Objectives: This study aimed to describe the development, implementation, and material costs of four low-cost educational strategies for zoonosis prevention and One Health education in schools. Design: Methodological, qualitative, and descriptive study. Setting: Public elementary schools in Contagem, Minas Gerais, Brazil. Method: Four educational strategies were developed for elementary school children: board games, theatre, group discussions, and videos. The strategies addressed sporotrichosis, leishmaniasis, Rocky Mountain spotted fever, and rabies. Materials, implementation procedures, practical adaptations, and costs were described. The activities incorporated elements of transformative education, including game-based learning, role-play, mediating questions, motivational phrases, encouragement, problem contextualisation, and collaborative problem-solving. Descriptive observations, facilitators’ qualitative impressions, and spontaneous student comments were used to contextualise the implementation process. Results: The strategies created opportunities for student participation, peer interaction, and collaborative engagement during classroom activities. Their interactive, playful, visual, and contextualised elements supported active participation and discussion of One Health–related topics. The estimated production costs were low, and the materials were feasible, accessible, and adaptable to different school contexts. Conclusion: This study provides a practical description of low-cost and replicable educational strategies for zoonosis prevention and One Health education. The findings highlight the importance of careful material development and contextual adaptation when designing school-based educational activities related to One Health. Further research is needed to formally assess their effects on educational outcomes, knowledge retention, and behavioural change.
Background: Conversion practices – efforts to change or suppress a person’s sexual orientation or gender identity – cause profound and enduring harm. Survivors frequently report difficulty accessing safe, informed, and affirming mental health care, highlighting critical gaps in health workforce education and training. Aim: In this paper, we describe our research team’s journey when undertaking a participatory action research project to investigate survivors’ recovery needs and practitioners’ information needs. Approach: Guided by an intersectional, trauma-informed framework, the project privileged lived experience alongside practitioner and researcher expertise, and actively challenged dominant narratives that centre white, US, Christian contexts while overlooking informal and culturally embedded forms of conversion practices. These insights informed the co-production of an accredited health professional education programme, developed collaboratively with survivor advocates, researchers, and training designers. The programme was delivered nationally and internationally, co-facilitated by people with lived experience, and designed to support reflective learning and applied practice across diverse cultural, faith, and community contexts. Outcomes: Among exit-survey respondents, 96% of participants agreed or strongly agreed that the training improved their knowledge of conversion practices and their capacity to support survivors in ethical, affirming, and trauma-informed ways. Beyond knowledge transfer, the process fostered institutional and cultural change, informing subsequent education-focused initiatives with religious leaders to improve safety in pastoral care. Conclusions: This article reflects on the methodological and ethical considerations of translating participatory research into health education practice, the importance of survivor leadership, and the importance of co-produced approaches to advancing equity, inclusion, and systemic change.
Background: Comprehensive sexuality education plays a vital role in promoting adolescents’ informed decision-making, respectful relationships and sexual health. Although research on comprehensive sexuality education has expanded considerably, evidence remains fragmented across educational contexts and disciplines. This systematic review synthesises recent evidence to identify educational approaches shaping the implementation of comprehensive sexuality education in school settings. Method: This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Literature searches were conducted across Scopus, Web of Science and Education Resources Information Center databases for studies published between 2021 and 2026. A total of 1601 records were identified, and 22 studies met the inclusion criteria for qualitative synthesis. Results: Four major themes were developed from the synthesis: (1) teacher perspectives, training and professional practice; (2) implementation challenges and sociocultural influences; (3) student experiences, needs and outcomes; and (4) inclusive and whole-school approaches. The findings demonstrate that effective comprehensive sexuality education depends on teacher competence, inclusive curricula, institutional support and socioculturally responsive educational practices. Conclusion: The review highlights the importance of strengthening teacher preparation, institutional support and inclusive pedagogical approaches to improve the quality and sustainability of comprehensive sexuality education in schools. Future research should examine integrated educational strategies and policy frameworks that support effective comprehensive sexuality education implementation across diverse educational contexts.
