UNASSIGNED: This study set out to understand the association between teaching practices, teacher confidence, competence, self-efficacy, and the resulting student outcomes.
UNASSIGNED: Data regarding teaching behaviours were collected via video recording and then evaluated using the MASTER Observation Tool. The information about demographics, self-reported teaching confidence, competence, self-efficacy, and student outcomes was collected using questionnaires. The association between teacher characteristics, and teacher and/or student outcome variables were tested using a one-way analysis of variance (ANOVA).
UNASSIGNED: A total of ten primary schools were involved, including 597 children (age range: 10-12 years, grade 4-6) and 16 grade 4-6 PE teachers (with 16 PE classes). Most of the Physical Education (PE) lesson time was spent in training-form activities (60.2% ± 9.1), followed by instructional time (33.1% ± 8.6%), reflection (3.4% ± 2.3%), and warm-up (2.9% ± 2.0 %). It was observed that teaching behaviours and student outcomes were significantly better in urban than rural areas. Smaller class sizes (21-30 children) were found to have more positive feedback than larger ones (41-50 children). PE teachers with more than 10 years of teaching experience reported more teaching competence and self-efficacy than teachers with less than 10 years of experience. PE teachers with class sizes of 21-30 children enjoyed significantly better scores in self-efficacy than classes with 41-50 children. They also scored more highly in confidence and competence than classes with 41-50 and 51-60 pupils.
UNASSIGNED: The current study confirmed that teachers dedicated a large proportion of lesson time to PE delivering training-form activities, followed by instructional time. Teaching behaviour and student outcomes were associated with location and class size, but not gender. The study contributes to our understanding of PE instruction in Chinese primary schools and offers preliminary evidence to improve future PE teaching strategies in the country.

BACKGROUND: Setting healthy lifestyle habits during the formative years of childhood is critical as habits can track to adulthood and help prevent obesity and chronic disease risks in later life. While multicomponent interventions have been shown to be effective in changing the lifestyle behaviours of children, there is a limited understanding of the feasibility of such interventions in primary schools in Singapore. A multiphase mixed method study was conducted to develop and examine the feasibility of a theory-based multicomponent school-based intervention-Promoting hEatlthy Eating and Active Lifestyle (PEDAL).
METHODS: Underpinned by Kincaid\'s ideation model, the PEDAL intervention was developed to increase fruit and vegetable consumption and decrease sedentary behaviours among children. This study consists of three phases. Phase 1 details the development of PEDAL, which consists of four components: (A) a series of interactive health education lessons, (B) actionable home activities to support habit formation, (C) parental/guardian engagement, and (D) optimising the school environment. In Phase 2, components A and B of PEDAL were implemented in two public, co-educational primary schools among Primary 5 students (aged 10-12 years) in Singapore. Data was collected quantitatively using questionnaires and qualitatively using focus group discussions (FGDs) with students and teachers. The feasibility dimensions of components A and B, including recruitment capability, data collection, social validity, and practicality were examined, and ideation on healthy eating and physical activity was explored. In Phase 3, the full PEDAL intervention was pilot-tested in two other public, co-education primary schools with the same target population, using a concurrent mixed method quasi-experimental study design. Feasibility dimensions and potential effectiveness of the intervention will be assessed.
CONCLUSIONS: This study will provide insights into the feasibility of PEDAL and inform its refinement. Findings from the pilot test will guide the planning of a larger-scale definitive trial.
BACKGROUND: Registered with ISRCTN registry (ISRCTN16114046) on 16 October 2022.

UNASSIGNED: Although it is widely recognized that more attention needs to be paid to children\'s fluid intake, there is little information on how to improve it. Peer education has been suggested as an effective approach to changing health behaviors among school children. As a new approach, our study piloted a peer education program to improve children\'s fluid intake in primary schools.
UNASSIGNED: University students were prepared for their role as peer educators in an elective university course, including the concept of peer education and different pedagogical methods. The peer educators evaluated the training process by completing a questionnaire. The intervention took place during a School Health Day led by the peer educators. An anonymous survey with a questionnaire on knowledge of fluid intake was administered two weeks before, at the end of, and 15 weeks after the intervention. Changes in hydration knowledge were tested using repeated measures ANOVA.
UNASSIGNED: The pilot program showed increased knowledge about fluid consumption (p < 0.001) in lower and upper primary school children (N = 326) at the end of the School Health Day compared to pre-intervention measures. A positive change was observed after 15 weeks only in upper primary students. Feedback from peer educators was useful for fine-tuning the program.
UNASSIGNED: This innovative program induced positive changes in knowledge about fluid intake in primary school children. The persistence of the changes differed between lower and upper primary school children. Based on the results, the intervention should be replicated to adapt the program to the needs of lower primary school children. Because the training of peer educators and the peer education program appeared to be successful, this program is worthy of international replication. This approach may also be suggested for other behavior change issues.

