Effects of a kindergarten-based intervention to promote healthy lifestyles: Quasi experimental study in Sousse, Tunisia

Abstract

Introduction: Little research has been devoted to preschool obesity prevention in Tunisia. Our purpose was to evaluate feasibility and effects of an intervention program for preschoolers, parents and kindergarten staffs aiming to increase the proportion of children doing physical activity and those with balanced eating habits. Methods:We carried out a quasi-experimental intervention study with two groups: A control group and an intervention group. The participants were preschoolers aged 4 to 5 years, their parents and the kindergarten staffs. The sample size to select children was based on a significance level of α=5% and a power 1-β=80% and 10% change in physical activity practice and balanced eating habits. In each group, we made a pre-post assessment of diet and physical activity habits. The intervention consisted in a multidimensional lifestyle intervention with training sessions, workshops, tournaments and educative supports. Data analysis was stratified according to socioeconomic status.Results: At baseline, 270 and 269 preschoolers composed respectively the intervention and control groups. At the post-assessment, the number increased to respectively 347 and 230 preschoolers in intervention and control groups. In the intervention group, 52.9% of the mothers and 56.5% of the fathers were executive versus 37.1% and 43.5% respectively in the control group. In the intervention group, the proportion of children with balanced eating habits had significantly increased between baseline and post-assessment for both executive parents. The proportion of preschoolers doing physical activity outdoors the kindergarten was improved among executive mothers and fathers in the intervention group without significant change. In the control group, there was an increase observed only for executive fathers. Conclusion:Significant changes of physical activity habits and diet characteristics were obtained in the intervention group unlike the control group. The socioeconomic status seems to be determinant in guiding intervention program.

A Systematic Review of Data Collection Techniques Used to Measure Preschool Children’s Knowledge of and Preference for Physical Activity

“…Studies included in the review were published between 1985 and 2017, including 22 cross-sectional studies [6,7,18,20,23,30,33,34,35,36,37], one pre-post study [31], one quasi-experimental study [32] and one randomized controlled trial (RCT) [16]. The number of participants ranged from 17 to 1881 and included children aged three to 12 years.…”

“…Of the 14 reviewed articles, six studies used a questionnaire to assess PA knowledge and preferences [6,16,31,32,35,36]. In all six studies, questions were read out loud to participants, and pictures were used to facilitate activities in which children were asked to sort a selection of photographs according to which activity they prefer (PA preference), or according to which activity would contribute positively towards health and which would not (PA knowledge).…”

“…Only four out of 14 of the included studies reported an assessment of the validity of the data collection tool used, and six reported testing measures for at least one type of reliability (see Table 1). Pilot-testing of the instrument was done in six studies [6,16,30,31,32,34].…”

“…However, it was evident from the reviewed studies that a number of factors need to be considered when selecting photographs to reduce bias in the measurement of preschool children’s PA knowledge and preferences. To assess appropriateness, five studies tested the questionnaires for face or content validity through expert reviews or pilot-testing [6,16,31,32,35]. Validity and pilot-testing allows researchers to identify any issues with the tool, including the appropriateness of the tool content, issues with delivery, or how the participants understand what is being asked of them.…”