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Yoong SL, Brown AD, Leung GKW, Hillenaar M, David JL, Hayward J, Strugnell C, Bell C, Brown V, Jackson M, Allender S. A protocol of a pilot randomised trial (Action-RESPOND) to support rural and regional communities with implementing community-based systems thinking obesity prevention initiatives. PLoS One 2024; 19:e0302047. [PMID: 38696541 PMCID: PMC11065269 DOI: 10.1371/journal.pone.0302047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/23/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Over a quarter of children aged 2-17 years living in Australia are overweight or obese, with a higher prevalence reported in regional and remote communities. Systems thinking approaches that seek to support communities to generate and implement locally appropriate solutions targeting intertwined environmental, political, sociocultural, and individual determinants of obesity have the potential to ameliorate this. There have however been reported challenges with implementation of such initiatives, which may be strengthened by incorporating implementation science methods. METHODS This pilot randomised controlled trial protocol outlines the development and proposed evaluation of a multicomponent implementation strategy (Action-RESPOND). to increase the implementation of community-based systems thinking child obesity prevention initiatives The target of this intervention is ten rural and regional communities (or local government areas as the unit of allocation) within Northeast Victoria who were participants in a whole-of-systems intervention (RESPOND). Action-RESPOND builds on this intervention by assessing the impact of offering additional implementation strategies to five communities relative to usual care. The development of the multicomponent implementation strategy was informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework and consists of seven implementation strategies primarily delivered via 'facilitation' methods. Implementation strategies aimed to ensure initiatives implemented are i) evidence-based, ii) address community's specific needs and iii) are suitable for local context. Strategies also aimed to increase the community's capacity to implement, through iv) improving the health promotion team's implementation knowledge and skills, fostering v) leadership, vi) physical resources and vii) community culture to drive implementation. The feasibility, acceptability, potential impact, and cost of the strategy will be assessed at baseline and follow up using surveys administered to key representatives within the community and internal records maintained by the research team. DISCUSSION By leveraging an existing community-based whole-of-systems intervention, Action-RESPOND offers a unique opportunity to collect pilot feasibility and early empirical data on how to apply implementation and systems science approaches to support obesity prevention in rural and regional communities in Victoria.
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Affiliation(s)
- Sze Lin Yoong
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
- National Centre of Implementation Science, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Andrew D. Brown
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Gloria K. W. Leung
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Monique Hillenaar
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Jennifer L. David
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Josh Hayward
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Claudia Strugnell
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
- Institute for Phaysical Activity and Nutrition, Faculty of Health, Deakin University, Geelong, Australia
| | - Colin Bell
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
- School of Medicine, Faculty of Health, Deakin University, Geelong, Australia
| | - Vicki Brown
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Michelle Jackson
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Steven Allender
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
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Al-walah MA, Donnelly M, Alhusaini AA, Heron N. Pre-school-based behaviour change intervention to increase physical activity levels amongst young children: a feasibility cluster randomised controlled trial. Front Public Health 2024; 12:1379582. [PMID: 38756888 PMCID: PMC11096494 DOI: 10.3389/fpubh.2024.1379582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Background A significant rise in childhood obesity worldwide over the past three decades highlights the urgent need for early interventions, especially in preschools as key settings for child development. This study aimed to assess the feasibility and fidelity of a randomised controlled trial of "I'm an Active Hero" (IAAH), a theory- and evidence-based multi-component behaviour change intervention targeting physical activity and sedentary behaviour amongst preschool-aged children. Methods Two preschools in Taif city, Saudi Arabia were randomly assigned to either the intervention (n = 3 classrooms) or the usual curriculum control group (n = 3 classrooms). The intervention ran for 10 weeks from February to April 2023 and consisted of teacher-led physical activity and sedentary behaviour sessions in preschools, with an additional interactive home component. Primary outcome measures included intervention fidelity, recruitment rates, attrition rates, and compliance with trial procedures. Secondary outcomes included body mass index (BMI), objectively measured physical activity, and sedentary time via the ActiGraph GT3X accelerometer. Outcomes were measured at baseline and at 10 weeks in both study arms. Results The preschool intervention component had high fidelity (93.3%), but the home component fidelity was lower (74%). A cluster-level recruitment rate of 12% (13/112 centres) was attained, whilst the individual-level recruitment rate stood at 36% (52/143 children, mean age of 4.16 years; 23 girls). Attrition was 10%. Compliance varied with 90% for BMI, 71% for accelerometery, and 45% for questionnaires. The intervention group showed small decreases in BMI, slight increases in physical activity, and decreases in sedentary time at follow-up compared to the control group. Parents, facilitators, and assistant teachers considered the intervention to be feasible and beneficial. Conclusion The IAAH intervention was feasible to implement in Saudi Arabian preschools. Facilitators showed high fidelity in delivering it. However, preliminary data did not demonstrate effectiveness. A more comprehensive evaluation across a broader population is warranted. The intervention could be revised to optimise recruitment, compliance, and fidelity of the home-based component. Successful elements from this pilot should be retained whilst adaptations to implementation are made to strengthen key areas.Clinical trial registration: ClinicalTrials.gov, NCT05754359.
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Affiliation(s)
- Mosfer A. Al-walah
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Michael Donnelly
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Adel A. Alhusaini
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Neil Heron
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
- School of Medicine, Keele University, Newcastle-Under-Lyme, Staffordshire, United Kingdom
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Petro-Petro J, Arango-Paternina CM, Patiño-Villada FA, Ramirez-Villada JF, Brownson RC. Implementation processes of social network interventions for physical activity and sedentary behavior among children and adolescents: a scoping review. BMC Public Health 2024; 24:1101. [PMID: 38649855 PMCID: PMC11034017 DOI: 10.1186/s12889-024-18615-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The characteristics of the implementation process of interventions are essential for bridging the gap between research and practice. This scoping review aims to identify the implementation process of social network interventions (SNI) to address physical activity and sedentary behaviors in children and adolescents. METHODS The scoping review was conducted adhering to the established guidelines. The search was carried out in the ERIC, EBSCO, EMBASE, SCOPUS, and Lilacs databases in April 2023. Social network intervention studies in children and adolescents were included, addressing physical activity or sedentary behaviors. Replicability (TIDieR), applicability (PRECIS-2), and generalizability (RE-AIM) were the explored components of the implementation process. Each component was quantitatively and separately analyzed. Then, a qualitative integration was carried out using a narrative method. RESULTS Most SNI were theoretically framed on the self-determination theory, used social influence as a social mechanism, and used the individual typology of network intervention. Overall, SNI had strong replicability, tended to be pragmatic, and three RE-AIM domains (reach, adoption (staff), and implementation) showed an acceptable level of the generalizability of findings. CONCLUSIONS The analyzed SNI for physical activity and sedentary behaviors in adolescents tended to be reported with high replicability and were conducted pragmatically, i.e., with very similar conditions to real settings. The RE-AIM domains of reach, adoption (staff), and implementation support the generalizability of SNI. Some domains of the principles of implementation strategies of SNI had acceptable external validity (actor, action targets, temporality, dose, and theoretical justification).
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Affiliation(s)
- Jose Petro-Petro
- Instituto de Educación Física, Universidad de Antioquia, Carrera 75 Nº 65-87 - Bloque 45, Medellín, Colombia.
- Departamento de Cultura Física, Universidad de Córdoba, Montería, Colombia.
| | - Carlos Mario Arango-Paternina
- Research Group on Physical Activity for Health (AFIS), Instituto Universitario de Educación Física y Deportes; Universidad de Antioquia, Ciudadela Robledo, Medellín, Colombia
| | - Fredy Alonso Patiño-Villada
- Research Group on Physical Activity for Health (AFIS), Instituto Universitario de Educación Física y Deportes; Universidad de Antioquia, Ciudadela Robledo, Medellín, Colombia
| | - Jhon Fredy Ramirez-Villada
- Research Group on Physical Activity for Health (AFIS), Instituto Universitario de Educación Física y Deportes; Universidad de Antioquia, Ciudadela Robledo, Medellín, Colombia
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University, St. Louis, MO, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine; Washington University, St. Louis, MO, USA
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Jerebine A, Heering T, Barnett LM. Educator-Perceived Barriers and Facilitators to Structured-Physical Activity in Early Childhood Centres: A Systematic Review. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2024; 95:243-262. [PMID: 37327492 DOI: 10.1080/02701367.2023.2193243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
Purpose: Physical activity (PA) and motor competence development are vital for young children, yet many early childhood education and care (ECEC) centers struggle to successfully implement PA programs, particularly those organized and led by educators. This review aimed to synthesize qualitative literature to (1) identify educator-perceived barriers and facilitators to structured-PA in ECEC centers, and (2) map these to the COM-B model and Theoretical Domains Framework (TDF). Methods: Following PRISMA guidelines, a systematic search of five databases was conducted in April 2021 and updated in August 2022. Records were screened in Covidence software using predefined eligibility criteria. Using the framework synthesis method, data extraction and synthesis were conducted in coding forms in Excel and NVivo. Results: Of 2382 records identified, 35 studies were included, representing 2,365 educators across 268 ECEC centers in 10 countries. Using the COM-B model and TDF, an evidence-informed framework was developed. Findings revealed the greatest barriers concerned educator "opportunity" (e.g. competing time and priorities, policy tensions, indoor/outdoor space constraints) and "capability" (e.g. lack of PA knowledge and practical, hands-on skills) to implement structured-PA. Although fewer studies reported factors that influenced educator "motivation", several themes intersected across the three COM-B components illustrating the complexity of behavioral determinants in this setting. Conclusions: Interventions grounded in theory that utilize a systems approach to target multiple levels of influence on educator behavior, and are flexible and adaptable locally, are recommended. Future work should seek to address societal barriers, structural challenges in the sector, and the PA educational needs of educators. PROSPERO Registration: CRD42021247977.
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Hayek J, Elliott K, Vermette M, Lafave LM. eHealth Tools Supporting Early Childhood Education and Care Centers to Assess and Enhance Nutrition and Physical Activity Environments: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e52252. [PMID: 37874616 PMCID: PMC10630867 DOI: 10.2196/52252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Many children today are growing up in environments that predispose them to develop noncommunicable diseases. While no single preventive solution exists, evidence supports interventions in childcare settings for establishing good nutrition and physical activity behaviors as a "critical window" that could reduce the risk of developing noncommunicable diseases later in life. Emerging eHealth tools have shown potential in promoting best practices for nutrition and physical activity environments in early childhood education and care (ECEC) settings. OBJECTIVE The primary objective of this review is to map the breadth of available evidence on eHealth tools currently available to assess and support best practices for nutrition, physical activity, or both in ECEC settings and to highlight potential research directions. METHODS This scoping review will be conducted in accordance with the Joanna Briggs Institute Manual for Scoping Reviews with adherence to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist guidelines. Eligibility is based on the Population, Concept, and Context criteria as follows: (1) early childhood educators (population); (2) eHealth (digital) technology, such as websites, smartphone apps, email, and social media (concept); and (3) measurement and intervention tools to support best practices for nutrition, physical activity, or both in ECEC settings (context). The information sources for this review are the bibliographic databases PubMed, Scopus, CINAHL Plus, ERIC, and Embase in English and French with no date restrictions. Following this, a scan of gray literature will be undertaken. The electronic search strategy was developed in collaboration with two librarians. Two independent reviewers will screen the titles and abstracts of all relevant publications against inclusion criteria, followed by a full-text review using a data extraction tool developed by the reviewers. A synthesis of included papers will describe the publication, assessment, and intervention tool details. A summary of the findings will describe the types of eHealth assessment tools available, psychometric properties, eHealth intervention components, and theoretical frameworks used for development. RESULTS Preliminary searches of bibliographic databases to test and calibrate the search were carried out in May 2023. Study selection based on titles and abstracts was started in August 2023. The developed search strategy will guide our search for gray literature. The findings will be presented in visualized data map format, waffle chart, or tabular format accompanied by a narrative discussion. The scoping review is planned for completion in 2024. CONCLUSIONS A structured review of the literature will provide a summary of the range and type of eHealth tools available for ECEC programs to assess and improve nutrition environments, physical activity environments, or both in order to identify gaps in the current evidence base and provide insights to guide future intervention research. TRIAL REGISTRATION Open Science Framework XTRNZ; https://osf.io/xtrnz. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52252.
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Affiliation(s)
- Joyce Hayek
- Department of Health and Physical Education, Mount Royal University, Calgary, AB, Canada
| | - Katharine Elliott
- Department of Health and Physical Education, Mount Royal University, Calgary, AB, Canada
| | - Makayla Vermette
- Department of Health and Physical Education, Mount Royal University, Calgary, AB, Canada
| | - Lynne Mz Lafave
- Department of Health and Physical Education, Mount Royal University, Calgary, AB, Canada
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Al-Walah MA, Donnelly M, Cunningham C, Heron N. Which behaviour change techniques are associated with interventions that increase physical activity in pre-school children? A systematic review. BMC Public Health 2023; 23:2013. [PMID: 37845721 PMCID: PMC10580560 DOI: 10.1186/s12889-023-16885-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Insufficient physical activity (PA) is a significant risk factor that contributes to several health problems and there is a need to improve our understanding of how to increase PA, particularly among young children. This review (PROSPERO registration: CRD42022328841) investigated the relationship between behaviour change techniques (BCTs) and interventions that increased PA among pre-school children aged < 6 years old. METHODS Systematic searches of six databases were undertaken from inception to July 2022, updated in December 2022, to locate studies that evaluated interventions and reported a positive change in PA levels in children aged < 6 years old. RESULTS A total of 5,304 studies were screened, and 28 studies involving 10,605 subjects aged 2.5 to 5.9 years met the eligibility criteria. Each eligible study (n = 28) was independently appraised by two researchers using the Cochrane risk of bias tool. The BCT Taxonomy v1 and the Template for Intervention Description and Replication (TIDieR) guided the extraction and analysis of data, and this process led to the identification of 27 BCTs. CONCLUSIONS Potentially promising BCTs for increasing PA among young children included 'shaping knowledge,' 'antecedents,' 'goals and planning,' and 'comparison of behaviour.' Future PA interventions that target young children should consider integrating these promising BCTs into their programmes. However, such consideration needs to be tempered by the fact that most of the reviewed studies were deemed to have a high or unclear risk of bias and/or were limited with respect to the populations that they targeted. Further research using rigorous methodologies is required to establish a higher standard that addresses the needs of young children who are expected to have insufficient levels of physical activity.
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Affiliation(s)
- Mosfer A Al-Walah
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK.
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, 21974, Taif, Saudi Arabia.
| | - Michael Donnelly
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK
| | - Conor Cunningham
- School of Health Science, Ulster University, Northern Ireland, UK
| | - Neil Heron
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK
- School of Medicine, Keele University, England, UK
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Brown A, Philipson A, Dunstan K, Frazer-Ryan S. "Healthy Kids"-A capacity building approach for the early childhood education and care sector. Health Promot J Austr 2023; 34:765-774. [PMID: 36625415 DOI: 10.1002/hpja.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/22/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023] Open
Abstract
ISSUE ADDRESSED Queensland children have a higher level of developmental vulnerability compared to the Australian average. This paper reports on Healthy Kids-a capacity building strategy for the early childhood education and care (ECEC) sector targeting communities experiencing socio-economic and child development vulnerabilities. These communities may face additional barriers when engaging and participating in health promotion models. This paper reports on the development, key components and principles of a capacity building model referred to as Healthy Kids, that strategically responds to these barriers and supports these communities. METHODS The development of the Healthy Kids model emerged through a quality improvement process that included an environmental scan, and review of existing capacity building, health promotion, and workforce development approaches. It also involved consultation and engagement with the ECEC sector. RESULTS Evidence indicates Healthy Kids to be an innovative health promotion model focussed on building capacity through a workforce development strategy for the ECEC sector in a way that is accessible, low cost, and sustainable. SO WHAT?: This paper shares a model for building capacity through the establishment of localised cross-sector communities of practice across a large geographic region with a centralised coordinating hub. The hub and spoke model has facilitated community ownership to grow and be sustained over time. This model offers opportunities for partnerships, transferability, and contextualisation for those interested in contemporary health promotion, capacity building, and workforce development. The model offers an approach for those willing to step outside traditional boundaries to work across sectors and settings to achieve sustainable knowledge and skills, processes and resources that enables a collective commitment to improving health outcomes.
