Scottish Primary School Children - Early Years Feasibility Trial
Examination of Happy Homework 2.0 on 24-hour Movement Behaviours in Scottish Primary School Children - Early Years Feasibility Trial
Purpose
Happy Homework is a homework programme designed to help primary school children build healthier daily habits. It focuses on children's "24-hour movement behaviours," which include being physically active, spending less time sitting, and getting enough sleep. Children complete short activities at home during the week with a parent or caregiver.
An earlier version of Happy Homework, tested with children aged 9-12 years, helped improve physical activity, sleep, and healthy eating. Feedback from families and schools suggested that the programme could work even better if it was delivered through a digital app rather than paper homework sheets.
As a result, Happy Homework 2.0 was developed as an app-based version of the programme. This study aims to find out whether the app is suitable, acceptable, and helpful for younger children aged 4-8 years. The study will explore whether children and families enjoy using the app, whether schools can successfully deliver the programme, and whether it may improve children's daily movement habits.
Why This Study Is Important
Healthy movement behaviours across the whole day are important for children's physical and mental health. This includes regular physical activity, limited sedentary behaviour such as long periods sitting or using screens, and good sleep.
Several countries, including Canada, New Zealand, and Australia, have introduced 24-hour movement guidelines for children. These guidelines encourage children to move more, sit less, and sleep well. However, research shows that many children in the UK are not meeting these recommendations. Only a small number of children achieve healthy levels of physical activity, sleep, and low sedentary time together.
Parents and the home environment can strongly influence children's habits because children spend much of their time at home. Research has shown that school programmes which include homework activities can improve children's sleep, reduce sedentary behaviour, and increase physical activity.
Happy Homework was designed to support healthy movement habits in a simple and accessible way. It does not require expensive equipment or special facilities, making it suitable for families from different backgrounds. While the programme has already shown positive results in older primary school children, it has not yet been adapted or tested with younger children aged 4-8 years.
Research also shows that children often become less physically active as they get older, especially when moving into adolescence. Supporting healthy habits earlier in childhood may help prevent inactive lifestyles from developing later on. Since many children in the UK, including those in Scotland, are not meeting healthy movement recommendations, there is a need for programmes like Happy Homework that can be used widely in schools and homes.
Study Design
This study will use a mixed-methods design, meaning it will collect both numerical information and feedback from participants about their experiences.
The study will begin with up to three co-design workshops. These workshops will help researchers improve and adapt the app for younger children before the main study takes place. The workshops will involve primary school head teachers, classroom teachers, parents, caregivers, and primary school children aged 4-8 years. Children, parents, and teachers will share their views about the app and homework activities, and researchers will use this feedback to improve the programme.
After the workshops, a randomised feasibility trial will take place. The study has been designed using recognised research guidelines and will be registered on ClinicalTrials.gov before recruitment begins.
Methodology
Children will only take part if a parent or caregiver provides consent and the child agrees to participate. To avoid influencing results, schools and participants will take part in either the workshops or the feasibility trial, but not both.
The workshops will take place in schools so children are in a familiar and comfortable environment. Teachers and other adult participants will be encouraged to attend in person, although online participation will also be available if needed. Workshops will be audio-recorded using university equipment so researchers can accurately analyse discussions later. Recordings will then be written out word-for-word for analysis.
The main study will involve four primary schools in South Lanarkshire. Two schools will use the Happy Homework 2.0 app, while two schools will continue with normal practice as a comparison group.
The programme will last between 8 and 12 weeks. Researchers will collect information at the beginning of the study and again immediately after the programme ends. This will help assess whether the app can be successfully delivered and whether it may improve children's movement behaviours.
Purpose:
The Happy Homework (HH) intervention included homework activities which aimed to improve both activity-related behaviours across the whole day and key dietary behaviours. The physical activity (PA) activities were informed by the World Health Organisation (WHO) recommendations for children aged 5-17 years that most of children's daily activity should be aerobic, and vigorous-intensity activities should be incorporated including activities which strengthen muscle and bone at least 3 times per week. Additional activities encouraged children to break-up sedentary behaviour (SB) by standing or moving, limit recreational screen-time (ST) to no more than 2 h per day, have adequate sleep durations of between 9 and 11 h per night and maintain consistent bed and wake times. The activities did not require any equipment or large spaces and were mapped in-line with the Scottish Curriculum for Excellence (CfE). The development of the HH intervention was informed by Self-determination theory (SDT). The intervention aimed to develop children's motivation to lead healthier lifestyles by meeting their three basic psychological needs: autonomy (i.e., feeling one has choice and is willingly endorsing one's behaviour), competence (i.e., the experience of mastery and being effective in one's activity), and relatedness (i.e., the need to feel connected and a sense of belongingness with others). Satisfying children's three needs has been shown to be predictive of PA participation and positive health behaviours.
