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Liang Y, Ju F, Hao Y, Yang J, Liu Y. Teachers' perception on physical activity promotion in kindergarten children in China: a qualitative study connecting social-ecological model. BMC Public Health 2024; 24:2190. [PMID: 39134996 PMCID: PMC11321150 DOI: 10.1186/s12889-024-19636-x] [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: 07/23/2023] [Accepted: 07/29/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Globally, the majority of kindergarten-aged children face obesity issues and insufficient physical activity (PA) engagement. Regular PA participation can provide various health benefits, including obesity reduction, for kindergarten-aged children. However, limited studies have investigated the factors influencing kindergarten-aged children's PA engagement from the perspective of their teachers. This qualitative study aimed to identify factors that could help promote PA among kindergarten-aged children from teachers' perspectives, including facilitators, barriers, and teachers' recommendations. METHODS Fifteen kindergarten teachers (age range: 28-50 years; mean age: 38.53 years) with teaching experience ranging from 2 to 31 years (mean: 16.27 years) were recruited from Shanghai municipality, Henan, and Jiangsu provinces in China. One-on-one semi-structured interviews were conducted via face-to-face (n = 7) or telephone (n = 8) to gather insights into factors influencing PA promotion among kindergarten-aged children. The interviews were audio-recorded, transcribed, and analyzed using a constant comparison approach based on grounded theory, which involved open, axial, and selective coding processes. RESULTS The study revealed mutual theoretical support between themes and the social-ecological model (SEM), as factors identified in the study are distributed at various levels of the SEM. Twelve factors were identified at four levels of the SEM: (1) intrapersonal level (children's personality and skills), (2) interpersonal level (family, peers, and teachers influence), (3) organizational level (school environment and resources, opportunities for kindergarten teachers' training and children's PA, design and organization of PA, and PA that children need), (4) community level (family-school partnerships). CONCLUSION Various factors at different levels can influence kindergarten-aged children's PA. The study's findings revealed that these factors are distributed across the first four levels of SEM, with the majority being at the organizational level. These multilevel findings are expected to assist in developing and implementing more effective PA interventions for kindergarten-aged children. Future research is warranted to identify strategies for promoting PA among kindergarten-aged children at the policy level of the SEM.
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Affiliation(s)
- Yahan Liang
- School of Physical Education, Shanghai University of Sport, 650 Qingyuanhuan Road, Shanghai, 200438, China
- Department of Human Movement Studies and Special Education, Darden College of Education & Professional Studies, Old Dominion University, Norfolk, VA, 23529, USA
| | - Fangyuan Ju
- Department of Physical Education, Yangzhou University, Yangzhou, 225012, China
| | - Yueran Hao
- School of Physical Education, Shanghai University of Sport, 650 Qingyuanhuan Road, Shanghai, 200438, China
| | - Jia Yang
- Department of Physical Education, Yangzhou University, Yangzhou, 225012, China
| | - Yang Liu
- School of Physical Education, Shanghai University of Sport, 650 Qingyuanhuan Road, Shanghai, 200438, China.
- Shanghai Research Center for Physical Fitness and Health of Children and Adolescents, Shanghai University of Sport, 650 Qingyuanhuan Road, Shanghai, 200438, China.
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Bourke M, Bruijns BA, Vanderloo LM, Irwin J, Heydon R, Carson V, Naylor PJ, Johnson AM, Adamo KB, Burke SM, Timmons BW, Tucker P. The efficacy of the TEACH e-Learning course at improving early childhood educators' physical activity and sedentary behaviour self-efficacy, knowledge, intentions, and perceived behavioural control: a randomized controlled trial. Int J Behav Nutr Phys Act 2024; 21:79. [PMID: 39039543 PMCID: PMC11265122 DOI: 10.1186/s12966-024-01628-0] [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: 11/15/2023] [Accepted: 07/12/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Early childhood educators play a critical role in promoting physical activity and reducing sedentary time in childcare centres. However, early childhood educators receive limited specialised pre- and in-service learning opportunities relating to these behaviours and may lack the capacity to effectively engage children in healthy movement behaviours. This study aimed to examine the efficacy of an e-Learning course on increasing early childhood educators' physical activity and sedentary behaviour-related capacities. METHODS A two-group parallel randomized controlled trial was conducted with early childhood educators in Canada (Mage = 41.78, 97% female). Participants randomized to the intervention group were asked to complete a physical activity and sedentary behaviour e-Learning course within a 4-week period. Participants randomized to the waitlist control condition were assigned to a waitlist to receive the intervention after the testing period. Participants reported on their self-efficacy, knowledge, intentions, and perceived behavioural control relating to physical activity and sedentary behaviours at baseline, post-intervention, and 3 months follow-up. Linear mixed effects models were estimated to determine difference in changes in outcomes from baseline to post-intervention, and follow-up. RESULTS A total of 209 early childhood educators participated in the study (intervention n = 98; control n = 111). The TEACH e-Learning course was found to be efficacious at improving all of the examined outcomes, with standardized effect sizes ranging from d = 0.58 to d = 0.65 for self-efficacy outcomes, d = 0.66 to d = 1.20 for knowledge outcomes, d = 0.50 to d = 0.65 for intention outcomes, and d = 0.33 to d = 0.69 for perceived behavioural control outcomes post-intervention. The intervention effects were sustained at follow-up for all outcomes apart from perceived behavioural control to limit screen time. Additionally, the magnitude of the effect for knowledge outcomes decreased at follow-up, with standardized effect sizes ranging from d = 0.49 to d = 0.67. CONCLUSIONS The e-Learning course was highly successful at improving early childhood educators' capacity pertaining to physical activity and sedentary behaviours. Providing training content through e-Learning may be an efficacious approach to providing continual professional learning opportunities relating to physical activity and sedentary time to early childhood educators on a large scale.