BACKGROUND: There is ample evidence that most children do not perform enough physical activity (PA). To address this major public health problem, the French government implemented 30 minutes of daily PA (DPA) at schools but did not provide any supplemental resources or concrete guidance. Considering both children\'s interest in video games and the need for teachers to complete their curriculum, the use of a learning-based exergame that combines PA and learning appears particularly relevant.
OBJECTIVE: The first objective of this study was to evaluate the feasibility of implementing 30 minutes of DPA through exergaming among school-age children. The second objective was to examine the effects of an exergaming program on physical literacy, academic learning, and soft skills (motivation, self-efficacy, and concentration).
METHODS: This interventional study had a pre-post design and used the Play LÜ exergame platform. The study included 79 children with a mean age of 8.9 (SD 1.2) years from grade 2 (7 years old) to grade 5 (11 years old). Play LÜ requires players to throw balls against a wall to reach a target or to activate an object and provides an interactive game area for educational activities linked to specific learning themes. After a 4-session familiarization phase during which the teachers chose to prioritize mathematics learning in 30-minute DPA sessions, students took part in DPA sessions over a period of 3 weeks with Play LÜ and a motor skills circuit behind the LÜ setup to keep them continuously active. All sessions were carried out by PA specialists. Each session started with a warm-up using the Grööve application, continued with main activities promoting mathematics learning adapted to each grade level, and ended with a 3-minute meditation for returning to a calm and serene state using the Gaïa application. Before (T0) and after (T1) the program, students completed a self-evaluation booklet to assess their levels of physical literacy, academic performance, and soft skills.
RESULTS: The implementation of this exergaming program was welcomed by the school\'s administration, teaching staff, and parents. After the program, we observed increased scores for physical literacy (difference +2.6, percentage change +3.6%; W=933.0; P=.002; rrb=-0.39, 95% CI -0.58 to -0.16) and motivation in mathematics (+0.7, +9.8%; W=381.5; P=.005; rrb=-0.44, 95% CI -0.66 to -0.16). In addition, it is important to note that some measures progressed differently across learning levels and age groups.
CONCLUSIONS: The study results indicate positive impacts of learning-based exergaming on physical literacy and motivation in mathematics among school-age children.

BACKGROUND: Health-promoting schools (HPS) are acknowledged as a comprehensive approach to improving children\'s health and educational outcomes through learning and school life. Principals are key players in HPS implementation. However, concrete leadership practices in HPS in low- to middle-income countries have not been clarified. Therefore, this study aimed to explore and generate themes surrounding the leadership practices of principals in implementation of school health in Indonesia, a predominantly Muslim country consisting of diverse religions that have expanded HPS at the national level.
METHODS: In-depth interviews and focus group discussions (FGDs) were conducted with the principals, teachers, parent representatives, and school board committee members in 10 target schools. FGDs were conducted with school health supervisory board members in Mataram City. All interviews were recorded and transcribed. Thematic analysis was undertaken to generate themes.
RESULTS: The principals demonstrated leadership practices based on their religious beliefs, values, and morals. This may suggest that beliefs and morals support an understanding of their responsibility to ensure the well-being of all school community members, regardless of religion, in a diverse environment that is predominantly Muslim but also multicultural and multi-religious. Further, these beliefs and morals might reinforce implementation of school health. Importantly, the principals\' coordination skills in cooperating with multiple sectors might contribute to successful implementation of school health. Also, principals emphasized they were tasked to develop capacity for implementation of school health. Thus, principals should understand leadership in the implementation of school health as their duty from the training stage to encourage health at the school level.
CONCLUSIONS: In this study, \"have professional educators\' beliefs and religious beliefs and Indonesia\'s morals\" was generated as a new theme, whereas several common themes were found as in previous studies. The results of this study suggested the importance of leadership by principals in the implementation of school health. Strengthening the capacity of school principals by integrating the contents of school health leadership practice into pre- and in-service training through the development of a policy on principals\' duties in school health might contribute to the successful implementation of school health.

There is no tradition of serving school lunches in primary schools in the Netherlands. Most children tend to bring their own packed lunch, however these are often nutritionally suboptimal. While school lunch provision can aid healthy eating behavior amongst children, its introduction would constitute a profound change for children, parents and school staff. Therefore, this qualitative study aims to explore children\'s, parents and school staffs\' perceptions of both the current lunch situation and the implementation of school lunch provision within primary schools in the Netherlands.
In this qualitative study we conducted nine interviews with school principals, 98 interviews with children, and held six focus groups with teachers and six with parents at primary schools in two Dutch cities. The data was analysed via iterative coding.
The results showed that most children and parents are satisfied with the current lunch situation, although existing school food policies are not always put in place. Most teachers felt that children had insufficient time to consume their lunch in the current situation. The children were generally positive about the idea of a school lunch, and stressed that it was important to have the ability to choose. While both parents and school staff saw school lunch provision as an opportunity to educate families about healthy food options, they also expressed concern about who would be responsible, as well as the financial and organizational implications of its introduction.
Perceptions of children, parents and school staff about a school provided lunch are mixed. A complex intervention such as a new school lunch program is difficult to envisage for all parties involved and more research is needed regarding the effects, organization, logistics and the costs of school lunch provision in the Netherlands.