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Affiliation(s)
- Alice Brown
- School of Education, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Alanna Philipson
- Centre for Children's Health and Wellbeing, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Kym Dunstan
- Centre for Children's Health and Wellbeing, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Skye Frazer-Ryan
- Centre for Children's Health and Wellbeing, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
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Neshteruk C, Burkart S, Flanagan EW, Melnick E, Luecking C, Kracht CL. Policy, systems, and environmental interventions addressing physical activity in early childhood education settings: A systematic review. Prev Med 2023; 173:107606. [PMID: 37414226 PMCID: PMC10699121 DOI: 10.1016/j.ypmed.2023.107606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/30/2023] [Accepted: 07/02/2023] [Indexed: 07/08/2023]
Abstract
Policy, systems, and environmental (PSE) approaches can facilitate physical activity in priority populations (e.g., racial and ethnic minority, low wealth groups) within early childhood education (ECE) settings. The purpose of this review was to 1) characterize the inclusion of priority populations within ECE physical activity interventions containing PSE approaches and 2) identify and describe interventions within these populations. Seven databases were systematically searched (January 2000-Febrary 2022) for ECE-based interventions focusing on children (0-6 years) that utilized at least one PSE approach. Eligible studies included a child physical activity or physical activity environment outcome and child or center-level population characteristics. Forty-four studies, representing 42 interventions were identified. For Aim 1, half of interventions included one PSE approach (21/42), with only 11/42 including three or more approaches. Physical environment changes [e.g., adding play equipment, modifying space (25/42)] were the most used PSE approaches followed by system [e.g., integrating activity into routines, (21/42)] and policy [e.g., outdoor time (20/42)] approaches. Nearly half of interventions were conducted in predominantly priority populations (18/42). Studies were primarily rated as good (51%) or fair (38%) methodological quality using the Downs and Black checklist. In Aim 2, of the 12 interventions assessing child physical activity in priority populations, 9/12 reported at least one physical activity outcome in the expected direction. Of the 11 interventions assessing the physical activity environment, 9/11 reported an effect in the expected direction. Findings indicate clear opportunities exist to target priority populations by incorporating PSE approaches in ECE physical activity interventions.
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Affiliation(s)
- Cody Neshteruk
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America.
| | - Sarah Burkart
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Emily W Flanagan
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, United States of America
| | - Emily Melnick
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States of America
| | - Courtney Luecking
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, United States of America
| | - Chelsea L Kracht
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, United States of America
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Eichner-Seitz N, Pate RR, Paul IM. Physical activity in infancy and early childhood: a narrative review of interventions for prevention of obesity and associated health outcomes. Front Endocrinol (Lausanne) 2023; 14:1155925. [PMID: 37293499 PMCID: PMC10244791 DOI: 10.3389/fendo.2023.1155925] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/10/2023] [Indexed: 06/10/2023] Open
Abstract
In the context of the childhood obesity epidemic, this narrative review aims to explore opportunities to promote physical activity (PA) between birth and age 5 years as well as the health outcomes associated with PA in early childhood. Although early childhood is an ideal time to promote healthy habits, guidelines for PA have often ignored early childhood given the limited evidence for children <5 years old. Herein we discuss and highlight infant, toddler and preschool age interventions to promote PA and prevent obesity both in the short and long-term. We describe novel and modified interventions to promote improved early childhood health outcomes, encompassing cardiorespiratory, muscle, and bone strengthening components necessary for short-term motor development and long-term health. We call for new research aimed at developing and testing innovative early childhood interventions that may be performed in home or childcare settings, monitored by parents or caregivers.
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Affiliation(s)
- Natalie Eichner-Seitz
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States
| | - Russell R. Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Ian M. Paul
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States
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Buckler EJ, Faulkner GE, Beauchamp MR, Rizzardo B, DeSouza L, Puterman E. A Systematic Review of Educator-Led Physical Literacy and Activity Interventions. Am J Prev Med 2023; 64:742-760. [PMID: 37085246 DOI: 10.1016/j.amepre.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION Early childhood is a key time for the development of physical activity behaviors and physical literacy. A growing proportion of children spend a significant portion of their daytime in early childhood education and care settings where an early childhood educator cares for them. This systematic review (PROSPERO CRD42018087249) aimed to identify the differences between effective and noneffective educator-led interventions with a goal to improve physical literacy and/or physical activity in children aged 3-5 years in early childhood education and care settings. METHODS Interventions were included if they aimed to improve at least 1 physical literacy component or physical activity time in children aged 2-6 years through educator training. MEDLINE, Embase, CINAHL, ERIC, Australian Education Index, and Sport Discus were searched in March 2018 and April 2021. Risk of bias was assessed through a modified Cochrane assessment tool. RESULTS Data from 51 studies were analyzed in 2021 and 2022 and summarized narratively. Thirty-seven interventions aimed to promote physical activity, and 28 sought to promote physical literacy; 54% and 63% of these were effective, respectively. Interventions that were underpinned by theory, included ongoing support, or measured intervention fidelity were more effective, especially when all 3 were done. DISCUSSION This review was limited by a high risk of bias and inconsistency in reporting results across interventions. Reporting physical activity by minutes per hour and reporting both sub and total scores in physical literacy assessments will allow for greater cross-comparison between trials. Future training of educators should be underpinned by theory and incorporate ongoing support and objective fidelity checks.
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Affiliation(s)
- E Jean Buckler
- School of Exercise Science, Physical & Health Education, Faculty of Education, University of Victoria, Victoria, British Columbia, Canada; Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada.
| | - Guy E Faulkner
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark R Beauchamp
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Beth Rizzardo
- Department of Kinesiology, Langara College, Vancouver, British Columbia, Canada
| | - Liz DeSouza
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eli Puterman
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
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Nilsen A, Espedal H, Aadland KN, Aadland E. Associations between educators' and children's physical activity and sedentary time in Norwegian preschools: A cross-sectional study. J Sports Sci 2023; 41:200-208. [PMID: 37087749 DOI: 10.1080/02640414.2023.2204638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Preschool educators may be important role models influencing children's physical activity (PA) behaviours. The main aim of this paper was to examine the relationship between educators' and children's PA and sedentary time (SED) by including 1230 children (mean age 4.8 yrs, 48% girls) and 422 educators (mean age 42.4 yrs, 90% women) from 68 preschools in Western Norway. PA and SED were measured over 10 preschool days using hip worn ActiGraph GT3×+ accelerometers. Associations between child and educator PA and SED during preschool hours, determined by multivariate pattern analyses, provided explained variances (R2) = 2.8-5.2%. Levels of educator moderate PA were positively related to child PA (all intensities) and educator vigorous PA were positively related to child vigorous PA, while educator light PA was negatively associated with PA and positively associated with child SED. Educator SED were positively associated with child vigorous PA and negatively associated to child SED. Association patterns were similar for boys and girls, while educator moderate and vigorous PA were more strongly related to the younger vs. the older children's PA. The positive relationships between educators' moderate and vigorous PA and children's PA found herein suggest educators' PA behaviours should be addressed in future interventions.
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Affiliation(s)
- Ako Nilsen
- Western Norway University of Applied Sciences, Faculty of Education, Arts and Sports, Department of Sport, Food and Natural Sciences, Sogndal, Norway
| | - H Espedal
- Western Norway University of Applied Sciences, Faculty of Education, Arts and Sports, Department of Sport, Food and Natural Sciences, Sogndal, Norway
| | - K N Aadland
- Western Norway University of Applied Sciences, Faculty of Education, Arts and Sports, Department of Sport, Food and Natural Sciences, Sogndal, Norway
| | - E Aadland
- Western Norway University of Applied Sciences, Faculty of Education, Arts and Sports, Department of Sport, Food and Natural Sciences, Sogndal, Norway
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12
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Kracht CL, Burkart S, Flanagan EW, Melnick E, Luecking C, Neshteruk C. Policy, system, and environmental interventions addressing obesity and diet-related outcomes in early childhood education settings: A systematic review. Obes Rev 2023; 24:e13547. [PMID: 36601716 PMCID: PMC10214414 DOI: 10.1111/obr.13547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/06/2022] [Indexed: 01/06/2023]
Abstract
Early childhood education (ECE) settings play an important role in child dietary intake and excess weight gain. Policy, systems, and environment (PSE) approaches have potential to reduce disparities in children at higher risk for obesity. The purpose of this review was to (1) characterize the inclusion of populations at higher risk for obesity in ECE interventions and (2) identify effective ECE interventions in these populations. Seven databases were searched for ECE interventions. Intervention characteristics and methodological quality were assessed in 35 articles representing 34 interventions. Interventions identified were mainly a combination of ECE and parent interventions (41%) or stand-alone ECE intervention (29%), with few multisector efforts (23%) or government regulations assessed (5%). Many included policy (70%) or social environment components (61%). For Aim 1, two thirds were conducted in primarily populations at higher risk for obesity (67%). Studies were rated as fair or good methodological quality. For Aim 2, 10 studies demonstrated effectiveness at improving diet or reducing obesity in populations at higher risk for obesity. Most included a longer intervention (i.e., >6 months), multiple PSE components, and formative work. Opportunities to incorporate more PSE components in ECE-based interventions and collaborate with parents and communities are warranted to improve child health.
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Affiliation(s)
- Chelsea L. Kracht
- Clinical Science Department, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Sarah Burkart
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Emily W. Flanagan
- Clinical Science Department, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Emily Melnick
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Courtney Luecking
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, Kentucky, USA
| | - Cody Neshteruk
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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13
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Zhang T, Liu H, Lu Y, Wang Q. The Nexus of Sports-Based Development and Education of Mental Health and Physical Fitness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3737. [PMID: 36834432 PMCID: PMC9967856 DOI: 10.3390/ijerph20043737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
Physical inactivity has increased globally, particularly in developed nations. A high proportion of the human population is unable to meet the physical activity recommendation of the World Health Organisation due to hypertension, metabolic syndrome, obesity, and other medical conditions. Non-communicable diseases and mental health problems are becoming more prevalent, particularly in low and middle-income nations. This study aimed to determine the effectivenessof a mentorship programmeon university students' mental health and physical fitness. The intervention comprised the effects of sports-based development and education on physical fitness and mental health. A total of 196 and 234 students from two universities were randomly assigned to the intervention and control groups, respectively. The primary outcomes were engagement in physical activities (number of push-ups for 1 min, the strength of hand grip (kg), and the Jump test while standing (cm)), body fat proportion and psychological resilience, self-efficacy, and relationship with family and schoolmates. Participants in the control group had access to a web-based health education game, whereas the intervention group wassubjected to intensive interventional activities for one month based on the eight principles of the National Research Council and Institute of Medicine. Data were analysed using Analysis of Variance (ANOVA) to compare the physical and mental components between the intervention and control groups. Relative to baseline, all the physical health components (push-ups, sit-ups, and jump tests), psychological resilience, relationship with family members, and self-efficacy increased significantly in the intervention compared to the control group. Body fat composition was significantly reduced in the intervention when compared tothe control group. In conclusion, the mentorship programme effectively improved the participants' physical and psychological health and could be developed further for application in a larger population.
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Affiliation(s)
- Tiejun Zhang
- Sports Ministry, Henan University of Economics and Law, Zhengzhou 450011, China
| | - Huarong Liu
- School of Physical Education, China University of Geosciences, Wuhan 430074, China
| | - Yi Lu
- Sports Teaching and Research Section, Wuhan University of Communications, Wuhan 430205, China
| | - Qinglei Wang
- Faculty of Sport and Exercise Sciences, University of Malaya, Kuala Lumpur 50603, Malaysia
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14
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Beets MW, Weaver RG, Ioannidis JPA, Pfledderer CD, Jones A, von Klinggraeff L, Armstrong B. Influence of pilot and small trials in meta-analyses of behavioral interventions: a meta-epidemiological study. Syst Rev 2023; 12:21. [PMID: 36803891 PMCID: PMC9938611 DOI: 10.1186/s13643-023-02184-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/03/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Pilot/feasibility or studies with small sample sizes may be associated with inflated effects. This study explores the vibration of effect sizes (VoE) in meta-analyses when considering different inclusion criteria based upon sample size or pilot/feasibility status. METHODS Searches were to identify systematic reviews that conducted meta-analyses of behavioral interventions on topics related to the prevention/treatment of childhood obesity from January 2016 to October 2019. The computed summary effect sizes (ES) were extracted from each meta-analysis. Individual studies included in the meta-analyses were classified into one of the following four categories: self-identified pilot/feasibility studies or based upon sample size but not a pilot/feasibility study (N ≤ 100, N > 100, and N > 370 the upper 75th of sample size). The VoE was defined as the absolute difference (ABS) between the re-estimations of summary ES restricted to study classifications compared to the originally reported summary ES. Concordance (kappa) of statistical significance of summary ES between the four categories of studies was assessed. Fixed and random effects models and meta-regressions were estimated. Three case studies are presented to illustrate the impact of including pilot/feasibility and N ≤ 100 studies on the estimated summary ES. RESULTS A total of 1602 effect sizes, representing 145 reported summary ES, were extracted from 48 meta-analyses containing 603 unique studies (avg. 22 studies per meta-analysis, range 2-108) and included 227,217 participants. Pilot/feasibility and N ≤ 100 studies comprised 22% (0-58%) and 21% (0-83%) of studies included in the meta-analyses. Meta-regression indicated the ABS between the re-estimated and original summary ES where summary ES ranged from 0.20 to 0.46 depending on the proportion of studies comprising the original ES were either mostly small (e.g., N ≤ 100) or mostly large (N > 370). Concordance was low when removing both pilot/feasibility and N ≤ 100 studies (kappa = 0.53) and restricting analyses only to the largest studies (N > 370, kappa = 0.35), with 20% and 26% of the originally reported statistically significant ES rendered non-significant. Reanalysis of the three case study meta-analyses resulted in the re-estimated ES rendered either non-significant or half of the originally reported ES. CONCLUSIONS When meta-analyses of behavioral interventions include a substantial proportion of both pilot/feasibility and N ≤ 100 studies, summary ES can be affected markedly and should be interpreted with caution.