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Affiliation(s)
- Matthew Bourke
- School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada
| | - Brianne A Bruijns
- School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada
| | - Leigh M Vanderloo
- School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada
- ParticipACTION, Toronto, ON, Canada
| | - Jennifer Irwin
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Rachel Heydon
- Faculty of Education, University of Western Ontario, London, ON, Canada
| | - Valerie Carson
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Andrew M Johnson
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Shauna M Burke
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Brian W Timmons
- Child Health and Exercise Medicine Program, McMaster University, Hamilton, ON, Canada
| | - Patricia Tucker
- School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada.
- Children's Health Research Institute, London, ON, Canada.
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Bourke M, Haddara A, Loh A, Saravanamuttoo KA, Bruijns BA, Tucker P. Effect of capacity building interventions on classroom teacher and early childhood educator perceived capabilities, knowledge, and attitudes relating to physical activity and fundamental movement skills: a systematic review and meta-analysis. BMC Public Health 2024; 24:1409. [PMID: 38802762 PMCID: PMC11129429 DOI: 10.1186/s12889-024-18907-x] [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: 05/26/2023] [Accepted: 05/21/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Capacity building may play an important role in improving classroom teachers' and early childhood educators' (ECE) capacity to implement physical activity and FMS interventions. Capacity building is the development of knowledge, skills, and structures to improve the capability of individuals and organisations to achieve effective health promotion. This review aimed to determine the efficacy of capacity building interventions on teachers' and ECEs' perceived capabilities, knowledge, and attitudes relating to physical activity and fundamental movement skills. METHODS An exhaustive literature search of six electronic databases was conducted. Controlled, single-group pre-post studies were included if they measured the effect of a capacity building intervention on in-service or pre-service classroom teachers' (primary or secondary) or ECEs' physical activity or fundamental skills related perceived capabilities, knowledge, or attitudes. The effects of interventions were synthesised using random effects meta-analysis. Subgroup analysis and meta-regression was conducted to determine if the effects differed based on study design, type of teacher (ECE vs. primary school), or teacher level (pre-service vs. in-service). RESULTS A total of 22 studies reporting on 25 unique samples were included in the meta-analyses. Only studies reporting on ECEs and primary school teachers were identified. Interventions most commonly included training/professional development, resources and toolkits, communities of practice, mentorships, and ongoing support. Results showed that capacity building interventions significantly improved teachers' and ECEs' perceived capabilities (g = 0.614, 95% CI = 0.442, 0.786), knowledge (g = 0.792 95% CI = 0.459, 1.125), and attitudes (g = 0.376 95% CI = 0.181, 0.571). The effects did not differ significantly as a function of any of the moderators examined. CONCLUSION Findings from this review provide strong support that capacity building interventions are efficacious at improving teachers' and ECEs' perceived capabilities, knowledge, and attitudes related to promoting physical activity and teaching fundamental movement skills. Pre-service teachers and ECEs should be provided training in physical activity and fundamental movement skills as part of their degrees, and continual professional development and capacity building should be offered to in-service teachers and ECEs to promote physical activity and fundamental movement skills in children.
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Affiliation(s)
- Matthew Bourke
- School of Occupational Therapy, Faculty of Health Sciences, Western University, Elborn College, 1201 Western Road, London, ON, N6G 1H1, Canada.
