The effects of a preschool-based intervention for Early Childhood Education and Care teachers in promoting healthy eating and physical activity in young children: A cluster randomised controlled trial.

Nicole Toussaint,Ruben G Fukkink,Sandra Mul,Mirka Janssen,Marielle Balledux,Peter J M Weijs,Karen Van Drongelen,Martinette T Streppel,Shahrad Taheri

doi:10.1371/journal.pone.0255023

Nicole Toussaint, Ruben G Fukkink + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0255023

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Abstract

The need for excess weight gain prevention in disadvantaged young children is widely recognised. Early Childhood Education and Care teachers are potential key actors in early interventions to prevent overweight and obesity. This study examines the effects of a preschool-based intervention for teachers in promoting healthy eating and physical activity in young children. A cluster randomised controlled trial was conducted at 41 preschools in a deprived area of Amsterdam, The Netherlands. The intervention consisted of 2 programmes that were applied in succession: A Healthy Start and PLAYgrounds for TODdlers. The study period was 9 months. Primary outcomes were assessed via questionnaires and included teachers’ knowledge, attitude, food/activity-related practices, and level of confidence in promoting healthy behaviours. Secondary outcomes in this study were teachers’ and children’s BMI (z-score), body composition, dietary intake and physical activity level. Intention-to-treat analyses were performed using linear mixed models. In total, 115 teachers and 249 children (mean age 3.0 (0.2) years) were included. A positive effect on teachers’ knowledge about the Dutch dietary guidelines was found after the programme A Healthy Start (difference = 1.38; 1-sided 95% CL = 0.29; p = 0.02). This effect was not sustained at 9 months (difference = 0.34; 1-sided 95% CL = -0.76; p = 0.31). The overall intervention had a positive effect on 3 of the 5 attitude statements regarding a healthy lifestyle (difference ranged from 0.34 to 0.55) and on the practice scale Activity-related-Modelling (difference = 0.16; 1-sided 95% CL = 0.06; p = 0.01). No intervention effects were observed on food-related practice scales and the level of confidence in promoting healthy behaviours. At this stage, no effects were seen on teachers’ and children’s BMI (z-score). This study contributes to the professional development of Early Childhood Education and Care teachers and addresses the call for interventions to prevent overweight/obesity and to minimise health inequalities in young children.

Highlights

IntroductionThe problem is more severe in deprived urban settings, where it is related to the relatively high number of families with a migration background and/or low socio-economic status [2]
Excess weight gain in children remains a critical health issue worldwide [1]
As it is hypothesised that changes in Early Childhood Education and Care (ECEC) teachers eventually transfer to changes in children, the secondary objective of this study is to investigate if the intervention improves the teachers’ and children’s Body Mass Index (BMI) (z-score), body composition, dietary intake and physical activity level

Summary

Introduction

The problem is more severe in deprived urban settings, where it is related to the relatively high number of families with a migration background and/or low socio-economic status [2]. In the Netherlands, urban preschools provide an excellent opportunity to reach many young children (2.5 to 4 years old) from families with a migration background and/or low socio-economic status. Children generally spend up to 15 hours per week in preschool. These Early Childhood Education and Care (ECEC) settings are important environments for interventions in young children with disadvantaged backgrounds [9, 10]

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