Efficacy and Feasibility of the “Girls’ Recreational Activity Support Program Using Information Technology”: A Pilot Randomised Controlled Trial

doi:10.4236/ape.2012.21002

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Advances in Physical Education

2012. Vol.2, No.1, 10-16

Published Online February 2012 in SciRes (http://www.SciRP.org/journal/ape) http://dx.doi.org/10.4236/ape.2012.21002

Efficacy and Feasibility of the “Girls’ Recreational Activity

Support Program Using Information Technology”:

A Pilot Randomised Controlled Trial

Tracey L. Kelty, Philip J. Morgan, David R. Lubans

Faculty of Education and Arts, School of Education, Un i v ersity of Newcastle, Newcastle, Australia

Email: [email protected]

Received October 27th, 2011; revised November 30th, 2011; accepted December 10th, 2011

This study evaluated the effects of the Girls Recreational Activity Support Program Using Information

Technology (GRASP-IT) intervention. This group randomized controlled trial for older adolescent girls

(15 years+) combined face-to-face sessions with the use of a social network website, Facebook. Baseline

and follow-up measurements were taken for physical activity (5 day pedometer), height, weight, esti-

mated VO2max (Queen’s College Step Test), self-efficacy and peer social support. A process evaluation

was conducted and included questionnaires and focus groups interviews. Although, the intervention group

increased physical activity (mean 1878 steps/day) the difference between groups was not significant (p =

0.11, d = 0.8). BMI, fitness, self-efficacy and peer support all improved for the intervention group, how-

ever, changes were not statistically significant between groups. Although participants enjoyed the face-to-

face component, engagement with the on-line component was low. Future interventions that utilize Face-

book as a medium for increasing physical activity for adolescent girls require additional strategies to im-

prove engagement and compliance.

Keywords: Physical Activity; Adolescent Girls; Intervention; Internet

Introduction

It is well established that physical activity is positively asso-

ciated with improved health and wellbeing (Department of

Health and Ageing, 2004; US Department of Health and Hu-

man Services, 2000; WHO, 2004) and can prevent future life-

style diseases such as coronary heart disease, type 2 diabetes

and obesity (Biddle, Gorley, & Stensel, 2004; Booth et al.,

2006; Nader, Bradley, Houts, Richie, & O’Brien, 2008). Re-

search has highlighted the steady decline in physical activity

levels from childhood to adolescence, which is more pro-

nounced among girls (Jamner, Spruijt-Metz, Bassin, & Cooper,

2004; Nader et al., 2008; Pate, Dowda, O’Neill, & Ward, 2007)

The majority of Australian girls in the 14 - 16 year age group

are not meeting the recommended physical activity guidelines

(Department of Health and Ageing, 2008). In a recent study it

was noted that only 33 per cent of girls met the national re-

commendations for moderate to vigorous physical activity

(MVPA) on most days (i.e. at least 60 minutes of MVPA per

day) and similarly, only 16% to 26% of girls aged 14 - 16 years

met the recommended number of steps per day (i.e. between

11,000 and 12,000 steps) (Department of Health and Ageing,

2008; President’s Council on Physical Fitness and Sports, 2002;

Tudor-Locke & Bassett Jr., 2004).

Strategies to reduce the decline in activity among adolescent

girls and increase self-efficacy and motivation for an active

lifestyle are clearly warranted (Lubans, Foster, & Biddle, 2008;

van Sluijs, McMinn, & Griffin, 2007). Older adolescent girls

are particularly challenging to motivate and engage in physical

activity (Biddle & Wang, 2003) and the school is one setting

that has had varied success in increasing girls’ physical activity

(Dishman et al., 2004; Eliakim et al., 1996; Jamner et al., 2004;

