Background: Although children’s intake of fruit and vegetables has seen a recent rise, almost half of adolescents do not eat even one piece of fruit or vegetables per day. One way to address this problem is through interventions that provide fruit and vegetables directly to children in kindergartens and schools. For such interventions to meet their intended goals, what is important to consider in addition to impact is implementation. Our objective is to systematically review qualitative results reporting on the determinants (barriers and facilitators) to implementation of interventions that entail direct provision of fruit and vegetables in kindergarten and school settings and conduct a framework analysis of those results using the Consolidated Framework for Implementation Research (CFIR). Methods: A systematic search was designed and run in November 2019 for: MEDLINE (Ovid), Embase (Ovid), PsychINFO (Ovid), ERIC (Ovid), Cochrane Library Reviews and Cochrane Library Trials. A keyword search of the journal Implementation Science was completed. Screening of titles and abstracts (n = 5427) and full texts (n = 227), led to 14 included articles. Coding and analysis were done using the framework method and CFIR. Results: The following CFIR constructs were found relevant: 1) intervention characteristics domain: ‘design quality and packaging’, ‘adaptability’ ‘cost’; 2) outer setting: ‘cosmopolitanism’, ‘external policy and incentives’ ‘patients’ needs and resources’; 3) inner setting: ‘implementation climate’, ‘readiness for implementation’ and ‘structural characteristics’; 4) characteristics of individuals: ‘individual stage of change’, ‘knowledge and beliefs about the intervention’ 5) process: ‘engaging’, ‘executing’ and ‘reflecting and evaluating’. The review stresses the dual role of parents as both supporting the implementation and targets of the intervention, which could have implications for the design and implementation of future fruit and vegetables interventions. Positive child perceptions of the value of the intervention and perceived behavior change due to the intervention were reported as relevant facilitators to implementation across several studies, and should be taken into consideration in future design efforts. Conclusions: CFIR offers a systematic way to identify and organize barriers and facilitators to implementation of interventions in the kindergarten and school setting. Revisions are encouraged to allow adequate space for perceptions of various implementation actors and the target group. PROSPERO registration: CRD42020167697.

Public urban places and their environmental characteristics impact youth's physical activity (PA) through perceptions. The objective of this study was to use a qualitative participatory approach with children and adolescents to understand how their attachment to urban places perceived as PA-friendly or unfriendly is related to their PA behaviour. Ninety-three participants aged six to 17 from six neighbourhoods with varying objective walkability engaged in photovoice and walking interviews. Data were analysed by using the tripartite framework of place attachment (PPP model), which was adapted for application to PA behaviour and supplemented by photographs. Themes were identified for each (sub-)dimension of the PPP model with person, place and process factors influencing attachment. Further subdimensions (PA and other behaviours) and categories (travel mode, trip length and frequency of visits) were added to the PPP model. Urban design recommendations were derived by age and gender to promote PA through place attachment.

Background: Youth’s perceptions of a city or neighbourhood’s walkability are important for determining the physical activity (PA) friendliness of their environment. Traditional objective measures of walkability fail to incorporate children and youth’s (CY) subjective perceptions of places that they perceive as supportive for play and exercise. Internationally, the most promising subjective measure is the Neighborhood Environment Walkability Scale for Youth (NEWS-Y) questionnaire. Yet, the NEWS-Y is not available for German-speaking adolescents. In the WALKI-MUC project, a combination of participatory research methods is used to identify CY’s perceptions of PA-friendly places in Munich, Germany. Based on the findings, a German version of the NEWS-Y (NEWS-Y-G) for subjective walkability measurement is developed. Methods and design: CY aged six to 17 years from neighbourhoods with different objectively-measured walkability, take part in photovoice, walking interviews and mapping to gather their perceptions of PA-friendly places. The participatory study begins with an introductory workshop and concludes with a follow-up workshop, where characteristics of PA-friendly places are discussed in focus groups. In between these workshops, participants complete a photo mission with a walking interview, allowing for individual significance of PA-related places to be shared in a one-on-one setting with the researcher. The findings are used to adapt and translate the NEWS-Y for the German context. The newly developed NEWS-Y-G is then used to measure the subjective walkability perceived by a representative sample of adolescents in Munich. Discussion: The WALKI-MUC project introduces a participatory methodology for researchers and urban planners to assess subjective walkability with CY. The combination of qualitative and quantitative walkability measurements is described in this study protocol. Findings on PA-friendly places contribute to environmental psychology and the development of the NEWS-Y-G adds a German-language instrument for subjective walkability measurement.