- Health and Wellbeing Centre for Research Innovation, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
| | - Ameena Haddara
- School of Occupational Therapy, Faculty of Health Sciences, Western University, Elborn College, 1201 Western Road, London, ON, N6G 1H1, Canada
| | - Aidan Loh
- School of Occupational Therapy, Faculty of Health Sciences, Western University, Elborn College, 1201 Western Road, London, ON, N6G 1H1, Canada
| | - Kendall A Saravanamuttoo
- School of Occupational Therapy, Faculty of Health Sciences, Western University, Elborn College, 1201 Western Road, London, ON, N6G 1H1, Canada
| | - Brianne A Bruijns
- School of Occupational Therapy, Faculty of Health Sciences, Western University, Elborn College, 1201 Western Road, London, ON, N6G 1H1, Canada
| | - Patricia Tucker
- School of Occupational Therapy, Faculty of Health Sciences, Western University, Elborn College, 1201 Western Road, London, ON, N6G 1H1, Canada
- Children's Health Research Institute, 800 Commissioners Road East, London, ON, N6C 2V5, Canada
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Christiansen LB, Ekberg JE, Soini A, Larsen R, Kristjánsdóttir G, Froberg K, Sollerhed AC, Sääkslahti A, Fjørtoft I, Vilhjálmsson R, Olesen LG. A comparative analysis of movement and physical activity in early childhood teacher education policy in five Nordic countries. Front Sports Act Living 2024; 6:1352520. [PMID: 38645724 PMCID: PMC11026603 DOI: 10.3389/fspor.2024.1352520] [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: 12/08/2023] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction The aim of this study is to investigate the integration of movement and physical activity (MoPA) within Early Childhood Teacher Education (ECTE) policies across Denmark, Finland, Iceland, Norway, and Sweden. This knowledge can inform the development of ECTE policies and practices that promote MoPA in Early Childhood Education and Care (ECEC) in Nordic countries and other countries worldwide. Methods In this study, a Nordic cross-national network of researchers collaborated in investigating policy documents at the national and university levels, which govern the education of ECEC teachers. This study was inspired by the Non-affirmative Theory of Education, which provides a framework for understanding the various influences on curricular development in higher education. Based on this, a four-step comparative analytical process of national and university documents across the Nordic countries was conducted. It included keyword search for MoPA related courses and a qualitative description of MoPA in ECTE. Thus, a combination of investigations of policy documents at the national and university level and expert knowledge set a solid foundation for international comparison. Results The comparative analysis of MoPA in ECTE reveals diverse approaches influenced by national and university policies. A central theme is the variability in MoPA integration across these nations. Finland and Norway prioritize MoPA with independent mandatory courses. In Iceland, compulsory MoPA courses exist at one of two universities, and in Sweden at three out of 19. All university colleges in Denmark offer an elective course. Furthermore, learning objectives related to MoPA are, to varying degrees, part of the internships in the countries, with Sweden being an exception. In the participating countries, the teachers decide the content of the MoPA courses with little guidance, support, and agreement on essential MoPA content within and across the ECTE's. Norway has established guidelines, and in Finland, there is a network of ECTE Physical Education (PE) educators, which, to some degree, increases the consistency and quality of MoPA in education. Discussion The Nordic countries present diverse MoPA integration approaches rooted in national policies and educational traditions. The findings emphasize the necessity of independent and mandatory MoPA courses, integration of MoPA into internships and promoting networks across the educational and academic sectors to equip future early childhood educators with competencies for fostering physical activity, motor development and children's well-being.
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Affiliation(s)
- Lars Breum Christiansen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jan-Eric Ekberg
- Department of Sport Sciences, Malmö University, Malmö, Sweden
| | - Anne Soini
- Department of Education, Faculty of Education and Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Robert Larsen
- Department of Sports, Physical Education and Outdoor Studies, Faculty of Humanities, Sports and Educational Science, University of South-Eastern Norway, Notodden, Norway
| | - Gudrún Kristjánsdóttir
- Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Karsten Froberg
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Arja Sääkslahti
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyväskylä, Finland
| | - Ingunn Fjørtoft
- Department of Sports, Physical Education and Outdoor Studies, Faculty of Humanities, Sports and Educational Science, University of South-Eastern Norway, Notodden, Norway
| | - Rúnar Vilhjálmsson
- Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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Szpunar M, Johnson AM, Driediger M, Tucker P. Early Childhood Educators' Knowledge, Self-Efficacy and Risk Tolerance for Outdoor Risky Play Following a Professional Risk Re-Framing Workshop. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1346. [PMID: 37628345 PMCID: PMC10453272 DOI: 10.3390/children10081346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023]
Abstract
Children's outdoor risky play is important for healthy development. However, Early Childhood Educators (ECEs) concern for child safety often restricts risky play affordances during childcare. To reduce this trend, an Outdoor Play Risk Re-Framing workshop was delivered to ECEs in London, Ontario, and the immediate/short-term impact of the workshop on ECEs' knowledge, self-efficacy, and risk tolerance for engaging children in outdoor risky play was examined. Via a natural experiment, using a quasi-experimental design, ECEs in the experimental group (n = 119) completed an Outdoor Play Risk Re-Framing workshop, while ECEs in the comparison group (n = 51) continued their typical curriculum. All ECEs completed the same survey assessing their knowledge (n = 11 items), self-efficacy (n = 15 items), and risk tolerance (n = 27 items) at baseline and 1-week post-intervention. A maximum likelihood linear mixed effects model was conducted, while deductive content analysis was used for open-ended items. The workshop intervention resulted in significant improvements in ECEs' self-efficacy (p = 0.001); however, no significant changes were observed for knowledge (i.e., awareness and practices; p = 0.01 and p = 0.49, respectively) or risk tolerance (p = 0.20). Qualitative data revealed similar findings across both groups, highlighting physical development as a benefit to outdoor risky play and fear of liability as a barrier. In conclusion, providing ECEs with an Outdoor Play Risk Re-Framing workshop shows promise for supporting their self-efficacy to promote this behavior but does not impact ECEs' knowledge or risk tolerance to lead outdoor risky play.
