Active-Prem: Exercise Participation in Early Childhood for Children Born Very Preterm.

Brief name: Active-Prem group The Active-Prem intervention comprises six key steps (each described using the TIDiER format) Step 1) Physical activity participation goal setting Why? (rationale): Goal setting is recognised as an important and effective strategy for behaviour change, including in physical activity participation interventions for children. What: Physical activity participation goals will be set using the Canadian Occupational Performance Measure (COPM). Who provided: Physiotherapist or Occupational Therapist. How (mode of delivery): Goal setting will take place using a motivational interview conversation format with a healthcare professional (member of the study team) and a parent/caregiver. Goal setting will take approximately 20-40 minutes to complete. Where: Video conferencing or phone call. When and how much: During the baseline assessment period. Note: this step is completed by both intervention and control groups. Tailoring: Individualised goal-setting. Step 2) Active Start Active Prems parent program Why? (rationale): The parent program is designed to address key barriers and facilitators to children born preterm’s participation in physical activity identified from previous research and prioritised through the co-design process, What: This co-designed program aims to support parents to better support their child’s participation in community based physical activity. The program consists of self-directed learning and peer support. Self-Directed Learning includes knowledge content, goal setting and suggested activities. Topics covered in this content include: What is Active-Prem?, Benefits of physical activity, modelling physical activity at home, communicating about your child in recreational physical activity settings, advocating for your child, and addressing common worries and concerns. Peer support includes interactive online sessions (delivered via video conferencing software) and discussion boards (on program website). The online interactive sessions are designed to provide a space for parents to ask questions and problem solve, as well as learn about a particular topic. Who provided: The program content is written/presented by experts in each content area: parents of children born very preterm, physical activity coaches, physiotherapists, occupational therapists, and psychologists. How (mode of delivery): Website (Self-directed content and discussion board) and online video conferencing (online interactive sessions). There are 4 modules of self-directed content, each to be completed individually and by a specific time point (e.g. module 2 should be completed before choosing an activity). There is 1 optional module (addressing common concerns) which parents can access anytime if/when it is relevant for them. The Peer support sessions are group-based to provide a peer support system. Where: The parent program will be delivered online to promote accessibility and scalability. When and how much: The parent program will start after randomisation into the intervention group and continue throughout the intervention period until the completion of the term of physical activity (step 6). The Self-directed Learning consists of approximately 4hrs of content, presented as 4 modules. Modules 1-3 (3hrs) are designed to be completed prior to the Introductory Session, while module 4(1hr) is designed to be completed during the term of activity. An optional module (common concerns; 1hr) will be available throughout the whole program. Peer support will be provided through one ‘Welcome to Active-Prem’ online session (1 hour; compulsory) and two subsequent check-in sessions during the term of activity (approximately 60 minutes; optional). An online discussion forum will provide additional means of connected and peer support. Tailoring: The module addressing common concerns is optional, and available throughout the program for parents to access if and when they would like to. Most aspects of the Peer Support are optional. Parents can choose whether to participate in the discussion board conversations or join sessions during the term of activity. Step 3) Matching Why? (rationale): Our previous research indicates choice of activity was an important component for acceptable physical activity interventions. Furthermore, children are more likely to engage and participate in physical activities which they enjoy- emphasizing the importance of being able to choose something they believe will be fun. What: Children will be individually matched with a coach in their local community. Matched coaches will need to be eligible and willing to participate in Active-Prem as a coach. Who provided: Matching will be facilitated by a member of our research team. How (mode of delivery): Our research team will recruit coaches on a 1:1 basis. Where: n/a When and how much: Matching occurs prior to term of activity. Tailoring: Matching will be based on the children’s and family’s physical activity preference. Step 4) Coaching Essentials: Premature Children in Sport Why? (rationale): Lack of knowledge of preterm birth and skills for including children with disabilities have been identified as significant barriers to participation in physical activity for children born very preterm. What: The overall goal of this program is to improve coaches’ knowledge, skills, confidence