Background: The prevalence of physical inactivity among children and adolescents is alarmingly high despite the well-documented and comprehensive benefits of regular physical activity (PA). Therefore, PA promotion should start early in childhood and adolescence. Although reducing recreational screen time in children and adolescents is an urgent concern, digital approaches have the potential to make activity promotion attractive and age appropriate for the target group. KIJANI is a mobile app approach to promote PA in children and adolescents via gamification and augmented reality. Objective: This study protocol aims to describe the KIJANI intervention in detail, as well as the evaluation approach. Methods: KIJANI is based on the concept that virtual coins can be earned through PA, for example, in the form of a collected step count. With these coins, in turn, blocks can be bought, which can be used to create virtual buildings and integrate them into the player’s real-world environment via augmented reality. PA of users is detected via accelerometers integrated into the smartphones. KIJANI can be played at predefined play locations that were comprehensively identified as safe, child-friendly, and attractive for PA by the target group in a partner project. The evaluation process will be divided into 2 different stages. The phase-I evaluation will be a mixed methods approach with one-on-one semistructured interviews and questionnaires to evaluate the user experience and receive feedback from the target group. After the implementation of results and feedback from the target group, the phase-II evaluation will proceed in the form of a 2-arm randomized controlled trial, in which the effectiveness of KIJANI will be assessed via objectively measured PA as well as questionnaires. Results: The study received ethical approval from the ethical board of the Technical University of Munich. Participants for the phase-I evaluation are currently being recruited. Conclusions: The study will help to determine the efficacy, applicability, and user experience of a gamified activity promotion application in children and adolescents. Overall, digital health approaches provide easy and wide reachability at low cost and are age appropriate and attractive for the target group of adolescents. Strategies have to be developed to apply digital health approaches in the best possible way for activity promotion. International Registered Report Identifier (IRRID): DERR1-10.2196/55156

Background: Adolescents’ physical activity is related to characteristics of their neighbourhood environment. Understanding this relationship can help identify ways to promote this important health-related behaviour. The Neighbourhood Environment Walkability Scale for Youth (NEWS-Y) is the most prominent questionnaire to measure subjective perceptions on the neighbourhood environment that might have an influence on their physical activity. This study describes the development of the NEWS-Y for German-speaking adolescents (called NEWS-Y-G) and the evaluation of its reliability and validity. Methods: The NEWS-Y-G was adapted and validated through a five-step process. First, the original NEWS-Y was translated into German using a back-translation technique. Participatory methods were then used to establish content validity by identifying environmental aspects specifically relevant to the German context. Third, ten cognitive interviews with adolescents were conducted for ensuring understandability before piloting the questionnaire with 587 adolescents. Of these, 249 participants completed the questionnaire twice, allowing for a test-retest reliability evaluation of subscales and individual items by using intraclass correlation coefficients (ICCs). Finally, construct validity was tested through correlations among subscales and associations with self-reported physical activity levels of participants. Results: The NEWS-Y-G showed semantic equivalence with the original version. Five items were removed and twelve items were added, resulting in 74 items across the nine subscales: land use mix-diversity, recreational facilities, residential density, land use mix-access, street connectivity, walking/cycling facilities, aesthetics, traffic- and crime safety. The test-retest reliability of subscales (ICC range = 0.81–0.94) and individual items (ICC range = 0.32– 0.94) in the NEWS-Y-G was moderate to almost perfect. Moderate correlations were observed among several NEWS-Y-G subscales. Only two subscales – recreational facilities and aesthetics – showed statistically significant, albeit very weak, associations with self-reported physical activity (both ρ = 0.13, p < 0.01), while no significant associations were found for the other seven subscales (ρ = -0.08 to 0.03, p > 0.05). Conclusion: The NEWS-Y-G questionnaire demonstrated good test-retest reliability and provided preliminary evidence of validity. While this study supports its use in measuring subjective walkability among adolescents, further studies in German-speaking regions are needed to confirm its validity in relation to physical activity, accounting for different mobility types as well as gender and socioeconomic disparities. The NEWS-Y-G is a valuable tool for evaluating the neighbourhood environment’s impact on adolescents, providing results that can inform urban planning and research to promote physical activity.

BACKGROUND The prevalence of physical inactivity among children and adolescents is alarmingly high despite the well-documented and comprehensive benefits of regular physical activity (PA). Therefore, PA promotion should start early in childhood and adolescence. Although reducing recreational screen time in children and adolescents is an urgent concern, digital approaches have the potential to make activity promotion attractive and age appropriate for the target group. KIJANI is a mobile app approach to promote PA in children and adolescents via gamification and augmented reality. OBJECTIVE This study protocol aims to describe the KIJANI intervention in detail, as well as the evaluation approach. METHODS KIJANI is based on the concept that virtual coins can be earned through PA, for example, in the form of a collected step count. With these coins, in turn, blocks can be bought, which can be used to create virtual buildings and integrate them into the player’s real-world environment via augmented reality. PA of users is detected via accelerometers integrated into the smartphones. KIJANI can be played at predefined play locations that were comprehensively identified as safe, child-friendly, and attractive for PA by the target group in a partner project. The evaluation process will be divided into 2 different stages. The phase-I evaluation will be a mixed methods approach with one-on-one semistructured interviews and questionnaires to evaluate the user experience and receive feedback from the target group. After the implementation of results and feedback from the target group, the phase-II evaluation will proceed in the form of a 2-arm randomized controlled trial, in which the effectiveness of KIJANI will be assessed via objectively measured PA as well as questionnaires. RESULTS The study received ethical approval from the ethical board of the Technical University of Munich. Participants for the phase-I evaluation are currently being recruited. CONCLUSIONS The study will help to determine the efficacy, applicability, and user experience of a gamified activity promotion application in children and adolescents. Overall, digital health approaches provide easy and wide reachability at low cost and are age appropriate and attractive for the target group of adolescents. Strategies have to be developed to apply digital health approaches in the best possible way for activity promotion. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/55156