Objective: To evaluate the Lung Health Ambassadors Program (LHAP), a school-based public health programme designed to enhance students’ knowledge, self-efficacy, and advocacy skills regarding lung health, including electronic cigarettes (e-cigarettes), climate change (CC), and rare respiratory diseases. Design: Process evaluation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Setting: Schools in Baltimore, Maryland, that had implemented the LHAP. Method: We conducted 22 semi-structured interviews with 12 school staff members and 9 LHAP volunteers (LVs). School staff were individuals employed by participating schools who hosted LHAP sessions, while LVs were trained Johns Hopkins University students and affiliated staff responsible for delivering the LHAP curriculum. Interviews explored perceived programme strengths and challenges. We used a combined inductive and deductive analytic approach to identify themes and organise findings using the RE-AIM framework. Results: Overall, staff from the five schools and the LVs who participated were satisfied with LHAP. Adoption of LHAP was facilitated by the programme developer’s existing school/community connections, flexible scheduling, and curricular alignment. Regarding implementation, while many found LHAP relevant and engaging, this varied by grade level and LV delivery, highlighting the need for more age-appropriate content and standardised training. In terms of maintenance, educators hoped for LHAP’s continuation, and LVs valued the programme for skills development without incurring costs, as personal transport was covered, removing participation barriers. Conclusion: LHAP and future public health campaigns should allow flexibility in logistical planning of sessions such as length of time and teaching modality to increase reach. Furthermore, developing a context-specific curriculum was highly beneficial. Identifying and ensuring a standard for the training of teachers may help improve consistency in the future execution of programmes.
Objective: Dating and relationship violence and gender-based violence are common among adolescents globally and can have significant adverse long-term consequences, including widening health inequalities. There is evidence that while school-based curriculum interventions can be effective in preventing dating and relationship violence, whole-school elements are important for preventing gender-based violence. However, implementing whole-school components may be challenging in schools with limited capacity. We designed THINK AGAIN, a multi-component programme aiming to prevent dating and relationship violence and gender-based violence in schools in England. The programme comprised an assessment and report of student needs, relationships and sex education curriculum, student-staff “Action Aware Group” and staff training. Design: We conducted a non-controlled feasibility study of THINK AGAIN. Setting: State secondary schools in south-east England. The programme targeted all students in year 9 (aged 13–14) in participating schools. Method: We recruited four schools in which to pilot and assess the feasibility and acceptability of THINK AGAIN in the 2024/2025 school year. Our embedded mixed-methods process evaluation assessed the fidelity, reach and acceptability of the intervention. Results: We found that the curriculum component was delivered with fidelity across schools. However, the whole-school component was delivered with fidelity in only two of four schools. Accordingly, acceptability and reach of the curriculum component were mostly higher among both students and staff than the Action Aware Group component. Conclusion: Fidelity, reach and acceptability of the curriculum were greater than the Action Aware Group, suggesting that progression of THINK AGAIN to a phase III trial of effectiveness requires important refinements to the whole-school component.
Aim: The aim of this pre-implementation study was to assess mothers’ experiences of barriers and facilitators of receiving breastfeeding education and obtaining personalised support to guide the implementation of an eHealth resource for use in perinatal clinical settings in a health region of Canada. Design: We conducted a pre-implementation descriptive, exploratory qualitative study. Setting: Canadian mothers were recruited online to complete a survey and indicate interest in being interviewed. Method: An online survey was completed by 78 Canadian mothers who had breastfed an infant; five of these mothers participated in online interviews. Inductive thematic analysis using Braun and Clarke’s six-step approach was conducted to identify concepts, ideas, and themes related to mothers’ breastfeeding education and support experiences. The six steps included (1) becoming familiar with the data, (2) generating initial codes, (3) generating initial themes, (4) reviewing themes, (5) defining and naming the themes, and (6) writing the thematic analysis. Results: Five main themes were developed from the analysis, capturing mothers’ experiences receiving breastfeeding information, including (1) negative emotions from breastfeeding education and support; (2) inconsistent and insufficient breastfeeding information from healthcare providers; (3) barriers to obtaining personalised, competent breastfeeding support; (4) making breastfeeding education more accessible, engaging, and inclusive; and (5) timing and delivery of breastfeeding education. Conclusion: Mothers continue to report challenges related to complex emotional processes, the availability of education and personalised support, and receiving conflicting information from healthcare providers. Standardising education in multiple modalities that includes information on where mothers can access personalised, competent breastfeeding support when needed are potential solutions to these barriers.