HH workbooks were provided to children on a Monday, Wednesday, and Friday to encourage habitual involvement in the activities over an 8-week period from February - April 2019 (i.e., Winter - Spring), which included 2 Easter holiday weeks. Additional activities and health promotion reminders were also provided in the workbooks for the days when the child did not receive HH. Parents were required to sign off each activity that they completed with their child which the teachers subsequently recorded in their logbook, to be used as a measure of fidelity. If a child completed the weekly HH activities, their teacher would place a happy face sticker on their HH workbook at the end of each week as a small reward to foster adherence.
A pilot study in 9-12 year olds found that Happy Homework was effective in improving children's physical activity and sleep, as well as fruit and vegetable consumption, yet recommendations to improve the interventions efficacy included moving to a digital platform and away from traditional paper-based homework tasks. As such, Happy Homework 2.0 was co-developed as an app-based intervention, with the same goal of improving children's 24-hour movement behaviours. As such, the purpose of this randomised control feasibility trial will be to examine the feasibility, acceptability and efficacy of Happy Homework 2.0 in improving the 24-hour movement of younger children (i.e., 4-8 years old).
Justification:
Canada first published 24-hour movement guidelines for children in 2016, followed by New Zealand and Australia in 2017. These guidelines emphasize the importance of higher levels of PA and sleep, alongside lower levels of SB, for optimal health. Despite growing evidence, the United Kingdom (UK) has not yet developed or adopted 24-hour movement guidelines for children. In the UK, only 8% of children meet all three movement guidelines, while 11% meet none. This highlights a clear gap between recommended behaviours and children's actual movement patterns, yet research exploring 24-hour movement guidelines within the UK remains limited.
The home environment may play an important role in promoting 24-hour movement, as children spend roughly half their day at home, and parents have been shown to positively influence children's PA, SB, and sleep. While school-based interventions are commonly used to encourage these behaviours, a recent review found that school-based interventions incorporating homework significantly improved children's sleep and reduced sedentary behaviour. Longer interventions were also associated with increased PA. These findings suggest that future school-based programmes should include homework components that target reductions in SB and improvements in sleep.
Happy Homework is a school-based intervention designed to promote adherence to 24-hour movement guidelines and help prevent non-communicable diseases. The programme requires no special facilities or equipment, making it accessible to all children regardless of socioeconomic status. The intervention has shown success in improving PA (e.g., stepping time) and sleep in primary school children aged 9-12 years. However, it has not yet been adapted or tested for younger primary school children aged 4-8 years. Research clearly shows that physical inactivity tends to increase as children grow older, especially during the transition into adolescence. Therefore, intervening earlier may prevent this decline before sedentary habits become established. With UK children failing to attain positive 24-hour movement behaviours, and Scottish children being amongst the most inactive globally, development of scalable interventions, which show success, such as Happy Homework, is warranted.
Design:
This mixed-methods study will include a maximum of 2 co-design workshops which will inform the randomised feasibility trial we will undertake. Stakeholders included in the study will be:
An iterative co-design process with 4-8 year olds will be used to refine the existing co-produced app. This protocol was developed in accordance with the SPIRIT 2013 Statement and reporting will follow the CONSORT extension for pilot and feasibility trials. The study will be registered on ClinicalTrials.gov prior to participant recruitment.
Methodology:
Participants who provide both parental consent and child assent will be invited to take part in the study. To maintain study integrity and minimise contamination, schools and participants will be allocated to either the co-design workshops or the randomised feasibility trial study, but not both.
A maximum of three connected co-design workshops, and one co-production workshops with each of the 3 different stakeholder groups (i.e., parents, children and teachers/head teachers) will be conducted. The co-design workshops will involve the following: (1) stakeholders reviewing paper-based, low-fidelity prototypes of the HH app; (2) stakeholders providing feedback on the existing design (informed by ongoing study); (3) stakeholders engaging in individual/group design with blank wireframe templates provided (a process referred to as 'feature prioritisation') with their own ideas and features; (4) the 'feature prioritisation' from each workshop informing the proceeding round of co-design; and (5) consolidating the best ideas into a final design that represents a minimal viable product design (a product developed with sufficient features for those involved in early testing) which will be represented through online wireframes. The co-design workshops will be conducted in person.
