The Program SI! intervention for enhancing a healthy lifestyle in preschoolers: first results from a cluster randomized trial

José L Peñalvo, Mercedes Sotos-Prieto, Gloria Santos-Beneit, Stuart Pocock, Juliana Redondo, Valentín Fuster, José L Peñalvo, Mercedes Sotos-Prieto, Gloria Santos-Beneit, Stuart Pocock, Juliana Redondo, Valentín Fuster

Abstract

Background: Unhealthy lifestyles contribute to the development of cardiovascular risk factors, whose incidence is increasing among children and adolescents. The Program SI! is a long-term, multi-target behavioral intervention to promote healthy lifestyle habits in children through the school environment. The objective of the study is to evaluate the efficacy of this intervention in its first phase, preschoolers.

Methods: Cluster-randomized controlled trial in public schools in the city of Madrid, Spain. A total 24 schools, including 2062 children (3-5 years), 1949 families, and 125 teachers participated in the study. Schools were assigned to their usual school curriculum or to engage in an additional multi-component intervention (Program SI!). The primary outcome of this trial is 1-school year changes from baseline in scores for children's knowledge, attitudes and habits (KAH). Secondary outcomes are 1-school year changes from baseline in scores for knowledge, attitudes, and habits among parents, teachers, and the school environment.

Results: After 1-school year, our results indicate that the Program SI! intervention increases children's KAH scores, both overall (3.45, 95% CI, 1.84-5.05) and component-specific (Diet: 0.93, 95% CI, 0.12-1.75; Physical activity: 1.93, 95% CI, 1.17-2.69; Human body: 0.65, 95% CI, 0.07-1.24) score.

Conclusions: The Program SI! is demonstrated as an effective and feasible strategy for increasing knowledge and improving lifestyle attitudes and habits among very young children.

Trial registration: NCT01579708, Evaluation of the Program SI! for Preschool Education: A School-Based Randomized Controlled Trial (Preschool-SI!).

Figures

Figure 1
Figure 1
Flow chart for enrollment, baseline measurements and follow-up in the Program SI!.
Figure 2
Figure 2
Mean differences in knowledge, attitudes and habits (KAH) scores after 1-year follow-up in children (overall and by age). (A) KAH-overall. (B) KAH-diet. (C) KAH-physical activity. (D) KAH-heart and body. P values relate to overall mean differences in score changes between intervention and control groups. P trend values test whether the treatment effect varies with children’s age (by class year). **P<0.005. *P<0.05.
Figure 3
Figure 3
Mean differences (95% CI) in overall KAH score changes after 1-year follow-up between children in the intervention and control groups, according to selected variables.

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