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Peer-reviewedCC BY 4.0JAMA Network Open

A Policy-Based Intervention for Physical Activity and Screen Time in Childcare Outside School Hours

  • Carol Maher1
  • Luke Wolfenden2,3
  • Nicole Nathan2,3
  • Jacinta Brinsley1
  • Ty Ferguson1
  • Rachel Curtis1
  • Rosa Virgara1
  • Alyce Barnes2,3
  • Svetlana Bogomolova4
  • Kylie Brannelly5
  • Dylan P. Cliff6
  • Perry Campbell7
11 more authors
  • Adrian Esterman1
  • Lucy K. Lewis8
  • Rachel K. Milte8
  • Michael Noetel9
  • Anthony D. Okely10
  • Mandy Richardson11
  • Richard R. Rosenkranz12
  • Natasha Schranz13
  • Rebecca M. Stanley14
  • R. Glenn Weaver15
  • Hayley Christian16,17
17 affiliations
  1. 1Alliance for Research in Exercise, Nutrition and Activity (ARENA), Adelaide University, South Australia, Australia
  2. 2School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
  3. 3National Centre of Implementation Science, The University of Newcastle, Newcastle, New South Wales, Australia
  4. 4Centre for Social Impact, Flinders Business School, Flinders University, Adelaide, South Australia, Australia
  5. 5Queensland Children’s Activities Network, Woodend, Queensland, Australia
  6. 6Early Start, School of Education, University of Wollongong, Wollongong, New South Wales, Australia
  7. 7Australian Children’s Education and Care Quality Authority (ACECQA), Darlinghurst, New South Wales, Australia
  8. 8Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
  9. 9School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
  10. 10School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
  11. 11Department for Education, Adelaide, South Australia, Australia
  12. 12Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas
  13. 13Preventive Health SA, Adelaide, South Australia, Australia
  14. 14School of Social Sciences, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
  15. 15Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia
  16. 16The Kids Research Institute Australia, The University of Western Australia, Perth, Western Australia, Australia
  17. 17School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Abstract

Importance: Extended education programs reach tens of millions of children globally during discretionary hours when physical activity competes with screen use, yet scalable strategies to improve movement behaviors are limited.

Objective: To evaluate the effectiveness of Activated Outside School Hours Care (OSHC), a policy-based intervention to improve physical activity and screen time practices in extended education settings.

Design, Setting, and Participants: This cluster randomized clinical trial was conducted in Australia’s system of organized before- and after-school care in 3 Australian states (South Australia, New South Wales, and Western Australia) between August 1, 2022, and December 31, 2024, with assessments at baseline, 3 months, and 12 months.

Intervention: Activated OSHC is a web-based intervention offering voluntary accreditation to services aligning their policies with national physical activity and screen time guidelines through staff training. Services were randomized 1:1 to intervention or usual practice, in which services continued their typical programming.

Main Outcomes and Measures: The primary outcome was service-level adherence to OSHC sector physical activity and screen time guidelines. Secondary outcomes included staff physical activity–enabling behaviors, children’s moderate-to-vigorous physical activity and recreational screen time, and availability of physical activity equipment, assessed through direct observation. Intention-to-treat and per-protocol analyses were performed.

Results: Of 197 services (101 in the intervention group and 96 in the control group), 182 (92%; 90 in the intervention group and 92 in the control group) completed the 12-month follow-up. Of the 101 services in the intervention group, 48 (48%) achieved accreditation within 12 months. Intention-to-treat analyses showed no significant effects for guideline adherence or children’s activity levels. However, the services in the intervention group demonstrated greater staff physical activity–promoting behaviors during before-school care (odds ratio [OR], 1.72; 95% CI, 1.27-2.33) and greater availability of physical activity equipment during before- (OR, 1.21; 95% CI, 1.00-1.46) and after-school care (OR, 1.16; 95% CI, 1.04-1.30). In per-protocol analyses, accredited services were more likely than controls to meet all guidelines (OR, 7.35; 95% CI, 1.39-38.86), with improved after-school screen time adherence (OR, 5.63; 95% CI, 1.16-27.22). In per-protocol analyses, accredited services showed greater staff physical activity–enabling behaviors (OR, 3.00; 95% CI, 2.10-4.28), and children engaged in more physical activity during before-school care (incidence rate ratio, 1.23; 95% CI, 1.05-1.43) compared with controls.

Conclusions and Relevance: This randomized clinical trial found few population-level changes in intention-to-treat analyses. However, services achieving accreditation demonstrated consistent improvements in guideline adherence, staff behaviors relating to physical activity, and children’s physical activity. The intervention was effective when implemented, but limited uptake constrained population-level impact. The accreditation model is viable for practice improvement, but policy- or system-level strategies may be needed to drive widespread adoption.