Schneider et al., 2007; Stevens et al., 2005; van Sluijs et al.,

2007). It is important to note that the school setting plays a role

in the reduction of physical activity for older adolescent girls as

the transition from junior secondary school to senior secondary

school reduces the opportunities for many girls to be active at

school. Senior secondary students (Grades 11 - 12) in New

South Wales, Australia, currently move from compulsory

physical education lessons and sport in Grades 7 - 10, to op-

tional physical education and sport opportunities (New South

Wales Government, 2010). Therefore, without continued sup-

port to be active a reduction in physical activity for this cohort

is highly likely. Innovative strategies designed to combat the

decline in physical activity observed during adolescence are

needed and the internet has emerged as a promising strategy for

promoting physical activity in youth populations (Norman et al.,

2007). Notably, the use of social network sites in the world is

increaseing with the most popular sites being Facebook and

MySpace (ACM SIGCOMM Conference, 2008; Kazeniac,

2010; Thelwall, 2008), and these may be particularly appealing

for adolescent girls. Given their popularity, online communica-

tion sites that utilize social networking are a potential tool that

could allow adolescent girls to engage with each other to pro-

vide support to be active. However, few interventions have

targeted older adolescent girls using the internet as a source of

social support to be active (Norman et al., 2007). Furthermore, to

the authors’ knowledge, no previous study has used a social net-

work site to promote physical activity in adolescent girls (van

Sluijs et al., 2007). The aim of this paper is to report the feasibility

and prelim inary o utcom es of th e GRASP-I T pilot study.

T. L. KELTY ET AL.

Method

Recruitment and Description of Sample

This study was a group randomized controlled trial (RCT)

and involved two secondary schools. A convenience sample of

five schools from New South Wales, Australia was approached

to take part in the pilot study. Schools were approached based

on similar drawing areas and the population of similar low/

medium socio-economic status. Two schools consented to par-

ticipate and were randomly allocated to intervention or control.

The study was open to all girls currently enrolled in Year 10

during 2009. Study participants were either intervention (n = 29)

or control (n = 23) and a mean age of 15.7 ± 1.5 years. The

protocol for this study was reviewed and approved by The

NSW State Education Research Approval Process (SERAP)

and the University of Newcastle Human Research Ethics

Committee (HREC) and each participant gave informed con-

sent to participate in the study. Baseline and 12-week follow-up

assessments were conducted (Tables 2 and 3).

The flow of participants through the study process is reported

in Figure 1.

Treatment Condi tions

The GRASP-IT intervention involved a 6-week school-based

physical activity program delivered during school sport fol-

lowed by a 6-week web-based program using Facebook outside

of school hours. The online component was completed in the

girls’ own time as use of the social network site was not per-

mitted during school hours. Gi rls at the control school continued

their existing school sport program. The GRASP-IT interven-

tion involved two distinct phases:

Analysed for primary outcome

Intervention (n = 10)Analysed for primary ou tcome

Control (n = 10)

August 2009

Control (n = 10)

Lost to follow u p (n = 5)

Reason: Pedometer log not returned

Augus t 2009

Interventio n (n = 14)

Lost to follow up (n = 7)

Reason: Pedometer log not returned

June to August 2009

12 week Inte rventionJune to August 2009

1 2 week school sport program

(n = 14)

May 2009

Interventio n (n = 21)

Com pleted baseline asse ssmen t

Excluded ( n = 8)

Reaso n: Pedo mete r log not retu rned

May 2009

Int ervention (n = 29)

May 2009 Recruited participants

Assessed fo r eligibility an d consent obtaine d

N = 52

Mar ch 2009

5 schools invitedMarch 2009

3 schools

ine li gible due to

sport day/ time

restrictions

March 2009

2 schools randomize d

May 2 009

Control (n = 14)

Completed baseline asses sment

Exclu ded (n = 9)

Rea so n: Pedometer lo g not returned

May 2009

Control (n = 23)

Ph as e 1 - Information session and

school program - 6 weeks (n= 26)

Phase 2 - Facebook component -

6 weeks (n= 8)

3 Month

Follow-Up

I nterv ention

Baselin e

Figure 1.

Participant flow diagram analyzed for primary outcome.

Phase one was a face-to-face program that included a 30 min-

ute information session followed by approximatel y 60 minutes o f

physical activity for six weeks delivered by a member of the

research team who is a qualified teacher. The intervention was

developed in reference to Bandura’s Social Cognitive Theory

(Bandura, 1986) and was designed to target social support and

self-efficacy as key mediators of physical activity behaviour

change (Lubans, Foster, & Biddle, 2008). The information ses-

sions detailed strategies to be active alone and with friends as

well as identification of exercise intensity necessary for improv-

ing fitness and strategies to increase physical activity (Depart-

ment of Health and Ageing, 2008). The practical physical activity

sessions were designed to enhance exercise self-efficacy and

provided girls with an opportunity to participate in fun, easily

accessible, recreational physical activity that utilized community

and school facilities in a group setting. The sessions were de-

signed to provide girls with activity of moderate-to-vigorous

intensity that could easily be replicated by the girls in their spare

time (Table 1 ).

