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An educational intervention to promote healthy lifestyles in preschool children: a cluster-RCT

International Journal of Obesity volume 41, pages 582–590 (2017)Cite this article

Subjects

Abstract

Objective:

Promoting four healthy behaviours among preschool children:⩾4 servings of fruit and vegetables/day, ⩾2 h/day of active play, ⩽1 h per day of TV-watching and 0 sugar sweetened beverages/day.

Methods:

We conducted a c-RCT on 425 3-year-old children at 16 childcare centres based in Cesena, Italy. We randomly allocated eight childcare centres (199 children) to the intervention group and eight childcare centres (226 children) to the control group. All the randomized childcare centres completed our study protocol. Parents recorded their children's target behaviours at home over 3 Saturdays, at baseline and at follow-up. Then trained nurses measured children's weight and height. We conducted a 6-month-long intervention trial in local health care centres where nurses and primary care pediatricians, respectively, conducted two subsequent motivational interviews with parents to encourage children's healthy behaviours at home. At the same time, teachers involved children in learning experiences about healthy behaviours. Our primary outcome is a children's combined health behaviour score (CHBS) at home. Our secondary outcomes measure the BMI z-score and the percentage of children that show a BMI trajectory crossing upward. After collecting the CHBS and BMI data at baseline as well as at 1- and 2-year follow-ups, we performed an Intent-to-Treat (ITT) analysis.

Results:

After 2 years from baseline, 48.4% of intervention group children showed a low-risk CHBS in comparison with 28.0% of control group children. A multilevel analysis showed that they were by far more likely to achieve low-risk scores (adjusted OR: 3.41; 95% CI: 1.48–7.88; P=0.004). Our BMI outcomes showed no significant difference between groups.

Conclusions:

A multidimensional educational intervention, which consists of motivational interviews with parents and teacher-led learning experiences for children, improved preschool children's CHBS in the long term without influencing the outcomes of BMI z-score and BMI increase.

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Acknowledgements

We are grateful to the following primary care pediatricians and pediatric nurses who work in Cesena, Forlì-Cesena, Italy, carried out MI's with parents and completed a crucial component of our intervention trial. Pediatricians: Arturo Alberti, Antonio Belluzzi, Rita Casalboni, Giancarlo Cerasoli, Antonella De Pascale, Mila Degli Angeli, Paolo Faberi, Clara Faedi, Alessandra Foschi, Maurizio Iaia, Elide Lucchi, Marna Mambelli, Franco Mazzini, Marco Minghetti, Giuseppina Mingozzi, Loreta Piccolo, Barbara Poggioli, Antonella Stazzoni, Pierluigi Tonti, Miro Trebbi, Francesca Vaienti, Silvia Valentini. Nurses: Tosca Alessandrini, Patrizia Amaduzzi, Monica Bertozzi, Flavia Bonavita, Roberta Bracci, Barbara Gori, Fiammetta Mazzotti, Roberta Ruffilli, Milva Silvani. We thank the following colleagues for their effective cooperation that helped us conduct our study: Gianpaolo Guelfi, psychiatrist who led the Motivational Interviewing training for primary care paediatricians; Francesca Castoldi and Emanuela Baldassarri, psychologists who led a similar training course for nurses; Dr Lorena Quaranta, Health Education Office Coordinator, who gave her support to planning information tools for parents and teachers; Dr Rita Scalambra, Uisp (Unione Italiana Sport per tutti—Italian Sports Union for Everyone), who led a training course about the Promotion of Physical Activity among Preschool Children for childcare centre teachers; and all the directors and teachers of the 16 randomized childcare centres. We are also grateful to Leonardo Grilli, Associated Professor in Statistics, Department of Statistics, Information Technology, Applications ‘G.Parenti’ University of Florence, for his helpful suggestions on designing the statistical analysis model. Dr Iaia is grateful to Giancarlo Biasini, Senior Professor of Pediatrics, for his constructive suggestions. In September 2012, OROGEL S.p.A., a company based in via Dismano 2600, I-47522, Cesena, Forlì Cesena, Italy, granted €10 000 in support of our educational intervention. This sponsor had no role in designing and conducting our study; collecting, managing, analysing and interpreting its data; and preparing, reviewing and approving our paper.

Author contributions

Dr MI promoted the idea for this study and its design, and developed its score system for the evaluation of the intervention's effects on behaviours. He drafted the manuscript, coordinated the implementation of the intervention study and he is also the author of two versions of a manual guide ‘5210 messaggi in codice per crescere in salute’ (one for medical staff and one for parents and teachers). Drs MP, AB contributed to the study design and coordinated its implementation. They also measured children's weight and height at child care centres, and they entered all the data into our database for statistical analysis. Dr PV contributed to the statistical analysis model and carried out the statistical analysis of the results. Dr EA contributed to our statistical analysis model and thoroughly reviewed our paper. Dr MF contributed to our study design and thoroughly reviewed our paper. All authors approved the final paper version as submitted and agreed to be held accountable for all its contents.

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Authors and Affiliations

  1. Department of Primary Care, Primary Care Paediatrician and Community Paediatrician, Cesena, Italy

    M Iaia

  2. Department of Primary Care, Registered Dietitian, Dietetic and Nutrition Unit, Cesena, Italy

    M Pasini & A Burnazzi

  3. Department of Public Health, Biostatistician, Epidemiology and Communication Unit, Cesena, Italy

    P Vitali

  4. Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

    E Allara

  5. Department of Translational Medicine, Honorary research associate, Università del Piemonte Orientale, Novara, Italy

    E Allara

  6. Department of Primary Care, Director of Community Paediatrics Unit, Cesena, Italy

    M Farneti

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  1. M Iaia
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Correspondence to M Iaia.

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Iaia, M., Pasini, M., Burnazzi, A. et al. An educational intervention to promote healthy lifestyles in preschool children: a cluster-RCT. Int J Obes 41, 582–590 (2017). https://doi.org/10.1038/ijo.2016.239

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