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The status of active after-school clubs among primary school children in England (UK) after the COVD-19 lockdowns: implications for policy and practice
Children's physical activity in England is more dependent on active clubs after the COVID-19 pandemic. However, it is unclear how the COVID-19 pandemic and related cost-of-living crisis have impacted on active club participation, costs and provision. This mixed-methods natural experiment explor...
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Published in: | The international journal of behavioral nutrition and physical activity 2023-10, Vol.20 (1), p.120-13, Article 120 |
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description | Children's physical activity in England is more dependent on active clubs after the COVID-19 pandemic. However, it is unclear how the COVID-19 pandemic and related cost-of-living crisis have impacted on active club participation, costs and provision. This mixed-methods natural experiment explored school-based and community-based active clubs after lockdowns, using a unique combination of data sources to highlight implications for policy and practice post-COVID-19.
Cross-sectional questionnaire data on school and community active clubs were collected from 10-11-year-old children pre-COVID-19 in 2017-18 (N = 1,296; 50 schools), in 2021 (N = 393; 23 schools), and 2022 (N = 463; 27 schools). Club participation and attendance frequency were modelled using logistic and Poisson mixed effects models, adjusted for child age, gender and household education. In 2021 and 2022, parents reported expenditure on community-based clubs and schools provided data on school-based club provision, with data summarised descriptively. Qualitative data were collected in 2021 and 2022, with one-to-one interviews with school staff (N = 18) and parents (N = 43), and twelve child focus groups (N = 92), and analysed using the framework method.
School-based active club participation was higher in 2022 compared to pre-pandemic (50% /43%), while community-based club participation was lower (74%/80%). Children attended 0.3 fewer clubs per week. Those from lower education households were less likely to participate in both types of active clubs, and girls less likely to attend community clubs. In 2022, the median cost of community and school club sessions were £6.67 and £3.88 respectively, with 52% of school-based clubs free to parents. Schools offered an average of 3.4 active clubs per week for 10-11-year-olds in 2022, with 34% partly/wholly subsidised. Qualitative analysis highlighted the impact of the cost-of-living crisis and COVID-19 pandemic on family resources, encouraging a shift to more affordable and convenient school-based active clubs, which negatively impacted the community-based active club environment. However, many schools struggled to meet this increased demand.
Findings emphasise the importance for policymakers to support schools to meet increased demand for clubs and community clubs to increase affordable and convenient physical activity opportunities. Targeted support is needed to prevent socioeconomic and gender inequalities. |
doi_str_mv | 10.1186/s12966-023-01499-x |
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Cross-sectional questionnaire data on school and community active clubs were collected from 10-11-year-old children pre-COVID-19 in 2017-18 (N = 1,296; 50 schools), in 2021 (N = 393; 23 schools), and 2022 (N = 463; 27 schools). Club participation and attendance frequency were modelled using logistic and Poisson mixed effects models, adjusted for child age, gender and household education. In 2021 and 2022, parents reported expenditure on community-based clubs and schools provided data on school-based club provision, with data summarised descriptively. Qualitative data were collected in 2021 and 2022, with one-to-one interviews with school staff (N = 18) and parents (N = 43), and twelve child focus groups (N = 92), and analysed using the framework method.
School-based active club participation was higher in 2022 compared to pre-pandemic (50% /43%), while community-based club participation was lower (74%/80%). Children attended 0.3 fewer clubs per week. Those from lower education households were less likely to participate in both types of active clubs, and girls less likely to attend community clubs. In 2022, the median cost of community and school club sessions were £6.67 and £3.88 respectively, with 52% of school-based clubs free to parents. Schools offered an average of 3.4 active clubs per week for 10-11-year-olds in 2022, with 34% partly/wholly subsidised. Qualitative analysis highlighted the impact of the cost-of-living crisis and COVID-19 pandemic on family resources, encouraging a shift to more affordable and convenient school-based active clubs, which negatively impacted the community-based active club environment. However, many schools struggled to meet this increased demand.
