Increased health and well-being in preschools (DAGIS): rationale and design for a randomized controlled trial

Abstract

BackgroundEffective interventions that target socioeconomic status (SES) differences to avoid the potential widening of inequalities in health are needed. Children at preschool age is a valuable intervention target since sedentary behaviors, physical activity (PA), dietary behaviors, and sleep habits, jointly called the energy balance-related behaviors (EBRBs), are established in early childhood and tend to persist later in life. The interventions are most effective, when they focus on evidence-based factors. One potential factor associated with EBRBs and SES is children’s stress regulation, which receives special attention in this study. Based on the socioecological approach, the combinations of multiple levels (e.g. individual, environmental, societal) of analysis and diverse methodologies (e.g. surveys, observations, biological measurements) are used to assess the healthfulness of environments (e.g. social, physical, learning, policy) in preschool and family settings. The intervention aimed to diminish SES differences in EBRBs is then conducted in the preschool setting.Methods/designThe DAGIS study is divided into two phases. The first phase comprises focus group interviews and a cross-sectional survey. Parents and preschool personnel in low SES neighborhoods participated in interviews about children’s sedentary behaviors, dietary behaviors, and PA in 2014. In the cross-sectional survey beginning in autumn 2015, preschools will be recruited from a random sample of preschools in 3–5 municipalities in Southern Finland. A total of 800 children will wear an accelerometer for seven days. Children’s hair and saliva samples will be taken. Parents and preschool personnel will complete questionnaires on EBRBs, social and physical environments and SES factors. The quality of preschool environment is also observed. In the second phase, an intervention targeting to narrowing SES differences in EBRBs is conducted. The effects of the intervention will be evaluated in randomised controlled trial. The implementation of the intervention will also be evaluated.ConclusionIf effective, this unique preschool-based study will be able to narrow the SES differences in preschool children’s EBRBs. This study is anticipated to identify the most important modifiable factors in preschool and family environmental settings associated with children’s EBRBs, especially in children from low SES backgrounds.Trial registrationISRCTN57165350 (January, 8th, 2015).

Assessment of nutrition and physical activity environments in family child care homes: modification and psychometric testing of the Environment and Policy Assessment and Observation

“…The number of ECE-based interventions is rapidly increasing [31], and the EPAO has been a useful tool particularly for those evaluating center-based interventions [32–35]. There is a growing number of studies conducted in FCCHs and their unique characteristics present certain data collection challenges.…”

The mediating role of the home environment in relation to parental educational level and preschool children’s screen time: a cross-sectional study

“…DAGIS (Increased Health and Wellbeing in Preschools) is a research project that aims to diminish SES differences in preschool children’s energy balance-related behaviors (EBRBs) ( www.dagis.fi ). As a part of this project, a cross-sectional study was conducted between September 2015 and April 2016 [ 26 ].…”

Individual-, home- and preschool-level correlates of preschool children’s sedentary time

“…The cross-sectional DAGIS (Increased Health and Wellbeing in Preschools) survey was conducted in eight municipalities in Southern and Western Finland in 2015 and 2016. More detailed information about the study purposes and the flow chart of participation in this study can be read elsewhere [30,31]. Briefly, the main recruitment criterion for the randomly invited preschools was the existence of at least one preschool group with children aged between three and six.…”