In recent years, there is growing emphasis on the automatic (implicit) processes that drive health behaviour (e.g. impulsivity, attention bias) over and above the reflective (explicit) processes that assume individuals’ awareness (e.g. intention, self-efficacy)51. Focus on the latter might be another key reason for the moderate effectiveness of behaviour change interventions as the health decisions that people make are often less conscious than the explicit processes suggest52. Essentially, rumination, an emotion coping mechanism that is closely linked to implicit cognition such as attention bias and affective processes, could play a vital role in hindering our decisions to engage in positive health behaviour. While rumination has shown to be a potential self-regulatory mechanism that drives PA behaviour, our understanding of this coping style in its application to health behaviours is still in its infancy. This is partly attributable to a lack of a psychometric instrument to measure PA-specific rumination. Our study is the first to develop and validate a rumination scale specific to PA behaviour for school-aged UK children. The PARSC with a 3-point response scale has demonstrated sound internal validity, internal consistency and test-retest reliability. PA-specific rumination tendencies were also found to be predicted by self-perceived PA and avoidant coping. A main strength of this validation study is the use of Rasch modelling to generate meaningful interval scores for analysis55. The association between avoidant coping and rumination is as expected, as confronting stressors are undesirable for ruminators due to their heightened reactivity to stress, resulting in their urge to avoid the source of stress56,57. However, it is surprising that self-perceived PA, and not objectively measured PA, is linked to rumination tendencies. It is possible that the shrunken sample size in the analysis, due largely to attrition from PA measurement (40%), failed to capture the extreme ends of the PA spectrum while the possible underestimation of light-moderate PA and overestimation of moderate-vigorous PA from the self-report might have artificially inflated the variability58. Future studies should consider measuring objective PA in a larger sample to ascertain the predictive validity of PARSC.
As the PARSC was developed through accounts of the lived experience of children from the UK, it can be considered as a culture-specific instrument. Nonetheless, it can potentially be used for other child populations. Findings from previous qualitative studies on barriers of PA with Hispanic and Australian children are largely similar to the themes identified in the current study, however, additional prominent themes from the former include concerns about getting ‘sweaty’, and parent-driven rules such as expectations of behaviour indoor, and neither studies identified uncleanliness, sex stereotype and lack of a sense of purpose from their participants15,16. These discrepancies could potentially stem from cultural differences in parenting practice, and from the fact that focus of these studies is less on the intrinsic barriers but more on environmental barriers as well. Therefore, if PARSC is used in children from different cultural backgrounds, it is recommended that further validation process is in place to ascertain its suitability.
For some of the intrinsic barriers that are relatively uncontrollable by individuals, such as sex stereotype, uncleanliness, unfair play, previous negative experiences and to some extent, injuries and accidents, it is important for researchers and education professionals to help children overcome them by building resilience in order to minimize their influence on children’s PA. PA interventions can also consider implementing strategies that address the other barriers through effective coaching. For example, understanding that some children find the ‘out of breath’ experiences disconcerting, PE sessions can focus on pacing strategies for a more even distribution of effort intensity so that prolonged PA can be enjoyable, and at the same time, awareness about this sensation can be raised as part of normal physiological functioning so that children would not consider this to be negative59. Intriguingly, when children expressed that a lack of purpose being a barrier, they did not consider staying healthy as a purpose, yet, all agreed that PA is a means to lead a healthy lifestyle. This certainly has implications on the content of health messaging in PA interventions and public health campaigns, as focus on health promotion is perhaps less likely to motivate children than the intrinsic facilitators that attract them to engage in PA due to its lack of relevance to children’s value60.
Lastly, regarding the intrinsic facilitators, they generally agree with previous research in the area and these factors, such as sense of competence and social facilitation, can certainly be incorporated in children’s PA experiences by PE teachers and parents14. For example, children’s sense of accomplishments can be enhanced through effective goal-setting or errorless learning in the skill learning process as well as raising self-reflective ability61; their enjoyment gained from self-expression can be satisfied by allowing autonomy to create their own games or dance moves14, and the effect of social facilitation can be optimized through role modelling or amicable competitions62. Crucially, our data suggest that children are naturally drawn to movements and play, so any attempts to provide such opportunities are likely to reduce time spent sedentary and potentially reduce cardiovascular disease risks63. All of these strategies can be implemented within PE classes or integrated into PA interventions. In fact, the mentioned factors have provided support to existing theories of behaviour change, such as Self-Determination Theory and Social Learning Theory, but our findings have presented further insights into how these theories, and the associated PA determinants, may operationalise in a context specific to PA behaviour in UK children through which future PA interventions can model on.
Additionally, some intrinsic facilitators are unrelated to existing theories and less explored in PA behaviour literature. Specifically, children seemed to derive PA enjoyment from their sensory experiences and energy boost. The latter is particularly interesting as this factor seems to be novel within existing literature. As discussed previously, even though the concept of health might not be meaningful to children, having the energy to function in everyday life and to participate in enjoyable pursuits seem to be a crucial motivator for some children to engage in PA. This finding also suggests that children’s sensory experiences should not be undermined, hence strategies to promote an active lifestyle can include an emphasis of positive sensory experiences during and after PA, a concept similar to mindfulness training in encouraging attention to the present-moment feelings and sensations64.
A few limitations of the current study are worth noting. First, due to the limited linguistic repertoire and self-reflexive ability, drawing in-depth information from the youngest age group in focus group discussions was challenging. Focus group discussions might not be the best way to understand the lived experience of children under 7 years of age, instead, we might have to rely on reports from parents and teachers who can explore children’s in-the-moment PA experiences. Moreover, despite possessing sound psychometric properties, further confirmation of construct validity of PARSC is called for, due to a lack of validated rumination scales for children. The psychometric assessment led to a post-hoc rescaling of PARSC, and some DIF was indicated for both sex and age groups. Although the post-hoc scoring appeared to work favourably, and the impact of the DIF appeared to be small at the test level, this should be further tested by a different sample in order to confirm the psychometric properties of the PARSC, and to determine whether a 3-response category format is appropriate when tested prospectively. Nonetheless, we consider the themes identified from the focus group discussions and the phrasing of the items indicative of the construct, and potentially, future studies can lend support through neuroimaging or psychophysiological response to PA-related stimuli with children of extreme ends of the PA spectrum.