Purpose : It is aimed to assess whether school uniforms are associated with population-level gender inequalities in physical activity, and whether associations differ by school level, country/region income, and assessment method. Methods : An ecological study design was employed. We collected data about global uniform practices using an online survey. We searched for country/region-level estimates of school-aged youth meeting physical activity guidelines from international surveillance studies. Study selection was conducted in duplicate using a systematic process, and a random sample of all data was checked to ensure extraction and pooling processes were accurate. We calculated absolute and relative gender inequalities in physical activity for each country. Linear regression examined associations between country/region-level uniform practices (binary yes/no exposure variable) and country/region-level gender inequalities in physical activity guideline compliance (absolute and relative inequalities). We investigated moderation by school level, stratified analyses by income group, and repeated primary analyses using device-measured data. Results : Pooling data from 135 countries/regions (n = 1,089,852), we found no association between population-level uniform practices and gender inequalities in physical activity across all ages (absolute: beta = - 0.2; 95% confidence interval (95%CI): - 1.7 to 1.3, p = 0.74; relative: beta = 0.1; 95%CI: - 0.1 to 0.2, p = 0.51). Subgroup analysis suggested a positive association in primary school settings (absolute: beta = 4.3; 95%CI: - 0.0 to 8.6, p = 0.05). Among high-income countries, absolute inequalities were significantly greater in countries/regions with uniform practices (N = 37) compared to those without (N = 48) (9.1 (SD = 3.6) vs. 7.8 percentage points (SD = 4.3)). Repeating analyses using device-measured data (n = 32,130; N = 24) did not alter our primary finding. From initial descriptive statistics, we found that in countries/regions where a majority of schools (> 50%) reportedly use uniforms, there was lower compliance with physical activity guidelines among all genders (median: 16.0%, interquartile range: 13.2% - 19.9%, N = 103) compared to generally non-uniform countries/regions (median: 19.5%, interquartile range: 16.4% - 23.5%, N = 32) (z = 3.04, p = 0.002). (N = countries, regions and studies represented; n = sample size or participants included). Conclusion : School uniforms are associated with greater gender inequalities in physical activity in primary school settings and in high-income countries. Our population-level findings warrant testing using individual-level data across contexts.

Reporting of intervention research has been inadequate for many years. The development and promotion of freely available checklists aims to address this problem by providing researchers with a list of items that require reporting to enable study interpretation and replication. In this commentary, we present evidence from a recent systematic review of 51 randomised controlled trials published 2015-2020 that inadequate intervention reporting remains a widespread issue and that checklists are not being used to describe all intervention components. In 2022, we assessed the submission guidelines of 33 journals that published articles included in our review and found that just one at the time encouraged the use of reporting checklists for all intervention components. To drive progress, we contacted the editors of the other 32 journals and requested that they update their submission guidelines in response. We conclude by highlighting the waste associated with current practices and encourage journals from all fields to urgently review their submission guidelines. Only through collective action can we build an evidence base that is fit for purpose.

Introduction: To date, systematic reviews including research published up until 2015, which describe staff training delivered in school-based interventions targeting changes in students’ activity behaviour, have consistently reported insufficient information about staff training. Complete descriptions of the behaviour change techniques that target teachers (and other actors) involved in implementation are crucial to interpret student outcomes and replicate effective interventions. Given relevant guidelines to promote complete reporting of interventions were published in 2014, the quality may have improved in recent years. We therefore critically appraised the evidence around quality of reporting on staff training programmes in school-based activity behaviour interventions, published 2015-2020. Methods: We systematically searched seven databases from January 2015 to May 2020 for randomised controlled trials of teacher-led school-based activity behaviour interventions that included any form of staff training. Pilot, feasibility and small-scale (≤100 students) trials were excluded. We searched for information about training from any study output identified (e.g. protocols, process evaluations, outcome evaluations, trial registries, study websites). We used the Template for Intervention Description and Replication (TiDieR) checklist, a reporting guideline of the minimum set of items considered essential for intervention description and replication, to determine complete reporting. Results: We identified 183 study outputs reporting on 53 training programmes delivered within 51 randomised controlled trials (median student sample size: 779; interquartile range: 361-1397). Complete information, in which all TiDieR items were reported, was only available for one training programme (<2% of training programmes delivered). Intervention descriptions largely focused on intervention(s) delivered to students. While some study authors reported using checklists to describe student-targeted interventions; none reported using checklists to describe those aimed at teachers or other implementation actors (e.g. parents). As of May 2022, of the journals that published articles included in our review (n=33), only one explicitly requested that trial authors submit reporting checklists for all intervention components (though some did request at least one reporting checklist was submitted). Discussion: Our findings suggests that poor reporting of activity behaviour interventions in school-based research remains a widespread issue, despite the availability of guidelines to promote complete reporting. Collective action is required to facilitate much-needed progress in the field. We describe our efforts to change reporting practices, including contacting journal editors, calling on them to revise their submission guidelines. Registration: PROSPERO 2020 CRD42020180624 Impact and applications to the field: Complete descriptions of all interventions under evaluation is needed to build an evidence base that is fit for purpose to promote physical activity in schools. We report on the impact of contacting journal editors to drive important progress in reporting practices and intervention evaluation research. Conflict of interest statement: TH is the lead author of the TiDieR checklist guideline. EvS is an Associate Editor for the Journal of Physical Activity and Health, and was previously Member of the Editorial Board at IJBNPA. All other co-authors have no conflicts of interest of relevance to the submission of this abstract.