Children with dysfunction in sensory processing (DSP) may experience challenges, which might affect their participation in activities and potentially also their further development. This study examined the challenges of children with DSP who exhibit sensory seeking behavior, the differences in these challenges between boys and girls, and the possible effects of their use of ball vests. The challenges of 70 pupils (aged 6-12 years) exhibiting sensory seeking behavior were assessed by their parents (n = 66) and teachers (n = 60) by surveys containing items from the \'Strengths and Difficulties Questionnaire\' (SDQ) and the \'Five to Fifteen\' (FTF) questionnaire. Differences in the SDQ/FTF scores between boys and girls were explored using chi-square analysis. The potential effects of the ball vest were assessed using a study-specific follow-up survey. Linear mixed model regression analysis was used to examine associations between the extent of use of the vest and the assessed effects. The pupils were assessed for challenges that interfered with their learning (62%), forming friendships (51.7%), and the classroom environment (56.9%). After three weeks, the parents found that some pupils had improved regarding attention (39%), body perception (34%), and hyperactivity and impulsivity (33%). The teachers reported that 30% of the pupils had improved their coping skills in learning.

This study aimed to understand dropout stabilization and the factors affecting the return to primary school using a qualitative approach. Data were collected from 47 semi-structured interviews with dropouts, their parents, children who returned to school, social facilitators, school teachers, local community religious leaders, and education activists. Following Graneheim and Lundman\'s method, thematic data analysis revealed two main categories: \"dropout stabilization facilitators\" and \"dropout stabilization inhibitors\", with 10 subcategories. Dropout stabilization facilitators included the 7 subcategories of perceiving academic decline, inhibitory effects of shame, barriers to re-enrollment, relief from educational pressures and norms, the transformed value system, family satisfaction, and the inefficiency of the formal care system. On the other hand, dropout stabilization inhibitors included the three subcategories of sensitivity to the informal care system, financial incentives, and intensive and flexible training. Some events after dropping out of school resulted in stabilized and definite dropouts. Children at primary schools do not have a clear understanding of the importance of achievements and the effects of education, perceiving dropout as an escape from educational norms and associated hardships. Transitioning into adult roles, such as marriage, motherhood, and assuming responsibilities for siblings, often leads individuals to prioritize other aspects of life over educational achievements. Barriers, such as age limits for being admitted to schools and lack of mechanisms for compensating tuition fees, lead to family dissatisfaction and further reinforce the decision to withdraw their children from school. Factors such as timely actions and follow-ups by schools, financial incentives, and brief interventions provided by the informal network are likely to prevent students from dropping out of school.

BACKGROUND: The COVID-19 pandemic has impacted the lives of individuals, families, and children worldwide. In Italy, the implementation of measures such as lockdowns and distance learning in schools affected the mental health of children and families.
METHODS: This article employs a qualitative method to explore the efficacy of a death education project that aimed to help primary school children process the emotions and losses that they experienced during the COVID-19 pandemic. The study encompassed both the children who took part in the death education project and their teachers and parents to investigate their perspectives on the emotions of the minors and the effectiveness of the project.
RESULTS: Distance learning posed challenges for the learning process and exacerbated social inequalities. The children suffered from limited social contact with their friends and experienced negative emotions, including anger, fear, and concern for the health of their loved ones. The death education project provided a safe space for children\'s emotional expression and facilitated their acquisition of coping strategies. Open communication between adults and children about illness and death proved effective in mitigating the psychological impacts of loss and preventing traumatic bereavement.
CONCLUSIONS: The findings highlight the utility of death education in enhancing children\'s ability to express their emotions and approach the topic of death more frankly.

BACKGROUND: While existing research has explored changes in health behaviours among adults and adolescents due to the COVID-19 outbreak, the impact of quarantine on young children\'s well-being is still less clear. Moreover, most of the published studies were carried out on small and non-representative samples. The aim of the EpaS-ISS study was to describe the impact of the COVID-19 pandemic on the habits and behaviours of a representative sample of school children aged mainly 8-9 years and their families living in Italy, exploring the changes in children\'s well-being during the COVID-19 pandemic compared to the immediately preceding time period.
METHODS: Data were collected using a web questionnaire. The target population was parents of children attending third-grade primary schools and living in Italy. A cluster sample design was adopted. A Well-Being Score (WBS) was calculated by summing the scores from 10 items concerning the children\'s well-being. Associations between WBS and socio-demographic variables and other variables were analysed.
RESULTS: A total of 4863 families participated. The children\'s WBS decreased during COVID-19 (median value from 31 to 25; p = 0.000). The most statistically significant variables related to a worsening children\'s WBS were: time of school closure, female gender, living in a house with only a small and unliveable outdoor area, high parents\' educational level and worsening financial situation.
CONCLUSIONS: According to parents \' perception, changes in daily routine during COVID-19 negatively affected children\'s well-being. This study has identified some personal and contextual variables associated with the worsening of children\'s WBS, which should be considered in case of similar events.