Co-construct, implement and evaluate a multi-level intervention to prevent a sedentary lifestyle in children-Study protocol of the CIPRES study

BACKGROUND

A sedentary lifestyle is commonly associated with a higher risk of chronic disease development. Among school-aged children from European countries, screen-time represents a significant portion of sedentary time with 39.8% of children spending more than 2h/day in front of a screen on average. Therefore, effective solutions to reduce sedentary behavior (SB) must be found. Multilevel interventions based on the socio-ecological model (SEM) are particularly relevant to take into account influences of the social environment on individuals' SB. Moreover, the trans-contextual model (TCM) can offer complementary levers for individuals' behavior change. The CIPRES study is a theory-based multilevel intervention designed to decrease the SB in French primary school children aged 8-10 years. The present paper describes the protocol of a randomized controlled study to evaluate the effectiveness of the CIPRES multilevel intervention on SB.

METHODS

The CIPRES study is a cluster-randomized controlled trial comparing intervention vs control groups. A total of 700 children are targeted for inclusion, distributed in four municipalities considered as clusters. The study consists of two successive phases: 1) co-building of a SB prevention intervention by using a participatory approach involving representatives of each level of the SEM (e.g., children, parents, staff from municipalities, teachers) and 2) implementation and evaluation of the intervention. The intervention will last for 6 weeks in each involved class. Primary outcome will be the sedentary time of children per week, assessed by accelerometry. In addition, children and their parents will be asked to fill out questionnaires concerning children's physical activity level, screen time, quality-of-life and variables of the TCM.

DISCUSSION

This study will give information on the effectiveness of a theory-based intervention, involving multiple levels of actors in the co-construction and the implementation of the intervention, that may interest schools and public health officers looking for innovative sedentary prevention programs.

Effectiveness of multilevel interventions based on socio-ecological model to decrease sedentary time in children: a systematic review of controlled studies

Objectives

Preventive actions of sedentary behavior (SB) based on the socio-ecological model are needed among children and young adolescents. The aim of this systematic review is to ascertain the effectiveness of multilevel interventions (i.e., involving consideration of at least two interventional levels) in reducing sedentary time (ST) in children aged 5-12 years.

Methods

Adhering to PRISMA guidelines, a systematic literature search was conducted in three databases (PsyInfo, PubMed and ERIC) until July 2021.

Results

30 trials met the eligibility criteria and were included. They showed acceptable (< 8, n = 18) and high (≥ 8, n = 12) methodological quality. Among studies targeting 2 (n = 2), 3 (n = 19) and 4 levels (n = 9), 1 (50%), 9 (47%) and 7 (78%) were effective and reported significant reduction of ST, respectively.

Conclusion

Interventions tend to be more effective when they involve 4 levels, using both agentic and structural strategies (targeting intrinsic determinants, in the organizational environment of the child). Findings underline the relevance of multilevel strategies to reduce ST in children, but also raise issues about operationalization of the socio-ecological perspective.

Systematic review registration

PROSPERO, identifier: CRD42020209653.

Co-construct, implement and evaluate an intervention to prevent a sedentary lifestyle in children

Background

In children a sedentary lifestyle is associated with the development of chronic diseases, as well as unfavorable body composition and physical condition, lower levels of self-esteem, sociability, and school results. In Europe 39,8% of children (6-9 years) spend on average more than 2h/day in front of a screen, and 14,6% over 3h/day. In this context, designing and testing effective interventions to decrease sedentary behavior in children is a major public health research gap. The CIPRES intervention aims to reduce sedentary time in school-age children (7-10 years).

Methods

The CIPRES intervention is co-constructed with key local actors, by using a socio-ecological approach, and theory-based on the transcontextual model. The intervention is evaluated by a cluster-randomized controlled study currently ongoing. The target population is made up of 1000 children from 13 primary schools (in years 4-5) from southeast of France with different levels of social deprivation. Main outcomes are assessed by accelerometer and questionnaires before (T0) and after a six-week intervention (T1) and include sedentary behavior, physical activity (PA) and variables of the transcontextual model.

Results

Preliminary data were available in 152 children (53 intervention and 99 control). There was no significant difference across the time in sedentary time between intervention and control group (p = 0.11; η2=0,017); however, moderate-to-vigorous physical activity (MVPA) tended to be better in intervention vs control (p = 0.06; η2=0,023). In the intervention group, sedentary time and MVPA were significantly better across the time (p = 0.028 and p = 0.011, respectively) for children having a father with a university diploma as compared to children having a father with a lower education level.

Conclusions

Preliminary results on a small group of subjects (n = 152) are encouraging and suggest a positive impact of the intervention on children. More results will be available by summer 2022.

Key messages

• Based on the socio-ecological model, the CIPRES intervention aims to prevent sedentary in school-aged children.

• Preliminary data suggests a favorable impact of the intervention on physical activity.