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Affiliation(s)
- Monika Szpunar
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, University of Western Ontario, London, ON N6A 3K7, Canada;
| | - Andrew M. Johnson
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON N6A 3K7, Canada;
| | - Molly Driediger
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, ON N6A 3K7, Canada;
| | - Patricia Tucker
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON N6A 3K7, Canada;
- Children’s Health Research Institute, Lawson Health Research Institute, London, ON N6C 2R5, Canada
- School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON N6A 3K7, Canada
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Szpunar M, Bruijns BA, Vanderloo LM, Shelley J, Burke SM, Tucker P. Development of a Physical Activity and Sedentary Behaviour Policy for Canadian Childcare Settings: A Delphi Study. EARLY CHILDHOOD EDUCATION JOURNAL 2023:1-20. [PMID: 37360589 PMCID: PMC10042097 DOI: 10.1007/s10643-023-01473-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 06/28/2023]
Abstract
This study aimed to obtain consensus on physical activity (PA) and sedentary behaviour (SB) policy items for use in Canadian childcare settings. Purposeful sampling of Canadian experts in PA/SB (n = 19) and Early Childhood Education (ECE; n = 20) was used to form two distinct (i.e., PA/SB and ECE) panels for a 3-round Delphi study. In round 1, the PA/SB experts suggested their top 10 items for a Canadian childcare PA/SB policy. Policy items were then pooled to generate a list of 24 unique items. In round 2, experts in both panels rated the importance of the 24 policy items using a 7-point Likert scale (i.e., 1 = Not at all important to 7 = Extremely important). The ECE panel was also asked to report on the feasibility of the policy items using a 4-point Likert scale (i.e., 1 = Not at all feasible to 4 = Very feasible). Policy items that received an interquartile deviation (IQD) score of ≤ 1 (indicating consensus) and a median score of ≥ 6 (indicating importance) in both panels were considered shared priorities. In round 3, members of both panels re-rated the importance of the policy items that did not achieve consensus among their respective panel in round 2 and were asked to order items based on importance. Descriptive statistics were used to assess feasibility of policy items, and differences in panel ratings were quantified using Mann Whitney U tests. Consensus was achieved for 23 policy items in the PA/SB panel and 17 items in the ECE panel. Overall, 15 shared priorities were identified (e.g., provide 120 min of outdoor time per day, sedentary behaviour should not be used as a punishment), and six policy items exhibited a statistical difference in ratings across panels. Members of the ECE panel indicated that the policy item, "children should be permitted to go outside whenever they want, for as long as they want" (M = 1.78; SD = 0.65) was lowest in terms of feasibility, and the policy item, "children should receive opportunities to engage in both unstructured and structured physical activity opportunities daily" (M = 3.89; SD = 0.32) was the most feasible for daily implementation. Findings from this study can inform the development of an expert-generated and feasibility-informed institutional PA/SB policy for use in Canadian childcare settings. Supplementary Information The online version contains supplementary material available at 10.1007/s10643-023-01473-z.
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Affiliation(s)
- Monika Szpunar
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, University of Western Ontario, London, ON N6A 3K7 Canada
| | - Brianne A. Bruijns
- School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON N6A 3K7 Canada
| | - Leigh M. Vanderloo
- School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON N6A 3K7 Canada
- ParticipACTION, 77 Bloor Street West, Suite 1205, Toronto, ON M5S 1M2 Canada
| | - Jacob Shelley
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON N6A 3K7 Canada
- Faculty of Law, University of Western Ontario, London, ON N6A 3K7 Canada
| | - Shauna M. Burke
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON N6A 3K7 Canada
- Children’s Health Research Institute, Lawson Health Research Institute, London, ON N6C 4V3 Canada
| | - Patricia Tucker
- School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON N6A 3K7 Canada
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON N6A 3K7 Canada
- Children’s Health Research Institute, Lawson Health Research Institute, London, ON N6C 4V3 Canada
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Training Pre-Service Early Childhood Educators in Physical Activity (TEACH): Protocol for a Quasi-Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073890. [PMID: 35409573 PMCID: PMC8997760 DOI: 10.3390/ijerph19073890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/11/2022] [Accepted: 03/20/2022] [Indexed: 02/04/2023]
Abstract
Background: Early childhood educators (ECEs) influence young children’s early uptake of positive health behaviours in childcare settings and serve as important daytime role models. As such, it is imperative that post-secondary early childhood education programs provide students with the foundational knowledge and professional training required to confidently facilitate quality active play opportunities for young children. The primary objective of the Training pre-service EArly CHildhood educators in physical activity (TEACH) study is to develop and implement an e-Learning course in physical activity and sedentary behaviour to facilitate improvements in: pre-service ECEs’ self-efficacy and knowledge to lead physical activity and outdoor play opportunities and minimize sedentary behaviours in childcare. This study will also explore pre-service ECEs’ behavioural intention and perceived control to promote physical activity and outdoor play, and minimize sedentary behaviour in childcare, and the implementation of the e-Learning course. Methods/Design: A mixed-methods quasi-experimental design with three data collection time points (baseline, post-course completion, 3-month follow-up) will be employed to test the e-Learning course in early childhood education programs (n = 18; 9 experimental, 9 comparison) across Canada. Pre-service ECEs enrolled in colleges/universities assigned to the experimental group will be required to complete a 4-module e-Learning course, while programs in the comparison group will maintain their typical curriculum. Pre-service ECEs’ self-efficacy, knowledge, as well as behavioural intention and perceived behavioural control will be assessed via online surveys and module completion rates will be documented using website metrics. Group differences across timepoints will be assessed using linear mixed effects modelling and common themes will be identified through thematic analysis. Discussion: The TEACH study represents a novel, evidence-informed approach to address the existing gap in physical activity and sedentary behaviour-related education in Canadian post-secondary early childhood education programs. Moreover, e-Learning platforms, can be employed as an innovative, standardized, and scalable way to provide ECEs with consistent training across jurisdictions.
