Thursday, February 20, 2014

Why Well-Intended Interventions Can Backfire

sharma-obesity-kids-playing-outsideOne of the big dilemmas of well-meant interventions is that they can lead to unintended consequences which not only reduce the effectiveness of the intervention but sometimes even make things worse (if even just for a subgroup).

This has been the problem with countless “good ideas” that seem great on paper but fail to take into account basic tenets of human psychology and behaviours.

Case in point is this well-intended study by Pedro Saint-Maurice and colleagues from Iowa State University, published in BMC Public Health, that found unintended negative consequences of trying to increase kids physical activity during school recess.

The idea was simple enough: providing better play equipment and greater supervision during recess should provide a more stimulating and safer play environment thereby allowing more kids to be active.

The idea was tested in 12 schools randomly assigned to one of four conditions: control group, staff supervision, more equipment, and the combination of staff supervision and equipment.

To objectively measure physical activity, 400 kids from grades 3 through 6 (8-11 years old) were asked to wear activity monitors before and after the intervention.

It the authors expected clear-cut results, they were probably disappointed.

It turns out the responses to these interventions were highly variable, a key moderator being the baseline level of activity.

Thus, having staff supervision actually resulted in inactive kids being even less active.

“This may be because the structure allowed more active and skilled youth to dominate games.”

On the other hand, providing more equipment reduced activity in the more active kids.

“This may be because the equipment became more interesting than the active games that children play when equipment is not provided.”

From these observations the authors conclude that interventions need to be specifically tailored to the group that you are trying to influence. While one intervention may work well to get less-active kids moving, the same intervention may have the opposite effect on kids who are already active.

This “risk-benefit” trade off may thus limit the overall impact of such interventions.

Or, as the authors put it,

“Staff training should include how to work with inactive youth but also how to assure that active children remain active.”

Whether or not any intervention ultimately proves effective in changing behaviour or health trajectories certainly remains to be seen.

In the mean time, researchers and policy makers need to always pay close attention to the “unintended consequences” of good ideas.

For every group that stands to benefit from any intervention, there may always be a subgroup that stands to lose.

@DrSharma
Edmonton, AB

ResearchBlogging.orgSaint-Maurice PF, Welk GJ, Russell DW, & Huberty J (2014). Moderating influences of baseline activity levels in school physical activity programming for children: The Ready for Recess Project. BMC public health, 14 (1) PMID: 24484545

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2 Responses to “Why Well-Intended Interventions Can Backfire”

  1. Sukie Crandall says:

    I wonder what would happen if there simply were more units of the most used and friendly pieces of equipment such as swings rather than more variety? With less novelty the most active kids might get bored and return to their games, while with more units of the most friendly types of equipment perhaps the least active kids might have a better shot at actually using those toys.

    My recollection is that recess in the younger years was for active playing, but in the older years it was when I could associate with close friends who were in different classes so even when active like when walking to the far reaches of the school lot (which was very large then) or playing ever harder games of hopscotch in the sand by the sports equipment building we talked a lot during recess which I am sure decreased our level of activity but was otherwise very important for our happiness.

    The worst year was when one teacher wanted to have his choice of mandatory class games during recess, but he was a horrid teacher in worse ways (religious bigotry), and fired after his first year at the school. Only a few children did not mind his taking away their one free time in the day and those few were new to the area so lacked old friends they wanted to see at recess.

    I was a child during Kennedy’s push to get kids stronger. Back then it was not realized that exercise is not a one-size fits all situation and activity options available to the gym teachers were sorely limited, especially for girls since there were incorrect assumptions that girls should not engage in many types of activities. Still, having a hour of gym class three times a week, alternating in grade school with subjects like art, music, home ec, and shop, was good for health, I think, though I would gave benefited if girls had been permitted to engage in the then forbidden sport of weight training which suits my physiology very well.

    School days were longer then than they are locally these days, BTW, and there seemed to be fewer adults fussing over school costs, though that may simply be because so many adults were parents or grandparents during the baby boom. With longer days it was easier to get a good education in the basics while also having that hour of gym or other useful learning several times a week.

  2. Janet Karasz says:

    I am sure you’ve seen this, but I can’t help but be reminded, considering this topic. “Manitoba kids given Ritz Crackers to balance ‘unhealthy’ lunch; mom fined $10″ (November 18, 2013). Encouraging balanced, healthy lunches for children, good. Regulating such, unintended consequences.

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