A multilevel intervention to increase physical activity and improve healthy eating and physical literacy among young children (ages 3-5) attending early childcare centres: the Healthy Start-Départ Santé cluster randomised controlled trial study protocol

Mathieu Bélanger, Louise Humbert, Hassan Vatanparast, Stéphanie Ward, Nazeem Muhajarine, Amanda Froehlich Chow, Rachel Engler-Stringer, Denise Donovan, Natalie Carrier, Anne Leis, Mathieu Bélanger, Louise Humbert, Hassan Vatanparast, Stéphanie Ward, Nazeem Muhajarine, Amanda Froehlich Chow, Rachel Engler-Stringer, Denise Donovan, Natalie Carrier, Anne Leis

Abstract

Background: Childhood obesity is a growing concern for public health. Given a majority of children in many countries spend approximately 30 h per week in early childcare centers, this environment represents a promising setting for implementing strategies to foster healthy behaviours for preventing and controlling childhood obesity. Healthy Start-Départ Santé was designed to promote physical activity, physical literacy, and healthy eating among preschoolers. The objectives of this study are to assess the effectiveness of the Healthy Start-Départ Santé intervention in improving physical activity levels, physical literacy, and healthy eating among preschoolers attending early childcare centers.

Methods/design: This study follows a cluster randomized controlled trial design in which the childcare centers are randomly assigned to receive the intervention or serve as usual care controls. The Healthy Start-Départ Santé intervention is comprised of interlinked components aiming to enable families and educators to integrate physical activity and healthy eating in the daily lives of young children by influencing factors at the intrapersonal, interpersonal, organizational, community, physical environment and policy levels. The intervention period, spanning 6-8 months, is preceded and followed by data collections. Participants are recruited from 61 childcare centers in two Canadian provinces, New Brunswick and Saskatchewan. Centers eligible for this study have to prepare and provide meals for lunch and have at least 20 children between the ages of 3 and 5. Centers are excluded if they have previously received a physical activity or nutrition promoting intervention. Eligible centers are stratified by province, geographical location (urban or rural) and language (English or French), then recruited and randomized using a one to one protocol for each stratum. Data collection is ongoing. The primary study outcomes are assessed using accelerometers (physical activity levels), the Test of Gross Motor Development-II (physical literacy), and digital photography-assisted weighted plate waste (food intake).

Discussion: The multifaceted approach of Healthy Start-Départ Santé positions it well to improve the physical literacy and both dietary and physical activity behaviors of children attending early childcare centers. The results of this study will be of relevance given the overwhelming prevalence of overweight and obesity in children worldwide.

Trial registration: NCT02375490 (ClinicalTrials.gov registry).

Keywords: Childhood obesity; eating habits; food intake; physical activity; physical literacy; population health intervention; preschool.

Figures

Fig. 1
Fig. 1
Healthy Start components
Fig. 2
Fig. 2
Data collection timeline for the Healthy Start study
Fig. 3
Fig. 3
Flow diagram of selection and randomisation process for the Healthy Start study.

