Systematic review of interventions in the childcare setting with direct parental involvement: effectiveness on child weight status and energy balance-related behaviours

Abstract

BackgroundThe early years are a crucial period to promote healthy energy balance-related behaviours in children and prevent overweight and obesity. The childcare setting is important for health-promoting interventions. Increasingly, attention has been paid to parental involvement in childcare-based interventions. The aim of this systematic review is to evaluate the effectiveness of these interventions with direct parental involvement on the children’s weight status and behavioural outcomes.MethodsA systematic search was conducted in four electronic databases to include studies up until January 2019. Studies written in English, describing results on relevant outcomes (weight status, physical activity, sedentary behaviour and/or nutrition-related behaviour) of childcare-based interventions with direct parental involvement were included. Studies not adopting a pre-post-test design or reporting on pilot studies were excluded. To improve comparability, effect sizes (Cohen’s d) were calculated. Information on different types of environment targeted (e.g., social, physical, political and economic) was extracted in order to narratively examine potential working principles of effective interventions.ResultsA total of 22 studies, describing 17 different interventions, were included. With regard to the intervention group, 61.1% found some favourable results on weight status, 73.3% on physical activity, 88.9% on sedentary behaviour, and all on nutrition-related behaviour. There were studies that also showed unfavourable results. Only a small number of studies was able to show significant differences between the intervention and control group (22.2% weight status, 60.0% physical activity, 66.6% sedentary behaviour, 76.9% nutrition behaviour). Effect sizes, if available, were predominantly small to moderate, with some exceptions with large effect sizes. The interventions predominantly targeted the socio-cultural and physical environments in both the childcare and home settings. Including changes in the political environment in the intervention and a higher level of intensity of parental involvement appeared to positively impact intervention effectiveness.ConclusionChildcare-based interventions with direct parental involvement show promising effects on the children’s energy balance-related behaviours. However, evidence on effectiveness is limited, particularly for weight-related outcomes. Better understanding of how to reach and involve parents may be essential for strengthening intervention effectiveness.

Children’s experiences of participating in a school-based health promotion parental support programme – a qualitative study

“…Contradictory messages in different settings can create confusion for children and may hinder their ability to make healthy lifestyle choices [ 41 ]. Although efforts have been made to engage parents as much as possible in HSSP, more work is needed to understand how best to reach and involve parents, something also highlighted as an important factor for intervention effectiveness in childcare settings [ 42 ], where possible factors could include a firmer structure for home assignment and improve communication between home and school [ 27 , 28 , 39 ].…”

The Effects of a Comprehensive, Integrated Obesity Prevention Intervention Approach (SuperFIT) on Children’s Physical Activity, Sedentary Behavior, and BMI Z-Score

“…Studies have shown the importance of determinants in different types of environments on physical activity and sedentary behavior [36,61,62]. Systematic reviews have also stressed the importance of integrated interventions, i.e., combining the physical and sociocultural environment [63,64]. The integrated approach taken in SuperFIT, in which these different types of environments were taken into account was expected to be supportive for intervention effectiveness.…”

Obesity Prevention within the Early Childhood Education and Care Setting: A Systematic Review of Dietary Behavior and Physical Activity Policies and Guidelines in High Income Countries

“…Surprisingly, less than 1/3rd of dietary behavior guidelines recommended some form of parent engagement strategy. Despite mixed evidence surrounding the impact of parent involvement on child diet [ 78 , 79 ], there is some suggestion that involvement of parents particularly around the packing of childcare lunchboxes can improve vegetable intake [ 80 ].…”