Background Evaluations of school-based activity behaviour interventions suggest limited effectiveness on students’ device-measured outcomes. Teacher-led implementation is common but the training provided is poorly understood and may affect implementation and student outcomes. We systematically reviewed staff training delivered within interventions and explored if specific features are associated with intervention fidelity and student activity behaviour outcomes. Methods We searched seven databases (January 2015–May 2020) for randomised controlled trials of teacher-led school-based activity behaviour interventions reporting on teacher fidelity and/or students’ device-measured activity behaviour. Pilot, feasibility and small-scale trials were excluded. Study authors were contacted if staff training was not described using all items from the Template for Intervention Description and Replication reporting guideline. Training programmes were coded using the Behaviour Change Technique (BCT) Taxonomy v1. The Effective Public Health Practice Project tool was used for quality assessment. Promise ratios were used to explore associations between BCTs and fidelity outcomes (e.g. % of intended sessions delivered). Differences between fidelity outcomes and other training features were explored using chi-square and Wilcoxon rank-sum tests. Random-effects meta-regressions were performed to explore associations between training features and changes in students’ activity behaviour. Results We identified 68 articles reporting on 53 eligible training programmes and found evidence that 37 unique teacher-targeted BCTs have been used (mean per programme = 5.1 BCTs; standard deviation = 3.2). The only frequently identified BCTs were ‘Instruction on how to perform the behaviour’ (identified in 98.1% of programmes) and ‘Social support (unspecified)’ (50.9%). We found moderate/high fidelity studies were significantly more likely to include shorter (≤6 months) and theory-informed programmes than low fidelity studies, and 19 BCTs were independently associated with moderate/high fidelity outcomes. Programmes that used more BCTs (estimated increase per additional BCT, d : 0.18; 95% CI: 0.05, 0.31) and BCTs ‘Action planning’ (1.40; 0.70, 2.10) and ‘Feedback on the behaviour’ (1.19; 0.36, 2.02) were independently associated with positive physical activity outcomes ( N = 15). No training features associated with sedentary behaviour were identified ( N = 11). Conclusions Few evidence-based BCTs have been used to promote sustained behaviour change amongst teachers in school-based activity behaviour interventions. Our findings provide insights into why interventions may be failing to effect student outcomes. Trial registration PROSPERO registration number: CRD42020180624

Background Human papillomavirus (HPV)-based cervical screening is now replacing cytology-based screening in several countries and many women in screening programmes will consequently receive HPV-positive results. Because of the sexually transmitted nature of HPV, receiving an HPV-positive result may raise questions about disclosing the infection to a sexual partner.Objective To review the quantitative and qualitative literature exploring women's concerns about disclosing a high-risk cervical HPV infection to a sexual partner.Methods We searched MEDLINE, PsycINFO, CINAHL Plus, Web of Science and EMBASE for studies reporting at least one disclosure-related outcome among women with high-risk HPV. We also searched the grey literature and carried out forward/backward citation searches. A narrative synthesis for quantitative studies and a thematic synthesis for qualitative studies were conducted.Results Thirteen articles met the inclusion criteria (12 qualitative, 1 quantitative). In the quantitative study, 60% of HPV-positive women felt disclosing an HPV result was 'risky'. Concerns about disclosing HPV to a sexual partner were influenced by the stigma that is associated with having an STI and uncertainty about how their partner would respond. Women questioned how, when and to whom they should disclose their HPV-positive status.Conclusions The studies included in this review provide rich information about the range of concerns women have, the reasons for these concerns, and the questions women have about disclosing HPV to sexual partners. As studies were predominantly qualitative, the prevalence of concerns is unclear.