Phase two was the online support component and targeted

social support as an important mediator of behaviour change

(Dishman et al., 2004). This part of the program consisted of

information provision to increase physical activity and guid-

ance for social support using the online communication me-

dium Facebook. The girls from the intervention school were

invited by the researcher, directly and via email, to join a closed

group (to avoid contamination) on Facebook. The girls were

asked to complete some simple physical activity tasks each

week via online discussion. Due to the girls’ low level of activi-

ty and motivation evident during the face-to-face sessions tasks

set were created to motivate, engage and be achievable for all

participants with opportunity to increase intensity if desired.

The activities were set to be fun, of moderate intensity and the

girls were encouraged to increase their physical activity a varie-

ty of innovative ways (Table 1).

The online task requests were placed on Facebook asking the

girls to complete the weekly activities and then write on the

“Wall” (a comment box) in the Facebook site to discuss their

strategies to increase physical activity. The concluding investiga-

tion involved a process evaluation that used both questionnaires

and focus groups to reveal insights into the recruitment, retention,

adherence and satisfaction among the intervention group.

Measures

All assessments were conducted at the study schools using

the same instruments and equipment at baseline and 12-week

follow-up assessments. The primary outcome being physical

activity was measured using pedometers. All participants wore

a validated Yamax© digi-walker SW-700 pedometer (Lubans,

Morgan, & Tudor-Locke, 2009; Schofield, Schofield, Hinckson,

& Mummer, 2007) for five days (four weekdays and one

weekend day) and recorded their steps at night before sleep.

The researcher provided the girls with a text message to place

the pedometer on each morning and a message each night to

record their daily steps in their log books. Secondary measures

included BMI and cardio-respiratory fitness (CRF). Weight was

assessed using calibrated digital scales (measuring kilograms)

and height assessed using a calibrated stadiometer height slid-

ing scale (measuring centimetres). These measurements en-

abled BMI scores to be calculated (kg/m2) and age specific

cut-off points from the International Obesity Task Force were

T. L. KELTY ET AL.

Table 1.

Intervention descripti o n and components.

PHASE 1—Face to face component ( 6 weeks)

Wk Specific focus for the information sessio n Activity (tim e/minutes) Target ed construct

1 Introduction to GRASP-IT.

Target heart rate and use of pedometers for

fitness.

Informat ion and discussion (30 mins).

Beach walk (50 mins). Self-efficacy

Outcome expect an c y

2 Goal setting to increase physical activity.

Use of music and pom-pom.

Informatio n and discussion (30 mins).

Pom-Pom aerobic class and floor work in recreation

room (35 mins).

Behavioural strategies

Self-efficacy

3 Music speed/choice for an effective workout.

Counting beats in music for effective intensity

and duration.

Informat ion and discussion (30 mins).

Walk to local gym (800 m).

Step class at local gym (45 mins). Self-efficacy

4 Alternative ac tiv it ies for health and fitness. Informat ion and discussion (30 mins).

Walk to local gym (800 m).

Pilates/fitness class (50 mins).

Self-efficacy

Social support

5 Combinin g aerobi c exerci se with s trengt h and

conditioning.

Informatio n and discussion (30 mins).

Walk to local gym (800 m).

Aerobic class incorporating gymstick workout (40

mins).

Self-efficacy

6 Guide to online use.

Importance of continuous and regular physi-

cal activity.

Theory handout on Facebook registration.

Guide to joining Facebook and tips for use (30 mins).

Bush walk (50 mins).

Self-efficacy

Social support

Outcome expect an c y

PHASE 2—Online component (6 weeks)

Wk Specific focus for the week Activity and information placed on Facebook Targeted construct

7 Introduction to GRASP-IT online.

Goal setting update.

Tips for increasing physical activity.

Instructed to suggest activities you can do with

friends to keep active—Encouraged to write on the

online Wall.

Discussion about how it feels during and after a

physical activity session l.

Provided link s to websites for tips to be more active.

Social support

Behavioural strategies

Self-efficacy

Outcome expect an c y

8 Perception of current and future health status?

Nutrition and physical activity.

Provided further links to follow and discover health

status and nu tr itional tips.

Promote discussion about nutrition and physical

activity. Challenge to eat foods that are not processed

for one day—Wri te on the wall.

Social support

Self-efficacy

Outcome expect an c y

9 Music as a motivator to be active.

Activities to do alone or with friends.

