Intervention implementation involves multiple factors. Completeness and fidelity are the terms used to describe attendance rate, quantity, or perfection of dose (Carroll et al. 2007, Huijg et al. 2015), the intervention's content, and its implementation (Wiens & Gordon 2018). Further, to explain the intervention implementation, participants’ enjoyment is used for promoting behavioral change (Barnett et al. 2019).
2.3.1 Definitions of intervention adherence, fidelity, and enjoyment
The success of an intervention implementation can be determined based upon the participant’s level of involvement and commitment during the intervention.
Components of intervention implementation include both completeness and fidelity.
Completeness and fidelity have been used to explain the success of an implementation (Carroll et al. 2007; Huijg et al. 2015; Saunders et al. 2017), and enjoyment is given as a reason for greater motivation and commitment (Remmers et al. 2015; Rhodes & Kates 2015; Jekauc & Brand 2017). Further, adherence requires behavior change (Hay-Smith et al. 2016).
Completeness is defined as attendance rate, quantity, or perfection of dose, in the sense of how fully the intervention components are met or whether all the people who should be participating actually do so (Carroll et al. 2007; Huijg et al. 2015). Chin and Rickard (2012) used the time spent on a music activity,
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with frequency and regularity of participation, to define active engagement with music. They also underlined the importance of personal commitment and the motivation to learn, practice, or complete a specific program (Chin &
Rickard 2012). Further, Saunders and colleagues (2017) defined completeness as a number of PA opportunities.
Fidelity is defined as the quality of the intervention components, in the sense of how well those components are met and whether all the people implemented the content of the program (Carroll et al. 2007; Huijg et al. 2015), or as the quality of the program (Schaap et al. 2018). Program design, provider training, administration, and treatment receipt have all been named as elements of fidelity (Wiens & Gordon 2018).
Enjoyment is defined as a psychology-based flow (Barnett et al. 2019), involving satisfaction, appreciation, and acceptability (Schaap et al. 2018), or feelings of fun, liking, and pleasure (Domville et al. 2019), and also excitement, and interest (Barnett 2016). Enjoyment is described as a positive affective response at a particular time in a particular space (Barnett et al. 2019). It has a definite relation to competence and to activities being perceived as optimally challenging (Abuhamdeh & Csikszentmihalyi 2012a). Musical enjoyment has been described as a cycle that includes social, personal, kinesthetic, and musical experiences (Koops 2017). Enjoyment and motivation are linked and include the perceived challenge of the activity, the skill of the participant, and also their age and sex (Abuhamdeh & Csikszentmihalyi 2012a; Barnett 2016). Further, satisfaction with the music used in the exercise environment is found to be part of the exercise enjoyment (Wininger & Pargman 2003).
2.3.2 Assessment of intervention adherence, fidelity, and enjoyment
In an everyday context, questionnaires and/or diaries are useful for determining the frequency, length, and self-perceived intensity of exercise sessions and for assessing engagement, completeness, or adherence to a physical training program (Hawley-Hague et al. 2016). Observation is also used, for example, in preschool or daycare settings (Saunders et al. 2017). Further, for assessing a program's quality, implementation of content, or fidelity, observations, diaries, and questionnaires are used (Carroll et al. 2007; Huijg et al. 2015; Schaap et al. 2018). Home music practice logbooks have also been used to organize time effectively, to quantify the amount of practicing, to control the quality, and to estimate the child’s engagement during the session (Wiens &
Gordon 2018).
Barnett and colleagues (2019) point out that PA enjoyment, especially among children, has rarely been measured or discussed in interventions or theory. However, due to the unobservable nature of enjoyment, questionnaires have been developed. The 18-item Physical Activity Enjoyment Scale (PACES) by Kendzierski and DeCarlo (1991) has been shown to be valid and reliable in several target groups in several languages (Kendzierski & DeCarlo 1991; Moore et al. 2009; Jekauc et al. 2013; Zhou et al. 2014). The four-item Enjoyment in Sport (EIS) questionnaire by Scanlan (1993) has been shown to be valid and
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reliable in sport and exercise studies. A Finnish translation also exists, and it has been widely used (Liukkonen 1998; Gråstén et al. 2012). Other examples are the 10-item Groningen Enjoyment Questionnaire by Stevens and colleagues (2000) for measuring enjoyment of leisure-time physical activity, and a short, three-item questionnaire by Abuhamdeh and Csikszentmihalyi (2009), both of which have been used in earlier studies (Stevens et al. 2000; Abuhamdeh &
Csikszentmihalyi 2009; 2012b).
Using motivation theories or behavioral change models, it would be possible to take motivation into account as an explaining factor (Ryan & Deci 2000; Michie, van Stralen, & West 2011). One’s willingness to engage in an activity because of the activity itself and because of enjoying the experience of goal pursuit is described as intrinsic motivation (also called process-focused motivation), while commitment to the activity as a goal or for an expected reward rather than to the activity itself is described as extrinsic motivation (also called outcome-focused motivation) (Lepper, Greene, & Nisbett 1973;
Abuhamdeh & Csikszentmihalyi 2012b; Touré-Tillery & Fishbach 2014). Self-report measurements, such as motivation scales, or stable trait measurements, have been used in earlier studies. However, Touré-Tillery and Fishbach (2014) have emphasized that multiple aspects of the motivation and non-motivational effects have to be controlled before deciding how to measure motivation.
2.3.3 Effects of enjoyment on sedentary behavior and physical activity Remmers and colleagues (2015) found that children’s PA enjoyment was related to active behavior, specifically to all PA intensities combined. PA enjoyment is also linked with PA adoption, maintenance, and other positive health behaviors (Barnett et al. 2019).
Children’s PA has been found to be associated with positive communication with their friends, the PA of their friends, and the presence of friends during PA (Maturo & Cunningham 2013). Ward and colleagues (2017) highlighted that three- to five-year-olds observed and imitated their peers' behaviors in childcare centers, and that this could promote healthy PA behavior (Ward et al. 2017). Maturo and Cunningham (2013) discuss how the support of friends might benefit most children who are at high risk for physical inactivity.
However, younger children are more influenced by their families, while older children, are increasingly influenced by friends (Maturo & Cunningham 2013).
Young children are reported to like to play with their parents more than to play alone (Rebold et al. 2016). Having the parent involved or even watching the child’s play prompts more PA than when the child plays alone (Rebold et al.
2016). Further, a short-term group music therapy intervention for mother-child dyads can improve a young child’s interest and participation in a program’s activities (Williams et al. 2012). However, motivation and time constraints should be tailored to the participating families to ensure high-quality implementation (Brown et al. 2016).
Mark and Rhodes (2013) tested the effectiveness of exergaming using a stationary bicycle with four- to ten-year-old children and their families in the
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home environment. They found that interactive gaming during the cycling increased the children’s usage of the bike across the 6-week trial. Further, lean children were more motivated to play exergames than sedentary alternatives, while overweight or obese children were equally motivated to play any games (Penko & Barkley 2010).
Koops (2017) found that children’s enjoyment was linked to a balanced combination of structure and freedom, community and individual expression, musical pleasure and participation, and music risk-taking and activity. Further, enjoyment may act as a motivator to be active (Brockman, Jago, & Fox 2011;
Barnett et al. 2019).