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BMC Public Health
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Research article

Development of the DAGIS intervention study: a preschool-based family-involving study promoting preschoolers’ energy balance-related behaviours and self-regulation skills

Authors: Carola Ray, Riikka Kaukonen, Elviira Lehto, Henna Vepsäläinen, Nina Sajaniemi, Maijaliisa Erkkola, Eva Roos

Published in: BMC Public Health | Issue 1/2019

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Abstract

Background

Preschoolers’ energy balance-related behaviours (EBRBs) and self-regulation skills are important for their later health. Few preschool-based interventions aiming to promote preschoolers’ EBRBs and self-regulation skills, simultaneously reducing differences in EBRBs, due to children’s socio-economic status (SES) background, have been conducted. This study will present the Increased Health and Wellbeing in Preschools (DAGIS) intervention development process applying the Intervention Mapping (IM) framework.

Methods

The development of the DAGIS intervention study, a preschool level clustered randomized controlled trial (RCT), was based on the IM framework. The protocol in IM guides the development process of an intervention through six steps: needs assessment and logic model of the problem, programme outcomes and objectives, design of the programme, production, implementation plan, and evaluation plan.

Results

The needs assessment, part of the step 1 in IM, yielded the base for the DAGIS logic model of change. The model includes objectives related to changes in children’s EBRBs, self-regulation skills, and in psychosocial and physical environment that is determined by parents and early educators. A 22-week programme was developed, and materials for preschools and families were produced. A feasibility study of the recruitment processes, acceptability of the materials and methods, and implementation was conducted. The DAGIS intervention study was conducted September 2017–May 2018 as a clustered RCT including a comprehensive effectiveness and process evaluation. The process evaluation was run throughout the intervention targeting preschools and families.

Conclusion

A preschool-based family-involving programme was developed in the DAGIS intervention study by applying the IM protocol. It was a time- and resource-consuming process. However, the systematic planning, development, and running of the programme have reinforced a comprehensive evaluation, which is a strength in the intervention. The results from the evaluation will enhance the knowledge of how to promote EBRBs and self-regulation skills among preschoolers, and diminish SES differences in them.