References

    1. WHO . Population-based approaches to childhood obesity prevention. 2012. p. 54.
    1. de Onis M, Blössner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr. 2010;92:1257–64. doi: 10.3945/ajcn.2010.29786.
    1. Shields M. Overweight and obesity among children and youth. Heal Reports. 2006;17:27–42.
    1. Nader PR, O’Brien M, Houts R, Bradley R, Belsky J, Crosnoe R, Friedman S, Mei Z, Susman EJ. Identifying risk for obesity in early childhood. Pediatrics. 2006;118:e594–601. doi: 10.1542/peds.2005-2801.
    1. Quattrin T, Liu E, Shaw N, Shine B, Chiang E. Obese children who are referred to the pediatric endocrinologist: characteristics and outcome. Pediatrics. 2005;115:348–351. doi: 10.1542/peds.2004-1452.
    1. Gardner D, Hosking J, Metcalf B, Jeffery A, Voss L, Wilkin T. Contribution of early weight gain to childhood overweight and metabolic health: a longitudinal study. Pediatrics. 2009;123:e67–73. doi: 10.1542/peds.2008-1292.
    1. Guo S, Huang C, Maynard L, Demerath E, Towne B, Chumlea W, Siervogel R. Body mass index during childhood, adolescence and young adulthood in relation to adult overweight and adiposity: the Fels longitudinal study. Int J Obes Relat Metab Disord. 2000;24:1628–1635. doi: 10.1038/sj.ijo.0801461.
    1. Freedman D, Kettel Khan L, Serdula M, Dietz W, Srinivasan S, Berenson G. The relation of childhood BMI to adult adiposity: the Bogalusa Heart Study. Pediatrics. 2005;115:22–27.
    1. Reilly J, Methven E, McDowell Z, Hacking B, Alexander D, Stewart L, Kelnar C. Health consequences of obesity. Arch Dis Child. 2003;88:748–752. doi: 10.1136/adc.88.9.748.
    1. Hill JO, Melanson EL. Overview of the determinants of overweight and obesity: current evidence and research issues. Med Sci Sports Exerc. 1999;31(11 Suppl):S515–21. doi: 10.1097/00005768-199911001-00005.
    1. Birch L, Fisher J. Development of eating behaviors among children and adolescents. Pediatrics. 1998;101(3 Pt 2):539–549.
    1. Pabayo R, Spence JC, Casey L, Storey K. Food consumption patterns in preschool children. Can J Diet Pract Res. 2012;73:66–71. doi: 10.3148/73.2.2012.66.
    1. Reedy J, Krebs-Smith SM. Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States. J Am Diet Assoc. 2010;110:1477–84. doi: 10.1016/j.jada.2010.07.010.
    1. Langlois K, Garriguet D. Sugar consumption among Canadians of all ages. Heal Reports. 2011;22:23–7.
    1. Reilly J, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes. 2011;35:891–898. doi: 10.1038/ijo.2010.222.
    1. Temple V, Naylor P, Rhodes R, Higgins J. Physical activity of children in family child care. Appl Physiol Nutr Metab. 2009;34:794–798. doi: 10.1139/H09-061.
    1. Hardy LL, Reinten-Reynolds T, Espinel P, Zask A, Okely AD. Prevalence and correlates of low fundamental movement skill competency in children. Pediatrics. 2012;130:e390–8. doi: 10.1542/peds.2012-0345.
    1. Fisher A, Reilly JJ, Kelly LA, Montgomery C, Williamson A, Paton JY, Grant S. Fundamental movement skills and habitual physical activity in young children. Med Sci Sports Exerc. 2005;37:684–8. doi: 10.1249/01.MSS.0000159138.48107.7D.
    1. Gentier I, D’Hondt E, Shultz S, Deforche B, Augustijn M, Hoorne S, Verlaecke K, De Bourdeaudhuij I, Lenoir M. Fine and gross motor skills differ between healthy-weight and obese children. Res Dev Disabil. 2013;34:4043–51. doi: 10.1016/j.ridd.2013.08.040.
    1. Lubans DR, Morgan PJ, Cliff DP, Barnett LM, Okely AD. Fundamental movement skills in children and adolescents: review of associated health benefits. Sports Med. 2010;40:1019–35. doi: 10.2165/11536850-000000000-00000.
    1. Williams HG, Pfeiffer KA, O’Neill JR, Dowda M, McIver KL, Brown WH, Pate RR. Motor skill performance and physical activity in preschool children. Obesity (Silver Spring) 2008;16:1421–6. doi: 10.1038/oby.2008.214.
    1. Kjønniksen L, Torsheim T, Wold B. Tracking of leisure-time physical activity during adolescence and young adulthood: a 10-year longitudinal study. Int J Behav Nutr Phys Act. 2008;5:69. doi: 10.1186/1479-5868-5-69.
    1. Telama R, Yang X, Viikari J, Valimaki I, Wanne O, Raitakari O. Physical activity from childhood to adulthood: a 21-year tracking study. Am J Prev Med. 2005;28:267–273. doi: 10.1016/j.amepre.2004.12.003.
    1. Tammelin T. A review of longitudinal studies on youth predictors of adulthood physical activity. Int J Adolesc Med Heal. 2005;17:3–12.
    1. Telama R. Tracking of physical activity from childhood to adulthood: a review. Obes Facts. 2009;2:187–95. doi: 10.1159/000222244.
