The primary aim was to develop an evidence-based motor skills intervention that teachers could deliver with physiotherapy or occupational therapy oversight. The objectives were to determine the key factors to be considered and included in a scalable framework adaptable to different contexts, particularly in low—and middle-income countries with scarce external resources. The second objective was to design and implement a program in a local school to explore feasibility and impact in preparation for a randomised control trial.
A sequential mixed-methods design using the complex intervention development theoretical model was used. A PRISMA-SCR design scoping review was followed by a 3-round Delphi study involving motor skills experts to refine the framework for intervention to ensure it was feasible and cost-effective. A 12-week intervention, Hopscotch, that was school-based and facilitated by teachers who received therapist guidance and supervision, was designed, and a proposal for a stepped-wedge exploratory randomised controlled trial was developed. In preparation, a pilot study was conducted concerning recruitment, attendance rate, and protocol deviations, and the MABC2 was used to evaluate its impact on motor skills.
The scoping review identified key elements - treatment approach, role players, service delivery models, venue, structure and therapeutic activities - summarised into a framework for intervention planning. The Delphi study reached a consensus on a feasible, low-cost intervention model centred on teacher-facilitated motor skills development. This guided the Hopscotch program's development specific to the Western Cape's west coast region in South Africa. Results from the pilot study showed improved motor skills, especially in balance, and positive teacher and student feedback. The consent rate was 98.08%, with a 0% attrition rate, with children in the experimental group attending an average of 93.75% of sessions.
The Hopscotch intervention demonstrated that a teacher-led model, supervised by therapists, is an effective and scalable approach for improving motor skills in low-resource environments. This contextually relevant intervention has the potential to be adapted and implemented in other settings facing similar challenges.
The framework emanating from this project provides a potentially sustainable solution for addressing motor skills development in settings with limited professional therapy resources. Future research should focus on scaling the program to other regions and exploring its long-term impact on children's developmental outcomes.
school-based intervention
low resource settings