This paper advances our understanding of how schools can become change agents capable of transforming local practice to address the challenges arising from the Covid-19 pandemic. It presents a novel application of cultural-historical activity theory to reinterpret evidence on widespread learning loss and increasing educational inequities resulting from the pandemic, and to identify scalable transformative learning opportunities through reframing the crisis as a double stimulation. By reviewing evidence of the emerging educational landscape, we first develop a picture of the new ‘problem space’ upon which schools must act. We develop a problem space map to serve as the first stimulus to articulate local challenges. Integrating this problem space with research on professional change, we identify conceptual tools to capture learning gaps and implement pedagogic interventions at scale, in order to enhance schools’ agency in directly addressing the crisis. These tools can act as the second stimulus, enabling educators to address local challenges. We conclude by discussing the Covid-19 educational crisis as a unique stimulus for professional learning and outline the potential for durable shifts in educational thinking and practice beyond the pandemic. We argue that this unprecedented historic disruption can be harnessed as a transformative professional learning opportunity. In particular, we consider how research on professional change offers local, scalable interventions and tools that can support educators in preventing the new insights from ‘slipping away’ post-pandemic. Utilising the notions of boundaries and tool-mediated professional change, we examine the ways in which this disruption generates opportunities to envision alternative futures for equitable learning in school.

This review aims to systematically identify and synthesize qualitative data on adolescents' experiences of the barriers to and facilitators of physical activity to understand whether these differ by socioeconomic position. Multiple databases (MEDLINE, Web of Science Core Collection, PsycINFO, and ERIC) were searched in August 2020. Duplicate title/abstract and full text screening was conducted. Studies were included if they reported qualitative data collected from adolescents (aged 10-19), a measure of socioeconomic position and focused on physical activity. Studies not published in English or published before 2000 were excluded. Relevant data were extracted and methodological quality assessed (in duplicate). Data were analyzed using Thomas and Harden's methods for the thematic synthesis. Four analytical themes emerged from the 25 included studies: (1) social support, (2) accessibility and the environment, (3) other behaviors and health, and (4) gendered experiences. These themes appeared across socioeconomic groups; however, their narratives varied significantly. For example, provision and access to local facilities was discussed as a facilitator to middle and high socioeconomic adolescents, but was a barrier to low socioeconomic adolescents. These findings can be used to inform how different socioeconomic groups may benefit from, or be disadvantaged by, current interventions.

Background Human papillomavirus (HPV)-based cervical screening is now replacing cytology-based screening in several countries and many women in screening programmes will consequently receive HPV-positive results. Because of the sexually transmitted nature of HPV, receiving an HPV-positive result may raise questions about disclosing the infection to a sexual partner. Objective To review the quantitative and qualitative literature exploring women’s concerns about disclosing a high-risk cervical HPV infection to a sexual partner. Methods We searched MEDLINE, PsycINFO, CINAHL Plus, Web of Science and EMBASE for studies reporting at least one disclosure-related outcome among women with high-risk HPV. We also searched the grey literature and carried out forward/backward citation searches. A narrative synthesis for quantitative studies and a thematic synthesis for qualitative studies were conducted. Results Thirteen articles met the inclusion criteria (12 qualitative, 1 quantitative). In the quantitative study, 60% of HPV-positive women felt disclosing an HPV result was ‘risky’. Concerns about disclosing HPV to a sexual partner were influenced by the stigma that is associated with having an STI and uncertainty about how their partner would respond. Women questioned how, when and to whom they should disclose their HPV-positive status. Conclusions The studies included in this review provide rich information about the range of concerns women have, the reasons for these concerns, and the questions women have about disclosing HPV to sexual partners. As studies were predominantly qualitative, the prevalence of concerns is unclear.

This study explored the effects of message framing on vaccine hesitancy for the antenatal whooping cough vaccine. The study also assessed whether the Theory of Planned Behaviour (TPB) constructs had any explanatory utility for vaccine intentions and behaviours in pregnant women. A between-subjects, cross-sectional design was employed. Participants (n = 282) were women who were pregnant (mean = 28 weeks, SD = 7.0), living in England and between 18 and 44 years of age. A self-report web-based survey was used to collect data. Participants were randomly assigned to read either (i) disease risk, (ii) myth busting, or (iii) control information before answering questions based on the TPB. No significant effects of message framing were found. Attitudes (Beta = 0.699; p < 0.001) and subjective norms (Beta = 0.262, p < 0.001) significantly predicted intention to vaccinate but perceived behavioural control did not. The TPB constructs accounted for 86% and 36% of the variance in vaccine intention and vaccine history respectively. Disease risk information did not influence vaccine acceptability in this sample of English pregnant women. The study offered preliminary evidence that interventions targeting constructs from the TPB may promote vaccine acceptability among pregnant women.

