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Onyimadu O, Astbury NM, Achana F, Petrou S, Violato M. Childhood Transitions Between Weight Status Categories: Evidence from the UK Millennium Cohort Study. PHARMACOECONOMICS 2024; 42:649-661. [PMID: 38568340 PMCID: PMC11126508 DOI: 10.1007/s40273-024-01361-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Assessing the cost-effectiveness of interventions targeting childhood excess weight requires estimates of the hazards of transitioning between weight status categories. Current estimates are based on studies characterized by insufficient sample sizes, a lack of national representativeness, and untested assumptions. OBJECTIVES We sought to (1) estimate transition probabilities and hazard ratios for transitioning between childhood weight status categories, (2) test the validity of the underlying assumption in the literature that transitions between childhood bodyweight categories are time-homogeneous, (3) account for complex sampling procedures when deriving nationally representative transition estimates, and (4) explore the impact of child, maternal, and sociodemographic characteristics. METHODS We applied a multistate transition modeling approach accounting for complex survey design to UK Millennium Cohort Study (MCS) data to predict transition probabilities and hazard ratios for weight status movements for children aged 3-17. Surveys were conducted at ages 3 (wave 2 in 2004), 5 (wave 3 in 2006), 7 (wave 4 in 2008), 11 (wave 5 in 2012), 14 (wave 6 in 2015), and 17 (wave 7 in 2018) years. We derived datasets that included repeated body mass index measurements across waves after excluding multiple births and children with missing or implausible bodyweight records. To account for the stratified cluster sample design of the MCS, we incorporated survey weights and jackknife replicates of survey weights. Using a validation dataset from the MCS, we tested the validity of our models. Finally, we estimated the relationships between state transitions and child, maternal, and sociodemographic factors. RESULTS The datasets for our primary analysis consisted of 10,399 children for waves 2-3, 10,729 for waves 3-4, 9685 for waves 4-5, 8593 for waves 5-6, and 7085 for waves 6-7. All datasets consisted of roughly equal splits of boys and girls. Under the assumption of time-heterogeneous transition rates (our base-case model), younger children (ages 3-5 and 5-7 years) had significantly higher annual transition probabilities of moving from healthy weight to overweight (0.033, 95% confidence interval [CI] 0.026-0.041, and 0.027, 95% CI 0.021-0.033, respectively) compared to older children (0.015, 95% CI 0.012-0.018, at ages 7-11; 0.018, 95% CI 0.013-0.023, at ages 11-14; and 0.018, 95% CI 0.013-0.025 at ages 14-17 years). However, the resolution of unhealthy weight was more strongly age-dependent than transitions from healthy weight to non-healthy weight states. Transition hazards differed by child, maternal, and sociodemographic factors. CONCLUSIONS Our models generated estimates of bodyweight status transitions in a representative UK childhood population. Compared to our scenario models (i.e., time-homogeneous transition rates), our base-case model fits the observed data best, indicating a non-time-homogeneous pattern in transitions between bodyweight categories during childhood. Transition hazards varied significantly by age and across subpopulations, suggesting that conducting subgroup-specific cost-effectiveness analyses of childhood weight management interventions will optimize decision-making.
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Affiliation(s)
- Olu Onyimadu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Felix Achana
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
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Onyimadu O, Violato M, Astbury NM, Hüls H, Heath L, Shipley A, Taylor H, Wilkins LE, Abhari RE, Jebb SA, Petrou S. A systematic review of economic evaluations of interventions targeting childhood overweight and obesity. Obes Rev 2023; 24:e13597. [PMID: 37463862 DOI: 10.1111/obr.13597] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 05/03/2023] [Accepted: 05/29/2023] [Indexed: 07/20/2023]
Abstract
This systematic review critically appraised and synthesized evidence from economic evaluations of interventions targeting childhood excess weight. We conducted systematic searches in 11 databases from inception to April 19, 2023. Studies were eligible if they evaluated interventions targeting children up to 18 years and the study intervention(s) targeted childhood excess weight or sought to improve diet or physical activity, regardless of the type of economic evaluation or the underpinning study design. We synthesized evidence using narrative synthesis methods. One-hundred fifty-one studies met the eligibility criteria and were classified into three groups based on the intervention approach: prevention-only (13 studies), prevention and treatment (100 studies), and treatment-only (38 studies). The predominant setting and study design differed considerably between the three groups of studies. However, compared with usual care, most interventions were deemed cost-effective. The study participants' ages, sex, and socioeconomic status were crucial to intervention cost-effectiveness. Interventions whose effects were projected beyond childhood, such as bariatric surgery, lower protein infant formula, and home-based general practitioner consultations, tended to be cost-effective. However, cost-effectiveness was sensitive to the assumptions underlying the persistence and intensity of such effects. Our findings can inform future recommendations on the conduct of economic evaluations of interventions targeting childhood overweight and obesity, as well as practice and policy recommendations.