Trial registration

ISRCTN57165350 (Prospectively registered January the 8th, 2015).
Appendix
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Literature
1.
Viikari JS, Niinikoski H, Juonala M, Raitakari OT, Lagström H, Kaitosaari T, et al. Risk factors for coronary heart disease in children and young adults. Acta Paediatr Suppl. 2004;93(446):34–42.PubMed
2.
Wilson SM, Sato AF. Stress and paediatric obesity: what we know and where to go. Stress Heal. 2014;30(2):91–102.CrossRef
3.
Veijalainen A, Tompuri T, Haapala EA, Viitasalo A, Lintu N, Väistö J, et al. Associations of cardiorespiratory fitness, physical activity, and adiposity with arterial stiffness in children. Scand J Med Sci Sport. 2016;26(8):943–50.CrossRef
4.
Mantziki K, Vassilopoulos A, Radulian G, Borys J-M, Du Plessis H, Gregorio MJ, et al. Inequities in energy-balance related behaviours and family environmental determinants in European children: baseline results of the prospective EPHE evaluation study. BMC Public Health. 2015;15:1203.PubMedPubMedCentralCrossRef
5.
De Craemer M, De Decker E, De Bourdeaudhuij I, Vereecken C, Deforche B, Manios Y, et al. Correlates of energy balance-related behaviours in preschool children: A systematic review. Obes Rev. 2012;Suppl 1:13–28.CrossRef
6.
Bingham DD, Costa S, Hinkley T, Shire KA, Clemes SA, Barber SE. Physical activity during the early years: a systematic review of correlates and determinants. Am J Prev Med. 2016;51(3):384–402.PubMedCrossRef
7.
Fernandez-Alvira J, Mouratidou T, Bammann K, Hebestreit A, Barba G, Sieri S, et al. Parental education and frequency of food consumption in European children: the IDEFICS study. Public Health Nutr. 2013;16(3):487–98.PubMedCrossRef
8.
Vliegenthart J, Noppe G, van Rossum EFC, Koper JW, Raat H, van den Akker ELT. Socioeconomic status in children is associated with hair cortisol levels as a biological measure of chronic stress. Psychoneuroendocrinology. 2016;65:9–14.PubMedCrossRef
9.
Aparicio E, Canals J, Arija V, De Henauw S, Michels N. The role of emotion regulation in childhood obesity: implications for prevention and treatment. Nutr Res Rev. 2016;29(1):17–29.PubMedCrossRef
10.
Lumeng JC, Miller AL, Horodynski MA, Brophy-Herb HE, Contreras D, Lee H, et al. Improving self-regulation for obesity prevention in head start: a randomized controlled trial. Pediatrics. 2017;139(5):e20162047.PubMedCrossRef
11.
Seeyave DM, Coleman S, Appugliese D, Corwyn RF, Bradley RH, Davidson NS, et al. Ability to delay gratification at age 4 years and risk of overweight at age 11 years. Arch Pediatr Adolesc Med. 2009;163(4):303–8.PubMedPubMedCentralCrossRef
12.
Liang J, Matheson BE, Kaye WH, Boutelle KN. Neurocognitive correlates of obesity and obesity-related behaviors in children and adolescents. Int J Obes. 2014;38:494–506.CrossRef
13.
Miller AL, Lumeng JC. Pathways of association from stress to obesity in early childhood. Obesity. 2018;26(7):1117–24.PubMedCrossRef
14.
Biddle SJH, Petrolini I, Pearson N. Interventions designed to reduce sedentary behaviours in young people: a review of reviews. Br J Sports Med. 2014;48(3):182–6.PubMedCrossRef
15.
Marmot M. Proportionate universalism. In: The health gap- the challenge of an unequal world. 1st ed. London: Bloomsbury publishing; 2015. p. 279–89.
16.
Hesketh KD, Campbell KJ. Interventions to prevent obesity in 0–5 year olds: An updated systematic review of the literature. Obesity. 2010;Suppl 1:s27–35.CrossRef
17.
Temple M, Robinson JC. A systematic review of interventions to promote physical activity in the preschool setting. J Spec Pediatr Nurs. 2014;19(4):274–84.PubMed
18.
19.
20.
21.
22.
Kok G, Gottlieb N, Peters G, Mullen P, Parcel G, Ruiter R, et al. A taxonomy of behaviour change methods: an intervention mapping approach. Heal Psychol Rev. 2016;10(3):297–312.CrossRef
23.
Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015;19(359):h1258.CrossRef
24.
Durlak JA, DuPre EP. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008;41:327–50.PubMedCrossRef
25.
