An Australian trial tests whether staff training and voluntary accreditation can change how before- and after-school care services manage active play and recreational screens.
Study: A Policy-Based Intervention for Physical Activity and Screen Time in Childcare Outside School Hours. Image Credit: Natalia Deriabina
In a recent study published in the journal JAMA Network Open, researchers examined the effectiveness of a policy-based intervention, the Activated Outside School Hours Care (OSHC) program, to improve recreational screen time management and physical activity provision in childcare.
Higher recreational screen time and inadequate physical activity are associated with poor social, physical, and mental health outcomes in children. School-based interventions have produced mixed results, highlighting the need for strategies that reach large numbers of children outside school hours. In Australia, nearly one in four primary school children attends OSHC every week, gaining access to physical activity.
The OSHC sector in Australia co-developed service-level guidelines for screen time and physical activity. The Activated OSHC program was co-designed to support services in implementing national guidelines for screen time and physical activity through a systems-based approach. This program aims to embed guideline-aligned practices into the service workforce, structures, and policies rather than target children or families.
About the study
This cluster-randomized effectiveness–implementation trial was conducted between August 2022 and December 2024. The study enrolled OSHC services from three Australian states, Western Australia, South Australia, and New South Wales.
Eligible services provided before- and after-school care and enrolled at least 10 children daily. Services were randomized to the intervention or control group. Intervention services accessed the web-based Activated OSHC program, allowing them to align their policies and practices with the OSHC screen time and physical activity guidelines.
Staff at intervention services could complete four online training modules. To gain accreditation, services had to submit their screen time and physical activity policy for evaluation against OSHC guidelines and have at least 50% of staff complete the online training. Control group services maintained their usual programs.
The study’s main outcome was service adherence to guidelines, defined as scheduling ≤ 30 minutes of recreational screen time and ≥ 45 minutes of physical activity opportunities before school, and ≤ 60 minutes of recreational screen time and ≥ 90 minutes of physical activity opportunities after school. Coordinators reported these schedules; children could choose among activities offered. Secondary outcomes were staff physical activity-promoting behaviors, physical activity equipment and screen availability, and children’s observed screen time and physical activity during OSHC sessions.
Outcomes were assessed at baseline, three months, and 12 months. Observers assessed one before-school and one after-school session at each time point. Analyses were conducted in intention-to-treat (ITT) and per-protocol (PP) samples. In ITT analyses, services were evaluated regardless of intervention uptake. In PP analyses, services that complied with the study protocol and met accreditation requirements were compared with those in the control group.
Findings
The study randomized 101 OSHC services to the intervention and 96 to the control group, collectively providing care for about 10,000 children. Of these, 182 services completed the study. Intervention and control services had comparable baseline characteristics. Regarding intervention uptake, 80% of intervention services registered on the program website. Among registered services, 423 staff completed all four training modules.
Forty-eight intervention services met both policy and training requirements, achieved accreditation within 12 months, and formed the PP intervention sample. ITT analyses found no statistically significant differences in the proportion of services meeting all guidelines at 3 or 12 months. PP analyses showed that accredited services in the intervention group improved adherence to all guidelines more than those in the control group, mainly through improved after-school screen time adherence. Neither physical activity scheduling guideline showed a significant intervention effect.
Further, in ITT analyses, staff in the intervention group showed significantly greater increases in physical activity-promoting behaviors than control staff during before-school care at 12 months. These behaviors included encouraging active play and leading active games. In PP analyses, accredited services showed greater increases in these behaviors at 3 and 12 months than control-group services. In the PP analysis, children in accredited services also showed higher moderate-to-vigorous physical activity (MVPA) during before-school care at 12 months than those in the control group. Neither analysis showed significant effects on children’s observed recreational screen time or after-school MVPA.
Post hoc analyses showed that, in ITT analyses, intervention group services had higher odds of screen availability during before-school care at three months than control group services, while accredited services had lower odds during after-school care at three and 12 months in PP analyses. Intervention services also had lower odds of physical activity equipment availability during before-school care at three months but higher odds than control group services during before- and after-school care at 12 months in both ITT and PP analyses.
Conclusions
In sum, ITT analyses revealed no significant effects of the Activated OSHC program on guideline adherence, children’s observed recreational screen time, or MVPA, but showed improvements in staff behaviors and equipment availability at 12 months. PP analyses linked accreditation to greater improvements in guideline adherence and children’s before-school MVPA.
Only 48% of intervention services achieved accreditation. The authors linked limited uptake to the lack of broader effects. The PP findings remain vulnerable to selection bias and confounding: accredited services were more often metropolitan, school-run, and larger than unaccredited intervention services. These comparisons cannot establish that accreditation caused the improvements.
The study did not follow individual children, observation sessions were limited, and the added screen-availability measure lacked independent validation.
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