ObjectivesUptake of cervical screening among women aged 50–64 years is declining. Not feeling at risk because of current sexual behaviour is a reason some older women give for not being screened. We hypothesised that explaining the long interval between acquiring human papillomavirus (HPV) and developing cervical cancer would increase the relevance of screening in older women.MethodsWomen aged 50–64 years (n=597) who did not intend to go for screening were recruited through an online panel and randomised to one of three information conditions:cause only(basic information about HPV and cervical cancer),cause with basic timeline(also read a sentence describing the long interval between acquiring HPV and developing cervical cancer) andcause with explicit timeline(read the same as the timeline group alongside an explanation of what this means for older women). Perceived risk of cervical cancer, screening intention strength and understanding of HPV were assessed preinformation and postinformation exposure.ResultsInformation condition was significantly associated with risk perceptions and intention strength postintervention (F(2,593)=6.26, p=0.002 and F(2,593)=4.98, p=0.007 respectively). Women in thecause with explicit timelinecondition were more likely to increase their risk perceptions and intention strength compared withcause only(24% vs 9% and 25% vs 13% for risk perceptions and intention, respectively). In thecause with explicit timelinegroup, women with 4–10 lifetime partners had higher odds of increasing their perceived risk and intention strength postintervention compared with those with 0–1 partners (OR=2.27, 95% CI 1.01 to 5.12 and OR=3.20, 95% CI 1.34 to 7.67, respectively).ConclusionsProviding a clear explanation that decouples women’s perceived cervical cancer risk from their current sexual behaviour has the potential to increase perceived risk of cervical cancer and intentions to be screened among older women. Providing women with a clear cognitive representation of the aetiology of cervical cancer may be one approach to increasing screening uptake.

Background: School-based HPV vaccination in the UK will soon be extended to boys. Based on other countries' experience, uptake may initially be lower in boys than girls. We assessed HPV vaccine attitudes and decision-making in parents of boys and girls, to explore sex differences and inform public health messages. Methods: We carried out a cross-sectional population-based survey using home-based interviews in spring 2019. Participants were adults in England and Wales, with a child in school years 5-7 (aged 9-12 and eligible for HPV vaccination within 3 years). Measures included awareness of HPV and the vaccine, demographic factors, previous vaccine refusal and (after exposure to brief information) whether participants would allow their child to have the HPV vaccine (decided to vaccinate; decided not to vaccinate; undecided). We also assessed vaccine attitudes. Data were weighted to adjust for non-response. Multinomial logistic regression was used to explore predictors of deciding to (or not to) vaccinate compared with being undecided. Results: Among 1049 parents (weighted n = 1156), 55% were aware of HPV and the girls' vaccination programme, but only 23% had heard of plans to vaccinate boys. After information exposure, 62% said they would vaccinate their child, 10% would not, and 28% were undecided. Parents of girls were more willing to vaccinate than parents of boys (adjusted odds ratio: 1.80 (1.32-2.45)). Positive attitudes and HPV/vaccine awareness were significantly independently associated with deciding to vaccinate. Previous vaccine refusal for a child was the strongest predictor of not wanting the HPV vaccine. Conclusions: Our findings suggest a need for public health campaigns to raise awareness of plans to extend HPV vaccination to boys. Reassuringly only 10% of all parents were unwilling to vaccinate and our data suggest further information, including about safety and efficacy, may be important in supporting undecided parents to make the decision to vaccinate. (C) 2019 The Authors. Published by Elsevier Ltd.

Objectives Many countries are implementing human papillomavirus (HPV)-based cervical screening due to the higher sensitivity of the test compared with cytology. As HPV is sexually transmitted, there may be psychosexual consequences of testing positive for the virus. We aimed to review the literature exploring the psychosexual impact of testing positive for high-risk cervical HPV. Methods MEDLINE, PsycINFO, CINAHL Plus, Web of Science, and EMBASE were searched with no date limits. We also searched the grey literature, reference lists of included articles and carried out forward citation searching. Eligible studies reported at least one psychosexual outcome among HPV-positive women. Qualitative and quantitative papers were included. We extracted data using a standardised form and carried out a quality assessment for each article. We conducted a narrative synthesis for quantitative studies and a thematic synthesis for qualitative studies. Results Twenty-five articles were included. Quantitative study designs were diverse making it difficult to determine the impact that an HPV positive result would have in the context of routine screening. The qualitative literature suggested that psychosexual concerns cover a broad range of aspects relating to women's current and past relationships, both interpersonal and sexual. Conclusions The psychosexual impact of testing positive for high-risk cervical HPV is unclear. This review highlights the need for further research in the context of HPV-based cervical screening. As primary HPV testing is introduced more widely, it is important to understand women's responses to testing HPV positive in the cancer screening context to minimise any adverse psychosexual impact.