Findings emphasise the importance for policymakers to support schools to meet increased demand for clubs and community clubs to increase affordable and convenient physical activity opportunities. Targeted support is needed to prevent socioeconomic and gender inequalities.</description><identifier>ISSN: 1479-5868</identifier><identifier>EISSN: 1479-5868</identifier><identifier>DOI: 10.1186/s12966-023-01499-x</identifier><identifier>PMID: 37798727</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>After school programs ; Caregivers ; Child ; Children & youth ; Club provision ; Communicable Disease Control ; Cost and standard of living ; Cost of living crisis ; Costs ; COVID-19 ; COVID-19 - epidemiology ; COVID-19 - prevention & control ; Cross-Sectional Studies ; Educational aspects ; Elementary school students ; England ; Exercise ; Exercise for children ; Expenditures ; Families & family life ; Female ; Forecasts and trends ; Gender equality ; Health aspects ; Humans ; Pandemics ; Parents & parenting ; Participation ; Pediatric research ; Physical activity ; Physical fitness ; Physical fitness for children ; Policy ; Schools ; Spending ; Sport ; Statistical analysis ; Surveys and Questionnaires</subject><ispartof>The international journal of behavioral nutrition and physical activity, 2023-10, Vol.20 (1), p.120-13, Article 120</ispartof><rights>2023. BioMed Central Ltd., part of Springer Nature.</rights><rights>COPYRIGHT 2023 BioMed Central Ltd.</rights><rights>2023. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>BioMed Central Ltd., part of Springer Nature 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c598t-b0509607d1a7cbc06cf6c87f587d37be8f8b15c7772664703eb5f45f58ca7f5e3</citedby><cites>FETCH-LOGICAL-c598t-b0509607d1a7cbc06cf6c87f587d37be8f8b15c7772664703eb5f45f58ca7f5e3</cites><orcidid>0000-0001-9901-5285</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10552244/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2877503109?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25751,27922,27923,37010,37011,38514,43893,44588,53789,53791</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37798727$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Walker, Robert</creatorcontrib><creatorcontrib>Salway, Ruth</creatorcontrib><creatorcontrib>House, Danielle</creatorcontrib><creatorcontrib>Emm-Collison, Lydia</creatorcontrib><creatorcontrib>Breheny, Katie</creatorcontrib><creatorcontrib>Sansum, Kate</creatorcontrib><creatorcontrib>Churchward, Sarah</creatorcontrib><creatorcontrib>Williams, Joanna G</creatorcontrib><creatorcontrib>Vocht, Frank de</creatorcontrib><creatorcontrib>Hollingworth, William</creatorcontrib><creatorcontrib>Jago, Russell</creatorcontrib><title>The status of active after-school clubs among primary school children in England (UK) after the COVD-19 lockdowns: implications for policy and practice</title><title>The international journal of behavioral nutrition and physical activity</title><addtitle>Int J Behav Nutr Phys Act</addtitle><description>Children's physical activity in England is more dependent on active clubs after the COVID-19 pandemic. However, it is unclear how the COVID-19 pandemic and related cost-of-living crisis have impacted on active club participation, costs and provision. This mixed-methods natural experiment explored school-based and community-based active clubs after lockdowns, using a unique combination of data sources to highlight implications for policy and practice post-COVID-19.
Cross-sectional questionnaire data on school and community active clubs were collected from 10-11-year-old children pre-COVID-19 in 2017-18 (N = 1,296; 50 schools), in 2021 (N = 393; 23 schools), and 2022 (N = 463; 27 schools). Club participation and attendance frequency were modelled using logistic and Poisson mixed effects models, adjusted for child age, gender and household education. In 2021 and 2022, parents reported expenditure on community-based clubs and schools provided data on school-based club provision, with data summarised descriptively. Qualitative data were collected in 2021 and 2022, with one-to-one interviews with school staff (N = 18) and parents (N = 43), and twelve child focus groups (N = 92), and analysed using the framework method.
