An educational intervention to promote healthy lifestyles in preschool aged children

Educational intervention was based on the following components over a six months period (from the end of November 2012 to the end of May 2013): a)Two sequential, face to face, motivational interviews with parents, each lasting about 25 minutes, aimed to promote healthy family behaviour changes; each interview was problem-oriented taking into account the findings of baseline self reported diaries with respect to children’s 5210 behaviors in the family setting: daily intake of fruit and vegetable; daily time spent for outdoor play and screen time; daily intake of sweetened beverages . The first interview was conducted by the district pediatric nurse and the second (1-2 months later) by primary care (family) paediatricians in the primary care offices. Before the implementation of the intervention, both nurses and pediatricians had been separately trained in the practice of motivational interviewing by means of two distinct courses of 20 hours (subdivided in four sessions) conducted by specialists in the method. Motivational interviewing is a communication technique that enhance self-efficacy and motivation for change. Components include: de-emphasizing labelling, giving the parent responsibility for identifying which behaviours are problematic, encouraging parents to clarify and resolve ambivalence about change, setting goals to initiate the change process. b)Four teachers-led educational units for all 5210 behavioral goals direcly oriented on children were delivered in the child care centres, at the same time of the family-based intervention in order to promote translation of healthy behaviors in the family setting. The duration of an educational unit was about 2 hours per day (alternating any 5210 component in different days of the week) but each single unit often triggered related actions put on the curriculum in a creative way. In the middle of the intervention we met the teachers to know and collect the ongoing activities and to stimulate new actions. A summary of the educational activities implemented at childcare centres follows. TO PROMOTE MORE FRUIT AND VEGETABLE (FV) INTAKE: - eating vegetable first at childcare centre lunch -strategic allocation of those children “good eaters of FV” at different tables to promote intake in bad eaters by means of peer imitation - experiences of growing a vegetable garden involving kids in the whole process of planting, watering, organic fertilizing, picking up when vegetable is mature, preparing and tasting at lunch and/or snack - invention of stories with FV characters performed by children - invention of a song about FV properties that was producted as a compact disk - handling experiences with FV components aimed to artistic creations TO PROMOTE MORE INDOOR/OUTDOOR PHYSICAL ACTIVITY EVERY DAY: - Before the beginning of the intervention, the research team had provided for all teachers an 8 hour active training in two separate days, led by physical activity specialists of UISP (Unione Italiana Sport per Tutti), grouping the teachers in 3 groups according to school nearness. The training supported integration of physical activity across other learning areas linking to the service’s existing curriculum, programs and activity. The strategies to increase child physical activity levels and reduce time spent being sedentary in childcare centres included one or more of the following actions planned and delivered by teachers: -increasing daily time spent for outdoor unstructured active play: at least two daily opportunities , weather permitting -increasing variety of portable equipment for active indoor/outdoor play (ball, skipping-rope…) -active participation of teachers to indoor and outdoor play throughout the day (role modelling) -introduction of new psychomotor paths in curriculum -inclusion of brief structured activities each day -remotion whenever possible of barriers to outdoor play -modulation of indoor classroom routine activities toward more energy expenditure (e.g. singing a song or listening to music combined with promotion of dance to reduce time for sedentary activities) -providing verbal guidance (prompts to extend active play) and encouragement (positive statements about children’s activity) -sharing policies on promotion of physical activity with parents. In the middle time of intervention one refreshing focus group lasting 4 hours was conducted from the UISP specialists with all the teachers to support and strengthen the ongoing intervention. TO REDUCE SCREEN TIME: The guideline to limit television or videos for sporadic educational purposes was already established in every childcare centre. As a consequence, the teachers’ efforts aimed to ameliorate parents screen-related routine in the family context - teachers promoted a bright activity of books (age- appropriated) lending to parents to stimulate interactive reading with their kids, to the detriment of screen time in the household setting - An ecological day without TV was promoted by some childcare centres in which parents agreed on keeping TV turned off during a whole weekend day and their children reported coloured drawings about the alternative activities they had enjoyed with parents. TO LIMIT SUGAR SWEETENED BEVERAGES: At snacks it was established as a guideline to offer only the following kind of beverage: school-made fruit/vegetable centrifuged, fresh orange juice or a 100% fruit juice with no added sweeteners or partially skim pasteurized milk according to weekly menu planning. It was promoted water drinking (already existing as a guideline at lunch) on occasion of birthdays or other parties celebrated at school, to the detriment of sweetened beverages. In addition to this, teachers exposed in the childcare centres a poster that our staff produced (the same is present in pediatrician’s office waiting room) highlighting 5210 target behaviors. The teachers of a childcare centre produced a film (lasting 5 minutes) interpreted by children in which the enjoying activities implemented at school for achieving a greater intake of fruit/vegetable and more physical activity were reported. c)Diffusion of informative tools to parents and teachers Several tools were created by the research team to assist pediatricians and nurses in supporting parents in behaviour change. An educational folder to reinforce 5210 goals and the importance of parent role-modelling was submitted to parents during motivational interviews session. The same poster 5210 used in childcare centres was exposed in the pediatric office’s waiting room to stimulate dialogue during well-child care visits. A guide manual was offered to all parents and teachers to inform about evidence-based actions and strategies which may facilitate 5210 changes in the household context and in childcare centre.