This study explored knowledge of cervical cancer risk factors among cervical screening non-participants in Great Britain. The aim was to identify knowledge gaps that could be targeted in screening information materials or public education campaigns. We used a cross-sectional design to survey women aged 25 to 64 years living in Great Britain, identified as cervical screening non-participants through self-report questions. Data were collected via a household survey. Survey questions measured awareness of risk factors for cervical cancer and sociodemographic factors. Screening non-participants were included in the study (n = 793) and classified into non-participant groups based on the Precaution Adoption Process Model. Across the sample, 57% of participants identified 'not going for regular smear tests' as a risk factor for cervical cancer. Women who intended to be screened were more likely to identify this risk factor than other non-participant groups (OR = 2.13, 95% CI: 1.51-2.99). Women age 55-64 years (OR = 0.60, 95% CI: 0.39-0.93) and women from non-white ethnic backgrounds (OR = 0.70, 95% CI: 0.52-0.94) were less likely to recognise this risk factor. Recognition was lower for 'infection with human papillomavirus' (41%). Just over half the sample were aware that screening non-attendance is associated with increased cervical cancer risk, suggesting that non-attendance at screening is not always based on an accurate understanding of the offer. Overall, non-participants are poorly informed about cervical cancer risk factors and further work is needed to ensure that women are making informed choices about (non-) participation.

Objective: To assess the feasibility of offering women who are overdue for cervical screening the use of a smartphone app to book their appointment. Methods: Women who were at least six months overdue for cervical screening in three general practice surgeries in a deprived East London borough were identified from practice records. Staff sent batches of text messages informing women that they were overdue for screening, and inviting them to download an app to book their appointment. Results: Across the three practices, 2632 eligible women were identified. Valid mobile phone numbers were available for 1465 women. One woman had opted out of receiving text messages, so messages were sent to 1464 women. Of these, 158 (11%) booked a screening appointment within five months. The majority of these women booked without using the app (72%; 113/158); just over a quarter booked via the app (28%; 45/158). Conclusions: Just over 10% of cervical screening non-attenders booked an appointment in response to a text message with a link to a downloadable app; however, only one in four of these women booked using the app. This suggests that the text message reminder was likely to have been the key 'active ingredient' for most women, rather than the app itself. Future research could explore the optimal message for a text reminder in this context and evaluate the inclusion of a link to existing online booking systems.

ObjectivesMany women who do not attend screening intend to go, but do not get around to booking an appointment. Qualitative work suggests that these ‘intenders’ face more practical barriers to screening than women who are up-to-date (‘maintainers’). This study explored practical barriers to booking a screening appointment and preferences for alternative invitation and booking methods that might overcome these barriers.DesignA cross-sectional survey was employed.SettingGreat Britain.ParticipantsWomen aged 25–64, living in Great Britain who intended to be screened but were overdue (‘intenders’, n=255) and women who were up-to-date with screening (‘maintainers’, n=359).Results‘Intenders’ reported slightly more barriers than ‘maintainers’ overall (mean=1.36 vs 1.06, t=3.03, p<0.01) and were more likely to think they might forget to book an appointment (OR=2.87, 95% CI: 2.01 to 4.09). Over half of women said they would book on a website using a smartphone (62%), a computer (58%) or via an app (52%). Older women and women from lower social grades were less likely to say they would use online booking methods (all ps <0.05). Women who reported two or more barriers were more likely to say they would use online booking than women who reported none (ps <0.01).ConclusionsWomen who are overdue for screening face practical barriers to booking appointments. Future interventions may assess the efficacy of changing the architecture of the invitation and booking system. This may help women overcome logistical barriers to participation and increase coverage for cervical screening.

An increasing number of researchers are capitalising on widespread smartphone ownership to conduct a range of studies. Within the context of health-based research, this article explores several factors that should be considered when undertaking research using smartphone apps. The current research landscape is discussed and practical tips and resources are provided for app enthusiasts.