Bartholomew Eldredge LK, Markham CM, Ruiter RAC, Fernandez ME, Parcel GS. Planning health promotion programs- an intervention mapping approach. Fourth Edi. San Fransisco: Jossey-Bass; 2016. p. 678.
26.
Parikka S, Mäki P, Levälahti E, Lehtinen-Jacks S, Martelin T, Laatikainen T. Associations between parental BMI, socioeconomic factors, family structure and overweight in Finnish children: a path model approach. BMC Public Health. 2015;15:271.PubMedPubMedCentralCrossRef
27.
Määttä S, Lehto R, Nislin M, Ray C, Erkkola M, Sajaniemi N, et al. Increased health and well-being in preschools (DAGIS): Rationale and design for a randomized controlled trial Health behavior, health promotion and society. BMC Public Health. 2015;15(1):402.PubMedPubMedCentralCrossRef
28.
Määttä S, Ray C, Roos G, Roos E. Applying a Socioecological model to understand preschool Children’s sedentary behaviors from the viewpoints of parents and preschool personnel. Early Child Educ J. 2016;44(5):491–502.CrossRef
29.
Ray C, Määttä S, Lehto R, Roos G, Roos E. Influencing factors of children’s fruit, vegetable and sugar-enriched food intake in a Finnish preschool setting - preschool personnel’s perceptions. Appetite. 2016;103:72–9.PubMedCrossRef
30.
Putnam SP, Rothbart MK. Development of short and very short forms of the Children’s behavior questionnaire. J Pers Assess. 2006;87(1):102–12.PubMedCrossRef
31.
Lehto E, Ray C, Vepsäläinen H, Korkalo L, Lehto R, Kaukonen R, et al. Increased health and wellbeing in preschools (DAGIS) study—Differences in children’s energy balance-related behaviors (EBRBs) and in long-term stress by parental educational level. Int J Environ Res Public Health. 2018;15(10):2313.PubMedCentralCrossRef
32.
Bartholomew Eldredge LK, Markham CM, Ruiter RAC, Fernandez ME, Kok G, Parcel GS. Intervention mapping step 3: program design. In: Planning health promoting programs- an intervention mapping approach. 4th ed. San Fransisco: Jossey-Bass; 2016. p. 345–434.
33.
Glasgow R. Evaluation of theory-based interventions. In: Glannz K, Rimer B, Viswanath K, editors. Health behaviour and health education:theory, research, and practice. 3rd ed. San Fransisco: Jossey-Bass; 2002. p. 530–44.
34.
Dane AV, Schneider BH. Program integrity in primary and early secondary prevention: are implementation effects out of control? Clin Psychol Rev. 1998;18:23–45.PubMedCrossRef
35.
Linnan L, Steckler A. Process evaluation for public health interventions and research. San Fransisco: Jossey-Bass; 2002.
36.
Baranowski T, Stables G. Process evaluations of the 5-a-day projects. Heal Educ Behav. 2000;27(2):157–66.CrossRef
37.
Erkkola M, Kronberg-Kippilä C, Kyttälä P, Lehtisalo J, Reinivuo H, Tapanainen H, et al. Sucrose in the diet of 3-year-old Finnish children: sources, determinants and impact on food and nutrient intake. Br J Nutr. 2009;101:1209–17.PubMedCrossRef
38.
Kaikkonen R, Mäki P, Hakulinen-Viitanen T, Markkula J, Wikström K, Ovaskainen M-L, et al. Health and well-being inequalities among children and their families. Helsinki: National institute for health and wellfare (THL), Report 16/2012; 2012.
39.
Wijtzes AI, Jansen W, Kamphuis CBM, Jaddoe VWV, Moll HA, Tiemeier H, et al. Increased risk of exceeding entertainment-media guidelines in preschool children from low socioeconomic background: the generation R study. Prev Med (Baltim). 2012;55(4):325–9.CrossRef
40.
Vanaelst B, Michels N, Clays E, Herrmann D, Huybrechts I, Sioen I, et al. The association between childhood stress and body composition, and the role of stress-related lifestyle factors - cross-sectional findings from the baseline ChiBS survey. Int J Behav Med. 2014;21(2):292–301.PubMedCrossRef
41.
Määttä S, Kaukonen R, Vepsäläinen H, Lehto E, Ylönen A, Ray C, et al. The mediating role of the home environment in relation to parental educational level and preschool children’s screen time: A cross-sectional study. BMC Public Health. 2017;17(1):688.PubMedPubMedCentralCrossRef
42.
Pinket A, De Craemer M, De Bourdeaudhuij I, Deforche B, Cardon G, Androutsos O, Koletzko B, et al. Can parenting practices explain the differences in beverage intake according to socio-economic status: the Toybox-study. Nutrients. 2016;23(8):10.
