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Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Study protocol

A randomized controlled trial for families with preschool children - promoting healthy eating and active playtime by connecting to nature

Authors: Tanja Sobko, Michael Tse, Matthew Kaplan

Published in: BMC Public Health | Issue 1/2016

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Abstract

Background

Promotion of healthy lifestyles in children focuses predominantly on proper nutrition and physical activity, elements now widely recognised as essential for a healthy life. Systematic reviews have shown that nature-related activities also enhance general well-being as reflected in increased physical activity, a healthier diet, reduced stress and better sleep. Recent research suggests that many young children in Hong Kong between the ages of two and four in Hong Kong are more sedentary than recommended and seldom participate in active play, placing them at risk of becoming overweight or obese. The proposed project aims to investigate whether connecting families to nature positively influences physical activity (i.e., active playtime) and healthy eating routines in children aged 2 to 4.

Methods

We recently conducted a pilot study in Hong Kong to develop a programme, Play & Grow, based on the most successful evidence-based international preschool interventions. In addition to adopting the healthy eating and physical activity elements of these interventions, this project will additionally include a third novel element of Connectedness to nature: discovering nature through games and awareness of sounds, touch, smells, and temperature. To test the effectiveness of this modified intervention, a randomised controlled trial (RCT) involving 240 families with children aged 2 to 4 will be conducted. Families and children will take part in weekly one-hour activity sessions for 10-weeks. Lifestyle-related habits will be assessed before and immediately after the 10-week intervention, with follow up testing at 6 and 12 months’ post intervention.

Discussion

A novel measuring tool created specifically for assessing Connectedness to nature, Nature Relatedness Scale (NRS), will be validated and tested for reliability prior to the RCT. The results of the RCT are intended to be used to understand which components of the intervention are most effective. The objectives of this project will be achieved over a 30-month period and will contribute to the research that examines key components of successful healthy lifestyle promotion programmes during early childhood. We predict that the inclusion of Connectedness to nature will significantly improve recognised preschool interventions. Finally, the aim of targeting family involvement will hopefully increase the sustainability of longer-term lifestyle modifications in children.

Trial registration

ClinicalTrials.gov, NCT02715544. Registered 22 March 2016
Literature
1.
go back to reference Samuelson G. Global strategy on diet, physical activity and health. Food Nutr Res. 2004;48(2):57–7.CrossRef Samuelson G. Global strategy on diet, physical activity and health. Food Nutr Res. 2004;48(2):57–7.CrossRef
2.
go back to reference Chan CM, Deave T, Greenhalgh T. Obesity in Hong Kong Chinese preschool children: Where are all the nurses? J Pediatr Nurs. 2010;25(4):264–73.CrossRefPubMed Chan CM, Deave T, Greenhalgh T. Obesity in Hong Kong Chinese preschool children: Where are all the nurses? J Pediatr Nurs. 2010;25(4):264–73.CrossRefPubMed
3.
go back to reference Lo K, Cheung C, Lee A, Tam WWS, Keung V. Associations between parental feeding styles and childhood eating habits: a survey of Hong Kong pre-school children. PLoS One. 2015;10(4):e0124753.CrossRefPubMedPubMedCentral Lo K, Cheung C, Lee A, Tam WWS, Keung V. Associations between parental feeding styles and childhood eating habits: a survey of Hong Kong pre-school children. PLoS One. 2015;10(4):e0124753.CrossRefPubMedPubMedCentral
4.
go back to reference Palmer S. Toxic childhood : how the modern world is damaging the our children and what we can do about it. London: Orion; 2006. Palmer S. Toxic childhood : how the modern world is damaging the our children and what we can do about it. London: Orion; 2006.
5.
go back to reference Louv R. Last child in the woods: saving our children from nature-deficit disorder. Chapel Hill, N.C: Algonquin Books of Chapel Hill; 2008. Louv R. Last child in the woods: saving our children from nature-deficit disorder. Chapel Hill, N.C: Algonquin Books of Chapel Hill; 2008.
6.
go back to reference Leung S, Leung C, Luk W-Y. A Survey of Infant and Young Child Feeding in Hong Kong: Parental Perceptions and Practices. In. Edited by Service FH, Health TDo, Government HKS. Hong Kong; 2012: 2–62. Leung S, Leung C, Luk W-Y. A Survey of Infant and Young Child Feeding in Hong Kong: Parental Perceptions and Practices. In. Edited by Service FH, Health TDo, Government HKS. Hong Kong; 2012: 2–62.
7.
go back to reference Timmons BW, Proudfoot NA, MacDonald MJ, Bray SR, Cairney J. The health outcomes and physical activity in preschoolers (HOPP) study: rationale and design. BMC Public Health. 2012;12:284–4.CrossRefPubMedPubMedCentral Timmons BW, Proudfoot NA, MacDonald MJ, Bray SR, Cairney J. The health outcomes and physical activity in preschoolers (HOPP) study: rationale and design. BMC Public Health. 2012;12:284–4.CrossRefPubMedPubMedCentral
9.
go back to reference Davison KK CK. Obesity Prevention in the 21st Century: Public Health Approaches to Tackle the Obesity Pandemic. 2001 Evans Road, Cary, NC 27513, USA: Oxford University Press; 2005. Davison KK CK. Obesity Prevention in the 21st Century: Public Health Approaches to Tackle the Obesity Pandemic. 2001 Evans Road, Cary, NC 27513, USA: Oxford University Press; 2005.
10.
go back to reference Cooke L, Wardle J, Gibson E, Sapochnik M, Sheiham A, Lawson M. Demographic, familial and trait predictors of fruit and vegetable consumption by pre-school children. Public Health Nutr. 2004;7(02):295–302.CrossRefPubMed Cooke L, Wardle J, Gibson E, Sapochnik M, Sheiham A, Lawson M. Demographic, familial and trait predictors of fruit and vegetable consumption by pre-school children. Public Health Nutr. 2004;7(02):295–302.CrossRefPubMed
11.
go back to reference Sallis J, Prochaska J, Taylor W. A review of correlates of physical activity of children and adolescents. In: Med Sci Sports Exerc, vol. 32. 2000. p. 963–75. Sallis J, Prochaska J, Taylor W. A review of correlates of physical activity of children and adolescents. In: Med Sci Sports Exerc, vol. 32. 2000. p. 963–75.
12.
go back to reference Veselinovska SS, Osogovska TL. Engagement of students in environmental activities in school. Procedia - Soc Behav Sci. 2012;46:5015–20.CrossRef Veselinovska SS, Osogovska TL. Engagement of students in environmental activities in school. Procedia - Soc Behav Sci. 2012;46:5015–20.CrossRef
13.
go back to reference Styles JL, Meier A, Sutherland LA, Campbell MK. Parents’ and caregivers’ concerns about obesity in young children: a qualitative study. (Report). Fam Community Health. 2007;30(4):279.CrossRefPubMed Styles JL, Meier A, Sutherland LA, Campbell MK. Parents’ and caregivers’ concerns about obesity in young children: a qualitative study. (Report). Fam Community Health. 2007;30(4):279.CrossRefPubMed
14.
go back to reference Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O’Malley C, Stolk R, Summerbell CD. Interventions for treating obesity in children. Sao Paulo Med J. 2009;127(5):321–1.CrossRef Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O’Malley C, Stolk R, Summerbell CD. Interventions for treating obesity in children. Sao Paulo Med J. 2009;127(5):321–1.CrossRef
15.
go back to reference Cleland V, Crawford D, Baur LA, Hume C, Timperio A, Salmon J. A prospective examination of children’s time spent outdoors, objectively measured physical activity and overweight. Int J Obes (2005). 2008;32(11):1685–93.CrossRef Cleland V, Crawford D, Baur LA, Hume C, Timperio A, Salmon J. A prospective examination of children’s time spent outdoors, objectively measured physical activity and overweight. Int J Obes (2005). 2008;32(11):1685–93.CrossRef
16.
go back to reference Thompson Coon J, Boddy K, Stein K, Whear R, Barton J, Depledge MH. Does participating in physical activity in outdoor natural environments have a greater effect on physical and mental wellbeing than physical activity indoors? A systematic review. Environ Sci Technol. 2011;45(5):1761–72.CrossRefPubMed Thompson Coon J, Boddy K, Stein K, Whear R, Barton J, Depledge MH. Does participating in physical activity in outdoor natural environments have a greater effect on physical and mental wellbeing than physical activity indoors? A systematic review. Environ Sci Technol. 2011;45(5):1761–72.CrossRefPubMed
17.
go back to reference Dyment JE, Bell AC. Grounds for movement: green school grounds as sites for promoting physical activity. Health Educ Res. 2008;23:952–62.CrossRefPubMed Dyment JE, Bell AC. Grounds for movement: green school grounds as sites for promoting physical activity. Health Educ Res. 2008;23:952–62.CrossRefPubMed
18.
19.
go back to reference Monasta L, Batty GD, Macaluso A, Ronfani L, Lutje V, Bavcar A, van Lenthe FJ, Brug J, Cattaneo A. Interventions for the prevention of overweight and obesity in preschool children: a systematic review of randomized controlled trials. Obes Rev. 2011;12:e107–118.CrossRefPubMed Monasta L, Batty GD, Macaluso A, Ronfani L, Lutje V, Bavcar A, van Lenthe FJ, Brug J, Cattaneo A. Interventions for the prevention of overweight and obesity in preschool children: a systematic review of randomized controlled trials. Obes Rev. 2011;12:e107–118.CrossRefPubMed
20.
go back to reference Nisbet EK, Zelenski JM, Murphy SA. The nature relatedness scale: linking individuals’ connection with nature to environmental concern and behavior. Environ Behav. 2008;41(5):715–40.CrossRef Nisbet EK, Zelenski JM, Murphy SA. The nature relatedness scale: linking individuals’ connection with nature to environmental concern and behavior. Environ Behav. 2008;41(5):715–40.CrossRef
21.
go back to reference Barratt Hacking E, Barratt R, Scott W. Engaging children: research issues around participation and environmental learning. Environ Educ Res. 2007;13:529–44.CrossRef Barratt Hacking E, Barratt R, Scott W. Engaging children: research issues around participation and environmental learning. Environ Educ Res. 2007;13:529–44.CrossRef
22.
go back to reference Sobko T, Svensson V, Ek A, Ekstedt M, Karlsson H, Johansson E, Cao Y, Hagstromer M, Marcus C. A randomised controlled trial for overweight and obese parents to prevent childhood obesity - Early STOPP (STockholm Obesity Prevention Program). BMC Public Health. 2011;11(1):336.CrossRefPubMedPubMedCentral Sobko T, Svensson V, Ek A, Ekstedt M, Karlsson H, Johansson E, Cao Y, Hagstromer M, Marcus C. A randomised controlled trial for overweight and obese parents to prevent childhood obesity - Early STOPP (STockholm Obesity Prevention Program). BMC Public Health. 2011;11(1):336.CrossRefPubMedPubMedCentral
23.
go back to reference Campbell K, Hesketh K, Crawford D, Salmon J, Ball K, McCallum Z. The Infant Feeding Activity and Nutrition Trial (INFANT) an early intervention to prevent childhood obesity: cluster-randomised controlled trial. BMC Public Health. 2008;8(1):103.CrossRefPubMedPubMedCentral Campbell K, Hesketh K, Crawford D, Salmon J, Ball K, McCallum Z. The Infant Feeding Activity and Nutrition Trial (INFANT) an early intervention to prevent childhood obesity: cluster-randomised controlled trial. BMC Public Health. 2008;8(1):103.CrossRefPubMedPubMedCentral
24.
go back to reference Huang YJ, Wong SH, Salmon J, Hui SS. Reliability and validity of psychosocial and environmental correlates measures of physical activity and screen-based behaviors among Chinese children in Hong Kong. Int J Behav Nutr Phys Act. 2011;8:16.CrossRefPubMedPubMedCentral Huang YJ, Wong SH, Salmon J, Hui SS. Reliability and validity of psychosocial and environmental correlates measures of physical activity and screen-based behaviors among Chinese children in Hong Kong. Int J Behav Nutr Phys Act. 2011;8:16.CrossRefPubMedPubMedCentral
25.
go back to reference Patterson GR. Performance models for parenting: a social interactional perspective. 1997. Patterson GR. Performance models for parenting: a social interactional perspective. 1997.
26.
go back to reference Nelson CS, Wissow LS, Cheng TL. Effectiveness of anticipatory guidance: recent developments. Curr Opin Pediatr. 2003;15(6):630–5.CrossRefPubMed Nelson CS, Wissow LS, Cheng TL. Effectiveness of anticipatory guidance: recent developments. Curr Opin Pediatr. 2003;15(6):630–5.CrossRefPubMed
27.
go back to reference Mullis F. Active parenting: an evaluation of two Adlerian parent education programs. J Individ Psychol. 1999;55:225–32. Mullis F. Active parenting: an evaluation of two Adlerian parent education programs. J Individ Psychol. 1999;55:225–32.
29.
go back to reference Liefländer AK, Fröhlich G, Bogner FX, Schultz PW. Promoting connectedness with nature through environmental education. Environ Educ Res. 2013;19(3):370–84.CrossRef Liefländer AK, Fröhlich G, Bogner FX, Schultz PW. Promoting connectedness with nature through environmental education. Environ Educ Res. 2013;19(3):370–84.CrossRef
30.
go back to reference Cutter-Mackenzie A, Edwards S. Toward a model for early childhood environmental education: foregrounding, developing, and connecting knowledge through play-based learning. J Environ Educ. 2013;44(3):195–213.CrossRef Cutter-Mackenzie A, Edwards S. Toward a model for early childhood environmental education: foregrounding, developing, and connecting knowledge through play-based learning. J Environ Educ. 2013;44(3):195–213.CrossRef
32.
go back to reference Larson LR, Green GT, Castleberry SB. Construction and validation of an instrument to measure environmental orientations in a diverse group of children. Environ Behav. 2011;43(1):72–89.CrossRef Larson LR, Green GT, Castleberry SB. Construction and validation of an instrument to measure environmental orientations in a diverse group of children. Environ Behav. 2011;43(1):72–89.CrossRef
33.
go back to reference Varni JW, Burwinkle TM, Seid M, Skarr D. The PedsQL™* 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr. 2003;3(6):329–41.CrossRefPubMed Varni JW, Burwinkle TM, Seid M, Skarr D. The PedsQL™* 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr. 2003;3(6):329–41.CrossRefPubMed
34.
go back to reference Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol. 2001;1(1):2.CrossRefPubMedPubMedCentral Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol. 2001;1(1):2.CrossRefPubMedPubMedCentral
35.
go back to reference Skouteris H, McCabe M, Swinburn B, Hill B. Healthy eating and obesity prevention for preschoolers: a randomised controlled trial. BMC Public Health. 2010;10:220–0.CrossRefPubMedPubMedCentral Skouteris H, McCabe M, Swinburn B, Hill B. Healthy eating and obesity prevention for preschoolers: a randomised controlled trial. BMC Public Health. 2010;10:220–0.CrossRefPubMedPubMedCentral
36.
go back to reference Reilly JJ, Coyle J, Kelly L, Burke G, Grant S, Paton JY. An objective method for measurement of sedentary behavior in 3- to 4-year olds. Obes Res. 2003;11(10):1155–8.CrossRefPubMed Reilly JJ, Coyle J, Kelly L, Burke G, Grant S, Paton JY. An objective method for measurement of sedentary behavior in 3- to 4-year olds. Obes Res. 2003;11(10):1155–8.CrossRefPubMed
38.
go back to reference Uzun FV, Keles O. The effects of nature education project on the environmental awareness and behavior. Procedia - Soc Behav Sci. 2012;46:2912–6.CrossRef Uzun FV, Keles O. The effects of nature education project on the environmental awareness and behavior. Procedia - Soc Behav Sci. 2012;46:2912–6.CrossRef
39.
go back to reference Heath P, Houston-Price C, Kennedy OB. Let’s look at leeks! Picture books increase toddlers’ willingness to look at, taste and consume unfamiliar vegetables. Front Psychol. 2014;5(March):191–1.PubMedPubMedCentral Heath P, Houston-Price C, Kennedy OB. Let’s look at leeks! Picture books increase toddlers’ willingness to look at, taste and consume unfamiliar vegetables. Front Psychol. 2014;5(March):191–1.PubMedPubMedCentral
40.
go back to reference Duerden MD, Witt PA. The impact of direct and indirect experiences on the development of environmental knowledge, attitudes, and behavior. J Environ Psychol. 2010;30(4):379–92.CrossRef Duerden MD, Witt PA. The impact of direct and indirect experiences on the development of environmental knowledge, attitudes, and behavior. J Environ Psychol. 2010;30(4):379–92.CrossRef
41.
go back to reference McPherson Frantz C, Mayer FS. The importance of connection to nature in assessing environmental education programs. Studies in Educational Evaluation 2013:(Article in Press)-(Article in Press). McPherson Frantz C, Mayer FS. The importance of connection to nature in assessing environmental education programs. Studies in Educational Evaluation 2013:(Article in Press)-(Article in Press).
42.
go back to reference Mayer FS, Frantz CM, Bruehlman-Senecal E, Dolliver K. Why is nature beneficial?: The role of connectedness to nature. Environ Behav. 2008;41(5):607–43.CrossRef Mayer FS, Frantz CM, Bruehlman-Senecal E, Dolliver K. Why is nature beneficial?: The role of connectedness to nature. Environ Behav. 2008;41(5):607–43.CrossRef
43.
go back to reference Bennett C-A, de Silva-Sanigorski AM, Nichols M, Bell AC, Swinburn BA. Assessing the intake of obesity-related foods and beverages in young children: comparison of a simple population survey with 24 hr-recall. Int J Behav Nutr Phys Act. 2009;6(1):71.CrossRefPubMedPubMedCentral Bennett C-A, de Silva-Sanigorski AM, Nichols M, Bell AC, Swinburn BA. Assessing the intake of obesity-related foods and beverages in young children: comparison of a simple population survey with 24 hr-recall. Int J Behav Nutr Phys Act. 2009;6(1):71.CrossRefPubMedPubMedCentral
44.
go back to reference Cao YT, Svensson V, Marcus C, Zhang J, Zhang JD, Sobko T. Eating behaviour patterns in Chinese children aged 12-18 months and association with relative weight--factorial validation of the Children’s Eating Behaviour Questionnaire. Int J Behav Nutr Phys Act. 2012;9:5.CrossRefPubMedPubMedCentral Cao YT, Svensson V, Marcus C, Zhang J, Zhang JD, Sobko T. Eating behaviour patterns in Chinese children aged 12-18 months and association with relative weight--factorial validation of the Children’s Eating Behaviour Questionnaire. Int J Behav Nutr Phys Act. 2012;9:5.CrossRefPubMedPubMedCentral
45.
go back to reference Dwyer GM, Higgs J, Hardy LL, Baur LA. What do parents and preschool staff tell us about young children’s physical activity: a qualitative study. Int J Behav Nutr Phys Act. 2008;5(1):66.CrossRefPubMedPubMedCentral Dwyer GM, Higgs J, Hardy LL, Baur LA. What do parents and preschool staff tell us about young children’s physical activity: a qualitative study. Int J Behav Nutr Phys Act. 2008;5(1):66.CrossRefPubMedPubMedCentral
46.
go back to reference Anderson D, Field D, Collins P, Lorch E, Nathan J. Estimates of Young Children's Time with Television: A Methodological Comparison of Parent Reports with Time-Lapse Video Home Observation. Child Dev. 1985;56(5):1345-1357. Retrieved from http://www.jstor.org/stable/1130249. Anderson D, Field D, Collins P, Lorch E, Nathan J. Estimates of Young Children's Time with Television: A Methodological Comparison of Parent Reports with Time-Lapse Video Home Observation. Child Dev. 1985;56(5):1345-1357. Retrieved from http://​www.​jstor.​org/​stable/​1130249.
47.
go back to reference Parmenter K, Wardle J. Development of a general nutrition knowledge questionnaire for adults. Eur J Clin Nutr. 1999;53(4):298–308.CrossRefPubMed Parmenter K, Wardle J. Development of a general nutrition knowledge questionnaire for adults. Eur J Clin Nutr. 1999;53(4):298–308.CrossRefPubMed
48.
go back to reference Baughcum AE, Powers SW, Johnson SB, Chamberlin LA, Deeks CM, Jain A, Whitaker RC. Maternal feeding practices and beliefs and their relationships to overweight in early childhood. J Dev Behav Pediatr. 2001;22(6):391–408.CrossRefPubMed Baughcum AE, Powers SW, Johnson SB, Chamberlin LA, Deeks CM, Jain A, Whitaker RC. Maternal feeding practices and beliefs and their relationships to overweight in early childhood. J Dev Behav Pediatr. 2001;22(6):391–408.CrossRefPubMed
49.
go back to reference AIHW. The Active Australia Survey: a guide and manual for implementation, analysis and reporting. Canberra: AIHW; 2003. AIHW. The Active Australia Survey: a guide and manual for implementation, analysis and reporting. Canberra: AIHW; 2003.
50.
51.
go back to reference Lohman TG, Roche AF, Martorell R. Anthropometric Standardization Reference Manual. Champaign, IL: Human Kinetics Books; 1988. Lohman TG, Roche AF, Martorell R. Anthropometric Standardization Reference Manual. Champaign, IL: Human Kinetics Books; 1988.
52.
go back to reference WHO. Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. In: WHO Child Growth Standards: Methods and development. Geneva: World Health Organization; 2006. p. 312. WHO. Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age. In: WHO Child Growth Standards: Methods and development. Geneva: World Health Organization; 2006. p. 312.
53.
go back to reference WHO. Growth velocity based on weight, length and head circumference. In: WHO Child Growth Standards: Methods and development. Geneva; 2009: 242. WHO. Growth velocity based on weight, length and head circumference. In: WHO Child Growth Standards: Methods and development. Geneva; 2009: 242.
54.
go back to reference Leys C, Schumann S. A nonparametric method to analyze interactions: the adjusted rank transform test. J Exp Soc Psychol. 2010;46(4):684–8.CrossRef Leys C, Schumann S. A nonparametric method to analyze interactions: the adjusted rank transform test. J Exp Soc Psychol. 2010;46(4):684–8.CrossRef
Metadata
Title
A randomized controlled trial for families with preschool children - promoting healthy eating and active playtime by connecting to nature
Authors
Tanja Sobko
Michael Tse
Matthew Kaplan
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3111-0

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