Task set to choose songs of 130 - 140 beats per min-

ute to create a song list to use for stepping at home

and use a music device to step at your target heart

rate or walk to every day.

Self-efficacy

Social support

10 Self-esteem and self-efficacy.

Link to an article about increasing self-esteem, feel-

ings of self- worth and motivation.

Asked to comment on activities done with friends

and/or family. Emailed a weekly workout log and

encouraged to stick to a program.

Self-efficacy

Social support

Physical

Self-perception

11 Alternative activities—Outdoor recreational

pursuits.

Progress update—Write on wall.

Encouragement to increase physical activity.

Link to girls’ outdoor education site for ideas to be

active.

Self-efficacy

Social support

Completion o f the progra m.

Encouragement to continue to increase phys-

ical activity behaviour and develop healthy

habits.

Encourag ed to continue t o exercise in many d ifferent

ways and to engage in physical activity every day.

Link to government health sites for current and future

use.

Self-efficacy

Social support

Note: Pom Pom’s were made b y the girl s to use during baseline assessment in group s. Gymstick is an elasticized resistance bar that is attached to the feet.

The “wall” is an area in Facebook used for a brief comment that is clearly seen. Discussion section is a larger area to write a more extensive discussion.

used to determine whether the girls were in the healthy weight,

overweight or obese weight range (Cole, Bellizzi, Flegal, &

Dietz, 2000). The Queens College Step test (QCST) was used to

provide an estimate of maximal oxygen uptake (VO2max) (Lu-

bans, Morgan, Callister, & Collins, 2008). The girls stepped up

and down for three minutes continuously using a 41 cm bench;

wearing a Polar© heart rate monitor at a cadence of 88 beats per

minute set by a metronome. After three minutes the girls’ heart

rate was taken three times for 15 seconds at the time of 5 sec-

onds, 10 seconds and 20 seconds after completion of the 3 min-

utes stepping (Zwiren, Freedson, Warn, Wilke, & Rippe, 1991).

The average of the three scores was calculated to estimate the

maximal oxygen uptake [VO2max (ml/kg/min) = 65.81 – 0.1847

× heart rate (beats/min)] (McArdle, Katch, Pchar, Jacobson, &

T. L. KELTY ET AL.

Ruck, 1972). Validated questionnaires were administered to

measure self-efficacy scales (Motl et al., 2000) and peer social

support scales (Prochaska, Redgers, & Sallis, 2002), as these

were identified as potential mediators of behavior (Lubans et al.,

2008; Whitehead, Biddle, Donovan, & Nevill, 2006).

The mixed-methods process evaluation used both question-

naires and focus groups to reveal insights into the recruitment,

retention, adherence and program satisfaction among the inter-

vention group. Upon completion of the intervention, the girls in

the intervention group completed a process evaluation question-

naire and participated in a self-selected (based on friendship and

time availability) focus group discussion for 30 minutes t o reveal

insights into their experiences and perceptions of GRASP-IT.

The process evaluation was developed using the conceptual

framework outlined by Crutzen that included items in the ques-

tionnaire being framed around three aspects of exposure 1) ac-

cess to the intervention website; 2) staying long enough to use

and process the information (noting that it is difficult to deter-

mine how long is enough) and 3) revisiting the intervention web-

site (Crutzen et al., 2009). The questionnaire also included open-

ended questions regarding satisfaction/enjoyment and sugges-

tions for program improvement. The qualitative data for analysis

of the process evaluation and focus gro ups respon ses were sorted

into themed responses for the 12 process evaluatio n items and 12

focus group questions and responses grouped according to com-

mon responses and themes.

Results

Analysis

Comparisons of the intervention and control groups were

completed using the Statistical Package for Social Sciences

(SPSS) version 16 software and statistical significance was set

at p < 0.05. Data were assessed for normality and satisfied the

criteria. Analysis of the covariance (ANCOVA) was used to

evaluate the impact of the GRASP-IT intervention on primary

and secondary outcomes. In the analysis the relationship be-

tween conditions (intervention and control) and time (baseline

and follow-up) was examined. For each outcome, the follow-up

score was the dependent variable, treatment condition was the

fixed factor and the baseline score was the covariate. This

analysis allowed for existing differences between groups at

baseline to be controlled for in the analysis. Cohen’s d was used

to determine effect sizes and was calculated using the mean

difference (3 months minus baseline) between groups and the

pooled standard deviation of change for the whole group. Effect

sizes were interpreted as small (d = 0.20), medium (d = 0.50) or

large (d = 0.80) (Cohen, 1988).