School-based active club participation was higher in 2022 compared to pre-pandemic (50% /43%), while community-based club participation was lower (74%/80%). Children attended 0.3 fewer clubs per week. Those from lower education households were less likely to participate in both types of active clubs, and girls less likely to attend community clubs. In 2022, the median cost of community and school club sessions were £6.67 and £3.88 respectively, with 52% of school-based clubs free to parents. Schools offered an average of 3.4 active clubs per week for 10-11-year-olds in 2022, with 34% partly/wholly subsidised. Qualitative analysis highlighted the impact of the cost-of-living crisis and COVID-19 pandemic on family resources, encouraging a shift to more affordable and convenient school-based active clubs, which negatively impacted the community-based active club environment. However, many schools struggled to meet this increased demand.
Findings emphasise the importance for policymakers to support schools to meet increased demand for clubs and community clubs to increase affordable and convenient physical activity opportunities. Targeted support is needed to prevent socioeconomic and gender inequalities.</description><subject>After school programs</subject><subject>Caregivers</subject><subject>Child</subject><subject>Children & youth</subject><subject>Club provision</subject><subject>Communicable Disease Control</subject><subject>Cost and standard of living</subject><subject>Cost of living crisis</subject><subject>Costs</subject><subject>COVID-19</subject><subject>COVID-19 - epidemiology</subject><subject>COVID-19 - prevention & control</subject><subject>Cross-Sectional Studies</subject><subject>Educational aspects</subject><subject>Elementary school students</subject><subject>England</subject><subject>Exercise</subject><subject>Exercise for children</subject><subject>Expenditures</subject><subject>Families & family life</subject><subject>Female</subject><subject>Forecasts and trends</subject><subject>Gender equality</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Pandemics</subject><subject>Parents & parenting</subject><subject>Participation</subject><subject>Pediatric research</subject><subject>Physical activity</subject><subject>Physical fitness</subject><subject>Physical fitness for children</subject><subject>Policy</subject><subject>Schools</subject><subject>Spending</subject><subject>Sport</subject><subject>Statistical analysis</subject><subject>Surveys and Questionnaires</subject><issn>1479-5868</issn><issn>1479-5868</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>COVID</sourceid><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptksFu1DAURSMEoqXwAyyQJTbtIq3txLHNBlVDgRGVKkHL1nIcO-MhsQc7KdMv4XdxOtNqpkJZJPa79zz75WbZWwRPEWLVWUSYV1UOcZFDVHKer59lh6ikPCesYs93vg-yVzEuISwQg-RldlBQyhnF9DD7e73QIA5yGCPwBkg12FsNpBl0yKNaeN8B1Y11BLL3rgWrYHsZ7sBDaWG7JmgHrAMXru2ka8DxzbeTDQAMiT27-vkpRxx0Xv1q_B8XPwDbrzqr5GC9i8D4AFY-re_A5F6F6QhKv85eGNlF_Wb7PspuPl9cz77ml1df5rPzy1wRzoa8hgTyCtIGSapqBStlKsWoIYw2Ba01M6xGRFFKcVWVFBa6JqYkqa5kUuniKJtvuI2XS7G9nvDSivsNH1ohQzpQpwVUiGBsdMI1JS2IrLlqCkQYpzp15on1ccNajXWvG6XdEGS3B92vOLsQrb8VCJJELstEON4Sgv896jiI3kaluzRY7ccoMKMlJhzzqdn7J9KlH4NLs5pUlKR_DXdUrUw3sM741FhNUHFOK8phhXGRVKf_UaWn0b1V3mlj0_6e4WTPkDSDXg-tHGMU8x_f97V4o1XBxxi0eRwIgmLKsdjkWKQci_sci3Uyvdsd5aPlIbjFP3Wz7UY</recordid><startdate>20231005</startdate><enddate>20231005</enddate><creator>Walker, Robert</creator><creator>Salway, Ruth</creator><creator>House, Danielle</creator><creator>Emm-Collison, Lydia</creator><creator>Breheny, Katie</creator><creator>Sansum, Kate</creator><creator>Churchward, Sarah</creator><creator>Williams, Joanna G</creator><creator>Vocht, Frank de</creator><creator>Hollingworth, William</creator><creator>Jago, Russell</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ISR</scope><scope>3V.