Barriers and facilitators to physical activity among ethnic Chinese children: a systematic review protocol

contact with), (3) environmental (structural elements such as facilities and transport), and (4) 91 policy- and program-related (relating to programs, organizations and staff). 3 We will follow the 92 Joanna Briggs Institute (JBI) systematic review process to ensure its quality. 42 Both English 93 and Chinese databases will be searched with a comprehensive search strategy. The review will include both qualitative studies and cross-sectional surveys and will be written in English 95 for a wider dissemination among international readers.


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Physical activity in childhood 10 Health benefits of physical activity can be found in all age groups. 1,2 In children, physical 11 activity promotes overall health, fitness and well-being. 3 It enhances their body composition 12 and skeletal health and contributes to the prevention and delay of chronic diseases (e.g. 13 obesity, type 2 diabetes, hypertension and cardiovascular diseases). 4-6 It improves their 14 psychological health, including self-esteem, and promotes social contacts and friendships. 3 In 15 terms of learning, it improves their concentration power, and ability to set priorities and goals. 7

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It can improve their intellectual development and academic and physical performance. 8-10 In 17 terms of economic benefits, it contributes to lower healthcare utilization and costs associated 18 with physical inactivity-related diseases. 5,10,11 In children with disabilities, it contributes to their 19 overall development, quality of life, sense of self, social well-being and future health. 7,8 20 Overall, physical inactivity increases the risk of many adverse health conditions, especially 21 chronic diseases. For example, it contributes around 6% to the burden of coronary heart 22 disease, 7% to type 2 diabetes, 10% to breast cancer and colon cancer. 5 Physical activity can 23 add around one year of life expectancy. 5 According to the World Health Organization (WHO), 24 physical inactivity is the fourth leading risk factor of global mortality and is responsible for 25 around 6% of all deaths worldwide. Annually, it causes around 0.7, 1.6 and 1 million deaths in 26 high, middle and low income countries, respectively. 12

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An individual's childhood has been recognized as the most crucial period to promote the 28 uptake and adherence to physical activity. [13][14][15] This period is recognized as the most physically 29 active period in a person's life. 15 This period is an important transition point where the physical activity level starts to decline. 16

Context
Any study setting will be included such as home, community and school, either in Chinese or 121 non-Chinese territories.

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Types of studies

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The review will include studies that focus on qualitative data, including, but not limited to, 125 designs such as phenomenology, ethnography, grounded theory and action research.

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Qualitative studies provide an in-depth understanding of the barriers and facilitators to physical 127 activity among children, including identification and exploration of areas unknown to 128 researchers. 44 We will also include cross-sectional surveys where free-text relating to the 129 review question is reported within the paper.

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The search results were inspected to ensure that the relevant articles were identified.

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We aim to search a wide range of sources, to find both published and unpublished studies.

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The following databases will be searched for published studies: MEDLINE (1946-present),  Following the search, all identified citations will be collated and uploaded into EndNote X8.2, 45 153 a reference management software. Subsequently, all the duplicate citations will be removed.

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Titles and abstracts will be screened for eligibility using the inclusion criteria by two reviewers  Full-text studies that do not meet the inclusion criteria will be excluded, and the reasons for 161 exclusion will be reported. Any disagreements that arise between the two reviewers will be 162 resolved through discussion. If consensus is not reached, then a third reviewer (KC/HB) will be 163 involved.

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Assessment of methodological quality 166 All studies, selected for inclusion, will be critically assessed, by two reviewers (HW and KC/HB) 167 using the standardized critical appraisal tools incorporated within JBI SUMARI (one for 168 qualitative studies and one for cross-sectional studies). 42,47 These tools use a series of criteria 169 that can be scored as being met (yes), not met (no) or unclear or where appropriate, not 170 applicable (n/a) to that particular study. The two reviewers will independently go through each 171 criterion as well as comment on it. Any disagreements that arise between the reviewers will be 172 resolved through discussion. If consensus is not reached, then a third reviewer (KC/HB) will be 173 involved. The results of critical appraisal for all questions will be presented in a table and 174 narrated.

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All studies, regardless of the results of their methodological quality, will undergo data 176 extraction and synthesis, where possible. As recommended by JBI, a cut-off score will not be 177 used to include/exclude studies as many studies are likely to be of poor quality. 42 Apart from 178 high-quality studies, poor quality studies can also generate potentially valuable insights.

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Together, they can lead to a richer understanding of the research phenomenon. 48

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Data extraction 182 Data will be extracted from papers included in the review using the standardized data 183 extraction tool incorporated within JBI SUMARI, 42,46 independently by two reviewers (HW and 184 KC/HB). Any disagreements that arise between the two reviewers will be resolved through 185 discussion. If consensus is not reached, then a third reviewer (KC/HB) will be involved. For 186 clarification or additional data, where necessary, the corresponding author of the included 187 paper will be contacted by email (two times per author). In the first phase of data extraction, 188 study characteristics will be extracted -study period, design, location (territory    In order to uncover any associated differences or similarities in the views, experiences, 207 attitudes, understandings, perceptions and perspectives regarding barriers and facilitators to 208 physical activity, the data from Chinese and non-Chinese territories will be analysed separately.
Study findings from all study designs will, where possible, be pooled using JBI SUMARI with 210 the meta-aggregation approach. 46,49 This will involve the aggregation or synthesis of findings 211 to generate a set of statements that represent that aggregation, through assembling the 212 findings and categorizing these findings on the basis of similarity in meaning. These categories 213 will then be subjected to a synthesis in order to produce a single comprehensive set of 214 synthesized findings. Where textual pooling is not possible, the findings will be presented in 215 narrative form.