Active Healthy Kids Global Alliance “Global Matrix” Initiative: Process, Results, Impact and Evaluation

Abstract

In response to growing concern about physical inactivity among children, the Report Card on Physical Activity for Children and Youth was created in Canada in 2005. The Report Card is a public-facing document reporting letter grades, updated scientific information, research gaps, and recommendations for improvement on physical activity indicators for children and youth (0 to 17 years old). In 2014, the Report Card process was replicated in 14 additional countries, constituting the Global Matrix 1.0, opening the door to standardized international comparisons. Following the release of the Global Matrix 1.0, the Active Healthy Kids Global Alliance (AHKGA, www.activehealthykids.org), a network of researchers, health professionals and stakeholders working together to advance physical activity in children and youth from around the world, was created. The AHKGA led the development of the Global Matrix 2.0, involving the replication of the Report Card process in 38 countries. The Global Matrices highlighted strengths, disparities, inequities, research and surveillance gaps, and showed that no participating country had all the solutions to tackle the physical inactivity issue. The initiative facilitated the cross-fertilization of innovative solutions for countries with low grades to learn from those with high grades in particular areas/indicators. In November 2018, the Global Matrix 3.0, involving the concurrent development of Report Cards with 10 common physical activity indicators from 49 countries was released at the Movement to Move event in Adelaide, Australia. The aim of this dissertation was to investigate how the Global Matrix initiative has contributed to global childhood physical activity promotion. To achieve this goal, the history of the development process from the Global Matrix 1.0 to Global Matrix 3.0 was detailed and explained; correlates of the physical activity grades from the Global Matrix 3.0 and trends of the physical activity grades over time were studied; the international impact of the past editions of the Global Matrices and Report Cards were assessed using both quantitative and qualitative methods; and an evaluation of the Global Matrix 3.0 process from its development to its launch was performed and analyzed to formulate recommendations for future editions. The report of the development process history from Global Matrix 1.0 to Global Matrix 3.0 showed that the Global Matrix of physical activity grades for children and youth has experienced great expansion since its creation. Despite the great variability of the data (e.g., in terms of benchmarks, measurement instruments, age range, sample size, quality, quantity) informing the grades between the countries for each indicator, the participation of 49 countries in the Global Matrix 3.0 allowed studying the potential associations between the childhood physical activity indicator grades and potential correlates with greater statistical power than in the past. A significant negative correlation was observed between the Overall Physical Activity indicator and several sociodemographic indicators including the Human Development Index (HDI) and Gross National Income per capita. Higher behavioural grades and lower sources of influence grades were generally observed in the low and medium HDI countries, whereas lower behavioural grades and higher sources of influence grades were observed for the very high HDI countries, and generally low average grades for each indicator in the high HDI countries. The Global Matrix 3.0 provided new evidence showing that the situation regarding the physical activity of children and youth is a universal concern worldwide. A case study of the 2018 French Report Card is provided, and the characteristics of the physical activity grades within the very high HDI countries were explored in greater detail. The Report Cards and the Global Matrices had demonstrable impact on the promotion of children’s physical activity globally, in various ways. The international comparisons of physical activity indicators from 49 countries highlighted disparities, inequities, remaining research and surveillance gaps, and contributed to raising awareness, cross-fertilizing successes, and stimulating policy and practice changes to promote physical activity within and across jurisdictions. In addition, the evaluation of the impact of the Report Cards and the Global Matrix projects showed that they have initiated a movement worldwide that is contributing to decrease surveillance gaps in childhood physical activity indicators. Finally, the evaluation of the Global Matrix 3.0 allowed for the identification of strengths and areas for improvement in the Global Matrix approach and to formulate recommendations for future editions of the Global Matrix. The work presented in this thesis shows that the Report Cards and Global Matrices contributed to advancing knowledge concerning the characteristics of physical activity in terms of behavioural and sources of influence physical activity indicators for children and youth at the global level. Findings from the Global Matrix 3.0 highlighted the need for strategic public investments to implement effective interventions within families, communities, and schools to increase physical activity opportunities for all children. The need for the development and international adoption of standardized methods to conceptualize and measure the 10 physical activity indicators was also emphasized in this work. Finally, this thesis demonstrated that this international initiative has the potential to raise awareness concerning the physical inactivity issue, facilitate the development of new physical activity data collection protocols, and support the development of physical activity promotion policies, even among countries with low quality or missing data.