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Affiliation(s)
- Michael W Beets
- Arnold School of Public Health, University of South Carolina, SC, Columbia, USA.
| | - R Glenn Weaver
- Arnold School of Public Health, University of South Carolina, SC, Columbia, USA
| | - John P A Ioannidis
- Department of Medicine, Stanford University, Stanford, CA, USA.,Department of Health Research and Policy, Stanford University, Stanford, CA, USA.,Department of Biomedical Data Science, Stanford University, Stanford, CA, USA.,Department of Statistics, Stanford University, Stanford, CA, USA.,Departments of Medicine, of Health Research and Policy, of Biomedical Data Science, and of Statistics, Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | | | - Alexis Jones
- Arnold School of Public Health, University of South Carolina, SC, Columbia, USA
| | | | - Bridget Armstrong
- Arnold School of Public Health, University of South Carolina, SC, Columbia, USA
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15
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Basterfield L, Machaira T, Jones D, Rapley T, Araujo-Soares V, Cameron N, Azevedo LB. Early Years Physical Activity and Motor Skills Intervention-A Feasibility Study to Evaluate an Existing Training Programme for Early Years Educators. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010145. [PMID: 36670695 PMCID: PMC9856565 DOI: 10.3390/children10010145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/21/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
A lack of fundamental motor skills (FMS) in the early years can lead to lower engagement with physical activity (PA), and track into adulthood. This study aimed to test the feasibility of an existing intervention for Early Years Educators ("Educators") designed to increase knowledge, confidence and the ability to increase PA and FMS of children in a deprived area of England. Non-randomised design with wait-list control. Sixty-seven settings in Middlesbrough, North East England were invited. Recruitment target: 10 settings, 2 Educators per setting, four children per Educator. INTERVENTION one-day training course "Physical Literacy in the Early Years", an age-appropriate theoretical and practical training course to support the development of physical literacy. PRIMARY OUTCOMES recruitment, retention, acceptability of intervention and outcome measures. SECONDARY OUTCOMES change in Educators' knowledge, intentions and behaviour, and change in children's BMI z-score, PA and FMS. Eight settings were recruited; all Intervention Educators completed the training. Six settings participated at follow-up (four Intervention, two Control). The target for Educator recruitment was met (two per setting, total n = 16). Questionnaires were completed by 80% of Intervention Educators at baseline, 20% at follow-up. Control Educators completed zero questionnaires. No Educators took part in a process evaluation interview. Forty-eight children participated at baseline, 28 at follow-up. The intervention was deemed acceptable. The recruitment, retention and acceptability of measurements were insufficient to recommend proceeding. Additional qualitative work is needed to understand and surmount the challenges posed by the implementation of the trial.
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Affiliation(s)
- Laura Basterfield
- Human Nutrition and Exercise Research Centre, and Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Correspondence:
| | | | - Dan Jones
- SHLS Nursing & Midwifery, Teesside University, Middlesbrough TS1 3BX, UK
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne NE7 7XA, UK
| | - Vera Araujo-Soares
- Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, D-68167 Mannheim, Germany
| | - Neil Cameron
- SportWorks (North East) Ltd., North Shields NE29 6DE, UK
| | - Liane B. Azevedo
- School of Human and Health Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
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16
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Dos Santos ECM, de Lima LRA, Yoong S, Guerra PH, Segurado AC. Home-based interventions to promote physical activity for people living with HIV - a systematic review. AIDS Care 2023; 35:25-34. [PMID: 35735412 DOI: 10.1080/09540121.2022.2091102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Although physical activity (PA) improves the physical, mental, and social outcomes of people living with HIV (PLH), multiple barriers prevent them from exercising. In this systematic review, we investigated the effect of home-based interventions to promote physical activity (HBI) among PLH. Randomised trials and quasi-experimental studies published in English until March 2020 were sought in five databases. Independent reviewers performed data extraction, risk of bias assessment and pragmatic-explanatory (PRECIS-2) evaluation of study characteristics. Outcomes included engagement in PA, body composition, cardiorespiratory fitness, strength, metabolic disturbances, and quality of life (QoL). Out of 480 retrieved references, six studies met inclusion criteria. Interventions lasted 12-48 weeks and involved 400 individuals (57.8% women). Ninety-eight (24.5%) participants completed interventions, but dropout rates varied considerably (5.0-54.5%). Resulted showed increased PA (two studies) and improved cardiorespiratory fitness or strength (three and two studies, respectively). Four studies demonstrated reduction of waist circumference and increase in lean body mass. QoL improved in two of three studies. We conclude HBI (aerobic and/or resistance exercises) may contribute to improve PA and/or cardiorespiratory fitness, body composition, strength and QoL of PLH. Further investigation using multi-centre standardised protocols is warranted to provide stronger evidence of their effectiveness in health promotion for PLH.
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Affiliation(s)
| | | | - Serene Yoong
- Faculty of Health, Art and Design, Swinburne University of Technology, Hawthorn, Australia
| | | | - Aluisio Cotrim Segurado
- Department/Division of Infectious Diseases (LIM-49), Faculdade de Medicina, Hospital das Clinicas, Universidade de São Paulo, São Paulo, Brazil
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17
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Asada Y, Lin S, Siegel L, Kong A. Facilitators and Barriers to Implementation and Sustainability of Nutrition and Physical Activity Interventions in Early Childcare Settings: a Systematic Review. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:64-83. [PMID: 36198924 DOI: 10.1007/s11121-022-01436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 02/01/2023]
Abstract
A stronger understanding of the factors influencing implementation of interventions in community-based early childcare settings is needed. The purpose of this systematic review was to synthesize existing research on facilitators and barriers to implementation and sustainability of nutrition and physical activity interventions in early childcare settings targeting 2-5-year-old children, including considerations for equitable implementation. This review adhered to PRISMA 2020 guidelines. Peer-reviewed literature was searched in PubMed, EMBASE, CINAHL, ERIC, and PsycINFO databases up to September 2020. Primary research studies that examined facilitators and barriers (or related synonyms) to the implementation and sustainability of nutrition and physical activity interventions in early childcare settings were eligible for inclusion. The search yielded 8092 records that were screened by four analysts in Covidence software with a final review of 24 studies. Two independent reviewers conducted study selection, data extraction, and quality appraisal (Mixed Methods Appraisal Tool). A "best fit" framework was applied using the Consolidated Framework for Implementation Research (CFIR) constructs to code barriers and facilitators. The most salient constructs were (1) "Available Resources," which was composed of time, staffing, space, and staff trainings; (2) adaptability; and (3) compatibility, the latter two indicating that easily modifiable interventions facilitated a smoother "fit" and were more likely to be successful, given adequate site-level resources. Only nine (28%) reported the use of a theory, model, or framework to guide evaluation; six studies (24%) included factors related to sustainability; and nine studies (38%) conducted their interventions with low-income or minoritized groups. The findings point to the need for intervention evaluations examining nutrition and physical activity to more consistently consider (a) sustainability factors early on in design and adoption phases; (b) use of theory, model, or framework to guide evaluation; and (c) equity-related frameworks and considerations for how equitable implementation.
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Affiliation(s)
- Yuka Asada
- School of Public Health, Community Health Sciences, University of Illinois Chicago, 1603 W Taylor St, Chicago, IL, 60612, USA.
| | - Shuhao Lin
- College of Applied Health Science, Department of Kinesiology and Nutrition, University of Illinois Chicago, 1919 W Taylor St, Chicago, IL, 60612, USA
| | - Leilah Siegel
- 4-H Youth Development, University of Illinois Extension, 535 S. Randall Road, St., Charles, IL, 60174, USA
| | - Angela Kong
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois Chicago, 833 S. Wood St., Chicago, IL, 60612, USA
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18
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Morgan PJ, Grounds JA, Ashton LM, Collins CE, Barnes AT, Pollock ER, Kennedy SL, Rayward AT, Saunders KL, Drew RJ, Young MD. Impact of the 'Healthy Youngsters, Healthy Dads' program on physical activity and other health behaviours: a randomised controlled trial involving fathers and their preschool-aged children. BMC Public Health 2022; 22:1166. [PMID: 35689191 PMCID: PMC9188227 DOI: 10.1186/s12889-022-13424-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background Targeting fathers may be a key strategy to increase physical activity among their preschool-aged children, but limited research exists in this area. The primary study aim was to examine the impact of a lifestyle program for fathers and their preschool-aged children on child physical activity levels. Methods A total of 125 fathers (aged: 38 ± 5.4 years, BMI: 28.1 ± 4.9 kg/m2) and 125 preschool-aged children (aged: 3.9 ± 0.8 years, BMI z-score: 0.3 ± 0.9, 39.2% girls) recruited from Newcastle, Australia, NSW were randomised to (i) the Healthy Youngsters, Healthy Dads (HYHD) program, or (ii) wait-list control group. The program included two fathers-only workshops (2 h each) and eight father-child weekly educational and practical sessions (75 min each), plus home-based activities targeting family physical activity and nutrition. Assessments took place at baseline, 10-weeks (post-intervention) and 9-months follow-up. The primary outcome was the children’s mean steps/day at 10-weeks. Secondary outcomes included: co-physical activity, fathers’ physical activity levels and parenting practices for physical activity and screen time behaviours, children’s fundamental movement skill (FMS) proficiency, plus accelerometer based light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA), screen time and adiposity for fathers and children. Process measures included; attendance, satisfaction, fidelity and retention. Linear mixed models estimated the treatment effect at all time-points for all outcomes. Results Intention-to-treat analyses revealed a significant group-by-time effect for steps per day at 10-weeks (+ 1417, 95%CI: 449, 2384) and 9-months follow-up (+ 1480, 95%CI: 493, 2467) in intervention children compared to control. There were also favourable group-by-time effects for numerous secondary outcomes including fathers’ physical activity levels, children’s FMS proficiency, and several parenting constructs. No effects were observed for both fathers’ and children’s accelerometer based LPA or MVPA, co-physical activity, screen-time and adiposity measures. Process evaluation data revealed very high levels of satisfaction, attendance, retention, and intervention fidelity. Conclusion Engaging fathers in a lifestyle program is a promising strategy to increase physical activity among preschool-aged children. Additional benefits to fathers’ physical activity levels, children’s FMS proficiency and parenting practices further support the importance of engaging fathers to improve family health outcomes. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12619000105145. Registered 24/01/2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13424-1.
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Affiliation(s)
- Philip J Morgan
- School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, 2308, Australia. .,Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia. .,Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Jacqueline A Grounds
- School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, 2308, Australia.,Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Lee M Ashton
- School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, 2308, Australia.,Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, 2308, Australia.,College of Health, Medicine and Wellbeing, School of Health Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Clare E Collins
- College of Health, Medicine and Wellbeing, School of Health Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia.,Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Alyce T Barnes
- School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, 2308, Australia.,Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Emma R Pollock
- School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, 2308, Australia.,Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Stevie-Lee Kennedy
- School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, 2308, Australia.,Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Anna T Rayward
- School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, 2308, Australia.,Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Kristen L Saunders
- School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, 2308, Australia.,Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Ryan J Drew
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,College of Engineering, Science and Environment, School of Environmental and Life Sciences, University of Newcastle, Ourimbah, NSW, 2258, Australia
| | - Myles D Young
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,College of Engineering, Science and Environment, School of Psychological Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
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19
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Parent Fruit and Vegetable Consumption Outcomes from the Translational 'Time for Healthy Habits' Trial: Secondary Outcomes from a Partially Randomized Preference Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106165. [PMID: 35627702 PMCID: PMC9141017 DOI: 10.3390/ijerph19106165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022]
Abstract
Healthy eating and active living interventions targeting parents of young children could have benefits for both children and parents. The aim of this study was to assess the effectiveness of two remotely delivered healthy eating and active living interventions delivered at scale to parents, in increasing parent vegetable and fruit consumption (pre-specified secondary outcomes). Parents of children aged 2–6 years residing in New South Wales, Australia (n = 458), were recruited to a partially randomized preference trial consisting of three groups (telephone intervention (n = 95); online intervention (n = 218); written material (Control) (n = 145)). This design allowed parents with a strong preference to select their preferred intervention, and once preference trends had been established, all parents that were subsequently recruited were randomized to obtain robust relative effects. Parent vegetable and fruit consumption was assessed via telephone interview at baseline and 9 months later. At follow-up, randomized parents who received the telephone intervention (n = 73) had significantly higher vegetable consumption compared to those who received the written control (n = 81) (+0.41 serves/day, p = 0.04), but there were no differences in parents allocated to intervention groups based on preference. No differences in fruit consumption were found for randomized or preference participants for either the telephone or online intervention. There may be some benefit to parents participating in the Healthy Habits Plus (telephone-based) intervention aimed at improving the eating behaviors of their children.
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20
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Tugault-Lafleur CN, Naylor PJ, Carson V, Faulkner G, Lau EY, Wolfenden L, Mâsse LC. Does an active play standard change childcare physical activity and healthy eating policies? A natural policy experiment. BMC Public Health 2022; 22:687. [PMID: 35395752 PMCID: PMC8991472 DOI: 10.1186/s12889-022-13079-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background In 2017, the provincial government of British Columbia (BC) implemented a mandatory policy outlining Active Play Standards (AP Standards) to increase physical activity (PA) levels, sedentary and motor skills among children attending licensed childcare centers. Concurrently, a capacity-building initiative was launched to help implement policies and practices supporting both PA and healthy eating (HE) in the early years. This study evaluated differences in center-level PA and HE policies and practices before and after the enforcement of the new provincial AP Standards. Methods Using a repeat cross-sectional design, surveys were distributed to managers and staff of licensed childcare facilities serving children aged 2–5 years before (2016–2017 or ‘time 1’) and after (2018–2019 or ‘time 2’) implementation of the AP Standards across BC. The total sample included 1,459 respondents (910 and 549 respondents at time 1 and time 2, respectively). Hierarchical mixed effects models were used to examine differences in 9 and 7 PA/sedentary policies and practices, respectively, as well as 11 HE policies between time 1 and time 2. Models controlled for childcare size and area-level population size, education, and income. Results Compared to centers surveyed at time 1, centers at time 2 were more likely to report written policies related to: fundamental movement skills, total amount of Active Play (AP) time, staff-led AP, unfacilitated play/free play, total amount of outdoor AP time, limiting screen time, breaking up prolonged sitting, staff role modeling of PA, and training staff about PA (P < 0.01 for all 9 policies examined). Compared to time 1, centers at time 2 reported more frequent practices related to ensuring children engaged in at least 120 min of AP, 60 min of outdoor AP daily, and limiting screen time (P < 0.01 for 3 out of 7 practices examined). Despite no additional policy intervention related to HE, centers were more likely to report having written policies related to: HE education for children, encouraging new foods, having family-style meals, offering only milk or water, limiting the amount of juice served, staff role modeling of HE, limiting the types of foods at parties/celebrations and foods brought from home (P < 0.05 for 9 out of 11 HE policies). Conclusion Approximately a year after the implementation of a governmental policy targeting PA supported by a capacity-building initiative, childcare centers reported positive changes in all 9 PA/sedentary policies examined, all 3 out of 7 PA/sedentary practices and 9 out of 11 HE policies evaluated at the center-level.
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Affiliation(s)
- Claire N Tugault-Lafleur
- School of Nutrition Sciences, Faculty of Health Sciences, The University of Ottawa, 25 University Private, Ottawa, ON, K1N 6N5, Canada
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, Faculty of Education, University of Victoria, Victoria, BC, V8W 3P1, Canada
| | - Valerie Carson
- Faculty of Kinesiology, Sport, and Recreation, Van Vliet Complex, University of Alberta, 1-151 University Hall, Edmonton, AB, T6G 2H9, Canada
| | - Guy Faulkner
- School of Kinesiology, University of British Columbia, 210-6081 University Blvd, Vancouver, BC, V6T 1Z1, Canada
| | - Erica Y Lau
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, 828West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Louise C Mâsse
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada. .,School of Population and Public Health, BC Children's Hospital Research Institute, F508-4490Oak Street, Vancouver, BC, V6H 3V4, Canada.