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Bruijns BA, Vanderloo LM, Johnson AM, Adamo KB, Burke SM, Carson V, Heydon R, Irwin JD, Naylor PJ, Timmons BW, Tucker P. Implementation of an e-Learning course in physical activity and sedentary behavior for pre- and in-service early childhood educators: Evaluation of the TEACH pilot study. Pilot Feasibility Stud 2022; 8:64. [PMID: 35300723 PMCID: PMC8927755 DOI: 10.1186/s40814-022-01015-1] [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: 09/16/2021] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Childcare-based physical activity (PA) and sedentary behavior (SB) interventions have traditionally used in-person training to supplement early childhood educators’ (ECEs) knowledge and confidence to facilitate physically active programming for the children in their care. However, this method of delivery is resource-intensive and unable to reach a high number of ECEs. The purpose of the Training pre-service EArly CHildhood educators in PA (TEACH) pilot study was to test the implementation (e.g., fidelity, feasibility, acceptability) of an e-Learning course targeting PA and SB among a sample of pre-service (i.e., post-secondary students) and in-service (i.e., practicing) ECEs in Canada. Methods A pre-/post-study design was adopted for this pilot study, and implementation outcomes were assessed cross-sectionally at post-intervention. Pre-service ECEs were purposefully recruited from three Canadian colleges and in-service ECEs were recruited via social media. Upon completing the e-Learning course, process evaluation surveys (n = 32 pre-service and 121 in-service ECEs) and interviews (n = 3 pre-service and 8 in-service ECEs) were completed to gather ECEs’ perspectives on the e-Learning course. Fidelity was measured via e-Learning course metrics retrieved from the web platform. Descriptive statistics were calculated for quantitative data, and thematic analysis was conducted to analyze qualitative data. Results Moderate-to-high fidelity to the TEACH study e-Learning course was exhibited by pre-service (68%) and in-service (63%) ECEs. Participants reported that the course was highly acceptable, compatible, effective, feasible, and appropriate in complexity; however, some ECEs experienced technical difficulties with the e-Learning platform and noted a longer than anticipated course duration. The most enjoyed content for pre- and in-service ECEs focused on outdoor play (87.5% and 91.7%, respectively) and risky play (84.4% and 88.4%, respectively). Conclusions These findings demonstrate the value of e-Learning for professional development interventions for ECEs. Participant feedback will be used to make improvements to the TEACH e-Learning course to improve scalability of this training. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01015-1.
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Affiliation(s)
- Brianne A Bruijns
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Leigh M Vanderloo
- ParticipACTION, Toronto, ON, Canada.,School of Occupational Therapy, Faculty of Health Sciences, Western University, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada
| | - Andrew M Johnson
- School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Shauna M Burke
- School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada
| | - Valerie Carson
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Rachel Heydon
- Faculty of Education, Western University, London, ON, Canada
| | - Jennifer D Irwin
- School of Health Studies, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Brian W Timmons
- Child Health and Exercise Medicine Program, McMaster University, Hamilton, ON, Canada
| | - Patricia Tucker
- School of Occupational Therapy, Faculty of Health Sciences, Western University, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada. .,Children's Health Research Institute, London, ON, Canada.
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9
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Bruijns BA, Vanderloo LM, Johnson AM, Adamo KB, Burke SM, Carson V, Heydon R, Irwin JD, Naylor PJ, Timmons BW, Tucker P. Change in pre- and in-service early childhood educators’ knowledge, self-efficacy, and intentions following an e-learning course in physical activity and sedentary behaviour: a pilot study. BMC Public Health 2022; 22:244. [PMID: 35125100 PMCID: PMC8818368 DOI: 10.1186/s12889-022-12591-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Early childhood educators (ECEs) are the primary daytime role models for many young children, and are responsible for facilitating physical activity (PA) opportunities and minimizing sedentary behaviour (SB) in childcare. However, they have reportedly received little related education in their pre-service training. The purpose of the Training pre-service EArly CHildhood educators in physical activity (TEACH) pilot study was to explore changes in pre- and in-service ECEs’ knowledge, self-efficacy, behavioural intention, and perceived behavioural control following the TEACH e-Learning course in PA and SB. Methods Pre-service ECEs were purposefully recruited from three Canadian colleges, while in-service ECEs were recruited via social media. A pre-post study design was used. ECEs completed two online surveys; one prior to, and one immediately following the completion of the TEACH e-Learning course (~ 5 h). Descriptive statistics were reported, and McNemar Chi-Square tests and paired samples t-tests were used to examine changes in ECEs’ question-specific, and total knowledge scores, respectively. Wilcoxon Signed Ranks tests were employed to examine changes in self-efficacy, behavioural intention, and perceived behavioural control. Results Both pre- (n = 32) and in-service (n = 121) ECEs significantly increased their total knowledge scores from pre- to post-course completion (p < .05*). Significant positive changes in self-efficacy (p < .025*), behavioural intention (p < .007*), and perceived behavioural control (p < .007*) were demonstrated by in-service ECEs following course completion, while only select composite scores within these tools were significant among pre-service ECEs. Conclusions These findings provide preliminary evidence of the potential efficacy of the e-Learning course at improving ECEs’ knowledge, self-efficacy, behavioural intention, and perceived behavioural control to support PA and minimize SB in childcare. Following the success of the pilot study, testing the effectiveness of the TEACH e-Learning course on a larger scale, with a comparison group, is warranted prior to recommending broader dissemination of the training in pre-service ECE programs and for in-service ECE professional learning.
