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An educational intervention to promote healthy lifestyles in preschool children: a cluster-RCT
M Iaia1, M Pasini2, A Burnazzi2
1Department of Primary Care, Primary Care Paediatrician and Community Paediatrician, Cesena, Italy.
Insights
This study improved preschool children's healthy behaviors through parent interviews and teacher-led activities. The intervention successfully boosted combined health behavior scores but did not impact BMI outcomes.
Area of Science:
- Pediatric Health
- Behavioral Science
- Public Health Interventions
Background:
- Preschool children require interventions promoting healthy habits like diet and physical activity.
- Childhood obesity and poor lifestyle choices necessitate effective, long-term strategies.
- Early childhood is a critical period for establishing lifelong health behaviors.
Purpose of the Study:
- To evaluate a multidimensional educational intervention's impact on preschool children's healthy behaviors.
- To assess the intervention's long-term effects on children's combined health behavior scores (CHBS) and BMI.
- To promote fruit and vegetable intake, active play, limit TV time, and eliminate sugar-sweetened beverages.
Main Methods:
- A cluster randomized controlled trial (c-RCT) involving 425 3-year-old children across 16 Italian childcare centers.
- Intervention included motivational interviews for parents and teacher-led activities for children over 6 months.
- Data collected at baseline, 1-year, and 2-year follow-ups, with Intent-to-Treat (ITT) analysis.
Main Results:
- After 2 years, 48.4% of intervention group children achieved a low-risk CHBS versus 28.0% in the control group.
- Intervention group children were significantly more likely to achieve low-risk scores (adjusted OR: 3.41, P=0.004).
- No significant differences in BMI z-score or BMI trajectory were observed between groups.
Conclusions:
- A multidimensional educational intervention effectively improved preschool children's healthy behaviors long-term.
- The intervention demonstrated success in enhancing combined health behavior scores without affecting BMI.
- Motivational interviewing and teacher-led learning experiences are valuable tools for promoting pediatric health behaviors.
Objective:
Promoting four healthy behaviours among preschool children:⩾4 servings of fruit and vegetables/day, ⩾2 h/day of active play, ⩽1 h per day of TV-watching and 0 sugar sweetened beverages/day.
Methods:
We conducted a c-RCT on 425 3-year-old children at 16 childcare centres based in Cesena, Italy. We randomly allocated eight childcare centres (199 children) to the intervention group and eight childcare centres (226 children) to the control group. All the randomized childcare centres completed our study protocol. Parents recorded their children's target behaviours at home over 3 Saturdays, at baseline and at follow-up. Then trained nurses measured children's weight and height. We conducted a 6-month-long intervention trial in local health care centres where nurses and primary care pediatricians, respectively, conducted two subsequent motivational interviews with parents to encourage children's healthy behaviours at home. At the same time, teachers involved children in learning experiences about healthy behaviours. Our primary outcome is a children's combined health behaviour score (CHBS) at home. Our secondary outcomes measure the BMI z-score and the percentage of children that show a BMI trajectory crossing upward. After collecting the CHBS and BMI data at baseline as well as at 1- and 2-year follow-ups, we performed an Intent-to-Treat (ITT) analysis.
Results:
After 2 years from baseline, 48.4% of intervention group children showed a low-risk CHBS in comparison with 28.0% of control group children. A multilevel analysis showed that they were by far more likely to achieve low-risk scores (adjusted OR: 3.41; 95% CI: 1.48-7.88; P=0.004). Our BMI outcomes showed no significant difference between groups.
Conclusions:
A multidimensional educational intervention, which consists of motivational interviews with parents and teacher-led learning experiences for children, improved preschool children's CHBS in the long term without influencing the outcomes of BMI z-score and BMI increase.
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