This work was conducted in partnership with New York Road Runners (NYRR). NYRR is the world’s premier community running organization with a mission to help and inspire people through running. They have disseminated youth running and PA programming since 1999. In 2017, NYRR released a new running-based youth program, Rising New York Road Runners (RNYRR), that can be incorporated into before-, during-, and after-school PA opportunities. RNYRR programming focuses on enjoyable, inclusive, developmentally appropriate games and activities that sequentially build motor skills in one or more domains (eg, locomotion, balance, and object control) to improve children’s physical literacy (PL), defined as their confidence, competence, and motivation to be physically active for life [36,37].

The innovation described in this descriptive study is derived from the multilevel intervention, the Supporting Physical Literacy at School and Home (SPLASH) feasibility study (NCT05887583). Implemented during the 2021‐2022 school year, SPLASH was designed to support RNYRR’s existing school-based PA program by developing and delivering strategies to engage families in children’s PA beyond school as well.

The aims of the SPLASH study included: (1) the development of a theory-informed home-based communications component, and (2) an assessment of implementation feasibility and acceptability in the target population. Aim 1 is the focus of this descriptive study, and results from aim 2 are forthcoming.

A 4-step process was used to develop the theory-informed parent communications. Each step in the process included several activities that were informed by theory and existing evidence. The outputs generated from the activities were then integrated into the subsequent step. The entire 4-step process serves as an example of designing theory-informed communication materials intended to engage parents in children’s PA. Table 1 outlines the steps, activities, and outputs.

Step 1 (formative research) took place during the grant proposal design phase in 2018‐2019. Steps 2‐4 took place from fall 2019 to spring 2021, with implementation of the multilevel intervention beginning in fall 2021.

The process included a planning and design team of 7 members, consisting of graduate students, research managers, research scientists, and faculty members from leading universities in nutrition, PA, and behavior change, and child PA specialists from RNYRR. The process was collaborative and iterative, consisting of recurring team meetings to review and discuss progress. Many team members had previously worked together on similar school- and community-based projects, including studies testing theory-informed approaches to promote child PA and improve health-related parenting practices [16,38-41]. Collectively, our team consisted of PA experts with experience in applying behavior change theories to intervention design and in developing and implementing communication campaigns to improve children’s health behaviors.

This study was reviewed and approved by the Social, Behavioral, and Educational Research Institutional Review Board at Tufts University (approval no 1812027; January 2019). All procedures were conducted following the ethical standards of the institutional research committee and the Declaration of Helsinki and later amendments. Informed consent was obtained from all participants before data collection. All data was deidentified and participants recieved a $50 Visa prepaid debit card for their time.

To engage parents to promote children’s PA, we needed to first identify priority PA parenting behaviors and the determinants of those PA parenting behaviors within the context of our theoretical basis. Reviewing the literature through the lens of SCT and SDT allowed us to understand how parents could both serve as an important socioenvironmental influence in the context of SCT and help satisfy needs in the context of SDT [59-61]. Our goal in step 2 was to (1) categorize the most influential parenting behaviors for promoting children’s PA based on our literature review of existing evidence and (2) ensure the PA parenting behaviors aligned with the formative research conducted in Steps 1a and 1b. Collectively, step 2 details how our PA parenting objectives relate to the theoretical determinants of children’s PA.

Our review of the parenting literature was conducted in the summer of 2019 by 3 study team members and supported by a Tufts University librarian. Web of Science, PubMed, and Ovid databases were used with a broad search strategy across all years of publication. Example search terms, informed by similar reviews, included terms related to parents (parent* OR famil* OR caregiver* OR family carer*), children (pediatric* OR child* OR kid* OR adolescen*), parent engagement (involv* OR participat* OR engage* OR outreach OR recruit* OR retain* OR retention*), intervention type (community-linked OR community-based OR school* OR teacher* OR student* OR classroom*), and child behavioral outcomes (exercis* OR recreation* OR fitness* OR physical activit*).

After reviewing 423 abstracts and 27 full-text papers, 3 categories of parental behaviors emerged as being supportive of children’s PA behavior change: modeling of PA, parental support of child PA, and parental encouragement for child PA [50,62-64]. Termed collectively as “PA parenting practices,” these behaviors are influenced by parents’ own PA attributes and perceptions. For example, parents with a positive perception of PA, who engage in, value, and enjoy PA, tend to have a high self-efficacy to promote their child’s PA. In addition, parents who perceive that their child enjoys and is competent in PA are more likely to adopt responsive and structured PA parenting practices [65,66]. Responsive and structured PA parenting practices can, in turn, indirectly influence children’s PA by enhancing children’s modifiable PA attributes, such as their perceived competence, self-efficacy, and motivation for PA [66-68]. Some PA parenting practices, such as supportive behaviors, are associated with a direct increase in children’s PA levels [50,64]. Therefore, by aiming to improve PA parenting practices through our materials, our intervention aimed to target parents as potential mediators of their child’s PA behaviors [16,17].

