Changing the preschool setting to promote healthy energy balance-related behaviours of preschoolers: a qualitative and quantitative process evaluation of the SuperFIT approach

Ilona van de Kolk, Sanne Gerards, Anke Verhees, Stef Kremers, Jessica Gubbels, Ilona van de Kolk, Sanne Gerards, Anke Verhees, Stef Kremers, Jessica Gubbels

Abstract

Background: The Early Care and Education (ECE) setting plays an important role in the promotion of a healthy lifestyle in young children. SuperFIT is a comprehensive, integrated intervention approach designed to promote healthy energy balance-related behaviours in preschoolers. Insight in the process of implementation and the context in which SuperFIT was implemented supports the understanding of how the intervention works in practice. This process evaluation examined factors that influenced the implementation and maintenance, as well as the (perceived) changes in the ECE setting.

Methods: A mixed-methods study was conducted. SuperFIT was implemented at twelve preschools in the south of the Netherlands. The process evaluation was performed among preschool teachers, managers of the preschool organisation, and implementers. Semi-structured in-depth (group) interviews, quantitative process questionnaires, the Child-care Food and Activity Practices Questionnaire (CFAPQ) and the Environmental and Policy Assessment and Observation (EPAO) were used to evaluate the implementation and maintenance of SuperFIT and the changes in the preschool setting. The interviews were analysed using a theoretical framework based on the Implementation Framework of Fleuren and Damschröder's Consolidated Framework for Implementation Research. Descriptive analyses were performed on the quantitative data.

Results: Various intervention activities were implemented in the preschool setting. Although the intention to maintain SuperFIT was present, this was hindered by time constraints and lack of financial resources. Important factors that influenced implementation and maintenance were incongruence with current practice, limited perceived capabilities to integrate SuperFIT in daily practice, group composition at the preschools, and the perceived top-down implementation. Organizational vision and societal attention regarding healthy behaviour in general were perceived to be supportive for implementation and maintenance. Predominantly, favourable changes were seen in the nutrition- and physical activity-related practices of preschool teachers and other aspects of the social preschool environment such as the use of play materials. Limited changes were observed in the physical preschool environment.

Conclusions: Several factors influenced the implementation and maintenance of SuperFIT in the preschool setting. Some factors evolved over time from hindering to facilitating, emphasising the importance of allowing sufficient time for intervention implementation. SuperFIT changed mainly the social preschool environment.

Trial registration: Clinicaltrials.gov, NCT03021980 , date registered: January 16, 2017, prospectively registered.

Keywords: Process evaluation; childcare; context; environment; implementation; maintenance; preschool.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Timeline of the implementation of the preschool component of SuperFIT and the measurements of the process evaluation. Yellow= activities for the development of SuperFIT, purple= intervention activities aimed at the sociocultural environment, green= intervention activities aimed at the physical environment, red= intervention activities aimed at the political environment, blue= quantitative process measurements, orange= qualitative process measurements. Indicates duration of an activity. Indicates continuous activities or availability.
Fig. 2
Fig. 2
Theoretical framework for the process evaluation within the preschool setting; adapted from the Implementation Framework [28] and the Consolidated Framework For Implementation Research [27]

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