{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:56:07Z","timestamp":1792788967456,"version":"4.5.0"},"update-to":[{"DOI":"10.3310\/nihropenres.14336.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000}}],"reference-count":56,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"UKRI","award":["EP\/X023508\/1"],"award-info":[{"award-number":["EP\/X023508\/1"]}]},{"name":"National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre","award":["BRC\u2013NIHR203315"],"award-info":[{"award-number":["BRC\u2013NIHR203315"]}],"id":[{"id":"https:\/\/ror.org\/0187kwz08","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["openresearch.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["NIHR Open Res"],"abstract":"<ns3:p>Background Public health interventions need to be designed for the intervention setting. Traditionally, to maximise internal validity, school-based pupil physical activity interventions deliver an identical programme across all settings. However, an interventions\u2019 success will depend on the context in which it is implemented, i.e. a schools\u2019 social, cultural, economic, environmental and other characteristics. In this paper we use the development of the PASSPORT (Physical Activity via a School-Specific PORTfolio) intervention as a case study for the development of context-specific public health interventions. We outline how we developed the intervention and draw out key learning from this for public health interventions generally. Methods The PASSPORT intervention takes a portfolio approach that allows schools to select and deliver tailored intervention content that is most suitable to their setting. The intervention was developed across multiple research steps that were designed to progressively build knowledge on school context and physical activity and integrate these into intervention design. We outline these in the paper. Formative studies include: a scoping review of intervention components; school staff interviews; a rapid ethnography; and a school survey. These findings informed the co-design of the intervention tool with primary school staff and the development of the portfolio content. Finally, we conducted a pilot study in two schools to learn from both the delivery of the intervention and associated evaluation data collection. Key learning Key learning for context-specific intervention design has been gathered around four areas: Ground intervention design in a range of data and insight, Centre contextual experience, Design for intervention flexibility and user autonomy, and, Build in processes to test and iterate. Conclusions Each of the formative studies and the intervention design steps provided parts of the complex picture of intervention context and design needs. Combined, the results of the studies supported the development of a context-specific intervention.<\/ns3:p>","DOI":"10.3310\/nihropenres.14336.2","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T11:34:06Z","timestamp":1791459246000},"page":"78","update-policy":"https:\/\/doi.org\/10.3310\/nihropenres.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Designing a context-specific intervention in practice: learning from a school-based physical activity intervention"],"prefix":"10.3310","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6171-9922","authenticated-orcid":false,"given":"Danielle","family":"House","sequence":"first","affiliation":[{"name":"Population Health Sciences Bristol England University of Bristol Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0613-3028","authenticated-orcid":false,"given":"Abi","family":"Howard","sequence":"additional","affiliation":[{"name":"Population Health Sciences Bristol England University of Bristol Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Kent-Saisch","sequence":"additional","affiliation":[{"name":"Population Health Sciences Bristol England University of Bristol Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Porter","sequence":"additional","affiliation":[{"name":"Population Health Sciences Bristol England University of Bristol Medical School"},{"name":"Bristol England NIHR Bristol Biomedical Research Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Reid","sequence":"additional","affiliation":[{"name":"Population Health Sciences Bristol England University of Bristol Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Morbey","sequence":"additional","affiliation":[{"name":"Population Health Sciences Bristol England University of Bristol Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia","family":"Emm-Collison","sequence":"additional","affiliation":[{"name":"Centre for Exercise, Nutrition & Health Sciences Bristol England University of Bristol"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"de Vocht","sequence":"additional","affiliation":[{"name":"Population Health Sciences Bristol England University of Bristol Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Salway","sequence":"additional","affiliation":[{"name":"Population Health Sciences Bristol England University of Bristol Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3394-0176","authenticated-orcid":false,"given":"Russell","family":"Jago","sequence":"additional","affiliation":[{"name":"Population Health Sciences Bristol England University of Bristol Medical School"},{"name":"Bristol England NIHR Bristol Biomedical Research Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6221","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"n1679","DOI":"10.1136\/bmj.n1679","article-title":"Adapting interventions to new contexts-the ADAPT guidance.","volume":"374","author":"G Moore","year":"2021","journal-title":"BMJ."},{"key":"ref2","doi-asserted-by":"crossref","first-page":"e029954","DOI":"10.1136\/bmjopen-2019-029954","article-title":"Guidance on how to develop complex interventions to improve health and healthcare.","volume":"9","author":"A O\u2019Cathain","year":"2019","journal-title":"BMJ Open."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"n2061","DOI":"10.1136\/bmj.n2061","article-title":"A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance.","volume":"374","author":"K Skivington","year":"2021","journal-title":"BMJ."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"535-546","DOI":"10.17269\/s41997-022-00644-6","article-title":"Regional differences in movement behaviours of children and youth during the second wave of the COVID-19 pandemic in Canada: follow-up from a national study.","volume":"113","author":"H Caldwell","year":"2022","journal-title":"Can. 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We have addressed these and feel they have improved the clarity and focus of the paper. Details on how we addressed each of your comments are provided below.  \n<b>Overall comment<\/b> \n<i>This is a methodological paper about the development of a context-specific intervention aiming to increase physical activity in primary school children. The intervention development process included interviews, an ethnographic study, a survey, and a pilot study, combined with co-design workshops with school staff.<\/i> \n<i>Overall, the paper is well-written and clearly structured, and some sections (particularly the description of the co-design workshops) present a good level of detail. However, I believe additional detail is needed in several areas to allow other researchers to replicate or adapt this approach, as the value of a methods paper like this one lies largely in its practical transferability.<\/i>  \n<b>Response:&nbsp;Thank you, we have tried to address this and have outlined this below.<\/b>  \n<b>Introduction<\/b> \n<i>Could the authors further clarify why they focused on children aged 7\u201311 years specifically? Is this age range based on developmental considerations (e.g. autonomy, ability to engage with active travel or breaktime activities), alignment with UK primary school key stages, precedent from the existing literature\/scoping review, or a more pragmatic\/logistical decision (e.g. school structure, ease of recruitment)? A brief justification would help readers understand whether this age range is a necessary feature of the approach or one that could be adapted for other age groups.<\/i>  \n<b>Response:&nbsp;Thank you for this comment. The PASSPORT study focuses on Year 5 children (aged 9-10 in the UK). This is because evidence shows that physical activity levels decline with age across childhood and the transition from primary to secondary school appears to be a key moment in this decline. This rationale for the focus on primary school broadly, and children at the end of primary school specifically, has been added to the \u2018Introduction\u2019 section.<\/b>  \n<b>Methodology<\/b> \n<i>Survey response rate: The survey achieved a 19% response rate (59\/311 schools). I think the authors could reflect more on this, as it would help readers who want to use this framework understand what barriers were faced in engaging schools, and whether the responding schools may differ systematically from non-responders (e.g. the sample skews towards urban, less deprived schools, as shown in Table 1 \u2014 was this anticipated, and how might it affect the generalizability of the context assessment items derived from this survey?). Some discussion of possible response bias and how this was accounted for (or not) in developing the context assessment would strengthen the methodology.<\/i>  \n<b>Response:<\/b>&nbsp;\n<b>Thank you for this suggestion. We have added reflection on the sample in the section \u2018School survey\u2019, namely that the survey was useful in many ways but demonstrated the value in triangulating data across several study designs.<\/b>  \n<i>Description of the intervention: The intervention itself is not entirely clear from the current description. Could the authors expand on: how many activities\/options are typically included within each of the six pathways; what a &quot;bespoke programme&quot; concretely looks like once selected (e.g. how many activities does a school typically choose, over what timeframe); how prescriptive versus flexible the research team's recommendations actually are in practice; and what the relationship is between the &quot;core package&quot; (identical for all schools) and the bespoke, school-selected content. A concrete example or illustrative case (even briefly) of one school's context assessment leading to specific recommended activities and a final bespoke programme would substantially help readers understand how the tool operates in practice.<\/i>  \n<b>Thank you for this comment, we have expanded on the section \u2018The PASSPORT intervention\u2019 in several ways to address this: &nbsp;<\/b>  \n<b>We have added details on the assessment, recommendation, and selection process, including on the likely numbers of activities that would be recommended and selected during the process.<\/b> \n<b>We have added an illustrative example from a hypothetical school, to demonstrate how a context assessment would identify strengths and opportunities, how this would inform recommendations for that school, and how a school would select a number of these activities to create their bespoke programme.<\/b> \n<b>We have moved the information on the core package to the end of the section and expanded on this to provide additional detail, with examples of core package resources, to demonstrate how it provides guides and evidence to support the delivery of bespoke programmes.<\/b> \n<b>We have also provided more description and detail of the content, i.e. the materials and resources a school might be given, in the \u2018Portfolio content development\u2019 section.<\/b>   \n<i>Figure 8: The image quality of Figure 8 (the digital prototype screenshot) is poor, and much of the text within the screenshot is illegible. Could this be replaced with a higher-resolution image, or could the key elements be summarized in the accompanying text\/caption to ensure the content is accessible even if the image quality cannot be improved?<\/i>  \n<b>Response:&nbsp;Thank you for this comment and apologies the original image quality was not sufficient. We have created a new version of this image with higher resolution.<\/b>  \n<b>Results<\/b> \n<i>It would be helpful if the authors linked findings from the related published papers more explicitly within this section (e.g. specific relevant findings from references 32, 33, 35, 36, 38 that directly informed particular design decisions), rather than relying mainly on citation. Even a sentence per referenced study summarizing the specific finding that shaped a specific aspect of the PASSPORT design would make this methods paper more self-contained and easier to follow without needing to consult each underlying paper separately.<\/i>  \n<b>Response:&nbsp;Thank you for this suggestion. We have used this prompt to emphasise and bring this out across each study in the section \u20183. Developing the PASSPORT intervention\u2019. Specifically, we have:<\/b>  \n<b>Stated more clearly where full study findings can be accessed.<\/b> \n<b>Better aligned sections and language to Figure 3 which demonstrates which studies provided information on which aspects of the intervention.<\/b> \n<b>Expanded across each study section on the precise findings that emerged and how these informed the intervention development and design.<\/b>","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/6-78\/v2#referee-comment-3636","order":2,"name":"referee-comment-3636","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This project is funded by UKRI REF EP\/X023508\/1. This study has been delivered through the National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre (BRC \u2013 NIHR203315). AP is funded by Bristol BRC and RJ is part funded. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}