An evaluation of a government-led financial incentive program addressing the cost barrier to structured physical activity participation for children and adolescents

Abstract

This thesis presents the rigorous and pragmatic evaluation of the New South Wales Government’s Active Kids program, a financial incentive program that allocated all school-aged children (4.5–18 years old) 5 vouchers valued at $100AUD each, available during 2018-2020. The vouchers could be used to support the cost of registration in structured physical activity programs. The evaluation was guided by the RE-AIM framework and used a natural experiment approach to understand the extent to which the program influenced children’s physical activity levels. Data were collected through the online administration platform, online surveys completed by parents/caregivers, and qualitative interviews with stakeholders involved in implementation. The Active Kids program reached 671375 school-enrolled children (53% of the eligible population) in the first year of implementation and annually increased reach. Most children (80%) registered for a voucher used it to register in a program however, many of these children were already regularly participating in structured physical activity. Children who used an Active Kids voucher reported increasing their days achieving physical activity guidelines from 4.0 days per week (95%CI 3.8, 4.2) at registration to 4.9 days per week (95%CI 4.7, 5.1) after 6 months and maintained these increases over more than 2 years. Population-level physical activity has not yet shifted. Policy-relevant evidence has been generated through integrating evaluation within a government-led program to inform future interventions addressing the cost barrier to participation for children and adolescents. Targeted investments to enable disadvantaged and inactive children to participate in structured programs and be physically active should be combined with financial incentives to strengthen population effects.