Trial Registration: Australian New Zealand Clinical Trials Registry Identifier: ACTRN12622000393752

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Cite

BibTeXRIS
BibTeX
@article{maher2026policybased,
  title = {{A Policy-Based Intervention for Physical Activity and Screen Time in Childcare Outside School Hours}},
  author = {Carol Maher and Luke Wolfenden and Nicole Nathan and Jacinta Brinsley and Ty Ferguson and Rachel Curtis and Rosa Virgara and Alyce Barnes and Svetlana Bogomolova and Kylie Brannelly and Dylan P. Cliff and Perry Campbell and Adrian Esterman and Lucy K. Lewis and Rachel K. Milte and Michael Noetel and Anthony D. Okely and Mandy Richardson and Richard R. Rosenkranz and Natasha Schranz and Rebecca M. Stanley and R. Glenn Weaver and Hayley Christian},
  journal = {JAMA Network Open},
  year = {2026},
  month = oct,
  doi = {10.1001/jamanetworkopen.2026.36741},
  url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854833},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - A Policy-Based Intervention for Physical Activity and Screen Time in Childcare Outside School Hours
AU  - Carol Maher
AU  - Luke Wolfenden
AU  - Nicole Nathan
AU  - Jacinta Brinsley
AU  - Ty Ferguson
AU  - Rachel Curtis
AU  - Rosa Virgara
AU  - Alyce Barnes
AU  - Svetlana Bogomolova
AU  - Kylie Brannelly
AU  - Dylan P. Cliff
AU  - Perry Campbell
AU  - Adrian Esterman
AU  - Lucy K. Lewis
AU  - Rachel K. Milte
AU  - Michael Noetel
AU  - Anthony D. Okely
AU  - Mandy Richardson
AU  - Richard R. Rosenkranz
AU  - Natasha Schranz
AU  - Rebecca M. Stanley
AU  - R. Glenn Weaver
AU  - Hayley Christian
PY  - 2026
DA  - 2026/10/05
JO  - JAMA Network Open
DO  - 10.1001/jamanetworkopen.2026.36741
UR  - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854833
AB  - Importance: Extended education programs reach tens of millions of children globally during discretionary hours when physical activity competes with screen use, yet scalable strategies to improve movement behaviors are limited.  Objective: To evaluate the effectiveness of Activated Outside School Hours Care (OSHC), a policy-based intervention to improve physical activity and screen time practices in extended education settings.  Design, Setting, and Participants: This cluster randomized clinical trial was conducted in Australia’s system of organized before- and after-school care in 3 Australian states (South Australia, New South Wales, and Western Australia) between August 1, 2022, and December 31, 2024, with assessments at baseline, 3 months, and 12 months.  Intervention: Activated OSHC is a web-based intervention offering voluntary accreditation to services aligning their policies with national physical activity and screen time guidelines through staff training. Services were randomized 1:1 to intervention or usual practice, in which services continued their typical programming.  Main Outcomes and Measures: The primary outcome was service-level adherence to OSHC sector physical activity and screen time guidelines. Secondary outcomes included staff physical activity–enabling behaviors, children’s moderate-to-vigorous physical activity and recreational screen time, and availability of physical activity equipment, assessed through direct observation. Intention-to-treat and per-protocol analyses were performed.  Results: Of 197 services (101 in the intervention group and 96 in the control group), 182 (92%; 90 in the intervention group and 92 in the control group) completed the 12-month follow-up. Of the 101 services in the intervention group, 48 (48%) achieved accreditation within 12 months. Intention-to-treat analyses showed no significant effects for guideline adherence or children’s activity levels. However, the services in the intervention group demonstrated greater staff physical activity–promoting behaviors during before-school care (odds ratio [OR], 1.72; 95% CI, 1.27-2.33) and greater availability of physical activity equipment during before- (OR, 1.21; 95% CI, 1.00-1.46) and after-school care (OR, 1.16; 95% CI, 1.04-1.30). In per-protocol analyses, accredited services were more likely than controls to meet all guidelines (OR, 7.35; 95% CI, 1.39-38.86), with improved after-school screen time adherence (OR, 5.63; 95% CI, 1.16-27.22). In per-protocol analyses, accredited services showed greater staff physical activity–enabling behaviors (OR, 3.00; 95% CI, 2.10-4.28), and children engaged in more physical activity during before-school care (incidence rate ratio, 1.23; 95% CI, 1.05-1.43) compared with controls.  Conclusions and Relevance: This randomized clinical trial found few population-level changes in intention-to-treat analyses. However, services achieving accreditation demonstrated consistent improvements in guideline adherence, staff behaviors relating to physical activity, and children’s physical activity. The intervention was effective when implemented, but limited uptake constrained population-level impact. The accreditation model is viable for practice improvement, but policy- or system-level strategies may be needed to drive widespread adoption.  Trial Registration: Australian New Zealand Clinical Trials Registry Identifier: ACTRN12622000393752
SN  - 2574-3805
ER  -