Baseline Characteristics

The flowchart for the study is displayed in Figure 1 and the

baseline results are displayed in Table 2. All 52 girls recruited

for the study were born in Australia and one was of Aboriginal

descent. The average age of the girls was 15.7 ± 1.5 years.

Physical activity for the intervention group was an average of

2639 steps less than the control group at baseline and the BMI

result for the intervention group was similar to the control

group being only 0.1 kg/m2 difference between the means at

baseline, additionally, the BMI z scores are all low and indicate

normal distribution (Table 2).

Effect of Intervention on Primary Outcome

The preliminary results for this study showed that there was

no treatment effect for physical activity. However, an increase

in physical activity from baseline to follow-up for the interven-

tion group was found while physical activity for the control

group regressed from baseline to follow-up (Table 3) and this

represented a large effect size (d = 0.8).

Effect of Intervention on Secondary Outcomes

The effect of the intervention on secondary outcomes show a

non significant reduction in BMI was observed among partici-

pants in the intervention group, with no change in BMI among

those in the control group. At baseline, 73 per cent of partici-

pants were in the healthy weight for age range and this increased

Table 2.

Baseline values by group for ou tc o mes.

Outcomes Control

(n = 14) Intervention

(n = 21) Whole

(n = 35)

MeanSD Mean SD MeanSD

Age 15.6 0.5 15.7 0.5 15.7 0.5

Weight 59.8 8.8 61.9 10.6 61.1 9.7

Height 1.62 0.5 1.65 0.0 1.64 0.5

BMI 22.8 3.7 22.7 4.1 22.8 3.9

BMI z scores –0.004–0.0 0.0 0.9 –0.0020.45

VO2max 35.4 2.0 35.2 3.2 35.3 2.6

Mean steps/daya11,69046969051 3466 10,3704081

Self-efficacyb 3.7 0.7 3.4 0.5 3.6 0.6

Peer supportb 2.3 0.9 1.9 0.9 2.1 0.9

aStudents wore pedometers for 4 weekdays and 1 weekend day; bQuestionnaire

scales ran ge f rom 0 to 4.

Table 3.

GRASP-IT intervention effects at post-intervention.

Mean (SD) Group × Time

Outcomes Assess-

ment Control Intervention F P D

Weight (kg)Baseline

post 59.8 (8.8)

60.0 (8.6) 61.9 (10.6)

60.3 (8.9) 1.460.235 –0.1

Height (cm)Baseline

post 1.62 (0.5)

1.63 (0.6) 1.65 (0.0)

1.66 (0.1) 1.01 0.3210.0

BMI (kg/m2)Baseline

post 22.8 (3.7)

22.8 (3.8) 22.7 (4.1)

21.8 (3.2) 2.480.124 –0.5

BMI z scoreBaseline

post 0.0 (0.9)

0.2 (1.1) –0.0038 (–0.0)

–0.1068 (–0.1) 2.480.124 –0.6

VO2max

(ml/kg/min) Baseline

post 35.4 (2.0)

36.3 (2.1) 35.2 (3.2)

35.6 (2.4) 0.00 0.9670.1

Steps per dayaBaseline

post 11,690 (4696)

9812 (4745) 9051 (3466)

9883 (3512) 2.75 0.1120.8

Self-efficacybBaseline

post 3.7 (0.7)

3.6 (0.8) 3.4 (0.5)

3.5 (0.7) 3.72 0.060.8

Peer supportbBaseline

post 2.3 (0.9)

2.2 (1.0) 1.9 (0.9)

2.1 (0.9) 2.12 0.160.6

Note: The means and standard deviation (SD) are reported for all participants;

BMI = Body Mass Index; Effect sizes (d) were calculated by subtracting baseline

from post-test values then dividing by the pooled standard deviation of change.

ANCOVA was used to compare the means between tr eatment and control condi-

tions d = Cohen’s d (d = (M1 – M2)/σpooled). aPedometer worn for 4 weekdays and

1 weekend day; bQuestionnaire scales range from 0 to 4.