43.
Bandura A. Social foundations of thought and action : a social cognitive theory / Albert Bandura. Englewood Cliffs, N.J: Prentice-Hall; 1986.
44.
Ajzen I. The theory of planned behavior: organizational behavior and human decision processes. Organ Behav Hum Decis Process. 1991;50(2):179–211.CrossRef
45.
Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2002;55:68–78.PubMedCrossRef
46.
Kreichauf S, Wildgruber A, Krombholz H, Gibson EL, Vögele C, Nixon CA, et al. Critical narrative review to identify educational strategies promoting physical activity in preschool. Obes Rev. 2012;13(Suppl. 1):96–105.PubMedCrossRef
47.
Sisson SB, Krampe M, Anundson K, Castle S. Obesity prevention and obesogenic behavior interventions in child care: a systematic review. Prev Med (Baltim). 2016;87:57–69.CrossRef
48.
Nixon CA, Moore HJ, Douthwaite W, Gibson EL, Vogele C, Kreichauf S, et al. Identifying effective behavioural models and behaviour change strategies underpinning preschool- and school-based obesity prevention interventions aimed at 4–6-year-olds: A systematic review. Obes Rev. 2012;13(Suppl. 1):106–17.PubMedCrossRef
49.
Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81–95.PubMedCrossRef
50.
Golley RK, Hendrie GA, Slater A, Corsini N. Interventions that involve parents to improve children’s weight-related nutrition intake and activity patterns - what nutrition and activity targets and behaviour change techniques are associated with intervention effectiveness? Obes Rev. 2011;12(2):114–30.PubMedCrossRef
51.
Hendrie GA, Brindal E, Corsini N, Gardner C, Baird D, Golley RK. Combined home and school obesity prevention interventions for children: what behavior change strategies and intervention characteristics are associated with effectiveness? Heal Educ Behav. 2012;39(2):159–71.CrossRef
52.
Hendrie GA, Lease HJ, Bowen J, Baird DL, Cox DN. Strategies to increase children’s vegetable intake in home and community settings: a systematic review of literature. Matern Child Nutr. 2017;13(1):12276.CrossRef
53.
54.
Maloney JE, Stewart Lawlor M, Shonert-Reichl KA, Whitehead J. A universal, mindfulness-based social and emotional learning (SEL) program designed to be implemented in schools by regular classroom teachers. In: Shonert-Reichl KA, Roeser RW, editors. Handbook of mindfulness in education- integrating theory into practice. New York: Springer-Verlag; 2016. p. 313–34.CrossRef
55.
56.
57.
Nyberg G, Sundblom E, Norman Å, Bohman B, Hagberg J, Elinder LS. Effectiveness of a universal parental support programme to promote healthy dietary habits and physical activity and to prevent overweight and obesity in 6-year-old children: the healthy school start study, a cluster-randomised controlled trial. PLoS One. 2015;10(2):e0116876.PubMedPubMedCentralCrossRef
58.
Elinder LS, Patterson E, Nyberg G, Norman Å. A healthy school start plus for prevention of childhood overweight and obesity in disadvantaged areas through parental support in the school setting - study protocol for a parallel group cluster randomised trial. BMC Public Health. 2018;18(1):459.PubMedPubMedCentralCrossRef
59.
Bayer O, von Kries R, Strauss A, Mitschek C, Toschke AM, Hose A, et al. Short- and mid-term effects of a setting based prevention program to reduce obesity risk factors in children: a cluster-randomized trial. Clin Nutr. 2009;28(2):122–8.PubMedCrossRef
60.
Niederer I, Bürgi F, Ebenegger V, Marques-Vidal P, Schindler C, Nydegger A, et al. Effects of a lifestyle intervention on adiposity and fitness in overweight or low fit preschoolers (Ballabeina). Obesity. 2013;21(3):E287–93.PubMedCrossRef
61.
Payr A, Birnbaum J, Wildgruber A, Kreichauf S, Androutsos O, Lateva M, et al. Concepts and strategies on how to train and motivate teachers to implement a kindergarten-based, family-involved intervention to prevent obesity in early childhood. The ToyBox-study. Obes Rev. 2014;15(Suppl 3):40–7.PubMedCrossRef
62.