Objective: There is limited evidence on how sports clubs implement health promotion (HP) through a settings-based approach. This study explored how grassroots sports club promote health by examining their organisational contexts and the roles of sports managers across different stages of HP implementation. Design: Qualitative multiple case study design. Setting: Grassroots sports clubs operating in five countries. Method: Six sports clubs were selected based on predefined criteria: affiliation with a national sports federation, more than 5 years of operation, and provision of sports activities for at least four age categories. Data were collected through semistructured interviews with sports club managers. A deductive thematic analysis was conducted using the Health Promoting Sports Club (HPSC) logic model to examine inputs, activities, outcomes, and impacts, alongside managerial roles across different stages of HP development. Results: Sports clubs varied in organisational context and orientation towards HP, with implementation stages ranging from initial activity-based approaches to fully embedded, organisation-wide strategies. Managerial leadership emerged as a key driver of progression, evolving from basic coordination in the early stages to strategic planning, partnership development, and system integration in more advanced stages. Common inputs included support from sports federations, municipalities, volunteers, and local partnerships. HP activities included health education integrated into training, inclusive and accessible programmes, safeguarding policies, and community-oriented events. Reported outcomes included improved health literacy, safer sports practices, and enhanced organisational competence. Long-term impacts were perceived as healthier lifestyles, stronger social cohesion, and improved club sustainability. Conclusion: Grassroots sports clubs represent a valuable setting for HP; however, health impact depends on the extent to which HP is systematically embedded within organisational policies, practices, and culture. Managerial capacity and multi-level partnerships are critical mechanisms for achieving sustainable HP development.
Objective: Knowledge about sexual and reproductive health is often limited among adolescents in Zambia, and this limitation may have negative health effects. Although programmes have been developed to increase such knowledge, these programmes can sometimes be seen as being in conflict with cultural values. Design: This study examined the effects of adding a novel programme involving teaching and storytelling about character (Lubuto Mentoring ) to a standard sexual and reproductive health programme (Stepping Stones), which engages with topics such as communication, assertiveness, safer sex, sexually transmitted diseases, and gender-based violence. Method: The experimental group participated in the novel curriculum, which combined Lubuto Mentoring and Stepping Stones, and the control group took part in the standard curriculum (Stepping Stones). Both treatments lasted 13 weeks. Setting: Participants were 371 Zambian young people aged 15–19 years. Results: Participants in both programmes demonstrated increases from before the intervention to after in knowledge about sexual and reproductive health, and confidence in their ability to undertake challenging behaviours pertaining to sexuality, and well-being. The increases did not differ between groups. Participants were run in three cohorts. In each cohort, one group of participants took part in then Lubuto Mentoring -enhanced programme, and the other cohort took part in Stepping Stones. Later cohorts showed larger increases than did earlier cohorts. Conclusion: Study findings suggest that training in character strengths using techniques such as storytelling as part of sexual and reproductive health programmes in Zambia is feasible without reducing overall efficacy.
Objective: Substantial segments of the US public are misinformed about the relative risks of nicotine products. There have been recent calls to educate the public about these relative risks. This study analyses correlates of “don’t know” responses on the relative risks of e-cigarettes and combustible cigarettes. Design and setting: Self-reported, nationally representative data from the USA’s Health Information National Trends Survey 2022 cycle (HINTS 6) were used ( n = 5835). Methods: Multivariable logistic regression examined associations between sociodemographic characteristics and “don’t know” responses to a question about the relative risks of e-cigarettes compared to cigarettes. Analyses used jackknife estimation sampling weights to provide population representative estimates. Results: Over one-third (38.2%) of adults indicated they “don’t know” the relative harm of e-cigarettes compared to cigarettes, with increasing prevalence with older age. In adjusted models, middle-aged/older adults, race/ethnicities other than White, and adults with lower incomes had higher odds of selecting a “don’t know” response ( p < 0.05, compared to respective reference groups). Adults with some college education/college degree, females, current/former users of cigarettes, and current/former users of e-cigarettes had lower odds of selecting “don’t know” ( p < 0.05). Conclusions: An improved understanding of “don’t know” responses assessing the public’s understanding of the relative risks of nicotine products could serve as a vital tool to identify knowledge gaps among older adults and in other marginalised populations, serving as an indicator for targeted educational programmes and interventions. Data such as this are necessary to inform populations about the risks of smoking and the benefits of cessation and harm-reduction strategies.
