MY DAILY MOVES Determinants and measurement of movement behaviors from the child-perspective

Background The majority of children around the world do not meet the physical activity guidelines, spend too much time in sedentary behavior, and children’s sleep duration has declined over the past century. Importantly, sufficient physical activity and sleep are associated with many health benefits. Accurate measurement instruments are necessary to measure these behaviors, e.g. questionnaires, as they can provide additional information on the context of children’s behavior, e.g. what type of activities children engage in. Insight into the levels and contextual information of children’s 24-hour movement behaviors is important for the development of interventions targeting these behaviors, e.g. the types of activities that should be stimulated and locations that facilitate or limit physical activity. Moreover, knowledge on the most important determinants of these behaviors is also necessary for the development of interventions. Especially the perspectives of the key population, the children themselves, can provide valuable insights as they are the experts of their own behavior. Aims 1) Co-create and evaluate a 24-hour movement behavior tool, including physical activity, sedentary behavior, and sleep, for and together with 9-12-year- old children (MyDailyMoves) 2) Examine potential determinants of children’s sedentary behavior from the perspectives of children and parents and to examine potential determinants of the activity-friendliness of the environment from the adolescent perspective Co-creation of MyDailyMoves The co-creation process of MyDailyMoves started with summarizing the measurement properties of existing questionnaires measuring sedentary behavior (chapter 2) and physical activity (chapter 3) in children in two systematic reviews. Based on the findings of these reviews, the format of MyDailyMoves was established, i.e. the Greek version of the 3DPARecord was the only physical activity questionnaire with acceptable validity, therefore we used a similar format for MyDailyMoves. The format included a timeline and different time segments, which might help the children to more accurately report their activities of the previous day. The next steps of the co-creation (chapter 4) included photovoice and concept mapping sessions in which children indicated important physical activity categories: playing inside, playing outside, sports, hobbies, chores, personal care, transport, and others. Based on the literature, two additional sedentary behavior categories were identified, i.e. schoolwork and screen time, and five domains for sleep, i.e. sleep duration, efficiency, timing, quality, and daytime sleepiness. All physical activity and sedentary behavior categories were added to MyDailyMoves as activities that could be placed on the timeline. Subsequently, questions covering above-mentioned sleep domains were added to MyDailyMoves. The content validity of the first version of MyDailyMoves was examined in separate focus groups with children and researchers (chapter 4). Based on the focus groups the activity category ‘eating’ was added, and an explanatory video was created. Unfortunately, due to the COVID-19 pandemic the construct validity and test-retest reliability study of MyDailyMoves was postponed and is therefore not part of this thesis. Potential determinants of children’s movement behaviors Adolescent-perceived determinants of an activity-friendly environment were examined by conducting concept mapping meetings with secondary school students (chapter 5), aged 13-17 years old. Across all groups, 23 unique potential determinants of an activity-friendly environment were identified, which could be categorized in four domains: 1) physical characteristics, 2) social characteristics, 3) economic characteristics, and 4) motivational characteristics. Potential determinants of children’s sedentary behavior were examined by conducting concept mapping meetings with 11–13-year-old children and parents (chapter 6). Children identified eight to ten potential determinants, and parents identified six to seven potential determinants. Particularly determinants in the physical and the social/cultural environment were rated as most important both by children and parents, e.g. ‘Sitting because it is the norm (I have to)’ and ‘Sitting because I can work/play better that way’.