    1. Hallal P, Victora C, Azevedo M, Wells J. Adolescent physical activity and health: a systematic review. Sport Med. 2006;36:1019–1030. doi: 10.2165/00007256-200636120-00003.
    1. About Obesity in Canada - Canadian Obesity Network []
    1. Baur LA. Tackling the epidemic of childhood obesity. CMAJ. 2009;180:701–2. doi: 10.1503/cmaj.090196.
    1. Larson N, Ward DS, Neelon SB, Story M. What role can child-care settings play in obesity prevention? A review of the evidence and call for research efforts. J Am Diet Assoc. 2011;111:1343–62. doi: 10.1016/j.jada.2011.06.007.
    1. Bushnik T. Child Care in Canada. 2006.
    1. Dooris M, Poland B, Kolbe L, et al. Global Perspectives on Health Promotion Effectiveness. New York: Springer; 2007. Healthy Settings: Building evidence for the effectiveness of whole system health promotion. Challenges and future directions; pp. 327–352.
    1. Sharma S, Chuang R, Hedberg A. Pilot-testing CATCH early childhood: a preschool-based healthy nutrition and physical activity program. Am J Heal. 2011;42(1):12–23. doi: 10.1080/19325037.2011.10599169.
    1. Stettler N, Bhatia J, Parish A, Stallings V. Feeding healthy infants, children, and adolescents. In Nelson Textbook of Pediatrics. 19. Philadelphia: Saunders Elsevier; 2011.
    1. Story M, Kaphingst K, French S. The role of child care settings in obesity prevention. Futur Child. 2006;16:143–168. doi: 10.1353/foc.2006.0010.
    1. Hesketh KD, Campbell KJ. Interventions to prevent obesity in 0–5 year olds: an updated systematic review of the literature. Obesity (Silver Spring) 2010;18(Suppl 1):S27–35. doi: 10.1038/oby.2009.429.
    1. Kaphingst KM, Story M. Child care as an untapped setting for obesity prevention: state child care licensing regulations related to nutrition, physical activity, and media use for preschool-aged children in the United States. Prev Chronic Dis. 2009;6:A11.
    1. Public Health Agency of Canada and the Canadian Institute for Health Information. Obesity in Canada. Ottawa: Government of Canada; 2011.
    1. Evans R, Barer M, Marmor T. Why Are Some People Healthy and Others Not?: The Determinants of Health of Populations. 1994.
    1. Implementing the Population Health Approach - Public Health Agency of Canada []
    1. Kumanyika S, Jeffery RW, Morabia A, Ritenbaugh C, Antipatis VJ. Obesity prevention: the case for action. Int J Obes Relat Metab Disord. 2002;26:425–36. doi: 10.1038/sj.ijo.0801938.
    1. Prince S. A population health approach to obesity in Canada—Putting the problem back into context. Transdiscipl Stud Popul Heal Ser. 2009;1:22–33.
    1. Huynen MMTE, Martens P, Hilderink HBM. The health impacts of globalization: a conceptual framework. Global Health. 2005;1:14. doi: 10.1186/1744-8603-1-14.
    1. Sallis J, Owen N, Fisher E. Ecological models of health behavior. In: Glanz K, Rimer BK, Viswanath K, editors. Health Behavior and Health Education: Theory, Research, and Practice. 4. San Francisco: Wiley; 2008. pp. 465–485.
    1. Kao H, Hsu M, Clark L. Conceptualizing and Critiquing Culture in Health Research. J Transcult Nurs. 2004;15:269–277. doi: 10.1177/1043659604268963.
    1. Community Information Database - Metropolitan Influence Zone (MIZ) Topology []
    1. Maher E, Frestedt B, Grace C. Differences in Child Care Quality in Rural and Non-Rural Areas. J Res Rural Educ. 2008;23:1–13.
    1. Swenson K. Child care arrangements in urban and rural areas. US Dep Heal Hum Serv Pg. 2008; p. 1–16.
    1. Adolph A, Puyau M, Vohra F, Nicklas T, Zakeri I, Butte N. Validation of uniaxial and triaxial accelerometers for the assessment of physical activity in preschool children. J Phys Act Heal. 2012;9:944–953.
    1. Pate RR, O’Neill JR, Mitchell J. Measurement of physical activity in preschool children. Med Sci Sports Exerc. 2010;42:508–12. doi: 10.1249/MSS.0b013e3181cea116.
    1. Pfeiffer K, Mciver K, Dowda M, Almeida M, Pate R. Validation and calibration of the Actical accelerometer in preschool children. Med Sci Sports Exerc. 2006;38:152–157. doi: 10.1249/01.mss.0000183219.44127.e7.
    1. Esliger D, Tremblay M. Technical reliability assessment of three accelerometer models in a mechanical setup. Med Sci Sports Exerc. 2006;38:2173–2181. doi: 10.1249/01.mss.0000239394.55461.08.
    1. Colley R, Connor Gorber S, Tremblay M. Quality control and data reduction procedures for accelerometry-derived measures of physical activity. Heal Reports. 2010;21:63–69.
    1. Colley R, Garriguet D, Janssen I, Craig C, Clarke J, Tremblay M. Physical activity of Canadian children and youth: accelerometer results from the, to 2009 Canadian Health Measures Survey. Heal Reports. 2011;22:15–23.