Background and Objectives: Cardiovascular disease (CVD) is a major cause of premature mortality and morbidity in the UK and globally, driving health inequality and spiralling healthcare costs. Reducing CVD and its risk factors is a global policy priority. There is growing recognition that CVD risk trajectories are shaped in early life, with risk factors developing in children aged as early as 3–11 years, leading to later CVD events. Our objective with this study was to advance the evidence base on cardiovascular health promotion with children through primary schools. Methods: We conducted a systematic mapping and review of reviews to examine the factors associated with successful cardiovascular health promotion in primary schools and the intervention elements that impact knowledge and behaviour. Our work was informed by the needs of a community-based CVD-prevention initiative in London which sought to address the challenge of high CVD and childhood obesity rates locally. Results: Of 141 articles screened, only 15 focused on CVD health. Key findings revealed that curriculum-based approaches embedded in school routines and complemented by engaging children in a process of experiential learning can lead to statistically significant improvement in both knowledge and health behavioural change outcomes. The evidence shows that supporting children to attain positive CVD health-related behaviours is vital as they enter the foundational years of compulsory education. Conclusion: Schools, in particular primary schools, are crucial for early modelling and establishing the lifelong healthy habits that will positively impact children’s healthy behaviours and the wider population’s CVD health.
Objective: To investigate the perceived acceptability of food nudging interventions among individuals with type 2 diabetes mellitus in the Czech Republic. Design: Mixed-methods study combining a quantitative survey and qualitative expert interviews. Setting: Outpatient and community settings involving patients diagnosed with type 2 diabetes mellitus in the Czech Republic. Method: A survey was conducted with 505 patients assessing the acceptability of 33 different food nudging strategies, supplemented by expert interviews to provide contextual insights and validate the findings. Results: Non-digital nudges, such as product placement and discount incentives, were generally well accepted, whereas digital nudges (e.g. text message reminders) had significantly lower acceptance across all sociodemographic groups. Acceptability varied by gender and age, with women and younger participants showing greater openness to nudging. Experts interpreted the findings and discussed potential mechanisms and contextual conditions under which nudging may influence dietary behaviour. Conclusion: Food nudging appears to be an acceptable behavioural policy tool for patients with type 2 diabetes mellitus, especially in non-digital formats, although its real-world effectiveness still needs empirical verification. This study offers a conceptual model to guide tailored nudging and survey design rather than to explain causal mechanisms. Implementation should remain culturally sensitive, ethically transparent, and respectful of patient autonomy. Future research should assess behavioural responses and long-term health outcomes to determine whether chosen interventions produce sustained improvements beyond short-term acceptability and intention effects.
Background: Comics are visual media that combine images and text to convey educational content. Their use in health education has gained increasing attention because they can simplify complex information, enhance engagement, and support learning, particularly among children. Aim: This scoping review aimed to map and summarise the use of comic-based interventions in oral health education and evaluate their reported outcomes across different populations and settings. Methods: A detailed search of eight databases was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines to identify peer-reviewed studies published between 2010 and December 2025. Studies were included if comics were used as a central component of oral health education interventions. Results: Seventeen studies met the inclusion criteria. Most studies targeted school-age children and used pre- and post-test designs to evaluate educational outcomes. Comic-based interventions were associated with significant improvements in oral health knowledge and, in some cases, positive behavioural outcomes such as increased flossing and improved oral hygiene practices. Comparative studies suggested that comics performed similarly to, or better than, traditional educational approaches such as oral instruction, posters, and leaflets for knowledge outcomes. However, evidence regarding long-term behavioural and clinical effects remained limited. Conclusion: Comic-based educational interventions appear to be promising tools for improving oral health knowledge and supporting preventive behaviours, particularly in school and community settings. Future research should focus on long-term outcomes and standardised evaluation methods to better understand their impact on sustained oral health behaviours.
Background: Persistent health disparities in the rural south of the USA—particularly in Alabama’s Black Belt—reflect historical, social, and structural inequities. Health literacy and Internet access are increasingly recognised as important, yet underexplored, factors contributing to these disparities, especially in rural Black communities. Objective: This study examines the relationship between Internet access and health literacy among African American/Black adults residing in Alabama’s Black Belt region. Guided by Digital Divide Theory, it explores how digital barriers relate to individuals’ ability to obtain, process, and understand health information necessary for informed decision-making. Methods: We conducted a cross-sectional survey of 257 African American/Black adults. Health literacy was assessed using two validated screening items, and Internet access was measured through self-reported home Internet availability. Multiple linear regression was used to examine associations between Internet access and health literacy while controlling for sociodemographic and health-related characteristics. Results: Internet access was significantly associated with higher health literacy scores after adjusting for covariates. Participants with Internet access demonstrated higher health literacy, and lower health literacy was more common among older adults. Conclusion and implications: The findings suggest that digital access may represent an important factor related to health literacy in rural Black communities. Efforts to expand broadband availability and support digital inclusion may help address barriers to health information access and contribute to broader health equity initiatives.