The final parental behavior change objectives, with a brief description of specific behaviors, for our communications campaign were as follows. First, parents will serve as role models for their children’s PA. Parents will model enjoyable and relevant PA behaviors individually and with their children. Second, parents will provide instrumental and informational support, including the provision of choices, for their children’s PA. Specifically, (2a) parents will provide choices and descriptions of activities for their children to select from, and (2b) parents will promote a sense of familial connection around PA. Third, parents will provide praise and encouragement for their children’s PA. This includes (3a) giving frequent, direct, specific, and positive feedback and encouragement regarding some aspect of their children’s performance, and (3b) encouraging the use of process goals that allow for success and are achievable.

Table 3 exemplifies the relationships between the 3 parental behavior change objectives and the previously established theoretical basis for children’s PA behavior change.

To target the parental objectives in our communication materials, we needed to (1) identify the theoretical determinants of the PA parenting behaviors we wished to change and (2) outline the methods for addressing the determinants in a communication campaign. Collectively, step 3 can be thought of as the theory-informed strategy for advancing our PA parenting objectives. Here, our definition of “theory-informed” is that the strategy for operationalization is informed by behavioral and social science theories [28]. Our theoretical basis provides evidence for why we anticipate our strategy will result in the desired parental behavior change.

Within the theoretical basis, we identified the determinants of the PA parenting behaviors we aimed to influence in our communications campaign. This process included a combination of literature and expert review from our team. After identifying the SCT or SDT constructs indicative of the parenting behavior, we then described the role of the theoretical determinant in advancing the behavioral objective. All constructs were contextualized based on their reciprocal relationships with one another. After determining the constructs predictive of the desired behavior change, we sought to outline the application of the constructs, or the methods for operationalizing the determinants into the communication messages. Outlining the methods for operationalizing the theoretical constructs required careful consideration for how to address the determinants through communication messages.

Table 4 shows how the PA parenting objectives were linked to methods via the behavioral determinants. The methods were applied by operationalizing the theoretical constructs into the communication materials in step 4.

In the final design step, the theory-informed messages were written and fully integrated into communication materials. Communication channels included emails, text messages, Facebook posts, and newsletters. The process for drafting and editing the messages was iterative and involved the entire research team.

Figure 2 includes sample messages exemplifying how we operationalized our strategy to achieve our PA parenting behavioral objectives. Each sample message is a manifestation of one or more methods (Figure 2A). In operationalizing our strategy, we can target key parent-level determinants (Figure 2C) that influence our PA parenting behaviors (Figure 2D). The PA parenting objectives are linked to changes in children’s PA behavior via the child-level determinants (Figure 2E).

Two study team members worked together to write the first draft of the family communication messages. One Tufts team member served as the behavior change expert, ensuring the theoretical constructs, methods, and parameters identified in step 3 were incorporated into the content; the other RNYRR team member served as the curriculum expert, ensuring the school-based curriculum was aligned with the family content. Both team members carefully deconstructed each message and mapped theoretical constructs to the messages. A grid was created to keep track of construct operationalization, ensuring intentionality. Input was obtained from other team members over multiple rounds and edits. Careful consideration was taken to ensure the content was appropriate for the target audience’s sociodemographic, cultural, and educational backgrounds. Messages were refined and final edits were presented to and agreed upon by all team members. Final materials were translated into Spanish for the study’s target audience.

Email served as the primary communication channel, with the other modes of communication written to reinforce that channel. All materials were aligned with the program theme, Rising Together, emphasizing the importance of being active as a family. Final material design was overseen by RNYRR to ensure consistency in appearance. When families signed up to receive the materials, they had the option to sign up for emails only, text messages only, or both emails and texts. To achieve equity in access to materials, all email communications were printed and delivered to participating schools to be placed into children’s backpacks on a weekly basis. Print-based emails contained QR codes that could be scanned to access the electronic content. The 20-week communications campaign and multilevel program were pilot tested in 6 NYC elementary schools during the 2021‐2022 school year.

This descriptive study details a 4-step process used to operationalize behavior change theory in a multichannel communications campaign, nested within a multilevel PA intervention. We describe systematic procedures that can be used in designing behavior change communication messages seeking to improve PA parenting behaviors and promote children’s PA.

The ability of parent engagement strategies to effectively engage parents and promote children’s PA in school-based interventions remains inconclusive [18]. We provide a practical 4-step process using commonly cited strategies that can be applied and empirically evaluated for their independent impact on school-based intervention effectiveness [14,50]. As Bandura [69] noted, public health campaigns are important for getting people to adopt health behaviors. However, health communications foster adoption of health behaviors to the extent that they raise individuals’ self-efficacy. Health communications must therefore be designed to enable people to build the necessary skills and self-beliefs needed to change their behaviors. Given the intentionality and feasibility of our communications to engage parents and impact parental-level determinants and behaviors, future applications of our methods can begin to advance understanding of the isolated impact of parent engagement strategies on child-level outcomes.