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21
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Interventions to Improve Child Physical Activity in the Early Childhood Education and Care Setting: An Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041963. [PMID: 35206152 PMCID: PMC8872396 DOI: 10.3390/ijerph19041963] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 02/04/2023]
Abstract
Early childhood education and care (ECEC) services are a key setting to support improvements in the physical activity of young children. This umbrella review gathered and synthesised systematic review evidence of the effectiveness of interventions in the ECEC setting on the physical activity levels of children aged 0-6. We also mapped the current evidence to the existing ECEC sector-specific physical activity practice recommendations. Five electronic databases were searched to identify systematic reviews that evaluated the impact of any ECEC-based interventions on the physical activity levels (e.g., moderate-to-vigorous physical activity, total physical activity) of children aged 0-6. One reviewer extracted data on intervention effectiveness and quality of the reviews, checked by a second reviewer. Ten reviews were included. Overall, the majority of the reviews found interventions delivered in ECEC improved child physical activity. Across reviews, the impact of six intervention strategies were identified, mapped to four (of eight) broad recommendations (i.e., providing opportunity, offering educator training, educators promoting the benefits of physical activity, creating a physical activity-promoting environment). The impact of the majority of recommendations, however, did not have systematic review evidence. Further investigation of the effectiveness of ECEC-based physical activity strategies is required to demonstrate support for the existing recommended practices.
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22
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Müller C, Hassel H. Cooperative planning in childcare centers to improve physical activity: a qualitative investigation of directors' perspectives. Health Promot Int 2021; 36:ii8-ii15. [PMID: 34905610 PMCID: PMC8670625 DOI: 10.1093/heapro/daab171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Interventions to promote physical activity (PA) in childcare centers have been shown to increase children’s PA levels; moreover, a growing number of evidence-based best practice guidelines exist for this setting. However, there is a lack of knowledge on the facilitators of and barriers to the successful implementation of PA guidelines and interventions. We used Cooperative Planning to improve capabilities for PA in childcare centers. This qualitative study aimed to explore childcare center directors’ views on the Cooperative Planning process and identify the facilitators of and barriers to its implementation. We conducted guided semi-structured interviews with the directors of nine childcare centers after completion of the 12-month Cooperative Planning process. The interviews were recorded, transcribed and analyzed using qualitative content analysis with inductive category development. Facilitators and barriers were systematized according to the Consolidated Framework for Implementation Research (CFIR). Cooperative Planning was regarded as being helpful for structuring the process and involving all team members. Several facilitators within the CFIR domains inner setting (structural characteristics, networks and communications, implementation climate), outer setting (support from parents and provider), characteristics of individuals (intrinsic motivation of the staff) and process (individual drivers) were identified. The reported barriers included structural characteristics (e.g. lack of time), networks and communications (e.g. team conflicts) and characteristics of individuals (e.g. lack of willingness to accept change). Several contextual and interpersonal factors seem to influence the extent to which a Cooperative Planning process can be implemented by a childcare center’s team. Future research is needed to evaluate the strategies needed to overcome the identified barriers.
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Affiliation(s)
- Christina Müller
- Institute of Sports Science, University of Würzburg, Judenbühlweg 11, Würzburg 97082, Germany
- Corresponding author. E-mail:
| | - Holger Hassel
- Institute of Applied Health Sciences, Coburg University of Applied Sciences and Arts, Friedrich-Streib-Straße 2, Coburg 96450, Germany
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23
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Mclaughlin M, Campbell E, Sutherland R, McKenzie T, Davies L, Wiggers J, Wolfenden L. Extent, Type and Reasons for Adaptation and Modification When Scaling-Up an Effective Physical Activity Program: Physical Activity 4 Everyone (PA4E1). FRONTIERS IN HEALTH SERVICES 2021; 1:719194. [PMID: 37007208 PMCID: PMC10062321 DOI: 10.3389/frhs.2021.719194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/30/2021] [Indexed: 06/03/2023]
Abstract
Background: Few studies have described the extent, type and reasons for making changes to a program prior to and during its delivery using a consistent taxonomy. Physical Activity 4 Everyone (PA4E1) is a secondary school physical activity program that was scaled-up for delivery to a greater number of schools. We aimed to describe the extent, type and reasons for changes to the PA4E1 program (the evidence-based physical activity practices, implementation support strategies and evaluation methods) made before its delivery at scale (adaptations) and during its delivery in a scale-up trial (modifications). Methods: The Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) was used to describe adaptations (planned and made prior to the scale-up trial) and modifications (made during the conduct of the trial). A list of adaptations was generated from a comparison of the efficacy and scale-up trials via published PA4E1 protocols, trial registrations and information provided by trial investigators. Monthly trial team meetings tracked and coded modifications in "real-time" during the conduct of the scale-up trial. The extent, type and reasons for both adaptations and modifications were summarized descriptively. Results: In total, 20 adaptations and 20 modifications were identified, these were to physical activity practices (n = 8; n = 3), implementation support strategies (n = 6; n = 16) and evaluation methods (n = 6, n = 1), respectively. Few adaptations were "fidelity inconsistent" (n = 2), made "unsystematically" (n = 1) and proposed to have a "negative" impact on the effectiveness of the program (n = 1). Reasons for the adaptations varied. Of the 20 modifications, all were "fidelity consistent" and the majority were made "proactively" (n = 12), though most were "unsystematic" (n = 18). Fifteen of the modifications were thought to have a "positive" impact on program effectiveness. The main reason for modification was the "available resources" (n = 14) of the PA4E1 Implementation Team. Conclusions: Adaptations and modifications to public health programs are common. Modifications have the potential to impact the implementation and effectiveness of programs. Our findings underscore the importance of comprehensive reporting of the extent, type and reasons for modifications as part of process evaluations, as this data may be important to the interpretation of trial findings. Clinical Trial Registration: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372870, Identifier ACTRN12617000681358.
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Affiliation(s)
- Matthew Mclaughlin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Elizabeth Campbell
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Tom McKenzie
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Lynda Davies
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
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24
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Shoesmith A, Hall A, Wolfenden L, Shelton RC, Powell BJ, Brown H, McCrabb S, Sutherland R, Yoong S, Lane C, Booth D, Nathan N. Barriers and facilitators influencing the sustainment of health behaviour interventions in schools and childcare services: a systematic review. Implement Sci 2021; 16:62. [PMID: 34118955 PMCID: PMC8199827 DOI: 10.1186/s13012-021-01134-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 06/03/2021] [Indexed: 12/14/2022] Open
Abstract
Background Sustainment has been defined as the sustained use or delivery of an intervention in practice following cessation of external implementation support. This review aimed to identify and synthesise factors (barriers and facilitators) that influence the sustainment of interventions (policies, practices, or programmes) in schools and childcare services that address the leading risk factors of chronic disease. Methods Seven electronic databases and relevant reference lists were searched for articles, of any design, published in English, from inception to March 2020. Articles were included if they qualitatively and/or quantitatively reported on school or childcare stakeholders’ (including teachers, principals, administrators, or managers) perceived barriers or facilitators to the sustainment of interventions addressing poor diet/nutrition, physical inactivity, obesity, tobacco smoking, or harmful alcohol use. Two independent reviewers screened texts, and extracted and coded data guided by the Integrated Sustainability Framework, an existing multi-level sustainability-specific framework that assesses factors of sustainment. Results Of the 13,158 articles identified, 31 articles met the inclusion criteria (8 quantitative, 12 qualitative, 10 mixed-methods, and 1 summary article). Overall, 29 articles were undertaken in schools (elementary n=17, middle n=3, secondary n=4, or a combination n=5) and two in childcare settings. The main health behaviours targeted included physical activity (n=9), diet (n=3), both diet and physical activity (n=15), and smoking (n=4), either independently (n=1) or combined with other health behaviours (n=3). Findings suggest that the majority of the 59 barriers and 74 facilitators identified to impact on intervention sustainment were similar across school and childcare settings. Factors predominantly relating to the ‘inner contextual factors’ of the organisation including: availability of facilities or equipment, continued executive or leadership support present, and team cohesion, support, or teamwork were perceived by stakeholders as influential to intervention sustainment. Conclusions Identifying strategies to improve the sustainment of health behaviour interventions in these settings requires a comprehensive understanding of factors that may impede or promote their ongoing delivery. This review identified multi-level factors that can be addressed by strategies to improve the sustainment of such interventions, and suggests how future research might address gaps in the evidence base. Trial registration This review was prospectively registered on PROSPERO: CRD42020127869, Jan. 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01134-y.
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Affiliation(s)
- Adam Shoesmith
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia. .,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia. .,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, 2305, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, 2305, NSW, Australia
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Byron J Powell
- Brown School and School of Medicine, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Hannah Brown
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, 2305, NSW, Australia
| | - Serene Yoong
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, 2305, NSW, Australia
| | - Cassandra Lane
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia
| | - Debbie Booth
- University Library, Academic Division, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, 2305, NSW, Australia
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25
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Luecking CT, Vaughn AE, Burney R, Hennink-Kaminski H, Hales D, Ward DS. Fidelity and factors influencing implementation of Healthy Me, Healthy: process evaluation of a social marketing campaign for diet and physical activity behaviors of children in childcare. Transl Behav Med 2021; 11:733-744. [PMID: 33538306 PMCID: PMC8034246 DOI: 10.1093/tbm/ibab001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The effectiveness of interventions targeting children's eating and physical activity behaviors through childcare settings is inconsistent. To enhance public health impact, it is imperative to evaluate fidelity of implementing complex interventions in real-world settings. This study evaluated fidelity and contextual factors influencing implementation of Healthy Me, Healthy We (HMHW). HMHW was an 8-month social marketing campaign delivered through childcare to support children's healthy eating and physical activity. HMHW required two levels of implementation support (research team and childcare providers) and two levels of campaign delivery (childcare providers and parents). Process evaluation was conducted among childcare centers in the intervention group (n=48) of the cluster-randomized control trial. Measures included attendance logs, self-report surveys, observation checklists, field notes, and semi-structured interviews. A 35-item fidelity index was created to assess fidelity of implementation support and campaign delivery. The fidelity with which HMHW was implemented by childcare providers and parents was low (mean 17.4 out of 35) and decreased between childcare providers and parents. Childcare providers had high acceptability of the program and individual components (80 - 93%). Only half of parents felt intervention components were acceptable. Frequently cited barriers to implementation by childcare providers included time constraints, parent engagement, staff turnover, and restrictive policies. The lack of observable effect of HMHW on children's dietary or physical activity behaviors may be due to inadequate implementation at multiple levels. Different or additional strategies are necessary to support implementation of multilevel interventions, particularly when individuals are expected to deliver intervention components and support others in doing so.
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Affiliation(s)
- Courtney T Luecking
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, USA
| | - Amber E Vaughn
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Regan Burney
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Heidi Hennink-Kaminski
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Derek Hales
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dianne S Ward
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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26
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Telford RM, Olive LS, Telford RD. A peer coach intervention in childcare centres enhances early childhood physical activity: The Active Early Learning (AEL) cluster randomised controlled trial. Int J Behav Nutr Phys Act 2021; 18:37. [PMID: 33726777 PMCID: PMC7962250 DOI: 10.1186/s12966-021-01101-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background As numbers of children and time spent in childcare centres increase, so does the potential influence of these centres on early childhood physical activity (PA). However, previous reports indicate little success of interventions aimed at improving PA. The Active Early Learning (AEL) program is a multi-component pragmatic intervention designed to imbed PA into the daily curriculum. Delivered by childcare centre staff, it is directed and supported by a peer coach who works across a network of centres. The objective of the study is to investigate the effect of the AEL program on children’s PA. Methods Fifteen childcare centres (8 intervention, 7 control centres; 314 children, 180 boys, 4.3y ± 0.4) participated in a 22-week stratified cluster randomised controlled trial. To be eligible to participate, centres needed to have ≥15 preschool children aged 3 to 5-years. The primary outcome was PA measured by accelerometer (Actigraph GT3X) during childcare centre hours over a 3-day period, calculated in min/h of Total PA and moderate-to-vigorous PA (MVPA). The effect of the intervention was evaluated using linear mixed models adjusted for age, sex, accelerometer wear time and centre clustering. Results There was an intervention effect for Total PA (+ 4.06 min/h, 95% CI [2.66 to 5.47], p < .001) and MVPA (+ 2.33 min/h, 95% CI [1.31 to 3.34] p < .001). On average, a child taking part in the intervention attending a childcare centre from 8 am to 3 pm performed 28 min more Total PA and 16 min more MVPA per day than children receiving usual practice care. Conclusion In contrast with the findings of previous pragmatic trials in early childcare centres, this study shows that a peer-coach facilitated program, focussed on integrating PA into the daily childcare routine, can elicit increases in preschool children’s PA of practical as well as statistical significance. Trial registration Australian New Zealand Clinical Trials registry: ACTRN12619000638134. Registered 30/04/2019.
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Affiliation(s)
- R M Telford
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia
| | - L S Olive
- School of Psychology, Deakin University, Geelong, Victoria, Australia.,Centre for Social and Early Emotional Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia.,IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - R D Telford
- Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT, Australia.
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27
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Yoong SL, Jones J, Pearson N, Swindle T, Barnes C, Delaney T, Lum M, Golley R, Matwiejczyk L, Kelly B, Kerr E, Love P, Esdaile E, Ward D, Grady A. An Overview of Research Opportunities to Increase the Impact of Nutrition Intervention Research in Early Childhood and Education Care Settings According to the RE-AIM Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2745. [PMID: 33800463 PMCID: PMC7967470 DOI: 10.3390/ijerph18052745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/18/2021] [Accepted: 02/24/2021] [Indexed: 12/26/2022]
Abstract
Objective: To highlight opportunities for future nutrition intervention research within early childhood and education care (ECEC) settings, with a focus on generating evidence that has applicability to real-world policy and practice. Methods: An overview of opportunities to progress the field was developed by the authors using a collaborative writing approach and informed by recent research in the field. The group developed a list of recommendations aligned with the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework. Pairs of authors drafted individual sections of the manuscript, which were then reviewed by a separate pair. The first and senior author consolidated all sections of the manuscript and sought critical input on the draft iterations of the manuscript. Results: Interventions that employ digital platforms (reach) in ECEC settings, as well as research in the family day care setting (effectiveness) were identified as areas of opportunities. Research understanding the determinants of and effective strategies for dissemination (adoption), the implementation of nutrition programs, in addition to de-implementation (implementation) of inappropriate nutrition practices, is warranted. For maintenance, there is a need to better understand sustainability and the sustainment of interventions, in addition to undertaking policy-relevant research. Conclusions: The ECEC setting is prime for innovative and practical nutrition intervention research.
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Affiliation(s)
- Sze Lin Yoong
- Hunter New England Population Health, Wallsend, NSW 2287, Australia; (J.J.); (N.P.); (C.B.); (T.D.); (M.L.); (A.G.)