Reproductive health is a topic that concerns everyone but its coverage in schools worldwide is patchy. Given current falls in total fertility rate and rises in the age at which women have their first child, there is an urgent need to ensure that teenagers and young adults understand fertility and reproductive health. This would help them to make informed choices about family building. Recent research has shown that even in England, one of the few countries that explicitly incorporates reproductive health education into its school curriculum, teenagers report being taught little about reproductive health and fertility. We conclude that there is an urgent need to improve the quality of the education that school students receive about reproductive health.
Background: Childhood overweight and obesity are increasing public health concerns internationally, contributing to significant long-term health risks. School-based interventions integrating policy and behavioural strategies are needed to address this issue. Objectives: This study aimed to evaluate the effects of a school-based intervention informed by the Thailand Healthy Living Strategy (THLS) for weight control and obesity prevention among school-age children. Design: Cluster randomised controlled trial. Setting: Eight primary schools located in Northeastern Thailand. Methods: A total of 214 students were randomly assigned to intervention and control groups. The intervention consisted of five structured education sessions delivered over a 3-month period but also included policy development and parental engagement. Data were collected using a structured questionnaire at baseline (pretest) and at 1-month posttest following the intervention. Independent and paired t -tests were used to compare outcomes between and within groups. Results: At posttest, the intervention group showed significant improvements in self-efficacy (mean difference = 1.85, p = 0.03), outcome expectation (mean difference = 1.71, p = 0.03), and practice scores (mean difference = 8.40, p = 0.01). Between-group comparisons demonstrated significantly higher outcome expectations ( p < 0.001) and practice scores ( p < 0.001) in the intervention group compared to the control group. No significant differences were observed for knowledge between groups. Conclusions: The THLS-integrated school-based intervention improved self-efficacy, outcome expectations and obesity prevention practices among schoolchildren. These findings support the implementation of multi-component, school-based strategies involving policy, education, and family engagement to promote healthy lifestyles.
Objective: To examine the receipt and perceived relevance of relationships and sexuality education (RSE) over time among secondary school students in Australia.Design: Data from four waves of the Australian Survey of Secondary Students and Sexual Health were included (2013, 2018, 2021, and 2024).Setting: Anonymous, periodic, cross-sectional surveys of secondary students aged 14-18 years and living in Australia.Method: Data from 13,860 students were analysed using logistic regression to assess changes in RSE receipt and perceived relevance across survey waves. Analyses explored receipt during primary school over the years and perceived relevance by sexual identity.Results: RSE receipt was significantly higher in 2024 (93%) than that in 2013 (86%), most noticeably during primary school, with around one quarter of students receiving RSE in years 11 and 12. Perceived relevance remained below 50% across all years, with older students and sexually diverse students less likely to find RSE relevant and more likely to opt out of RSE classes than heterosexual young people. Predicted relevance was, on average, more than 18% higher when content about condoms, sexual and gender diversity, and contraception was included. The number of topics discussed was positively associated with perceived relevance.Conclusion: RSE in Australia is changing, with delivery higher in recent years, particularly during primary school. Despite improvements in delivery, perceived relevance has remained low, particularly among sexually diverse young people who were less likely to find RSE relevant than their heterosexual peers and more likely to opt out of RSE classes, suggesting persistent inequities in RSE content and provision. These disparities highlight the need for inclusive, responsive, and comprehensive RSE that reflects the identities and experiences of gender and sexually diverse young people.
Objective: Teaching internships represent a critical phase in teacher education but are frequently associated with high and overlapping demands. Coping and stress-management skills are essential for pre-service teachers to prevent long-term consequences such as emotional exhaustion. However, many university curricula lack needs-based interventions addressing the specific stressors of teaching internships. This study aimed to develop a theory of change (ToC) to guide the development of context-sensitive stress-management interventions for pre-service teachers. Design: Mixed-methods design. Setting: German pre-service teachers completing their internship semester in teacher education. Method: A problem analysis based on findings from surveys ( n = 698) and interviews ( n = 4) with pre-service teachers was used to identify core stressors and intervention needs. In addition, two dialogues with professionals in teacher education and psychology informed and refined the intervention design. A review of existing stress-management interventions for teachers and other relevant occupations complemented these findings. Results: The analysis revealed key stressors including workload from simultaneous academic and teaching demands, organisational challenges, performance pressure, and financial strain. Based on these findings, the ToC outlines how awareness of personal stressors, improved time management, and structured problem-solving can strengthen coping and reduce emotional exhaustion. The resulting group-based intervention consisted of two 2-hour sessions combining cognitive-behavioural strategies with relaxation exercises while fostering social support. Conclusion: The identified ToC offers a conceptual foundation for a targeted health-promotion intervention in teacher education. By addressing stressors specific to the internship semester, it offers a basis for future evaluation and sustainable integration into initial teacher education and training curricula.
