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Table 1 Summary of FRESH intervention components

From: The development and feasibility of a randomised family-based physical activity promotion intervention: the Families Reporting Every Step to Health (FRESH) study

Intervention components Dose Description Behaviour change techniques Targeted SDT constructs Hypothesised mediators
1. Family time Minimum 1×/week, 10–20 min ‘Family time’ provided an opportunity for index childrena and family members to plan PA, monitor their week’s steps, and discuss any potential PA barriers and strategies to overcome them by logging in their family action planners [27]. Regular family time was hypothesised to provide index children with:
• A consistent (re)structured environment, where family members supported index children in choosing an optimally challenging and realistic goal (reflected as an easy, moderate, or difficult challenge on the FRESH website), breaking down goals into proximal (daily) and distal (weekly) step count targets, and providing praise and positive feedback on progress towards those goals. These strategies provide direct support for participants’ perceived competence [70].
• Consistent parental involvement which directly facilitates relatedness [70]. Parental involvement (via co-participation in PA) may also positively affect family connectedness [71].
• An opportunity for consistent autonomy support. Autonomy support has been shown to directly support participants’ autonomy and indirectly support their basic needs for competence and relatedness [72].
Additionally, index children were named their family’s team captain (i.e. change agent) where they were in charge of initiating ‘family time’. Evidence suggests that children may elicit changes to the psychosocial environment [27]; therefore, promoting the index children to the role of family ‘team captain’ may strengthen child buy-in, perceived autonomy, and improve intervention fidelity.
Goal-setting
Self-monitoring
Positive feedback on progress
Social support
Praise
Positive reinforcement
Perceived competence
Perceived relatedness
Perceived autonomy
Family social norms for PA
PA awareness
Basic needs satisfaction
PA motivation
2. FRESH website Minimum 1×/week, 5–20 min The FRESH website facilitated self-monitoring of step counts, and goal-setting through selecting challenges. Specifically, the FRESH website allowed families to choose one of three target cities to ‘walk to’ weekly, with the aim to eventually ‘walk’ around the world. Each week, families chose an easy, moderate, or difficult challenge, which represented a 0%, 5%, or 10% increase, respectively, relative to the average steps they had taken in preceding weeks. Increases were adjusted to 0%, 2.5%, and a 5% once adults and children accumulating an average of 10,000 and 12,000 steps/day, respectively. Families also had access to a general resources area with suggestions for activities that families could do together and a map for a visual representation of the locations families have travelled to. Goal-setting
Self-monitoring
Positive feedback on progress
Rewards
Perceived competence
Perceived relatedness
Perceived autonomy
Social support
Family social norms for PA
PA awareness
Basic needs satisfaction
PA motivation
3. Pedometry Throughout intervention (6 weeks) Participants were provided with pedometers for self-monitoring and immediate feedback. Pedometers are simple to use and convenient and are associated with effective interventions for increasing parent-child physical activity [73]. Index children logged their steps (and their family members’ steps) into the FRESH website and/or onto the family action planners, which allowed participants to view their progress towards their proximal and distal step goals. Self-monitoring
Immediate feedback
Perceived competence
Perceived autonomy
Social support
Family social norms for PA
PA awareness
Basic needs satisfaction
PA motivation
4. Virtual rewards/competence reinforcement ~ 1×/week (6 weeks) To praise effort (i.e. competence reinforcement), participants received supportive messages, virtual passport stamps (i.e. virtual rewards), and access reinforcement materials (i.e. interactive multimedia information about the cities they have visited) on the FRESH website as they completed challenges to various cities around the world. Participants received 2–4 passport stamps for completed challenges (i.e. as difficulty increased, more stamps were awarded) and 1 passport stamp for an incomplete challenge. Feedback on progress
Rewards
Perceived competence Basic needs satisfaction
PA awareness
  1. aThe index child refers to the child aged 8–10 years in the family. PA physical activity, SDT Self-Determination Theory