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Carson V, Predy M, Hunter S, Storey K, Farmer AP, McIsaac JL, Flynn J. An Environmental Scan of Existing Canadian Childcare Resources Targeting Improvements in Health Behaviours. EARLY CHILDHOOD EDUCATION JOURNAL 2021; 50:1417-1428. [PMID: 36339969 PMCID: PMC9622543 DOI: 10.1007/s10643-021-01266-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 06/16/2023]
Abstract
UNLABELLED The objective was to conduct an environmental scan of existing Canadian childcare resources targeting nutrition, physical activity, sedentary behaviour, and/or sleep. A comprehensive search plan was conducted that involved four search strategies: (1) grey literature databases, (2) customized Google search engines, (3) targeted websites, and (4) consultation with content experts. A resource (i.e., information, materials) must have been created by government or an organization/agency within Canada, available in English, intended for childcare educators or directors working with children ≤ 5 years of age, and focused on targeting improvements in nutrition, physical activity, sedentary behaviour, and/or sleep. The quality of each included resource was assessed using a modified version of the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist. A total of 192 eligible resources were included. Most resources targeted only nutrition (n = 101) or physical activity (n = 60), and few resources targeted only sedentary behaviour (n = 2) or sleep (n = 1). The remaining 28 resources targeted more than one health behaviour. The 4 most common topics of resources were menu/meal planning (n = 55), healthy nutrition practices/environment (n = 37), physical activities/games (n = 33), and nutrition/food literacy (n = 20). Only 52 included resources cited evidence. One-third of the included resources (n = 64) were rated as high quality, including 55 that received a point for the significance criterion. Therefore, numerous high quality Canadian childcare resources exist for nutrition and physical activity. Future resource development is needed for sedentary behaviour and sleep. Findings can assist future intervention work and the database of resources can be utilized by relevant stakeholders to support other childcare initiatives. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10643-021-01266-2.
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Affiliation(s)
- Valerie Carson
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB Canada
| | - Madison Predy
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB Canada
| | - Stephen Hunter
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB Canada
| | - Kate Storey
- School of Public Health, University of Alberta, Edmonton, AB Canada
| | - Anna P. Farmer
- Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, AB Canada
| | - Jessie-Lee McIsaac
- Department of Child and Youth Study, Faculty of Education, Mount Saint Vincent University, Halifax, NS Canada
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11
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Szpunar M, Bruijns B, Tucker P. Measuring Early Childhood Educators' Physical Activity and Sedentary Behavior-Related Self-Efficacy: A Systematic Review of Tools. HEALTH EDUCATION & BEHAVIOR 2021; 48:455-467. [PMID: 34254546 PMCID: PMC8278557 DOI: 10.1177/10901981211025471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Early childhood educators’ (ECEs) self-efficacy is often predictive of their ability and likelihood of promoting healthy activity behaviors in childcare settings. To date, ECEs’ physical activity and sedentary behavior–related self-efficacy has been measured in a variety of ways in childcare-based research, creating difficulty when comparing across studies. To identify the different approaches ECEs’ self-efficacy is assessed, the current study aimed to compare all existing tools that quantitatively measure physical activity and sedentary behavior–related self-efficacy of pre- and in-service ECEs. Seven online databases were searched for original, peer-reviewed, English-written journal articles. Articles were deemed eligible if they employed a tool which measured physical activity and/or sedentary behavior–related self-efficacy of pre- or in-service ECEs. A total of 16 studies were included in this review, and 13 unique tools were identified. All tools measured task self-efficacy (n = 13), while only 1 tool measured barrier self-efficacy, and approximately half of the tools (n = 7; 54%) reported on the validity and reliability. Great variability existed among the self-efficacy items included in the tools; however, common constructs included: teaching/leading physical activity, fundamental movement skill development, and physical activity programming. Very few tools mentioned sedentary behavior (n = 2) and outdoor/risky play (n = 2). Given the low number of studies that tested validity and reliability of their self-efficacy tools, the lack of consideration for barrier self-efficacy, and the paucity of tools that fully encompassed physical activity, sedentary behavior, and outdoor play considerations for ECEs, future research is needed to validate a new, reliable tool.
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Affiliation(s)
| | | | - Patricia Tucker
- University of Western Ontario, London, Ontario, Canada
- Patricia Tucker, School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Road, Elborn College, Room 2547, London, Ontario N6G 1H1, Canada.