Background: Racialised health professions students frequently experience overt and covert racism, which can erode confidence, provoke emotional distress, and hinder learning, academic performance, and wellness. Innovative, accessible resources to build critical thinking and equip learners with strategies to navigate racism are urgently needed. Virtual simulation offers a promising approach to build capacity to respond to racism in health professions education. Objective: The objective of this study was to evaluate feasibility and impact of a virtual simulation educational module on cultural humility and perceived competence to respond to racism. Methods: A quasi-experimental pretest-post-test multi-site design was implemented across six academic sites in Canada and the USA. Participants completed standardised prebriefing materials, three asynchronous virtual simulations, and a self or group debrief. Outcome measures included feasibility indicators, the Simulation Effectiveness Tool-Modified (SET-M), Foronda's Cultural Humility Scale, and scenario-specific perceived competency rubrics. Results: Among 354 consenting participants, 139 completed both pre- and post-surveys. The module demonstrated strong feasibility and acceptability, with high ratings for prebriefing, simulation design, and debriefing (>= 96% agreement). Cultural humility scores increased significantly from pre- to post-intervention (p < .001), remaining within the "usually culturally humble" range. Perceived competence to respond to racism improved significantly across all scenarios (p < .001), with post-test scores approaching the "competent learner" category. Conclusions: This research improves understanding of the use of virtual simulations to prepare health professions students to address racism in classroom and clinical settings.
Objective: The objectives of this study were to examine the efficacy of a group-based coaching intervention on office workers' leisure-time physical activity (LTPA), to identify potential differences in effects based on age, education, baseline physical activity status (BPAS) and gender, and to determine perceived satisfaction with the intervention. Design: The study used a single-group pre- and post-test design with post-tests conducted 8 weeks from baseline. Thirty-nine office workers were enrolled in the study, and 35 were included in the analysis. Setting: The intervention was conducted at six workplaces located in southern Sweden. Method: The Godin Leisure Time Exercise Questionnaire was used to measure LTPA, and a five-item questionnaire was used to identify perceived satisfaction with the intervention. A repeated measures ANOVA was conducted for the statistical analysis. Results: The mean perceived satisfaction with the intervention was 20.1, where 25 was the highest possible score. LTPA increased significantly from pre- to post-test (p < .001). A significant time & times; age interaction indicated smaller increases in LTPA among older participants. No significant moderation effects were observed for BPAS, education, or gender. The proportion of participants classified as active increased from 17.1% at pre-test to 45.7% at post-test. Conclusions: This brief coaching intervention was well received and associated with increased LTPA among office workers, with smaller increases observed among older participants. However, causal conclusions cannot be drawn due to study limitations, and future randomised controlled trials with objective PA measures are needed.
Objective: To develop an improved tool with which to assess the efficacy of the Dangerous Decibels (DD) programme, delivered as a training programme. The theoretical foundations for the tool were the capabilities, opportunities, motivation-behaviour (COM-B) model, and a separate set of scales was included at the level of individual components of the programme. Design: The research was conducted in three phases: draft questionnaire design, Delphi review, and pilot testing. Setting: Primary schools in the Auckland region, Aotearoa New Zealand. Method: The Dangerous Decibels Assessment (DDA) questionnaire was developed. A Delphi review was conducted to assess readability, face validity, and content validity. The questionnaire was tested for age appropriateness and intelligibility using a small sample of children ( n = 23) and, finally, piloted with a larger sample of children ( n = 78) along with the existing assessment questionnaire. Results: The questionnaire achieved a consensus of >78% for readability, >78% face validity, and 100% content validity. Component and overall scores for the DDA improved significantly after the DD training programme, as did the overall score on the original assessment questionnaire. Most scales achieved acceptable internal consistency (Cronbach’s alpha value of > .7). Conclusion: The DDA can be used to evaluate the efficacy of the DD programme in terms of its component parts and overall. It will be useful for evaluating the future efficacy of DD training.