- School of Health Science, Swinburne University of Technology, Melbourne, VIC 3122, Australia
| | - Jannah Jones
- Hunter New England Population Health, Wallsend, NSW 2287, Australia; (J.J.); (N.P.); (C.B.); (T.D.); (M.L.); (A.G.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Nicole Pearson
- Hunter New England Population Health, Wallsend, NSW 2287, Australia; (J.J.); (N.P.); (C.B.); (T.D.); (M.L.); (A.G.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Courtney Barnes
- Hunter New England Population Health, Wallsend, NSW 2287, Australia; (J.J.); (N.P.); (C.B.); (T.D.); (M.L.); (A.G.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Tessa Delaney
- Hunter New England Population Health, Wallsend, NSW 2287, Australia; (J.J.); (N.P.); (C.B.); (T.D.); (M.L.); (A.G.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Melanie Lum
- Hunter New England Population Health, Wallsend, NSW 2287, Australia; (J.J.); (N.P.); (C.B.); (T.D.); (M.L.); (A.G.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Rebecca Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; (R.G.); (L.M.)
| | - Louisa Matwiejczyk
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; (R.G.); (L.M.)
| | - Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW 2522, Australia; (B.K.); (E.K.)
| | - Erin Kerr
- Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW 2522, Australia; (B.K.); (E.K.)
| | - Penelope Love
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3217, Australia;
| | - Emma Esdaile
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia;
| | - Dianne Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, CA 27516, USA;
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, CA 27514, USA
| | - Alice Grady
- Hunter New England Population Health, Wallsend, NSW 2287, Australia; (J.J.); (N.P.); (C.B.); (T.D.); (M.L.); (A.G.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308, Australia
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28
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Schmidt EM, Hoffman JA, Mulé C, Briesch A. Effects of a teacher training program to promote physically active play among preschoolers with autism spectrum disorders. J Sch Psychol 2021; 85:57-79. [PMID: 33715781 DOI: 10.1016/j.jsp.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 10/21/2020] [Accepted: 01/29/2021] [Indexed: 12/20/2022]
Abstract
Wellness Enhancing Physical Activity for Young Children (WE PLAY) is an intervention intended to promote physical activity (PA) among typically-developing preschool children in child care settings. It was adapted for use by teachers who educate children with Autism Spectrum Disorders (ASD). This study used a multiple baseline design across participants to evaluate the impact of WE PLAY-Autism on teachers' PA facilitating behaviors and on the PA levels of children with ASD. Visual analysis and effect size estimates indicated that two of the three teachers increased their PA facilitating behavior, although this was insufficient to demonstrate a functional relation. Children's (n = 5) PA was measured daily during school hours using accelerometry. Visual analysis, which was further supported by effect size calculations, indicated higher average levels of moderate-to-vigorous PA (MVPA) among preschoolers with ASD in the intervention phase (Tau-UA vs. B = 0.53, p < .001, Hedges' g = 0.99, 95% CI [0.56, 1.43]) and post-training phase (Tau-UA vs. B = 0.55, p < .001, Hedges' g = 1.17, 95% CI [0.73, 1.60]) in comparison to the baseline phase. WE PLAY-Autism is an intervention deserving of further investigation given its meaningful impact on the MVPA of preschoolers with ASD paired with its potential for broad implementation in preschools.
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Affiliation(s)
- Ellyn M Schmidt
- Northeastern University, Department of Applied Psychology, 360 Huntington Avenue, Boston, MA 02115, United States of America.
| | - Jessica A Hoffman
- Northeastern University, Department of Applied Psychology, 360 Huntington Avenue, Boston, MA 02115, United States of America
| | - Christina Mulé
- Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, 800 Washington Street #334, Boston, MA 02111, United States of America; Golisano Children's Hospital, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, United States of America
| | - Amy Briesch
- Northeastern University, Department of Applied Psychology, 360 Huntington Avenue, Boston, MA 02115, United States of America
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Lane C, McCrabb S, Nathan N, Naylor PJ, Bauman A, Milat A, Lum M, Sutherland R, Byaruhanga J, Wolfenden L. How effective are physical activity interventions when they are scaled-up: a systematic review. Int J Behav Nutr Phys Act 2021; 18:16. [PMID: 33482837 PMCID: PMC7821550 DOI: 10.1186/s12966-021-01080-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/05/2021] [Indexed: 12/18/2022] Open
Abstract
Background The ‘scale-up’ of effective physical activity interventions is required if they are to yield improvements in population health. The purpose of this study was to systematically review the effectiveness of community-based physical activity interventions that have been scaled-up. We also sought to explore differences in the effect size of these interventions compared with prior evaluations of their efficacy in more controlled contexts, and describe adaptations that were made to interventions as part of the scale-up process. Methods We performed a search of empirical research using six electronic databases, hand searched reference lists and contacted field experts. An intervention was considered ‘scaled-up’ if it had been intentionally delivered on a larger scale (to a greater number of participants, new populations, and/or by means of different delivery systems) than a preceding randomised control trial (‘pre-scale’) in which a significant intervention effect (p < 0.05) was reported on any measure of physical activity. Effect size differences between pre-scale and scaled up interventions were quantified ([the effect size reported in the scaled-up study / the effect size reported in the pre-scale-up efficacy trial] × 100) to explore any scale-up ‘penalties’ in intervention effects. Results We identified 10 eligible studies. Six scaled-up interventions appeared to achieve significant improvement on at least one measure of physical activity. Six studies included measures of physical activity that were common between pre-scale and scaled-up trials enabling the calculation of an effect size difference (and potential scale-up penalty). Differences in effect size ranged from 132 to 25% (median = 58.8%), suggesting that most scaled-up interventions typically achieve less than 60% of their pre-scale effect size. A variety of adaptations were made for scale-up – the most common being mode of delivery. Conclusion The majority of interventions remained effective when delivered at-scale however their effects were markedly lower than reported in pre-scale trials. Adaptations of interventions were common and may have impacted on the effectiveness of interventions delivered at scale. These outcomes provide valuable insight for researchers and public health practitioners interested in the design and scale-up of physical activity interventions, and contribute to the growing evidence base for delivering health promotion interventions at-scale. Trial registration PROSPERO CRD42020144842. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01080-4.
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Affiliation(s)
- Cassandra Lane
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia. .,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia. .,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Sam McCrabb
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Adrian Bauman
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Andrew Milat
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Melanie Lum
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Judith Byaruhanga
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Jackson JK, Jones J, Nguyen H, Davies I, Lum M, Grady A, Yoong SL. Obesity Prevention within the Early Childhood Education and Care Setting: A Systematic Review of Dietary Behavior and Physical Activity Policies and Guidelines in High Income Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020838. [PMID: 33478165 PMCID: PMC7835808 DOI: 10.3390/ijerph18020838] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 11/21/2022]
Abstract
As a strategy for early childhood obesity prevention, a variety of dietary behavior and physical activity policies and guidelines published by leading health agencies and early childhood education and care (ECEC) licensing and accreditation bodies exist. Given the potential diversity in recommendations from these policies, this narrative review sought to synthesize, appraise and describe the various policies and guidelines made by organizational and professional bodies to highlight consistent recommendations and identify opportunities to strengthen such policies. An electronic bibliographic search of seven online databases and grey literature sources was undertaken. Records were included if they were policies or guidelines with specific recommendations addressing dietary behavior and/or physical activity practice implementation within the ECEC setting; included children aged >12 months and <6 years and were developed for high income countries. Recommended dietary behavior and physical activity policies and practices were synthesized into broad themes using the Analysis Grid for Environments Linked to Obesity framework, and the quality of included guidelines appraised. Our search identified 38 eligible publications mostly from the US and Australia. Identified guidelines were largely consistent in their recommendation and frequently addressed the physical and sociocultural environment and were well-aligned with research evidence. Broader consideration of policy and economic environments may be needed to increase the impact of such policies and guidelines within the ECEC setting.
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Affiliation(s)
- Jacklyn Kay Jackson
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (J.K.J.); (J.J.); (M.L.); (A.G.)
- Hunter Medical Research Institute (HMRI), New Lambton, NSW 2305, Australia
- Priority Research Centre for Health Behavior, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science (NCOIS), School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW 2305, Australia
| | - Jannah Jones
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (J.K.J.); (J.J.); (M.L.); (A.G.)
- Hunter Medical Research Institute (HMRI), New Lambton, NSW 2305, Australia
- Priority Research Centre for Health Behavior, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science (NCOIS), School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW 2305, Australia
| | - Hanh Nguyen
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia; (H.N.); (I.D.)
| | - Isabella Davies
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia; (H.N.); (I.D.)
| | - Melanie Lum
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (J.K.J.); (J.J.); (M.L.); (A.G.)
- Hunter Medical Research Institute (HMRI), New Lambton, NSW 2305, Australia
- Priority Research Centre for Health Behavior, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science (NCOIS), School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW 2305, Australia
| | - Alice Grady
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (J.K.J.); (J.J.); (M.L.); (A.G.)
- Hunter Medical Research Institute (HMRI), New Lambton, NSW 2305, Australia
- Priority Research Centre for Health Behavior, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science (NCOIS), School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW 2305, Australia
| | - Sze Lin Yoong
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (J.K.J.); (J.J.); (M.L.); (A.G.)
- Hunter Medical Research Institute (HMRI), New Lambton, NSW 2305, Australia
- Priority Research Centre for Health Behavior, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- National Centre of Implementation Science (NCOIS), School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW 2305, Australia
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC 3122, Australia; (H.N.); (I.D.)
- Correspondence: ; Tel.: +61-3-9214-4935
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Wolfenden L, Foy R, Presseau J, Grimshaw JM, Ivers NM, Powell BJ, Taljaard M, Wiggers J, Sutherland R, Nathan N, Williams CM, Kingsland M, Milat A, Hodder RK, Yoong SL. Designing and undertaking randomised implementation trials: guide for researchers. BMJ 2021; 372:m3721. [PMID: 33461967 PMCID: PMC7812444 DOI: 10.1136/bmj.m3721] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Implementation science is the study of methods to promote the systematic uptake of evidence based interventions into practice and policy to improve health. Despite the need for high quality evidence from implementation research, randomised trials of implementation strategies often have serious limitations. These limitations include high risks of bias, limited use of theory, a lack of standard terminology to describe implementation strategies, narrowly focused implementation outcomes, and poor reporting. This paper aims to improve the evidence base in implementation science by providing guidance on the development, conduct, and reporting of randomised trials of implementation strategies. Established randomised trial methods from seminal texts and recent developments in implementation science were consolidated by an international group of researchers, health policy makers, and practitioners. This article provides guidance on the key components of randomised trials of implementation strategies, including articulation of trial aims, trial recruitment and retention strategies, randomised design selection, use of implementation science theory and frameworks, measures, sample size calculations, ethical review, and trial reporting. It also focuses on topics requiring special consideration or adaptation for implementation trials. We propose this guide as a resource for researchers, healthcare and public health policy makers or practitioners, research funders, and journal editors with the goal of advancing rigorous conduct and reporting of randomised trials of implementation strategies.
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Affiliation(s)
- Luke Wolfenden
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Department of Family Medicine and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Byron J Powell
- Brown School and School of Medicine, Washington University in St Louis, St Louis, MI, USA
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - John Wiggers
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Christopher M Williams
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Melanie Kingsland
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Andrew Milat
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Rebecca K Hodder
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Sze Lin Yoong
- Swinburne University of Technology, School of Health Sciences, Faculty Health, Arts and Design, Hawthorn, VIC, Australia
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Lee K, Ding D, Grunseit A, Wolfenden L, Milat A, Bauman A. Many Papers but Limited Policy Impact? A Bibliometric Review of Physical Activity Research. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2021. [DOI: 10.1249/tjx.0000000000000167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Taghizadeh S, Farhangi MA. The effectiveness of pediatric obesity prevention policies: a comprehensive systematic review and dose-response meta-analysis of controlled clinical trials. J Transl Med 2020; 18:480. [PMID: 33317542 PMCID: PMC7734784 DOI: 10.1186/s12967-020-02640-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/27/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Childhood obesity persists as a serious public health problem. In the current meta-analysis, we summarized the results of controlled trials that evaluated the effect of obesity prevention policies in children and adolescents. METHODS Three databases (SCOPUS, PubMed and Embase) were searched for studies published before the 6th April 2020, by reported outcome measures of body mass index (BMI) and BMI-Zscore. Forty-seven studies reported BMI, while 45 studies reported BMI-Zscore as final outcome. RESULTS The results showed that the obesity-prevention policies had significant effect in reducing BMI (WMD: - 0.127; CI - 0.198, - 0.056; P < 0.001). These changes were not significant for BMI-Zscore (WMD: - 0.020; CI - 0.061, 0.021; P = 0.340). In dose-response meta-analysis, a non-linear association was reported between the duration of intervention and BMI (Pnonlinearity < 0.001) as well as BMI-Zscore (Pnonlinearity = 0.023). In subgroup analysis, the more favorite results were observed for 5-10 years old, with combination of physical activity and diet as intervention materials. CONCLUSION In conclusion, the obesity prevention policies in short-term periods of less than 2 years, in rather early age of school with approaches of change in both of diet and physical activity, could be more effective in prevention of childhood obesity. Trial registration PROSPERO registration number: CRD42019138359.
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Affiliation(s)
- Shahnaz Taghizadeh
- Student Research Committee, Department of Community Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdieh Abbasalizad Farhangi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Attar Nishabouri St., POBOX: 14711, 5166614711, Tabriz, Iran.
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Andersen E, Øvreås S, Jørgensen KA, Borch-Jenssen J, Moser T. Children's physical activity level and sedentary behaviour in Norwegian early childhood education and care: effects of a staff-led cluster-randomised controlled trial. BMC Public Health 2020; 20:1651. [PMID: 33148218 PMCID: PMC7640688 DOI: 10.1186/s12889-020-09725-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 10/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A growing body of evidence suggest that the children's physical activity (PA) level in early childhood education and care (ECEC) settings are insufficient. Since most children attend ECEC settings for many hours on most days of the week, and these institutions reach children across the socioeconomic spectrum, the ECEC settings may serve as an ideal avenue for increasing physical activity level, reduce sedentary time and enhance the overall health of young children. This paper investigates the effectiveness of the "Active Kindergarten - Active Children" study to increase children's PA level and reduce sedentary time within the ECEC setting. METHODS Accelerometers were used to asses PA and sedentary time. A total of 116 three to four-year olds took part in a randomised controlled trial in 11 ECEC settings. Participants were cluster-randomised, by ECEC setting, to either a 12 week staff-led and expert-supported intervention or a waiting list control group. RESULTS The intervention group increased time spent in moderate- and vigorous intensity PA by 10 min/day (95% CI = 3, 18; P = 0.01), took 1909 more steps per day (95% CI = 1130, 2688; P < 0.01) and reduced sedentary time with 14 min/day (95% CI = - 27, - 1; P = 0.04) compared to the control group. The intervention group had a 2.4 higher odds (95% CI = 1.05, 5.7; P = 0.04) of meeting the PA recommendations compared to the control group at follow-up. CONCLUSIONS Our results show that a flexible staff-led and expert-supported multicomponent PA intervention can increase total PA level, moderate- and vigorous intensity PA and reduce time spent sedentary in three to four-year old children during their stay in ECEC settings. TRIAL REGISTRATION The trial was retrospectively registered on September 19, 2020 and available online at ClinicalTrials.gov: No. NCT04555746 .