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12
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Bruijns BA, Johnson AM, Irwin JD, Burke SM, Driediger M, Vanderloo LM, Tucker P. Training may enhance early childhood educators' self-efficacy to lead physical activity in childcare. BMC Public Health 2021; 21:386. [PMID: 33607984 PMCID: PMC7893737 DOI: 10.1186/s12889-021-10400-z] [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: 07/21/2020] [Accepted: 02/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background Early childhood educators (ECEs) play a critical role in promoting physical activity (PA) among preschoolers in childcare; thus, PA-related training for ECEs is essential. The Supporting PA in the Childcare Environment (SPACE) intervention incorporated: 1. shorter, more frequent outdoor play sessions; 2. provision of portable play equipment; and, PA training for ECEs. An extension of the SPACE intervention (the SPACE-Extension) incorporated only the shorter, more frequent outdoor play periods component of the original SPACE intervention. The purpose of this study was to explore the individual impact of these interventions on ECEs’ PA-related self-efficacy and knowledge. Methods ECEs from the SPACE (n = 83) and SPACE-Extension (n = 31) were administered surveys at all intervention time-points to assess: self-efficacy to engage preschoolers in PA (n = 6 items; scale 0 to 100); self-efficacy to implement the intervention (n = 6 items); and, knowledge of preschooler-specific PA and screen-viewing guidelines (n = 2 items). A linear mixed effects model was used to analyze the impact of each intervention on ECEs’ self-efficacy and knowledge and controlled for multiple comparison bias. Results The SPACE intervention significantly impacted ECEs’ self-efficacy to engage preschoolers in PA for 180 min/day (main effect), and when outdoor playtime was not an option (interaction effect). Further, the interaction model for ECEs’ knowledge of the total PA guideline for preschoolers approached significance when compared to the main effects model. Participants within the SPACE-Extension did not demonstrate any significant changes in self-efficacy or knowledge variables. Conclusions Findings from this study highlight the benefit of ECE training in PA with regard to fostering their PA-related self-efficacy and knowledge. Future research should explore the impact of PA training for ECEs uniquely in order to determine if this intervention component, alone, can produce meaningful changes in children’s PA behaviours at childcare. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10400-z.
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Affiliation(s)
- Brianne A Bruijns
- Health and Rehabilitation Sciences, Western University, London, Canada
| | - Andrew M Johnson
- School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Jennifer D Irwin
- School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Shauna M Burke
- School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Molly Driediger
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Leigh M Vanderloo
- Child Health and Evaluative Science, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia Tucker
- School of Occupational Therapy, Faculty of Health Sciences, Western University, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada.
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Wang N, Rahman MNBA, Daud MAKBM. Diversified Talent Cultivation Mechanism of Early Childhood Physical Education Under the Full-Practice Concept - Oriented by Preschooler Mental Health and Intelligent Teaching. Front Psychol 2021; 11:593063. [PMID: 33584429 PMCID: PMC7873970 DOI: 10.3389/fpsyg.2020.593063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022] Open
Abstract
In order to improve early childhood physical education, in this study, the talent cultivation mechanism for undergraduates was explored under the "full-practice" concept, oriented by preschooler mental health. First, from the perspective of preschooler psychology, the mechanisms of ability training and talent cultivation for undergraduates majoring in early childhood education were explored under the "full-practice" concept. Considering that the physical, psychological, and intellectual development of preschoolers shall follow the rules of physical education, and current early childhood education mainly focuses on intelligence education in China, early childhood physical education was analyzed further in this study. By investigating the undergraduate majors of early childhood education in Henan University, this study first summarized the current problems in early childhood education systems in universities. Secondly, combined with the form of physical education in kindergartens, strategies for talent cultivation and curriculum setting of early childhood physical education majors in colleges and universities were proposed. Finally, from the perspective of innovation and diversification of training forms, the cultivation of early childhood educators' physical education ability was analyzed at multiple levels and multiple objectives, and the integrated training system of early childhood education talents was constructed. The results show that, among all the courses for early childhood education major, compulsory courses account for 81.2% and optional courses account for 18.8%. In addition, a survey on undergraduates' attitudes toward the curriculum of their major demonstrates that 81.2% of the undergraduates thought that the range and content of practical courses should be increased, indicating that undergraduates majoring in early childhood education are dissatisfied with the current curriculum system, and they have an increased demand for practical courses. Correspondingly, it is vital to build and improve on the early childhood physical education. In terms of its talent cultivation, the "full-practice" concept helps combine theory with practice to improve the effectiveness of education and teaching, pushing forward the reform of the education system. Meanwhile, data- and intelligence-oriented teaching will become the new direction of modern sports development, as well as an important link for tracking and monitoring children's sports teaching in China. Through the continuous introduction of wearable artificial intelligence (AI) products, real-time monitoring of children's physical conditions can be realized, which helps improve the effectiveness of early childhood physical education.