T. L. KELTY ET AL.

to 92 per cent at follow up. In addition, those in the overweight

category decreased from 19 per cent to 4 per cent and those in

the obese category decreased from 8 per cent to 4 per cent re-

spectively (Cole et al., 2000). Large effect sizes were noted for

self-efficacy (d = 0.8). The estimated VO2max of girls in both

intervention and control groups increased slightly but with no

significant difference between groups (Table 3). Self-efficacy

and social support marginally increased (p = 0.06) between

groups and improved slightly for the intervention group.

Process Evaluation

Recruitment at both schools was generally successful with 29

girls recruited at the intervention school and 23 girls at the con-

trol school. Retention and adherence to the assessment compo-

nents of the program was low and the drop off rate of the girls

to log and/or return their pedometers decreased during the 12-

week time-frame (Figure 1) The intervention retention for the

face-to-face component was high (mean 80% attendance) for

the six week time-frame. However, the number of girls who

registered and participated during the on-line component of the

intervention was low (33 percent registered). The intervention

school process evaluation (n = 24) revealed that the girls were

satisfied with the GRASP-IT study. However, they indicated

that they preferred a face-to-face program rather than an internet-

led program. Of note was there preferred atmosphere to engage

in physical activity being with a small group of friends (Table

4).

Focus groups revealed that the girls would prefer to interact

with friends online using Myspace not Facebook. During the

focus group sessions the girls indicated that they were not inter-

ested in the online activities and therefore, would not have

stayed on the site long enough to benefit from its use. The three

main themes extracted from the focus group responses were

firstly, the girl’s lack of interest to register and engage with each

other using the Facebook site. Quotes regarding the online

component stated “Facebook is for old people” and “Facebook

is for the older generation”. Secondly, they indicated a prefer-

ence for MySpace over Facebook to interact online stating

“MySpace is for the younger generation” and “we all know how

to use MySpace and we enjoy it more”. The third theme was a

preference for the program to be extended with many girls stat-

ing “I think it should be longer and we want more time”.

Discussion

The aim of this study was to report the feasibility and prelimi-

nary efficacy of GRASP-IT intervention which utilized both

face-to face and online components. Notably, this is the first

tudy to evaluate a program that utilized a social networking s

Table 4.

Process evaluation for the GRASP-IT study.

Construct

(number of items) Example item Mean

(SD)

Website appeal and navigational design

(7) a

“I found the Facebook si t e visually appealing.”

“It was ea sy to navigate from one point to another in the site.” 3.06

(0.2)

Expectations and use of website features

(8) a “Did the website meet your expectations.”

“Was the website personally use ful to you?” 2.23

(0.6)

Instigation of physical activity planning

(3) a

“I am now aware of how much physical activity is beneficial to

girls my age.”

“I now keep a record of my physical activity.”

3.40

(0.7)

Satisfaction (5) a “My involve ment in the GRASP - I T p r ogram was enjoyable.”

“I am satisfied with the GRASP-IT program.” 3.60

(0.3)

Social support structures (4) a

“The GRASP-IT program provided me with enough support to

help me i ncrease my physical activity.”

“I now enjoy physic al activity with my friends m ore often.”

3.57

(0.5)

Action taken to increase physical activity

(6) a

“My involvement in the GRASP-IT program encouraged me to

be more active with my friends.”

“My involvement in the GRASP-IT program encouraged me to

discuss my physical activity strategies with others.”

1.32

(0.2)

Current use and type of social network

site/s (1)

Facebook

MySpace

None

91%

Frequency of use with the site of choice

(1)

More than once a day

Once a day

Once every two days

Once a week

Not at all

50%

23%

Preferred atmosphere to engage in PA (1)

Alone

With one friend

Small group of friends

Large grou p of friends

Group of un k nown people

14%

55%

18%

Preferred program choice for increasing

physical activity (1)

Prefer an internet based program.

Prefer a program that meets face-to-face

Undecided

13%

78%

Note: a = item measured on a scale of 1 to 5.

T. L. KELTY ET AL.

component to increase physical activity in adolescent girls.

Although participants in the GRASP-IT intervention group

increased their physical activity and enjoyed the face-to-face

intervention component, engagement and compliance with the

online component was low. Our failure to detect a statistically

significant between group differences for physical activity was

likely due to our sample size and inadequate statistical power as

a pilot study. It was encouraging to note that self-efficacy and

peer support all improved during the 12-week study among

participants in the intervention group. However, there was no

between group differences and the sample size may have also

been a possible explanation and limitation to our study. The use

of the internet to promote physical activity is an emerging area

of research and no previous study has attempted to engage ado-

lescent girls using social networking sites (Buis et al., 2009).