Nathan N, Wolfenden L, Butler M, Bell AC, Wyse R, Campbell E, et al. Vegetable and fruit breaks in Australian primary schools: prevalence, attitudes, barriers and implementation strategies. Health Educ Res. 2011;26(4):722–31.PubMedCrossRef
63.
Davis SM, Sanders SG, Fitzgerald CA, Keane PC, Canaca GF, Volker-Rector R. CHILE: an evidence-based preschool intervention for obesity prevention in head start. J Sch Health. 2013;83(3):223–9.PubMedPubMedCentralCrossRef
64.
Hoelscher DM, Feldman HA, Johnson CC, Lytle LA, Osganian SK, Parcel GS, et al. School-based health education programs can be maintained over time: results from the CATCH institutionalization study. Prev Med (Baltim). 2004;38(5):594–606.CrossRef
65.
Ransford CR, Greenberg MT, Domitrovich CE, Small M, Jacobson L. The role of teachers ’ psychological experiences and perceptions of curriculum supports on the implementation of a social and emotional learning curriculum. School Psych Rev. 2009;38(4):510–32.
66.
Klenberg L, Tommo H, Jämsä S, Häyrinen T. Pienten lasten keskittymiskysely PikkuKesky. Käsikirja. (The attention and executive functions rating inventory ATTEX-P. handbook). Helsinki: Hogrefe Publishing Corp.; 2017.
67.
Hogan AE, Scott KG, Bauer CR. The adaptive social behavior inventory (ASBI): a new assessment of social competence in high-risk three-year-olds. J Psychoeduc Assess. 1992;10(3):230–9.CrossRef
68.
69.
De Craemer M, Verloigne M, De Bourdeaudhuij I, Androutsos O, Iotova V, Moreno L, et al. Effect and process evaluation of a kindergarten-based, family-involved cluster randomised controlled trial in six European countries on four- to six-year-old children’s steps per day: the ToyBox-study. Int J Behav Nutr Phys Act. 2017;14(1):116.PubMedPubMedCentralCrossRef
70.
Saunders RP, Pfeiffer K, Brown WH, Howie EK, Dowda M, O’Neill JR, et al. Evaluating and refining the conceptual model used in the study of health and activity in preschool environments (SHAPES) intervention. Heal Educ Behav. 2017;44(6):876–84.CrossRef
71.
De Craemer M, De Decker E, De Bourdeaudhuij I, Verloigne M, Duvinage K, Koletzko B, et al. Applying the Intervention Mapping protocol to develop a kindergarten-based, family-involved intervention to increase European preschool children’s physical activity levels: The ToyBox-study. Obes Rev. 2014;15(Suppl. 3):14–26.PubMedCrossRef
72.
Pérez-Rodrigo C, Wind M, Hildonen C, Bjelland M, Aranceta J, Klepp KI, et al. The pro children intervention: applying the intervention mapping protocol to develop a school-based fruit and vegetable promotion programme. Ann Nutr Metab. 2005;49(4):267–77.PubMedCrossRef
73.
Mann CM, Ward DS, Vaughn A, Benjamin Neelon SE, Long Vidal LJ, Omar S, et al. Application of the intervention mapping protocol to develop keys, a family child care home intervention to prevent early childhood obesity. BMC Public Health. 2015;15:1227.PubMedPubMedCentralCrossRef
74.
Määttä S, Ray C, Vepsäläinen H, Lehto E, Kaukonen R, Ylönen A, et al. Parental education and pre-School children’s objectively measured sedentary time: The role of co-participation in physical activity. Int J Environ Res Public Health. 2018;15(2):366.PubMedCentralCrossRef
75.
Burström B, Marttila A, Kulane A, Lindberg L, Burström K. Practising proportionate universalism – a study protocol of an extended postnatal home visiting programme in a disadvantaged area in Stockholm, Sweden. BMC Health Serv Res. 2017;17(91):1–8.
76.
Lehto R, Maatta S, Lehto E, Ray C, Te Velde S, Lien N, et al. The PRO GREENS intervention in Finnish schoolchildren - the degree of implementation affects both mediators and the intake of fruits and vegetables. Br J Nutr. 2014;112(7):1185–94.PubMedCrossRef
Metadata
Title
Development of the DAGIS intervention study: a preschool-based family-involving study promoting preschoolers’ energy balance-related behaviours and self-regulation skills
Authors
Carola Ray
Riikka Kaukonen
Elviira Lehto
Henna Vepsäläinen
Nina Sajaniemi
Maijaliisa Erkkola
Eva Roos
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-7864-0

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