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Affiliation(s)
- Eivind Andersen
- Faculty of Humanities, Sports and Educational Science, University of South-Eastern Norway, Horten, Norway.
| | - Steinar Øvreås
- Faculty of Humanities, Sports and Educational Science, University of South-Eastern Norway, Horten, Norway
| | - Kari Anne Jørgensen
- Faculty of Humanities, Sports and Educational Science, University of South-Eastern Norway, Horten, Norway
| | | | - Thomas Moser
- Faculty of Humanities, Sports and Educational Science, University of South-Eastern Norway, Horten, Norway
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Chen C, Ahlqvist VH, Henriksson P, Magnusson C, Berglind D. Preschool environment and preschool teacher's physical activity and their association with children's activity levels at preschool. PLoS One 2020; 15:e0239838. [PMID: 33057340 PMCID: PMC7561096 DOI: 10.1371/journal.pone.0239838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 09/14/2020] [Indexed: 11/24/2022] Open
Abstract
Objective The aim of this study was to investigate the association between preschool playground size, formalized physical activity (PA) policies, time spent outdoors and preschool teacher’s levels of PA and children’s objectively assessed levels of PA and sedentary time (ST) during preschool hours. Methods In total, 369 children and 84 preschool teachers from 27 preschools in Södermalm municipally, Stockholm Sweden wore an Actigraph GT3X+ accelerometer during 7 consecutive days. Preschool environmental and structural characteristics were measured via the Environment and Policy Evaluation Self-Report (EPAO-SR) instrument and time in- and outdoors was recorded by preschool teachers during the PA measurements. Weight and height of children were measured via validated scales and parents filled out a questionnaire on demographical and descriptive variables. Linear mixed models, nested on preschool level, were used to assess the association between predictors and outcomes. Results The mean child age was 4.7 years (SD 0.8) and 45% were girls. We found that children were more active in preschools with a formalized PA policy, compared to preschools without such a policy, but not less sedentary. The association between policy and activity seemed to be more pronounced when accounting for other environmental factors. Similar associations were found in children spent most time outdoors (uppermost quartile) compared with children spent least time outdoors (Lowermost quartile). Preschool teachers’ light PA (LPA) (ß = 0.25, P = 0.004) and steps (ß = 0.52, P<0.001) were associated with children’s LPA and steps while the preschool playground size showed no association with PA in children, when accounting for other environmental factors. Conclusion The current study showed that preschool structural characteristics such as formalized PA policies and more time spent outdoors were positively associated with children’s PA. These findings suggest that formalized PA policies and time outdoors may be of importance for promoting children’s PA during preschool hours.
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Affiliation(s)
- Chu Chen
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- * E-mail:
| | - Viktor H. Ahlqvist
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Cecilia Magnusson
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Daniel Berglind
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
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Sanchez-Flack JC, Herman A, Buscemi J, Kong A, Bains A, Fitzgibbon ML. A systematic review of the implementation of obesity prevention interventions in early childcare and education settings using the RE-AIM framework. Transl Behav Med 2020; 10:1168-1176. [PMID: 33044537 PMCID: PMC7549410 DOI: 10.1093/tbm/ibz179] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Previous systematic reviews have examined the efficacy of obesity prevention interventions within early childcare/education settings. Often lacking in these reviews is reporting on external validity, which continues to be underemphasized compared to internal validity. More attention to external validity would help better translate evidence-based interventions to real-world settings. This systematic review aimed to determine the availability of data on both internal and external validity across dimensions of the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework in studies reporting on obesity prevention interventions in early childcare/education settings. Inclusion criteria included: randomized controlled trials, early childcare/education setting, targeted children 2-6 years old, addressed both diet and physical activity, collected measures of weight status and diet and/or physical activity, and published within the last 10 years. Searches were conducted in ERIC, PsychInfo, and PubMed; 23 studies met inclusion criteria. A validated RE-AIM abstraction tool was used to code studies. Most commonly reported dimensions were Reach (62.3%), Implementation (53.5%), and Efficacy/Effectiveness (48.7%). Adoption (21.7%) and Maintenance (11.6%) were less often reported. All studies reported on primary outcomes, but few reported on RE-AIM indicators of characteristics of participation and adoption, quality of life, methods used to identify staff, staff inclusion/exclusion criteria and adoption rates, implementation fidelity, measures of cost to start-up and deliver the intervention, and indicators of maintenance. This systematic review underscores the need for more focus on external validity to inform replication, dissemination, and implementation so that evidence-based early childcare/education obesity interventions can be generalized to real-world settings.
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Affiliation(s)
| | - Annie Herman
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Joanna Buscemi
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Angela Kong
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Alexis Bains
- Department of Kinesiology and Nutrition, College of Applied Health, Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Marian L Fitzgibbon
- Department of Pediatrics and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
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The effects of intervening with physical activity in the early years (ages 3-5) on health-related quality of life: a secondary analysis of the Activity Begins in Childhood (ABC) trial. Qual Life Res 2020; 30:221-227. [PMID: 32700186 DOI: 10.1007/s11136-020-02587-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Limited research has measured the effect of physical activity (PA) interventions on health-related quality of life (HRQoL) among pre-school-aged children. This study evaluates the effect of the Activity Begins in Childhood (ABC) cluster-randomized controlled trial designed to increase PA in the ages 3-5 years on HRQoL. METHODS This was a cluster-randomized controlled trial where the intervention group included PA education delivered to daycare providers only, or daycare providers and parents. In the current study, the two PA intervention groups were combined. The comparator group received standard daycare curriculum (COM). A total of 215 children were included (PA n = 161, COM n = 54). Parents completed the proxy Pediatric Quality of Life Inventory Generic Core Scale (PedsQL™ 4.0) to measure HRQoL at baseline and the end of the 6-month trial. HRQoL scores were analyzed as physical, psychosocial, and total domains. Baseline and 6-months measurements were compared for PA and COM groups, and mean changes in scores (95% confidence intervals) were measured using absolute values. RESULTS No between-group differences were observed for the physical (p = 0.17), psychosocial (p = 0.95) or total scores (p = 0.20). Paired comparisons showed that only the PA group improved psychosocial- (PA mean difference = 2.18 (0.20, 4.15), p = 0.03; COM mean difference = 2.05 (- 1.03, 5.13), p = 0.19) and total-HRQoL scores (PA mean difference = 2.83 (1.83, 3.84), p < 0.001; COM mean difference = 0.19 (- 1.78, 2.16), p = 0.84) after 6 months. CONCLUSION Although the within-PA group analysis showed an improvement in psychosocial and total HRQoL scores from baseline, no between-group differences were observed in the HRQoL over time among children aged 3-5 years.
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Aadland E, Tjomsland HE, Johannessen K, Nilsen AKO, Resaland GK, Glosvik Ø, Lykkebø O, Stokke R, Andersen LB, Anderssen SA, Pfeiffer KA, Tomporowski PD, Størksen I, Bartholomew JB, Ommundsen Y, Howard SJ, Okely AD, Aadland KN. Active Learning Norwegian Preschool(er)s (ACTNOW) - Design of a Cluster Randomized Controlled Trial of Staff Professional Development to Promote Physical Activity, Motor Skills, and Cognition in Preschoolers. Front Psychol 2020; 11:1382. [PMID: 32719636 PMCID: PMC7350704 DOI: 10.3389/fpsyg.2020.01382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/25/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION There is a dearth of high-quality evidence on effective, sustainable, and scalable interventions to increase physical activity (PA) and concomitant outcomes in preschoolers. Specifically, there is a need to better understand how the preschool context can be used to increase various types of physically active play to promote holistic child development. The implementation of such interventions requires highly competent preschool staffs, however, the competence in promoting PA is often low. The main aim of the ACTNOW study is therefore to investigate the effects of professional development for preschool staffs on child PA and developmental outcomes. METHODS The study will be conducted in Norway 2019-2022 and is designed as a two-arm (intervention, control) cluster randomized controlled trial (RCT) with 7- and 18-months follow-ups. We aim to recruit 60 preschools and 1,200 3- to 5-years-old children to provide sufficient power to detect effect sizes (ESs) between 0.20 and 0.30. The intervention is nested within two levels: the preschool and the child. Central to the ACTNOW intervention are opportunities for children to engage in a variety of "enriched," meaningful, and enjoyable physically active play that supports the development of the whole child. To this end, the main intervention is a 7-month professional development/education module for preschool staff, aimed to provide them with the necessary capacity to deliver four core PA components to the children (moderate-to-vigorous PA, motor-challenging PA, cognitively engaging play, and physically active learning). We will include a range of child-level outcomes, including PA, physical fitness, adiposity, motor skills, socioemotional health, self-regulation, executive function, and learning. At the preschool level, we will describe implementation and adaptation processes using quantitative and qualitative data. DISCUSSION Professional development of staff and a whole-child approach that integrates PA with cognitively engaging play and learning activities in the preschool setting may provide a feasible vehicle to enhance both physical and cognitive development in young children. ACTNOW is designed to test this hypothesis to provide a sustainable way to build human capital and provide an early solution to lifelong public health and developmental challenges. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.gov identifier NCT04048967.
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Affiliation(s)
- Eivind Aadland
- Department of Sport, Food and Natural Sciences, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
| | - Hege Eikeland Tjomsland
- Department of Sport, Food and Natural Sciences, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
| | - Kjersti Johannessen
- Department of Sport, Food and Natural Sciences, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
| | - Ada Kristine Ofrim Nilsen
- Department of Sport, Food and Natural Sciences, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
| | - Geir Kåre Resaland
- Center for Physically Active Learning, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
| | - Øyvind Glosvik
- Department of Pedagogy, Religion and Social Studies, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
| | - Osvald Lykkebø
- Department of Strategic Initiatives, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
| | - Rasmus Stokke
- Department of Sport, Food and Natural Sciences, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
| | - Lars Bo Andersen
- Department of Sport, Food and Natural Sciences, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
| | - Sigmund Alfred Anderssen
- Department of Sport, Food and Natural Sciences, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Karin Allor Pfeiffer
- Department of Kinesiology, Michigan State University, East Lansing, MI, United States
| | | | - Ingunn Størksen
- Norwegian Centre for Learning Environment and Behavioural Research in Education, University of Stavanger, Stavanger, Norway
| | - John B. Bartholomew
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, United States
| | - Yngvar Ommundsen
- Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
| | - Steven James Howard
- Early Start and School of Education, University of Wollongong, Wollongong, NSW, Australia
| | - Anthony D. Okely
- Early Start and School of Education, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia
| | - Katrine Nyvoll Aadland
- Department of Sport, Food and Natural Sciences, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
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Mannocci A, D’Egidio V, Backhaus I, Federici A, Sinopoli A, Ramirez Varela A, Villari P, La Torre G. Are There Effective Interventions to Increase Physical Activity in Children and Young People? An Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3528. [PMID: 32443505 PMCID: PMC7277151 DOI: 10.3390/ijerph17103528] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Obesity and physical inactivity among children and young people are public health concerns. While numerous interventions to promote physical activity are available, little is known about the most effective ones. This study aimed to summarize the existing evidence on interventions that aim to increase physical activity. METHODS A systematic review of reviews was conducted. Systematic reviews and meta-analyses published from January 2010 until November 2017 were identified through PubMed, Scopus and the Cochrane Library. Two reviewers independently assessed titles and abstracts, performed data extraction and quality assessment. Outcomes as level of physical activity and body mass index were collected in order to assess the efficacy of interventions. RESULTS A total 30 studies examining physical activity interventions met the inclusion criteria, 15 systematic reviews and 15 meta-analyses. Most studies (N = 20) were implemented in the school setting, three were developed in preschool and childcare settings, two in the family context, five in the community setting and one miscellaneous context. Results showed that eight meta-analyses obtained a small increase in physical activity level, out of which five were conducted in the school, two in the family and one in the community setting. Most promising programs had the following characteristics: included physical activity in the school curriculum, were long-term interventions, involved teachers and had the support of families. CONCLUSION The majority of interventions to promote physical activity in children and young people were implemented in the school setting and were multicomponent. Further research is needed to investigate nonschool programs.
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Affiliation(s)
- Alice Mannocci
- Department of Public Health and Infectious Disease, Sapienza University of Rome, 00182 Rome, Italy; (A.M.); (I.B.); (P.V.); (G.L.T.)
| | - Valeria D’Egidio
- Department of Public Health and Infectious Disease, Sapienza University of Rome, 00182 Rome, Italy; (A.M.); (I.B.); (P.V.); (G.L.T.)
| | - Insa Backhaus
- Department of Public Health and Infectious Disease, Sapienza University of Rome, 00182 Rome, Italy; (A.M.); (I.B.); (P.V.); (G.L.T.)
| | | | | | | | - Paolo Villari
- Department of Public Health and Infectious Disease, Sapienza University of Rome, 00182 Rome, Italy; (A.M.); (I.B.); (P.V.); (G.L.T.)
| | - Giuseppe La Torre
- Department of Public Health and Infectious Disease, Sapienza University of Rome, 00182 Rome, Italy; (A.M.); (I.B.); (P.V.); (G.L.T.)
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Hammersley ML, Wyse RJ, Jones RA, Wolfenden L, Yoong S, Stacey F, Eckermann S, Okely AD, Innes-Hughes C, Li V, Green A, May C, Xu J, Rissel C. Translation of two healthy eating and active living support programs for parents of 2-6 year old children: a parallel partially randomised preference trial protocol (the 'time for healthy habits' trial). BMC Public Health 2020; 20:636. [PMID: 32381052 PMCID: PMC7204000 DOI: 10.1186/s12889-020-08526-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/16/2020] [Indexed: 12/13/2022] Open
Abstract
Background Parents are key decision makers and role models in establishing and maintaining healthy behaviours in their children. Interventions involving parents have been shown to be more effective than those that do not, but there are barriers to participation. Efficacy trials have previously been conducted on two such parent-focussed healthy eating and active living interventions with the potential to overcome these barriers - Healthy Habits (telephone-based) and Time2bHealthy (online) with promising results. Further research is now required to determine the effectiveness of these interventions in a real-world context. The Time for Healthy Habits study is a 3-arm partially randomised preference trial which aims to evaluate the effectiveness and cost-effectiveness of two theory-based programs to promote healthy eating and appropriate levels of movement behaviours (physical activity, sedentary behaviour and sleep) for parents of 2- to 6-year-old children (Healthy Habits Plus telephone-based program and Time2bHealthy online program), when compared to a comparison group receiving written materials. Methods Participants will be recruited across five Local Health Districts in New South Wales, Australia. The partially randomised preference design initially allows for participants to decide if they wish to be randomised or opt to select their preferred intervention and has been recommended for use to test effectiveness in a real-world setting. Both interventions incorporate multiple behaviour change techniques and support parents to improve their children’s healthy eating, and movement behaviours (physical activity, sedentary behaviour and sleep) and run for 12 weeks, followed by a 3-month and 9-month post-baseline follow-up. Participants will also be asked to complete a process evaluation questionnaire at the completion of the intervention (3-months post-baseline). Outcomes include fruit and vegetable intake (primary outcome), non-core food intake, weight status, physical activity, sedentary behaviour, and sleep habits. Discussion To our knowledge, this is the first translational research trial evaluating the effectiveness and cost-effectiveness of a healthy eating and active living intervention in the 2- to 6-years age group. The results will build the evidence base in regard to translation of effective childhood obesity prevention interventions and inform the implementation and delivery of community based childhood obesity prevention programs. Trial registration UTN: U1111–1228-9748, ACTRN: 12619000396123p.