to better include preschool-aged children born very preterm in their classes. The program includes Self-Directed Learning and optional Coach Support Workshops. Self-Directed Learning includes knowledge content, tasks and assessments. Topics covered in this content include: Understanding prematurity, Understanding key outcomes for children born prematurely, Supporting physical skill development, Supporting social, emotional & behavioural skill development, Developing goals & lesson objectives, and Communication with the team around the child. Coach Support Workshops are designed to provide a supportive space to problem-solve challenges across the Coaching Essentials course and/or Active Prem project, and to facilitate a community of practice, where coaches already in the program can provide mentoring opportunities for less experienced coaches. Who provided: The program content written/presented by experts in each content area: parents of children born very preterm, physical activity coaches, physiotherapists, occupational therapists, and psychologists. How (mode of delivery): The program will be delivered online; self directed learning will be delivered via an online educational platform (FutureLearn) and optional coach support workshops will be delivered via online video conferencing. Where: The intervention will be delivered online to promote accessibility and scalability. When and how much: The Coaching essentials: Premature children in sport course will be open to individual coaches from enrolment in the study until the conclusion of the matched child’s term of activity. Coaches recruited into the Active-Prem program will need to complete the online co-designed Coaching Essentials: Premature Children in Sport program prior to the commencement of the term of physical activity. The Self-directed Learning is 8hrs of content presented in four 2hr modules. Coaches complete this content at their own pace. The Coach Support Workshops will be 1hr long and are offered 6-8 times across the year at a variety of times to suit coaches’ schedules. Tailoring: Self-directed Learning is designed to be completed within approximately 4 weeks. However, this duration can be flexible based on individual preferences and circumstances. Coach Support Workshops are optional and coaches can choose to attend as many of them as they feel they need (titrating their own support). Step 5) Introductory session Why? (rationale): The introductory session has been included to address a number of perceived barriers to successful inclusion of children born very preterm in community based physical activities. These barriers include coach knowledge of individual children’s support needs and strengths, parent knowledge of expectations of the activity and how they can best prepare their child. What: Children and parents will attend an introductory session with their matched coach. This session will allow parents and children to meet the coach, discuss the child’s individual support needs and allow the child and family to become familiar with the environment and activity. The Active Start Active Prems parent program includes information and tasks to prepare for the introductory session. Likewise, the Coaching Essentials: Premature Children in Sport program contains information and activities (including planning the session) that must be completed prior to the introductory session. Who provided: Delivered by the participating matched coach. How (mode of delivery): Face to face. Children and parent/carer with their matched coach. Where: At the location of their chosen physical activity (e.g. at the sports club). When and how much: This session will occur prior to step 6. This session will be approx. 60 minutes in duration; and includes ‘getting to know you’ time, and tailored introduction to foundational skills of activity. Tailoring: Introductory Sessions will be individualised depending on the needs and preferences of families/coaches. If more than one family enrolled in Active-Prem is matched to the same coach, the introductory session may be delivered in a group format. Step 6) Term of physical activity Why? (rationale): Integrating the Active-Prem intervention into already existing physical activity classes in the local community enhances the likelihood that improved physical activity participation will be sustainable for children and families. Furthermore, this intervention approach is more likely to be implementable and scalable (if the intervention is effective) through embedding Active-Prem into local communities. This approach has been successfully trialled in a feasibility study using dance classes. What: Children will attend one preschool term of their chosen activity facilitated by their matched coach. Children will be integrated into publicly available physical activity classes. One term of the activity will be subsidized by the study to minimise financial burden. Who provided: Coach who has completed the Coaching Essentials: Premature Children in Sport program. How (mode of delivery): Face to face group physical activity class. Where: At the location of their chosen physical activity (e.g. at the sports club). When and how much: Once per week for the duration of a preschool term. Preschool terms are usually 8-10 weeks in length. Tailoring: Families may choose to continue the activity (at their own cost) after the study has concluded.