Many factors may have potentially hindered the success of the

program, and in particular, use of the social network site Face-

book for social support to be active. First, in the majority of

Australian schools social networking sites used by adolescents

are currently blocked by the educational authorities in state

system schools and students cannot access them during the

school day while at school (Department of Education and

Training, 2010). Second, limited ongoing support for the online

component of GRASP-IT existed as there was minimal contact

with the researcher for phase two. During phase one an outline

was given about the online component at the initial information

session, a further session to guide and encourage online Regis-

tration and use at the end of the face-to-face session was deliv-

ered and then reminders sent to the girls via email during phase

two was conducted. Furthermore, we found that girls preferred

mode of delivery for increasing physical activity was one that

meets face-to-face (78 percent) over an internet based (13 per-

cent) program.

A limited number of previous intervention studies have ex-

clusively targeted older adolescent girls’ physical activity (Dis-

hman et al., 2005; Eliakim et al., 1996; Jamner et al. 2004;

Murphy, Ni Khuinn, Browne, & O’Rathaille, 2006; Neumark-

Sztainer, Story, Hannan, & Rex, 2003; Schneider, Dunton, &

Cooper, 2008), but none have combined face-to-face component

with the use of a social networking site to enhance social support

for physical activity. While many previous studies have suc-

cessfully increased their physical activity in this cohort, they

have all differed in their design and delivery. One study, Project

FAB, did use the internet for participants to record physical

activity but not to support or motivate girls to increase physical

activity (Schneider et al., 2007). Another study promoted a self-

led activity program versus a teacher-led activity program and

concluded that both groups significantly increased physical acti-

vity however, the self-led program group also continued physi-

cal activity after the intervention (Murphy et al., 2006) which

demonstrates the need for studies to follow-up participants after

an intervention has concluded. The length of physical activity

interventions is also a key influencing factor in promoting self-

efficacy and ramifications of a longer GRASP-IT study with a

more comprehensive face-to-face component may have been

required to further increase self-efficacy. Of note, Project FAB

researchers described that a program that is longer than two

semesters, or 6 months or more, is more likely to successfully

impact on physical activity, as physical activity increased in the

later months of their intervention as did New Moves interven-

tion (Neumark-Sztainer et al., 2003; Schneider et al., 2007).

Our process evaluation provided a number of insights re-

garding elements of the GRASP-IT intervention. In general, the

girls were satisfied with the GRASP-IT intervention and were

more likely to self-monitor their physical activity at post-

treatment. They believed the GRASP-IT intervention provided

them with enough support to be active but interestingly, they

believed that this level of support did not necessarily lead to

physical activity behaviour change. Despite the girls preference

for participating in physical activity in small groups of friends,

rather than alone or in a large group, additional strategies may

be required to encourage girls to provide social support for

physical activity for each other. We determined that they pre-

ferred a longer program however, we were not able to deter-

mine whether they would have liked more face-to-face sessions

and/or an extended period of time to engage with the website,

however, future studies should consider integrating both the

face-to-face and online component to encourage compliance,

monitor use and trouble shoot to maximize the intervention

dose and potentially impact on physical activity behaviour.

That is, engagement with the website may have been greater if

the face-to-face component used some time to encourage, clari-

fy and motivate the girls to use the website in conjunction with

the face-to-face activities. GRASP-IT recruitment at both

schools was initially successful; however, strategies to address

compliance for the collection of physical activity data is an

issue to be further addressed in future studies (Neumark-

Sztainer et al., 2003; Schneider et al., 2007).

Conclusion

This is the first study that has attempted to engage older ado-

lescent girls to increase their physical activity behaviour using

the social networking site Facebook. We recommend that future

programs targeting older adolescent girls could include an in-

crease in the length of time for face-to-face sessions to maxi-

mize outcomes given the girls preference for this medium and

the possible investigation of other more popular sites that may

be more desirable for adolescent girls to engage and enjoy

while supporting each other to be physically active. The inter-

net is clearly an emerging area for engaging the youth of today

with a high use of technology on their agenda for social, educa-

tional and entertainment pursuits. Interventions need to em-

brace this technologically evolving world and consider innova-

tive ways to engage older adolescent girls in physical activity.

The availability of computer access with internet is increasing

and advancing technology in schools will give many adolescent

girls access to internet support, both during schools hours and

out of school hours and this in turn may potentially benefit their

health through the use of programs such as GRASP-IT.

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