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Affiliation(s)
- Nina Wang
- Faculty of Education, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Nazri Bin Abdul Rahman
- Department of Educational Psychology and Counseling, Faculty of Education, University of Malaya, Kuala Lumpur, Malaysia
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Ward S, Bélanger M, Leis A. Comparison between the Healthy Start-Départ Santé online and in-person training of childcare educators to improve healthy eating and physical activity practices and knowledge of physical activity and fundamental movement skills: A controlled trial. Prev Med Rep 2020; 20:101264. [PMID: 33354492 PMCID: PMC7744750 DOI: 10.1016/j.pmedr.2020.101264] [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: 07/03/2020] [Revised: 09/30/2020] [Accepted: 11/21/2020] [Indexed: 01/04/2023] Open
Abstract
Healthy Start Départ Santé online training improved educators’ practices. Healthy eating and physical activity practices improved with online training. Knowledge gains of FMS and physical activity did not differ across groups. Online training is a sustainable way of reaching a greater number of educators.
Online training may be a more effective and sustainable way to reach educators in early childcare centres (ECCs). This study compared the effectiveness of an online version of the Healthy Start-Départ Santé (HSDS) training to the traditional in-person version of the training as well as to the usual practice condition on ECC educators’ healthy eating (HE) and physical activity (PA) practices and knowledge of PA and fundamental movement skills (FMS). Seventy-eight ECCs were randomly chosen across the provinces of New Brunswick and Saskatchewan, Canada and were allocated to either the online training, the in-person training or the usual practice groups between 2013 and 2018. Educators in each group completed a self-administered questionnaire before and nine months after the intervention, which included questions regarding their HE and PA practices in the ECC, as well as their knowledge of children’s FMS and PA. Group differences were assessed with mixed-effect models. Compared to educators in the usual practice group, educators in the online training group reported a greater improvement in scores for HE and PA practices (p = 0.03 and 0.03, respectively), but change for educators in the in-person training group were not different (p = 0.8 and 0.56, respectively). The rate of improvement in FMS and PA knowledge did not differ across all three groups (p = 0.9). The HSDS online training is an effective method of improving educators’ HE and PA practices in ECCs. Trial registration: ClinicalTrials.gov (NCT02375490)
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Affiliation(s)
- Stephanie Ward
- Université de Moncton, École des Sciences des Aliments, de Nutrition et d’études Familiales, Pavillon Jacqueline-Bouchard, 51, Avenue Antonine-Maillet, Moncton, NB E1A 3E9, Canada
- Corresponding author.
| | - Mathieu Bélanger
- Université de Sherbrooke, Centre de Formation Médicale du Nouveau-Brunswick, Pavillon J.-Raymond Frenette, 18, rue des Aboiteaux, Moncton, NB E1A 3E9, Canada
| | - Anne Leis
- University of Saskatchewan, Department of Community Health and Epidemiology, College of Medicine, Health Science Building, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada
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15
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Bruijns BA, Johnson AM, Tucker P. Content development for a physical activity and sedentary behaviour e-learning module for early childhood education students: a Delphi study. BMC Public Health 2020; 20:1600. [PMID: 33097030 PMCID: PMC7584084 DOI: 10.1186/s12889-020-09670-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 10/09/2020] [Indexed: 12/03/2022] Open
Abstract
Background Early childhood educators play a prominent role in promoting healthy activity behaviours in childcare. However, they have expressed that they lack the appropriate pre-service training to confidently lead physical activity (PA), and minimize sedentary behaviour (SB), in childcare. As such, the purpose of this Delphi study was to generate and reach agreement on content areas for inclusion in a PA and SB e-Learning module for Early Childhood Education (ECE) students. Methods Purposeful sampling of Canadian/international researchers was used to form two expert panels: a PA/SB expert panel (n = 26), and a Canadian ECE panel (n = 35). The PA/SB experts suggested their top 12 PA/SB topics for the module via online survey. These topics were then pooled to generate a list of 19 content areas. In a second online survey, both panels of experts rated the importance of each content area (0 = unimportant to 5 = very important). Mean ratings (M) were ranked separately for each panel, and then ratings were pooled to create an overall ranking of the 19 content areas. Inter-panel agreement of importance rankings was visually represented as a scatterplot and quantified using Spearman’s rho (rs). Results The top-rated content area was Outdoor Play (M = 4.77 ± 0.64), followed by Benefits of PA in the Early Years (M = 4.75 ± 0.66), and Factors Influencing PA and SB in Childcare (M = 4.71 ± .74). Monitor PA and Sedentary Time Within Your Classroom had the lowest combined score (M = 3.77 ± 1.44). There was moderate-to strong inter-panel agreement for content area importance rankings (rs = 0.60, 95% CI: 0.20 to 0.83). The majority of the ECE expert panel considered this training important for ECE students (94.3%), aligning with ECE curriculum objectives (91.4%) and accreditation standards (78.8%), and complementary to the present ECE curriculum (88.6%). Conclusions Providing PA and SB training to ECE students is a proactive way to ensure healthy movement behaviours are prioritized in childcare programming. With the PA/SB expert-developed content areas, and endorsement by the ECE expert panel, implementing this training within ECE programs is a necessary next step. Supplementary information Supplementary information accompanies this paper at 10.1186/s12889-020-09670-w.
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Affiliation(s)
- Brianne A Bruijns
- Health and Rehabilitation Sciences Program, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Andrew M Johnson
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada
| | - Patricia Tucker
- School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada.
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