    1. Boudreau J, Bélanger M. SAS Code for Actical Data Cleaning and Management: Version 1.3. Centre de formation médicale du Nouveau-Brunswick. Moncton; 2015.
    1. Crouter SE, Schneider PL, Karabulut M, Bassett DR. Validity of 10 electronic pedometers for measuring steps, distance, and energy cost. Med Sci Sports Exerc. 2003;35:1455–60. doi: 10.1249/01.MSS.0000078932.61440.A2.
    1. Schneider PL, Crouter SE, Lukajic O, Bassett DR. Accuracy and reliability of 10 pedometers for measuring steps over a 400-m walk. Med Sci Sports Exerc. 2003;35:1779–84. doi: 10.1249/01.MSS.0000089342.96098.C4.
    1. Schneider PL, Crouter SE, Bassett DR. Pedometer measures of free-living physical activity: comparison of 13 models. Med Sci Sports Exerc. 2004;36:331–5. doi: 10.1249/01.MSS.0000113486.60548.E9.
    1. Ulrich D. Test of gross motor development-2. Austin: Prod-Ed; 2000.
    1. Williamson DA, Allen HR, Martin PD, Alfonso AJ, Gerald B, Hunt A. Comparison of digital photography to weighed and visual estimation of portion sizes. J Am Diet Assoc. 2003;103:1139–45. doi: 10.1016/S0002-8223(03)00974-X.
    1. Blakeway SF, Knickrehm ME. Nutrition education in the Little Rock school lunch program. J Am Diet Assoc. 1978;72:389–91.
    1. Lee H, Lee K, Shanklin C. Elementary students’ food consumption at lunch does not meet recommended dietary allowance for energy, iron, and vitamin A. J Am Diet. 2001;101(9):1060–63. doi: 10.1016/S0002-8223(01)00261-9.
    1. Whatley J, Donnelly J. Energy and macronutrient consumption of elementary school children served modified lower fat and sodium lunches or standard higher fat and sodium lunches. J Am Coll Nutr. 1996;15(6):602-7.
    1. Jacko C, Dellava J, Ensle K, Hoffman D. Use of the Plate-Waste method to Measure food intake in children. J Ext. 2007;45:6RIB7.
    1. Wolper C, Heshka S, Heymsfield S. Measuring food intake: An overview. In: Allison D, editor. Handbook of Assessment Measures for Eating Behaviors and Weight-Related Problems. Thousand Oaks, CA: Sage Publications Inc; 1995. pp. 215–240.
    1. NutriSTEP® - NutriSTEP® Implementation Toolkit and Resources []
    1. Randall Simpson JA, Keller HH, Rysdale LA, Beyers JE. Nutrition Screening Tool for Every Preschooler (NutriSTEP): validation and test-retest reliability of a parent-administered questionnaire assessing nutrition risk of preschoolers. Eur J Clin Nutr. 2008;62:770–80. doi: 10.1038/sj.ejcn.1602780.
    1. Benjamin S, Neelon B, Ball S, Bangdiwala S, Ammerman A, Ward D. Reliability and validity of a nutrition and physical activity environmental self-assessment for child care. Int J Behav Nutr Phys Act. 2007;4:29–39. doi: 10.1186/1479-5868-4-29.
    1. Benjamin S, Ammerman A, Sommers J, Dodds J, Neelon B, Ward D. Nutrition and physical activity self-assessment for child care (NAP SACC): results from a pilot intervention. J Nutr Educ Behav. 2007;39:142–149. doi: 10.1016/j.jneb.2006.08.027.
    1. Trost S, Messner L, Fitzgerald K, Roths B. Nutrition and physical activity policies and practices in family child care homes. Am J Prev Med. 2009;37:537–540. doi: 10.1016/j.amepre.2009.09.020.
    1. Ward D, Morris E, McWilliams C, Vaughn A, Erinosho T, Mazzuca S, Hanson P, Ammerman A, Neelon S, Sommers S, Ball S. Go NAP SACC: Nutrition and Physical Activity Self-Assessment for Child Care. 2013.
    1. Bandura A. The explanatory and predictive scope of self-efficacy theory. J Soc Clin Psychol. 1986;4:359–73. doi: 10.1521/jscp.1986.4.3.359.
    1. Bandura A, McClelland D. Social learning theory. 1977.
    1. Lee P, Macfarlane D, Lam T, Stewart S. Validity of the international physical activity questionnaire short form (IPAQ-SF): A systematic review. Int J Behav Nutr Phys Act. 2011;8(115):1–11.
    1. Canada S. Canadian Community Health Survey (CCHS) 2010.
    1. Martinent G, Naisseh M, Ferrand C, Bois J, Hautier C. Development and evaluation of the psychometric properties of the parents’ Perceptions of Physical Activity Importance and their Children’s Ability Questionnaire (PPPAICAQ) Psychol Sport Exerc. 2013;14:719–727. doi: 10.1016/j.psychsport.2013.05.008.
    1. National Health and Nutrition Examination Survey. Anthropometry Procedures Manual. 2004. p. 1-65.
    1. Monasta L, Lobstein T, Cole T, Vignerová J, Cattaneo A. Defining overweight and obesity in pre-school children: IOTF reference or WHO standard? Obes Rev. 2011;12:295–300. doi: 10.1111/j.1467-789X.2010.00748.x.

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