</scope><scope>7RQ</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>COVID</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-9901-5285</orcidid></search><sort><creationdate>20231005</creationdate><title>The status of active after-school clubs among primary school children in England (UK) after the COVD-19 lockdowns: implications for policy and practice</title><author>Walker, Robert ; Salway, Ruth ; House, Danielle ; Emm-Collison, Lydia ; Breheny, Katie ; Sansum, Kate ; Churchward, Sarah ; Williams, Joanna G ; Vocht, Frank de ; Hollingworth, William ; Jago, Russell</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c598t-b0509607d1a7cbc06cf6c87f587d37be8f8b15c7772664703eb5f45f58ca7f5e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>After school programs</topic><topic>Caregivers</topic><topic>Child</topic><topic>Children & youth</topic><topic>Club provision</topic><topic>Communicable Disease Control</topic><topic>Cost and standard of living</topic><topic>Cost of living crisis</topic><topic>Costs</topic><topic>COVID-19</topic><topic>COVID-19 - epidemiology</topic><topic>COVID-19 - prevention & control</topic><topic>Cross-Sectional Studies</topic><topic>Educational aspects</topic><topic>Elementary school students</topic><topic>England</topic><topic>Exercise</topic><topic>Exercise for children</topic><topic>Expenditures</topic><topic>Families & family life</topic><topic>Female</topic><topic>Forecasts and trends</topic><topic>Gender equality</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Pandemics</topic><topic>Parents & parenting</topic><topic>Participation</topic><topic>Pediatric research</topic><topic>Physical activity</topic><topic>Physical fitness</topic><topic>Physical fitness for children</topic><topic>Policy</topic><topic>Schools</topic><topic>Spending</topic><topic>Sport</topic><topic>Statistical analysis</topic><topic>Surveys and Questionnaires</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Walker, Robert</creatorcontrib><creatorcontrib>Salway, Ruth</creatorcontrib><creatorcontrib>House, Danielle</creatorcontrib><creatorcontrib>Emm-Collison, Lydia</creatorcontrib><creatorcontrib>Breheny, Katie</creatorcontrib><creatorcontrib>Sansum, Kate</creatorcontrib><creatorcontrib>Churchward, Sarah</creatorcontrib><creatorcontrib>Williams, Joanna G</creatorcontrib><creatorcontrib>Vocht, Frank de</creatorcontrib><creatorcontrib>Hollingworth, William</creatorcontrib><creatorcontrib>Jago, Russell</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Career & Technical Education Database</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Coronavirus Research Database</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest research library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>The international journal of behavioral nutrition and physical activity</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Walker, Robert</au><au>Salway, Ruth</au><au>House, Danielle</au><au>Emm-Collison, Lydia</au><au>Breheny, Katie</au><au>Sansum, Kate</au><au>Churchward, Sarah</au><au>Williams, Joanna G</au><au>Vocht, Frank de</au><au>Hollingworth, William</au><au>Jago, Russell</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The status of active after-school clubs among primary school children in England (UK) after the COVD-19 lockdowns: implications for policy and practice</atitle><jtitle>The international journal of behavioral nutrition and physical activity</jtitle><addtitle>Int J Behav Nutr Phys Act</addtitle><date>2023-10-05</date><risdate>2023</risdate><volume>20</volume><issue>1</issue><spage>120</spage><epage>13</epage><pages>120-13</pages><artnum>120</artnum><issn>1479-5868</issn><eissn>1479-5868</eissn><abstract>Children's physical activity in England is more dependent on active clubs after the COVID-19 pandemic. However, it is unclear how the COVID-19 pandemic and related cost-of-living crisis have impacted on active club participation, costs and provision. This mixed-methods natural experiment explored school-based and community-based active clubs after lockdowns, using a unique combination of data sources to highlight implications for policy and practice post-COVID-19.