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Affiliation(s)
- Megan L Hammersley
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia. .,Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW, 2522, Australia.
| | - Rebecca J Wyse
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Rachel A Jones
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Serene Yoong
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Fiona Stacey
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Simon Eckermann
- Australian Health Services Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Anthony D Okely
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia.,Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Christine Innes-Hughes
- NSW Office of Preventive Health, Liverpool Hospital, Locked Bag 7103, Liverpool BC, Sydney, NSW, Australia
| | - Vincy Li
- NSW Office of Preventive Health, Liverpool Hospital, Locked Bag 7103, Liverpool BC, Sydney, NSW, Australia
| | - Amanda Green
- NSW Office of Preventive Health, Liverpool Hospital, Locked Bag 7103, Liverpool BC, Sydney, NSW, Australia
| | - Christine May
- Formerly Murrumbidgee Local Health District, Cootamundra Health Service, McKay St, Cootamundra, NSW, Australia
| | - Joe Xu
- NSW Office of Preventive Health, Liverpool Hospital, Locked Bag 7103, Liverpool BC, Sydney, NSW, Australia
| | - Chris Rissel
- NSW Office of Preventive Health, Liverpool Hospital, Locked Bag 7103, Liverpool BC, Sydney, NSW, Australia.,Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
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Wolfenden L, Barnes C, Jones J, Finch M, Wyse RJ, Kingsland M, Tzelepis F, Grady A, Hodder RK, Booth D, Yoong SL. Strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices or programmes within childcare services. Cochrane Database Syst Rev 2020; 2:CD011779. [PMID: 32036618 PMCID: PMC7008062 DOI: 10.1002/14651858.cd011779.pub3] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite the existence of effective interventions and best-practice guideline recommendations for childcare services to implement evidence-based policies, practices and programmes to promote child healthy eating, physical activity and prevent unhealthy weight gain, many services fail to do so. OBJECTIVES The primary aim of the review was to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating, physical activity and/or obesity prevention. The secondary aims of the review were to: 1. Examine the cost or cost-effectiveness of such strategies; 2. Examine any adverse effects of such strategies on childcare services, service staff or children; 3. Examine the effect of such strategies on child diet, physical activity or weight status. 4. Describe the acceptability, adoption, penetration, sustainability and appropriateness of such implementation strategies. SEARCH METHODS We searched the following electronic databases on February 22 2019: Cochrane Central Register of Controlled trials (CENTRAL), MEDLINE, MEDLINE In Process, Embase, PsycINFO, ERIC, CINAHL and SCOPUS for relevant studies. We searched reference lists of included studies, handsearched two international implementation science journals, the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp/) and ClinicalTrials.gov (www.clinicaltrials.gov). SELECTION CRITERIA We included any study (randomised or nonrandomised) with a parallel control group that compared any strategy to improve the implementation of a healthy eating, physical activity or obesity prevention policy, practice or programme by staff of centre-based childcare services to no intervention, 'usual' practice or an alternative strategy. Centre-based childcare services included preschools, nurseries, long daycare services and kindergartens catering for children prior to compulsory schooling (typically up to the age of five to six years). DATA COLLECTION AND ANALYSIS Two review authors independently screened study titles and abstracts, extracted study data and assessed risk of bias; we resolved discrepancies via consensus. We performed meta-analysis using a random-effects model where studies with suitable data and homogeneity were identified; otherwise, findings were described narratively. MAIN RESULTS Twenty-one studies, including 16 randomised and five nonrandomised, were included in the review. The studies sought to improve the implementation of policies, practices or programmes targeting healthy eating (six studies), physical activity (three studies) or both healthy eating and physical activity (12 studies). Studies were conducted in the United States (n = 12), Australia (n = 8) and Ireland (n = 1). Collectively, the 21 studies included a total of 1945 childcare services examining a range of implementation strategies including educational materials, educational meetings, audit and feedback, opinion leaders, small incentives or grants, educational outreach visits or academic detailing, reminders and tailored interventions. Most studies (n = 19) examined implementation strategies versus usual practice or minimal support control, and two compared alternative implementation strategies. For implementation outcomes, six studies (one RCT) were judged to be at high risk of bias overall. The review findings suggest that implementation strategies probably improve the implementation of policies, practices or programmes that promote child healthy eating, physical activity and/or obesity prevention in childcare services. Of the 19 studies that compared a strategy to usual practice or minimal support control, 11 studies (nine RCTs) used score-based measures of implementation (e.g. childcare service nutrition environment score). Nine of these studies were included in pooled analysis, which found an improvement in implementation outcomes (SMD 0.49; 95% CI 0.19 to 0.79; participants = 495; moderate-certainty evidence). Ten studies (seven RCTs) used dichotomous measures of implementation (e.g. proportion of childcare services implementing a policy or specific practice), with seven of these included in pooled analysis (OR 1.83; 95% CI 0.81 to 4.11; participants = 391; low-certainty evidence). Findings suggest that such interventions probably lead to little or no difference in child physical activity (four RCTs; moderate-certainty evidence) or weight status (three RCTs; moderate-certainty evidence), and may lead to little or no difference in child diet (two RCTs; low-certainty evidence). None of the studies reported the cost or cost-effectiveness of the intervention. Three studies assessed the adverse effects of the intervention on childcare service staff, children and parents, with all studies suggesting they have little to no difference in adverse effects (e.g. child injury) between groups (three RCTs; low-certainty evidence). Inconsistent quality of the evidence was identified across review outcomes and study designs, ranging from very low to moderate. The primary limitation of the review was the lack of conventional terminology in implementation science, which may have resulted in potentially relevant studies failing to be identified based on the search terms used. AUTHORS' CONCLUSIONS Current research suggests that implementation strategies probably improve the implementation of policies, practices or programmes by childcare services, and may have little or no effect on measures of adverse effects. However such strategies appear to have little to no impact on measures of child diet, physical activity or weight status.
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Affiliation(s)
- Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Courtney Barnes
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Jannah Jones
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Meghan Finch
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Melanie Kingsland
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Alice Grady
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Debbie Booth
- University of NewcastleAuchmuty LibraryUniversity DriveCallaghanNSWAustralia2308
| | - Sze Lin Yoong
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
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Okely AD, Stanley RM, Jones RA, Cliff DP, Trost SG, Berthelsen D, Salmon J, Batterham M, Eckermann S, Reilly JJ, Brown N, Mickle KJ, Howard SJ, Hinkley T, Janssen X, Chandler P, Cross P, Gowers F. 'Jump start' childcare-based intervention to promote physical activity in pre-schoolers: six-month findings from a cluster randomised trial. Int J Behav Nutr Phys Act 2020; 17:6. [PMID: 31948454 PMCID: PMC6966838 DOI: 10.1186/s12966-020-0910-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 01/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Participation in adequate levels of physical activity during the early years is important for health and development. We report the 6-month effects of an 18-month multicomponent intervention on physical activity in early childhood education and care (ECEC) settings in low-income communities. METHODS A cluster randomised controlled trial was conducted in 43 ECEC settings in disadvantaged areas of New South Wales, Australia. Three-year-old children were recruited and assessed in the first half of 2015 with follow-up 6 months later. The intervention was guided by Social Cognitive Theory and included five components. The primary outcome was minutes per hour in total physical activity during ECEC hours measured using Actigraph accelerometers. Intention-to-treat analysis of the primary outcome was conducted using a generalized linear mixed model. RESULTS A total of 658 children were assessed at baseline. Of these, 558 (85%) had valid accelerometer data (mean age 3.38y, 52% boys) and 508 (77%) had valid accelerometry data at 6-month follow-up. Implementation of the intervention components ranged from 38 to 72%. There were no significant intervention effects on mins/hr. spent in physical activity (adjusted difference = - 0.17 mins/hr., 95% CI (- 1.30 to 0.97), p = 0.78). A priori sub-group analyses showed a greater effect among overweight/obese children in the control group compared with the intervention group for mins/hr. of physical activity (2.35mins/hr., [0.28 to 4.43], p = 0.036). CONCLUSIONS After six-months the Jump Start intervention had no effect on physical activity levels during ECEC. This was largely due to low levels of implementation. Increasing fidelity may result in higher levels of physical activity when outcomes are assessed at 18-months. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12614000597695.
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Affiliation(s)
- Anthony D Okely
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, New South Wales, 2522, Australia.
| | - Rebecca M Stanley
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, New South Wales, 2522, Australia
| | - Rachel A Jones
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, New South Wales, 2522, Australia
| | - Dylan P Cliff
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, New South Wales, 2522, Australia
| | - Stewart G Trost
- Institute of Health and Biomedical Innovation at Queensland Centre for Children's Health Research, School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Donna Berthelsen
- School of Early Childhood, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Marijka Batterham
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, New South Wales, 2522, Australia
| | - Simon Eckermann
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, New South Wales, 2522, Australia
| | - John J Reilly
- School of Psychological Science and Health, University of Strathclyde, Glasgow, Scotland, UK
| | - Ngiare Brown
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, New South Wales, 2522, Australia
| | - Karen J Mickle
- Institute of Health and Sport, Victoria University, Melbourne, Australia
| | - Steven J Howard
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, New South Wales, 2522, Australia
| | - Trina Hinkley
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Xanne Janssen
- School of Psychological Science and Health, University of Strathclyde, Glasgow, Scotland, UK
| | - Paul Chandler
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, New South Wales, 2522, Australia
| | - Penny Cross
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, New South Wales, 2522, Australia
| | - Fay Gowers
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, New South Wales, 2522, Australia
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Toussaint N, Streppel MT, Mul S, Fukkink RG, Weijs PJ, Janssen M. The Effects of the PLAYTOD Program on Children's Physical Activity at Preschool Playgrounds in a Deprived Urban Area: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010329. [PMID: 31947735 PMCID: PMC6981873 DOI: 10.3390/ijerph17010329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/24/2019] [Accepted: 12/31/2019] [Indexed: 12/15/2022]
Abstract
Interventions to improve children’s physical activity in Early Childhood Education and Care (ECEC) settings are needed. This randomized controlled trial examines the effects of a preschool-based playground program for ECEC teachers in a deprived urban area. On intervention preschools, the PLAYgrounds for TODdlers program (PLAYTOD) was performed. It focused on teacher’s knowledge and skills in order to create a challenging outdoor environment in which young children (2.5 to 4 years old) are able to practice their motor skills. Observations were performed before and after the program with a modified version of the SOPLAY protocol. The activating role of teachers (score from 0 = inactive to 4 = participating), the number of different physical activities, and the quality of children’s physical activity on playgrounds were observed. The latter included the number of performed fundamental movement skills and the estimated physical activity intensity (score from 0 = sedentary to 3 = vigorous). Descriptive statistics and linear regression analyses were used to evaluate the effects of PLAYTOD. After the program, the activating role of teachers on intervention playgrounds improved. Moreover, the program and consecutively the changes made by teachers had a positive effect on the number of different activities and the quality of children’s physical activity. The results emphasize an important role for ECEC teachers in improving physical activity in young children.
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Affiliation(s)
- Nicole Toussaint
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Dokter Meurerlaan 8, 1067 SM Amsterdam, The Netherlands; (N.T.); (M.T.S.); (S.M.)
| | - Martinette T. Streppel
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Dokter Meurerlaan 8, 1067 SM Amsterdam, The Netherlands; (N.T.); (M.T.S.); (S.M.)
| | - Sandra Mul
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Dokter Meurerlaan 8, 1067 SM Amsterdam, The Netherlands; (N.T.); (M.T.S.); (S.M.)
| | - Ruben G. Fukkink
- Faculty of Child Development and Education, Amsterdam University of Applied Sciences, Wibautstraat 2-4, 1091 GM Amsterdam, The Netherlands;
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands
| | - Peter J.M. Weijs
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Dokter Meurerlaan 8, 1067 SM Amsterdam, The Netherlands; (N.T.); (M.T.S.); (S.M.)
- Department of Nutrition & Dietetics, Amsterdam University Medical Centers, VU University, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Mirka Janssen
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Dokter Meurerlaan 8, 1067 SM Amsterdam, The Netherlands; (N.T.); (M.T.S.); (S.M.)
- Correspondence:
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Wolfenden L, Bolsewicz K, Grady A, McCrabb S, Kingsland M, Wiggers J, Bauman A, Wyse R, Nathan N, Sutherland R, Hodder RK, Fernandez M, Lewis C, Taylor N, McKay H, Grimshaw J, Hall A, Moullin J, Albers B, Batchelor S, Attia J, Milat A, Bailey A, Rissel C, Reeves P, Sims-Gould J, Mildon R, Doran C, Yoong SL. Optimisation: defining and exploring a concept to enhance the impact of public health initiatives. Health Res Policy Syst 2019; 17:108. [PMID: 31888666 PMCID: PMC6937822 DOI: 10.1186/s12961-019-0502-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/31/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Repeated, data-driven optimisation processes have been applied in many fields to rapidly transform the performance of products, processes and interventions. While such processes may similarly be employed to enhance the impact of public health initiatives, optimisation has not been defined in the context of public health and there has been little exploration of its key concepts. METHODS We used a modified, three-round Delphi study with an international group of researchers, public health policy-makers and practitioners to (1) generate a consensus-based definition of optimisation in the context of public health and (2i) describe key considerations for optimisation in that context. A pre-workshop literature review and elicitation of participant views regarding optimisation in public health (round 1) were followed by a daylong workshop and facilitated face-to-face group discussions to refine the definition and generate key considerations (round 2); finally, post-workshop discussions were undertaken to refine and finalise the findings (round 3). A thematic analysis was performed at each round. Study findings reflect an iterative consultation process with study participants. RESULTS Thirty of 33 invited individuals (91%) participated in the study. Participants reached consensus on the following definition of optimisation in public health: "A deliberate, iterative and data-driven process to improve a health intervention and/or its implementation to meet stakeholder-defined public health impacts within resource constraints". A range of optimisation considerations were explored. Optimisation was considered most suitable when existing public health initiatives are not sufficiently effective, meaningful improvements from an optimisation process are anticipated, quality data to assess impacts are routinely available, and there are stable and ongoing resources to support it. Participants believed optimisation could be applied to improve the impacts of an intervention, an implementation strategy or both, on outcomes valued by stakeholders or end users. While optimisation processes were thought to be facilitated by an understanding of the mechanisms of an intervention or implementation strategy, no agreement was reached regarding the best approach to inform decisions about modifications to improve impact. CONCLUSIONS The study findings provide a strong basis for future research to explore the potential impact of optimisation in the field of public health.
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Affiliation(s)
- Luke Wolfenden
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | | | - Alice Grady
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Sam McCrabb
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
| | - Melanie Kingsland
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | - John Wiggers
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
| | - Adrian Bauman
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW Australia
| | - Rebecca Wyse
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Nicole Nathan
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Rachel Sutherland
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Rebecca Kate Hodder
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Maria Fernandez
- Centre for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Centre, Houston, TX United States of America
| | - Cara Lewis
- Kaiser Permanent Washington Health Research Institute, Seattle, WA United States of America
| | - Natalie Taylor
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW Australia
- Cancer Council NSW, Woollomooloo, NSW Australia
| | - Heather McKay
- Centre for Hip Health and Mobility, Robert H N Ho Research Centre, University of British Columbia, Vancouver, BC Canada
| | | | - Alix Hall
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Joanna Moullin
- Faculty of Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University, Perth, WA Australia
| | - Bianca Albers
- European Implementation Collaborative, Sydney, Australia
| | | | - John Attia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Andrew Milat
- NSW Ministry of Health, North Sydney, NSW Australia
| | - Andrew Bailey
- Mid North Coast Local Health District, Port Macquarie, NSW Australia
| | - Chris Rissel
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW Australia
- NSW Office of Preventive Health, Liverpool, NSW Australia
| | - Penny Reeves
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
| | - Joanie Sims-Gould
- Centre for Hip Health and Mobility, Robert H N Ho Research Centre, University of British Columbia, Vancouver, BC Canada
| | - Robyn Mildon
- Centre for Evidence and Implementation, Carlton, VIC Australia
| | - Chris Doran
- Central Queensland University, North Rockhampton, QLD Australia
| | - Sze Lin Yoong
- Hunter New England Local Health District, Wallsend, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Newcastle, NSW Australia
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45
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Childcare Physical Activity Interventions: A Discussion of Similarities and Differences and Trends, Issues, and Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234836. [PMID: 31810156 PMCID: PMC6926705 DOI: 10.3390/ijerph16234836] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 12/20/2022]
Abstract
Early childhood education and care (ECEC) settings have a pivotal role in the promotion of physical activity for young children, and thus, the number of ECEC-based physical activity interventions has exponentially increased in the last two decades. The aim of this study was three-fold: (1) to discuss some of the similarities and differences in ECEC-based physical activity interventions, (2) to highlight current trends and issues in the ECEC sector relating to such interventions, and (3) to provide recommendations for future interventions. Twenty-four individual studies are discussed. Most studies have targeted children aged between 3 and 5 years and involved children participating in additional physical activity opportunities while at childcare. In all studies, educators participated in some professional development either prior or during the intervention. Less the half of the studies discussed reported significant positive changes in physical activity outcomes. Those involved in developing future interventions will need to consider current national and international trends in the ECEC sector (e.g., over-crowded curriculum, administrative requirements, and more highly-qualified educators devoting time for business development), as well as creative and unique ways of delivering ECEC-based physical activity interventions.