Workshop guides will build upon previous findings within the workshop before each, but will involve the following: (1) stakeholders reviewing an online wireframe of HH app; (2) stakeholders providing feedback on the design and perceived usability (which will be informed by co-design workshops); (3) stakeholders engaging in individual/group design with blank wireframe templates with changes or edits they suggest to change within the online wireframes (feature prioritisation); and (5) consolidating the best ideas into a final design that represents a minimal viable product design (a product developed with sufficient features for those involved in early testing).
All workshops will be conducted within the school setting as detailed in the risk assessment, providing a familiar and supportive environment for children. Adult participants (e.g., teachers) will be encouraged to attend in person, although an online option will be made available where necessary. Workshops will be audio-recorded using a university-issued device and transcribed verbatim for analysis.
During the feasibility RCT, children will be measured at two time-points: pre-intervention (1 week prior to intervention delivery) and post-intervention (1 week after the intervention). The included cluster-RCT measurements which will be taken include:
Demographic information - home postcode, child's eligibility for free school meals, parental/guardian occupation, household annual combined income, highest education qualification achieved by parents/guardian, family status, and number of children living at home will be obtained. The gender of each participant will be obtained to measure gender homogeneity in our sample.
Body mass- The height and weight of agreeing children will be collected to allow for the classification of Body Mass Index. Alternatively, children will be provided will the opportunity to self-report their height and weight. Weight will be measured barefoot to the nearest 0.1kg with an electronic scale (university supplied) while height will be measured barefoot to the nearest 0.1cm using a stadiometer in accordance with standard procedures.
Additionally, children will be fitted with accelerometer devices which must be worn for the duration of the week prior to intervention delivery and 1 week after intervention delivery. Full details of the devices will be shared will children and parents in an information sheet, including general upkeep, what do to if they fall off, and contact details for the primary researcher for further questions. During both the measurement periods, individuals will be encouraged to resume normal activity. The included devices are as follows:
PA - The ActiGraph GT3X will be used to measure the PA levels of children. This device detects accelerations in three axes (i.e., vertical, Mediolateral, and anteroposterior). Prior to data collection, parents, teachers, and children will be instructed on the positioning of the accelerometer (i.e., non-dominant wrist) and advised that the accelerometer should be worn for 7 days over the full day (24-hours), except during water-based activities (e.eg., showers or swimming).
SB - The activPAL 3TM monitors will be used with placement on the participants right thigh, midway between the anterior superior iliac spine and the knee, using a hypoallergenic Hypafix dressing. This device uses accelerometer-derived information about thigh position to determine the start and end of each period spent sitting/lying, standing, and stepping, as well as stepping speed, step counts, and postural transitions. This device will be worn for 7 days (24 hours) and will be made waterproof by the dressing; therefore, it can be worn during water-based activities.
Sleep - The activPAL 3TM monitors (thigh placement) will be used and has been validated for use within children, with a 24-hour wear time supporting estimates of sleep duration. The 'primary lying' outcome, derived from the activPAL software, will be used by the CREA (version 1.3) and GHLA (version 2.2) algorithms to estimate sleep time duration. The device will be placed on the right thigh, midway between the anterior superior iliac spine and the knee, using a hypoallergenic Hypafix dressing. This device will be worn for 7 days (24 hours) and will be made waterproof by the dressing; therefore, it can be worn during water-based activities.
The randomised feasibility trial will involve four primary schools in South Lanarkshire (two intervention and two control), with two classes from each school recruited to participate. Findings from the co-design workshops will inform key aspects of the intervention, including the nature and frequency of homework tasks. The intervention will run for a minimum of 8 weeks and a maximum of 12 weeks. Outcome measures will be collected at two time points: baseline (one week prior to intervention delivery) and post-intervention (the week immediately after the intervention is completed).
The primary researcher will familiarise themselves with each school's safeguarding procedures and identify the designated child protection officer prior to study commencement. Although the study is not expected to elicit sensitive disclosures, any concerns arising will be reported to the relevant child protection officer in line with safeguarding protocols. The primary researcher has experience in both qualitative and quantitative methods and holds current PVG clearance for work with children. They will ensure adherence to ethical guidelines throughout, including the rights and welfare of the child.
Inclusion Criteria:
Exclusion Criteria: