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

Open Access 01-12-2019 | Nutrition | Research article

A physical activity, nutrition and oral health intervention in nursery settings: process evaluation of the NAP SACC UK feasibility cluster RCT

Authors: Rebecca Langford, Russell Jago, James White, Laurence Moore, Angeliki Papadaki, William Hollingworth, Chris Metcalfe, Dianne Ward, Rona Campbell, Sian Wells, Ruth Kipping

Published in: BMC Public Health | Issue 1/2019

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Abstract

Background

The nutrition and physical activity self-assessment for childcare (NAP SACC) intervention has demonstrated effectiveness in the USA. A feasibility randomised controlled trial was conducted in England to adapt the intervention to the UK context. An embedded process evaluation focused on three key questions. 1. Was it feasible and acceptable to implement the intervention as planned? 2. How did the intervention affect staff and parent mediators? 3. Were the trial design and methods acceptable?

Methods

Twelve nurseries in south-west England were recruited and randomised to intervention or control. The intervention comprised: NAP SACC UK Partner (Health Visitor) support to nurseries to review practice and policies against best practice, and then set goals to improve physical activity, nutrition and oral health; two staff training workshops; and a web-based parent support element. The process evaluation comprised: observations of Partner training (n = 1), Partner/manager meetings (n = 5) and staff workshops (n = 10); semi-structured interviews with Partners (n = 4), managers (n = 12), staff (n = 4) and parents (n = 20); analysis of self-assessment forms, goal setting forms and Partner logbooks; and assessment of staff and parent knowledge, motivation and self-efficacy mediators.

Results

Overall, NAP SACC UK was feasible to implement and acceptable to nursery staff, managers, Partners and parents. The intervention was implemented as planned in five of the six intervention nurseries. Partners and managers appreciated the opportunity to review and improve nursery practices and valued the relationship forged between them. Staff rated the training workshops highly, despite attending outside of working hours. Most goals set by nurseries were achieved. However, Partners raised concerns about Health Visitors’ capacity to deliver the intervention in any subsequent roll out. Mediator scores improved in all but two areas in intervention staff and parents, with decreases or minimal changes in the control group. The web-based parent element was not well used and should be removed from any subsequent trial. The trial methods were acceptable to managers, staff, Partners and parents.

Conclusions

Implementing and evaluating a physical activity and nutrition intervention in nursery settings is feasible and acceptable. A full RCT of NAP SACC UK (with appropriate modifications) is warranted.

Trial registration

ISRCTN16287377 (10 Apr 2015).
Appendix
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Literature
1.
2.
Simmonds M, Llewellyn A, Owen C, Woolacott N. Predicting adult obesity from childhood obesity: a systematic review and meta-analysis. Obes Rev. 2016;17(2):95–107.CrossRef
3.
4.
5.
Public Health England & Food Standards Agency: National Diet and Nutrition Survey Results from Years 7 and 8 (combined) of the Rolling Programme (2014/2015–2015/2016). 2018.
6.
7.
8.
9.
10.
11.
O’Dwyer MV, Fairclough SJ, Knowles Z, Stratton G. Effect of a family focused active play intervention on sedentary time and physical activity in preschool children. Int J Behav Nutr Phys Act. 2012;9(117):1479–5868.
12.
Foulkes JD, Knowles Z, Fairclough S, Stratton G, O’Dwyer M, Ridgers N, Foweather L. Effect of a 6-week active play intervention on fundamental movement skill competence of preschool children:a cluster randomized controlled trial. Percept Mot Skills. 2017;124(2):393–412.CrossRef
13.
Watt R. Exploratory and developmental trial of a family centred nutrition intervention delivered in Children's Centres. London: University College London; 2012.
14.
Reilly JJ, Kelly L, Montgomery C, Williamson A, Fisher A, McColl JH, Lo Conte R, Paton JY, Grant S. Physical activity to prevent obesity in young children: cluster randomised controlled trial. Bmj. 2006;333(7577):1041.CrossRef
15.
Ward DS, Benjamin SE, Ammerman AS, Ball SC, Neelon BH, Bangdiwala SI. Nutrition and physical activity in child care: results from an environmental intervention. Am J Prev Med. 2008;35(4):352–6.CrossRef
16.
Alkon A, Crowley AA, Neelon SE, Hill S, Pan Y, Nguyen V, Rose R, Savage E, Forestieri N, Shipman L. Nutrition and physical activity randomized control trial in child care centers improves knowledge, policies, and children's body mass index. BMC Public Health. 2014;14(1):215.CrossRef
17.
Bonis M, Loftin M, Ward D, Tseng TS, Clesi A, Sothern M. Improving physical activity in daycare interventions. Child Obes. 2014;10(4):334–41.CrossRef
18.
19.
20.
Kipping R, Langford R, Brockman R, Wells S, Metcalfe C, Papadaki A, White J, Hollingworth W, Moore L, Ward D et al. Physical activity, oral health and nutrition environmental nursery and web-based home intervention for 2–4 year olds: NAP SACC UK feasibility cluster RCT. Public Health Research; 2019. In Press.
21.
Kipping R, Jago R, Metcalfe C, White J, Papadaki A, Campbell R, Hollingworth W, Ward D, Wells S, Brockman R. NAP SACC UK: protocol for a feasibility cluster randomised controlled trial in nurseries and at home to increase physical activity and healthy eating in children aged 2–4 years. BMJ Open. 2016;6(4):e010622.CrossRef
22.
Dias K, White J, Metcalfe C, Kipping R, Papadaki A, Jago R: Acceptability, internal consistency and test-retest reliability of scales to assess parental and nursery staff’s self-efficacy, motivation and knowledge in relation to preschoolers’ nutrition, oral health and physical activity. Public Health Nutrition In press.
23.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
24.
25.
Benjamin SE, Ammerman A, Sommers J, Dodds J, Neelon B, Ward DS. Nutrition and physical activity self-assessment for child care (NAP SACC): results from a pilot intervention. J Nutr Educ Behav. 2007;39(3):142–9.CrossRef
26.
Dias K, White J, Metcalfe C, Kipping R, Papadaki A, Jago R. Acceptability, internal consistency and test–retest reliability of scales to assess parental and nursery staff’s self-efficacy, motivation and knowledge in relation to pre-school children’s nutrition, oral health and physical activity. Public Health Nutr. 2019:1–9.
27.
Alhassan S, Sirard JR, Robinson TN. The effects of increasing outdoor play time on physical activity in Latino preschool children. Int J Pediatr Obes. 2007;2(3):153–8.CrossRef
28.
Binkley T, Specker B. Increased periosteal circumference remains present 12 months after an exercise intervention in preschool children. Bone. 2004;35(6):1383–8.CrossRef
29.
Dennison BA, Russo TJ, Burdick PA, Jenkins PL. An intervention to reduce television viewing by preschool children. Arch Pediatr Adolesc Med. 2004;158(2):170–6.CrossRef
30.
Fitzgibbon ML, Stolley MR, Schiffer LA, Braunschweig CL, Gomez SL, Horn L, Dyer AR. Hip-hop to health Jr. obesity prevention effectiveness trial: Postintervention results. Obesity. 2011;19(5):994–1003.CrossRef
31.
Trost SG, Fees B, Dzewaltowski D. Feasibility and efficacy of a “move and learn” physical activity curriculum in preschool children. J Phys Act Health. 2008;5(1):88.CrossRef
32.
Hardy L, King L, Kelly B, Farrell L, Howlett S. Munch and move: evaluation of a preschool healthy eating and movement skill program. Int J Behav Nutr Phys Act. 2010;7:80.CrossRef
33.
De Bock F, Breitenstein L, Fischer JE. Positive impact of a pre-school-based nutritional intervention on children’s fruit and vegetable intake: results of a cluster-randomized trial. Public Health Nutr. 2012;15(03):466–75.CrossRef
34.
Bayer O, von Kries R, Strauss A, Mitschek C, Toschke AM, Hose A, Koletzko BV. 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.CrossRef
35.
Manios Y, Grammatikaki E, Androutsos O, Chinapaw M, Gibson E, Buijs G, Iotova V, Socha P, Annemans L, Wildgruber A. A systematic approach for the development of a kindergarten-based intervention for the prevention of obesity in preschool age children: the ToyBox-study. Obes Rev. 2012;13(s1):3–12.CrossRef
36.
Natale R, Ludwig D, Sardinas K, Change Martinez C, Palenzuela J, M S SM. NIFA poster abstract healthy caregivers healthy children phase 2 (HC2): relationship between childcare center nutrition and physical activity environment and child body mass index over one school year. J Nutr Educ Behav. 2017;49(7, Supplement 1, July–August 2017):S119–20.CrossRef
37.
Roth K, Kriemler S, Lehmacher W, Ruf KC, Graf C, Hebestreit H. Effects of a physical activity intervention in preschool children. Med Sci Sports Exerc. 2015;47(12):2542–51.CrossRef
38.
Roth K, Mauer S, Obinger M, Ruf KC, Graf C, Kriemler S, Lenz D, Lehmacher W, Hebestreit H. Prevention through activity in kindergarten trial (PAKT): a cluster randomised controlled trial to assess the effects of an activity intervention in preschool children. BMC Public Health. 2010;10(1):410.CrossRef
39.
Pate RR, Brown WH, Pfeiffer KA, Howie EK, Saunders RP, Addy CL, Dowda M. An intervention to increase physical activity in children: a randomized controlled trial with 4-year-olds in preschools. Am J Prev Med. 2016;51(1):12–22.CrossRef
40.
De Craemer M, De Decker E, Verloigne M, De Bourdeaudhuij I, Manios Y, Cardon G. The effect of a kindergarten-based, family-involved intervention on objectively measured physical activity in Belgian preschool boys and girls of high and low SES: the ToyBox-study. Int J Behav Nutr Phys Act. 2014;11(1):38.CrossRef
Metadata
Title
A physical activity, nutrition and oral health intervention in nursery settings: process evaluation of the NAP SACC UK feasibility cluster RCT
Authors
Rebecca Langford
Russell Jago
James White
Laurence Moore
Angeliki Papadaki
William Hollingworth
Chris Metcalfe
Dianne Ward
Rona Campbell
Sian Wells
Ruth Kipping
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Nutrition
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-7102-9

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