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46
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Delaney T, Jackson JK, Jones J, Hall A, Dives A, Wedesweiler T, Campbell L, Nathan N, Romiti M, Trost SG, Lum M, Colliver Y, Hernandez L, Yoong SL. A Cluster Randomised Controlled Trial of an Intervention to Increase Physical Activity of Preschool-Aged Children Attending Early Childhood Education and Care: Study Protocol for the 'Everybody Energise' Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214275. [PMID: 31689905 PMCID: PMC6862613 DOI: 10.3390/ijerph16214275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 10/21/2019] [Accepted: 10/31/2019] [Indexed: 12/17/2022]
Abstract
The use of ‘Energisers,’ short bouts of moderate-to-vigorous physical activity (MVPA), have been shown to significantly increase children’s physical activity within the school setting but not within Early Childhood Education and Care (ECEC) centres. The aim of this study is to assess the efficacy of an intervention involving the provision of educator-led daily Energisers to increase the time children spend in MVPA while attending ECEC. Fourteen ECEC centres in the Hunter region of New South Wales, Australia, will be randomised to either an intervention or control group. The intervention group will be supported by the research team to implement three brief (5-min) educator-led Energisers each day for children aged three to six years between the hours of 9:00 a.m. to 3.00 p.m. Control ECEC centres will continue to provide ‘normal practice’ to children. The primary trial outcome is child minutes of MVPA whilst in ECEC, assessed objectively via accelerometery over three days. Outcome assessment will occur at baseline and 6 months post-baseline. Linear mixed models under an intention-to-treat framework will be used to compare differences between groups in MVPA at follow-up. This will be the first cluster randomised controlled trial to test the efficacy of Energisers in isolation on increasing the time children spend in MVPA.
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Affiliation(s)
- Tessa Delaney
- Hunter New England Population Health, Wallsend, New South Wales 2287, Australia.
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia.
- Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia.
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales 2308, Australia.
| | - Jacklyn K Jackson
- Hunter New England Population Health, Wallsend, New South Wales 2287, Australia.
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia.
- Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia.
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales 2308, Australia.
| | - Jannah Jones
- Hunter New England Population Health, Wallsend, New South Wales 2287, Australia.
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia.
- Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia.
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales 2308, Australia.
| | - Alix Hall
- Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia.
| | - Ashleigh Dives
- Hunter New England Population Health, Wallsend, New South Wales 2287, Australia.
| | - Taya Wedesweiler
- Hunter New England Population Health, Wallsend, New South Wales 2287, Australia.
| | - Libby Campbell
- Hunter New England Population Health, Wallsend, New South Wales 2287, Australia.
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia.
- Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia.
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales 2308, Australia.
| | - Nicole Nathan
- Hunter New England Population Health, Wallsend, New South Wales 2287, Australia.
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia.
- Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia.
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales 2308, Australia.
| | - Maria Romiti
- Hunter New England Population Health, Wallsend, New South Wales 2287, Australia.
| | - Stewart G Trost
- Institute of Health and Biomedical Innovation at Queensland Centre for Children's Health Research, Queensland University of Technology, Kelvin Grove 4059, Australia.
| | - Melanie Lum
- Hunter New England Population Health, Wallsend, New South Wales 2287, Australia.
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia.
- Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia.
| | - Yeshe Colliver
- Department of Educational Studies, Macquarie University, North Ryde, New South Wales 2109, Australia.
| | - Lara Hernandez
- NSW Office of Preventive Health, Liverpool, New South Wales 2170, Australia.
| | - Sze Lin Yoong
- Hunter New England Population Health, Wallsend, New South Wales 2287, Australia.
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia.
- Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia.
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales 2308, Australia.
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47
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Tandon PS, Downing KL, Saelens BE, Christakis DA. Two Approaches to Increase Physical Activity for Preschool Children in Child Care Centers: A Matched-Pair Cluster-Randomized Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16204020. [PMID: 31640110 PMCID: PMC6843925 DOI: 10.3390/ijerph16204020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 12/26/2022]
Abstract
Early childhood education settings are critical for promoting physical activity (PA) but intervention effects are often small. The aim of this study was to develop, test, and compare two approaches to increasing physical activity among preschoolers at child care centers: one focused on a teacher-led PA curriculum (Active Play!) and the other on increasing outdoor child-initiated free play time (Outdoor Play!). We conducted a matched-pair cluster-randomized study in 10 centers in and around Seattle, WA, USA (n = 97 children, mean age 4.6). Pre- and post-intervention data were collected from observations and accelerometers. At pre-intervention, 19% of Active Play! and 25% of Outdoor Play! children achieved >120 min/day of PA during child care. The total opportunity for PA increased in both interventions (Active Play! = 11 min/day; Outdoor Play! = 14 min/day), with the largest increase in outdoor child-initiated free playtime (Active Play! = 19 min/day; Outdoor Play! = 24 min/day). No changes in sedentary time, light or moderate- to vigorous-intensity PA (MVPA) were observed in either intervention and there was no difference between interventions in the percentage of children attaining more than 120 min/day of PA. A small (<3 min/day) relative increase in teacher-led outdoor activity was observed in the Active Play! intervention. Both intervention strategies led to an increase in active play opportunities, predominantly outdoors, but neither was able to substantially increase the intensity and/or duration of children's PA. Future studies are needed to better understand and inform sustainable approaches to increase PA in early learning settings.
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Affiliation(s)
- Pooja S Tandon
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA 98145, USA.
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA.
| | - Katherine L Downing
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong VIC 3220, Australia.
| | - Brian E Saelens
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA 98145, USA.
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA.
| | - Dimitri A Christakis
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA 98145, USA.
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA.
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48
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Armstrong B, Trude ACB, Johnson C, Castelo RJ, Zemanick A, Haber-Sage S, Arbaiza R, Black MM. CHAMP: A cluster randomized-control trial to prevent obesity in child care centers. Contemp Clin Trials 2019; 86:105849. [PMID: 31525490 DOI: 10.1016/j.cct.2019.105849] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 02/06/2023]
Abstract
Foundational elements of lifelong health are formed during the preschool years. Child care attendance has nearly doubled in the past 5 years making child care centers an ideal setting to establish healthy habits that prevent pediatric obesity. Despite the promising evidence of efficacy of child care-based obesity prevention interventions, limited attention has been directed to criteria needed for implementation at scale. There is potential to improve children's dietary and physical activity behaviors in diverse communities through theory-based, culturally appropriate, manualized interventions, delivered by child care staff. CHAMP (Creating Healthy Habits Among Maryland Preschoolers) is a 3-arm cluster randomized controlled childhood obesity prevention trial, aiming to improve motor skills, physical activity and willingness to try new foods among 864 preschoolers (age 3-5 years) enrolled in 54 child care centers in 10 Maryland counties. CHAMP is informed by social-cognitive and bioecological theories and based on an evidence-based program, The Food Friends®. The two intervention arms include: 1) child care-center based lessons (18-week gross motor and 12-week nutrition) administered by trained child care staff, and 2) a web-based intervention for caregivers in addition to center-based lessons. Evaluations are conducted among children, caregivers, and child care staff at fall enrollment, midline, and spring, following intervention completion. Analyses include linear mixed-models, accounting for clustering and repeated measures, incorporating center-arms as moderators. CHAMP will provide evidence-based information to inform wellness guidelines and policies that can be disseminated broadly, to ensure that child care centers provide opportunities for children to develop healthy eating, and physical activity habits. Trial Registration: NCT03111264; https://clinicaltrials.gov/ct2/show/NCT03111264.
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Affiliation(s)
- Bridget Armstrong
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Angela C B Trude
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Candace Johnson
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Romulus J Castelo
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Amy Zemanick
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Sophie Haber-Sage
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Raquel Arbaiza
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America
| | - Maureen M Black
- University of Maryland Baltimore School of Medicine, Department of Pediatrics, United States of America; RTI International, Department of Pediatrics, United States of America.
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49
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Yoong SL, Grady A, Stacey F, Polimeni M, Clayton O, Jones J, Nathan N, Wyse R, Wolfenden L. A pilot randomized controlled trial examining the impact of a sleep intervention targeting home routines on young children's (3-6 years) physical activity. Pediatr Obes 2019; 14:e12481. [PMID: 30417593 DOI: 10.1111/ijpo.12481] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/19/2018] [Accepted: 09/08/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Given evidence suggesting that sleep impacts on metabolic processes, interventions targeting sleep may improve child physical activity (PA). OBJECTIVES To describe the potential effect of an intervention to increase sleep on young children's (3-6 years) moderate to vigorous PA (MVPA) and total PA. To determine adherence to the intervention, impact on sleep duration as well as feasibility, uptake and acceptability was also assessed. METHODS Pilot randomized controlled trial with 76 parent-child dyads randomly allocated to an intervention (n = 38) or control group (n = 38). Parents in the intervention group received a 3-month theory-informed intervention consisting of an online video, a telephone call and two text messages. Child PA was assessed using accelerometers at baseline and approximately 3 months. Parents also completed a sleep log and a telephone interview. RESULTS The consent rate was 41% (76/186). Estimated effect size for the intervention relative to control was 10.8 min/day for MVPA, 2.7 min/day for PA and 0.9 h for sleep. Sixteen (44%) parents accessed the video, and 18 (50%) received the telephone call. Over 40% of parents found the video and telephone call useful/very useful. CONCLUSIONS This study reports promising effects that an intervention targeting sleep may improve child MVPA and sleep duration. Some modifications to data collection methods and intervention delivery are needed.
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Affiliation(s)
- S L Yoong
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, New South Wales, Australia
| | - A Grady
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, New South Wales, Australia
| | - F Stacey
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, New South Wales, Australia
| | - M Polimeni
- Parenting Research Centre, East Melbourne, Victoria, Australia
| | - O Clayton
- Parenting Research Centre, East Melbourne, Victoria, Australia
| | - J Jones
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, New South Wales, Australia
| | - N Nathan
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, New South Wales, Australia
| | - R Wyse
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, New South Wales, Australia
| | - L Wolfenden
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, New South Wales, Australia
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50
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Nilsen AKO, Anderssen SA, Resaland GK, Johannessen K, Ylvisaaker E, Aadland E. Boys, older children, and highly active children benefit most from the preschool arena regarding moderate-to-vigorous physical activity: A cross-sectional study of Norwegian preschoolers. Prev Med Rep 2019; 14:100837. [PMID: 30891396 PMCID: PMC6406623 DOI: 10.1016/j.pmedr.2019.100837] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/21/2019] [Accepted: 02/23/2019] [Indexed: 11/19/2022] Open
Abstract
The preschool environment exerts an important influence on children's behaviour, including physical activity (PA). However, information is lacking regarding where and when most of children's PA is undertaken. This study aimed to describe PA and sedentary time (SED) during preschool hours and time out-of-care, and on weekdays and weekend days, and to investigate differences in PA patterns according to sex, age, and MVPA levels. From September 2015 to June 2016, we measured PA levels of 1109 children (age range, 2.7-6.5 years; mean age 4.7 years; boys, 52%) using ActiGraph GT3X+ accelerometers for up to 14 consecutive days. We applied a linear mixed model to analyse associations and interactions between total PA (counts per minute [cpm]), light PA (LPA), moderate-to-vigorous PA (MVPA), SED, sex, age, and overall MVPA regardless of setting, during preschool hours versus time out-of-care, and on weekdays versus weekend days. Children undertook more PA and less SED on weekdays compared to weekend days (p < 0.01). For boys, MVPA levels were higher during preschool hours than during time out-of-care (p < 0.05). Differences in total PA and MVPA between preschool hours versus time out-of-care, and between weekdays and weekend days, were greater in boys, older children, and highly active children than in girls, younger children, and children with lower overall MVPA levels (p < 0.01). The preschool arena is important for children's PA. Concerning MVPA, this study showed that boys, older children, and highly active children benefit more from this environment compared to girls, younger preschoolers, and children with lower MVPA levels.
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Key Words
- Activity pattern
- CI, confidence interval
- Child care
- Early education
- Health behaviour
- ICC, intraclass correlation
- Kindergarten
- LPA, light physical activity
- MVPA, moderate-to-vigorous physical activity
- Min, minutes
- Objective monitoring
- PA, physical activity
- SD, standard deviation
- SED, Sedentary behaviour
- SES, Socioeconomic status
- TPA, total physical activity
- Young children
- cpm, counts per minute
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Affiliation(s)
- Ada Kristine Ofrim Nilsen
- Western Norway University of Applied Sciences, Faculty of Education, Arts and Sports, Department of Sports, Food, and Natural sciences, Box 133, 6851 Sogndal, Norway
- Norwegian School of Sport Sciences, Department of Sports Medicine, Box 4014, Ullevål Stadion, 0806 Oslo, Norway
- Corresponding author at: Western Norway University of Applied Sciences, Faculty of Education, Arts and Sports, Department of Sports, Food, and Natural Sciences, Box 133, 6851 Sogndal, Norway.
| | - Sigmund Alfred Anderssen
- Western Norway University of Applied Sciences, Faculty of Education, Arts and Sports, Department of Sports, Food, and Natural sciences, Box 133, 6851 Sogndal, Norway
- Norwegian School of Sport Sciences, Department of Sports Medicine, Box 4014, Ullevål Stadion, 0806 Oslo, Norway
| | - Geir Kåre Resaland
- Western Norway University of Applied Sciences, Faculty of Education, Arts and Sports, Center for Physically Active Learning, Box 133, 6851 Sogndal, Norway
| | - Kjersti Johannessen
- Western Norway University of Applied Sciences, Faculty of Education, Arts and Sports, Department of Sports, Food, and Natural sciences, Box 133, 6851 Sogndal, Norway
| | - Einar Ylvisaaker
- Western Norway University of Applied Sciences, Faculty of Education, Arts and Sports, Department of Sports, Food, and Natural sciences, Box 133, 6851 Sogndal, Norway
| | - Eivind Aadland
- Western Norway University of Applied Sciences, Faculty of Education, Arts and Sports, Department of Sports, Food, and Natural sciences, Box 133, 6851 Sogndal, Norway
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