Cross-sectional questionnaire data on school and community active clubs were collected from 10-11-year-old children pre-COVID-19 in 2017-18 (N = 1,296; 50 schools), in 2021 (N = 393; 23 schools), and 2022 (N = 463; 27 schools). Club participation and attendance frequency were modelled using logistic and Poisson mixed effects models, adjusted for child age, gender and household education. In 2021 and 2022, parents reported expenditure on community-based clubs and schools provided data on school-based club provision, with data summarised descriptively. Qualitative data were collected in 2021 and 2022, with one-to-one interviews with school staff (N = 18) and parents (N = 43), and twelve child focus groups (N = 92), and analysed using the framework method.
School-based active club participation was higher in 2022 compared to pre-pandemic (50% /43%), while community-based club participation was lower (74%/80%). Children attended 0.3 fewer clubs per week. Those from lower education households were less likely to participate in both types of active clubs, and girls less likely to attend community clubs. In 2022, the median cost of community and school club sessions were £6.67 and £3.88 respectively, with 52% of school-based clubs free to parents. Schools offered an average of 3.4 active clubs per week for 10-11-year-olds in 2022, with 34% partly/wholly subsidised. Qualitative analysis highlighted the impact of the cost-of-living crisis and COVID-19 pandemic on family resources, encouraging a shift to more affordable and convenient school-based active clubs, which negatively impacted the community-based active club environment. However, many schools struggled to meet this increased demand.
Findings emphasise the importance for policymakers to support schools to meet increased demand for clubs and community clubs to increase affordable and convenient physical activity opportunities. Targeted support is needed to prevent socioeconomic and gender inequalities.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>37798727</pmid><doi>10.1186/s12966-023-01499-x</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0001-9901-5285</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | After school programs Caregivers Child Children & youth Club provision Communicable Disease Control Cost and standard of living Cost of living crisis Costs COVID-19 COVID-19 - epidemiology COVID-19 - prevention & control Cross-Sectional Studies Educational aspects Elementary school students England Exercise Exercise for children Expenditures Families & family life Female Forecasts and trends Gender equality Health aspects Humans Pandemics Parents & parenting Participation Pediatric research Physical activity Physical fitness Physical fitness for children Policy Schools Spending Sport Statistical analysis Surveys and Questionnaires |
title | The status of active after-school clubs among primary school children in England (UK) after the COVD-19 lockdowns: implications for policy and practice |
url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-13T17%3A59%3A23IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20status%20of%20active%20after-school%20clubs%20among%20primary%20school%20children%20in%20England%20(UK)%20after%20the%20COVD-19%20lockdowns:%20implications%20for%20policy%20and%20practice&rft.jtitle=The%20international%20journal%20of%20behavioral%20nutrition%20and%20physical%20activity&rft.au=Walker,%20Robert&rft.date=2023-10-05&rft.volume=20&rft.issue=1&rft.spage=120&rft.epage=13&rft.pages=120-13&rft.artnum=120&rft.issn=1479-5868&rft.eissn=1479-5868&rft_id=info:doi/10.1186/s12966-023-01499-x&rft_dat=%3Cgale_doaj_%3EA767906223%3C/gale_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c598t-b0509607d1a7cbc06cf6c87f587d37be8f8b15c7772664703eb5f45f58ca7f5e3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2877503109&rft_id=info:pmid/37798727&rft_galeid=A767906223&rfr_iscdi=true |