To our knowledge, this 4-step design process is innovative within multilevel behavior change interventions. Similar strategies have been used in designing interventions for various behaviors, including medication adherence [70], hand hygiene compliance [71], and occupational sedentary behavior [33], and in various contexts, including tailored feedback during a weight loss intervention [72] and a garden-enhanced nutrition curriculum [73]. However, only one of these interventions [74] addresses the complexity of promoting behavior change through an additional level of influence, as we aim to do in influencing PA parenting practices to promote children’s PA. This additional level of behavior change makes our approach valuable for others seeking translatable methods for applying theory-informed strategies to multilevel behavior change, such as in efforts to promote children’s PA.

Current frameworks for theory application do not include specific methods for designing health communications as part of intervention design [29,30,75]. While the theoretical evidence includes guides for translating theory-based methods into practical applications, these frameworks fall short of providing advice for operationalizing theoretical determinants into behavior change communication messages. Furthermore, while the empirical evidence provides examples of how theoretical constructs were translated into behavior change methods [70] or intervention activities and components [33,73,74], none have been specific to the translation of theory for the content of communications. This descriptive study addresses gaps in current intervention design frameworks and studies and complements their use by providing practical advice and examples for operationalizing theory into communication messages. The methods used in this descriptive study may, therefore, be used by interventionists in congruence with current frameworks to create communications that can be incorporated into multilevel behavior change interventions, which have been recommended for increasing children’s PA [13].

While there are many functions and benefits of theory application during the design, implementation, and evaluation stages of interventions [49,75-77], increased effectiveness is often cited as the primary reason for the use of theory in behavior change intervention design [78]. This argument may hold for theory-informed approaches to promote children’s PA [46,49,50], despite inconsistent conclusions on whether the use of theory improves intervention effectiveness [15]. Prior studies have noted that the variable findings on the effectiveness of behavior change interventions, including those for children’s PA, could be explained by “methodological and reporting issues at study and review level,” including issues with how theory is applied during the intervention design process [78]. Michie and Prestwich [31], for example, point out that “where a theoretical base for an intervention is stated, there is seldom reference to a method describing how the theory informed the design of the intervention.” By providing a detailed example and replicable methods for applying theory to communication materials, one of the crucial steps in the intervention life cycle, we believe our study to be of benefit to others attempting to be more rigorous in both their application of theory and reporting of its use in PA interventions.

This descriptive study’s description of the operationalization of theory in our communication materials will provide important contextual information for interpreting future results of the communications campaign. The feasibility of implementing the communications campaign and the acceptability of the materials for the target population will also be considered in a pilot study, and adjustments to the materials will be made. The adapted communications will be implemented in a randomized controlled trial. Findings from the trial will be used to understand if our theory-informed communications effectively engage parents, thereby influencing their determinants of PA and PA parenting behaviors, while examining the overall impact of the intervention on children’s PA determinants and PA behaviors. After a second phase of adjustment, including any adjustments to the methods outlined in this study, the communications may be considered for dissemination across the NYRR network of schools. Given the diversity and reach of the schools and the continuous feedback solicited by the program, the materials may continue to be adapted to fit local contexts and populations. The present descriptive study, together with future research plans, will therefore jointly advance the broader field of childhood PA research and practice.

Given the lack of examples in the literature, our descriptive study is not without constraints. For example, when operationalizing the theory-informed strategy from step 3 into communication messages in step 4, we lacked explicit guidance on any methodological parameters that should be considered. As previously discussed by Kok et al [30], the effectiveness of a behavior change method will depend on whether the parameters for the method are satisfied. In other words, a theory-informed strategy requires more than outlining what constructs to target and what methods to use to operationalize the constructs; it requires a consideration for the “theoretical parameters under which the theoretical process is effective or not” [30,79]. An example in the context of our descriptive study would be that improving parental self-efficacy requires a series of reinforcing messages, as opposed to a single message [49]. Parameters for operationalizing theory are not clearly defined for the application of parenting behavior change. Empirical evidence of what conditions were used when operationalizing theory for parenting behaviors will be required to determine the relevant parameters for effectiveness.

Participation of the target population is important for establishing the most relevant theoretical determinants of a behavior or for understanding how theory-informed strategies should be applied in the design process [29]. Our formative research with the priority population, including focus groups with parents, focused on topics such as communication channel preference and the feasibility of engaging parents through communication materials but did not include an explicit theoretical focus. Additional formative research informed by SCT and SDT may have enabled further tailoring in how we operationalized theory in our communication messages.

This descriptive study advances progress in the development of school-based PA promotion efforts seeking to incorporate parent engagement strategies by detailing the operationalization of theory into communication messages. Future application of our 4-step process can be used to develop theory-informed communication materials that aim to target PA parenting behaviors.

The methodology detailed in this descriptive study is valuable for others seeking to translate theoretical constructs into behavior-change communication messages. This work provides an example and draws attention to the role of rigorous theory application and reporting in developing communications that support children’s PA behavior change as part of overall behavior-change intervention design.