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Affiliation(s)
- Olu Onyimadu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hannah Hüls
- The TUM School of Medicine, Technical University Munich, Munich, Germany
- The TUM School of Management, Technical University Munich, Munich, Germany
| | - Laura Heath
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alexandra Shipley
- Level 3, John Radcliffe Hospital, Oxford University Medical School, Oxford, UK
| | - Harriet Taylor
- Level 3, John Radcliffe Hospital, Oxford University Medical School, Oxford, UK
| | | | - Roxanna E Abhari
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Murphy P, Hinde S, Fulbright H, Padgett L, Richardson G. Methods of assessing value for money of UK-based early childhood public health interventions: a systematic literature review. Br Med Bull 2022; 145:88-109. [PMID: 36542119 PMCID: PMC10075243 DOI: 10.1093/bmb/ldac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/25/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Economic evaluation has an important role to play in the demonstration of value for money of early childhood public health interventions; however, concerns have been raised regarding their consistent application and relevance to commissioners. This systematic review of the literature therefore aims to collate the breadth of the existing economic evaluation evidence of these interventions and to identify the approaches adopted in the assessment of value. SOURCE OF DATA Recently published literature in Medline, EMBASE, EconLit, Health Management Information Consortium, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Health Technology Assessment, NHS EED and Web of Science. AREAS OF AGREEMENT The importance of the early childhood period on future health and well-being as well as the potential to impact health inequalities making for a strong narrative case for expenditure in early childhood public health. AREAS OF CONTROVERSY The most appropriate approaches to evaluating value for money of such preventative interventions relevant for UK decision-makers given the evident challenges. GROWING POINTS The presented review considered inconsistencies across methodological approaches used to demonstrate value for money. The results showed a mixed picture in terms of demonstrating value for money. AREAS TIMELY FOR DEVELOPING RESEARCH Future resource allocations decisions regarding early childhood public health interventions may benefit from consistency in the evaluative frameworks and health outcomes captured, as well as consistency in approaches to incorporating non-health costs and outcomes, incorporating equity concerns and the use of appropriate time horizons.
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Affiliation(s)
- Peter Murphy
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Sebastian Hinde
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Helen Fulbright
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
| | - Louise Padgett
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Gerry Richardson
- Centre for Health Economics, University of York, York, YO10 5DD, UK
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Traynor O, McCrorie P, Chng NR, Martin A. Evaluating Outdoor Nature-Based Early Learning and Childcare Provision for Children Aged 3 Years: Protocol of a Feasibility and Pilot Quasi-Experimental Design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7461. [PMID: 35742709 PMCID: PMC9224218 DOI: 10.3390/ijerph19127461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023]
Abstract
Systematic reviews have demonstrated the scarcity of well-designed evaluations investigating outdoor nature-based play and learning provision for children in the early learning and childcare (ELC) sector among global Western countries. This study will examine the feasibility and acceptability of the programme and the evaluation design of outdoor nature-based play and learning provision across urban ELC settings in a Scottish metropolitan city. Six ELC settings with different outdoor nature-based play delivery models will be recruited. One trial design will be tested: a quasi-experimental comparison of children attending three different models of outdoor play and learning provision. Measures will be assessed at baseline and five weeks later. Key feasibility questions include: recruitment and retention of ELC settings and children; suitability of statistical matching based on propensity score; completeness of outcome measures. Process evaluation will assess the acceptability of trial design methods and provision of outdoor nature-based play among ELC educators. These questions will be assessed against pre-defined progression criteria. This feasibility study will inform a powered effectiveness evaluation and support policy making and service delivery in the Scottish ELC sector.
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Affiliation(s)
- Oliver Traynor
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 99 Berkeley Street, Glasgow G3 7HR, UK; (P.M.); (N.R.C.); (A.M.)
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Phillips SM, Summerbell C, Hesketh KR, Saxena S, Hillier-Brown FC. Parental Views on the Acceptability and Feasibility of Measurement Tools Used to Assess Movement Behaviour of Pre-School Children: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3733. [PMID: 35329419 PMCID: PMC8949363 DOI: 10.3390/ijerph19063733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/04/2022]
Abstract
Movement behaviours (physical activity, sedentary behaviour, and sleep) are important for the health and development of pre-school children (aged 3-4 years). There is limited qualitative research examining the acceptability and feasibility of tools used to assess movement behaviours in pre-schoolers. This study explored parental views on various measurement tools in three deprived areas in England, UK (West Yorkshire, County Durham and Northumberland). The study consisted of a demonstration of the different tools (accelerometers, a diary and a questionnaire), directly followed by focus group discussions. Three focus group discussions with a total of eleven parents and carers were transcribed verbatim and analysed using thematic analysis. Findings revealed four main themes: (1) importance of contextual information when using any measurement tool (e.g., child illness, capturing different routines); (2) practical issues associated with devices (e.g., aversion to devices being attached directly to the skin of their child; concern of larger devices during sleep time); (3) encouraging children to wear a device (e.g., making devices attractive to children-'superpowers'); and (4) presentation of diaries and questionnaires (e.g., age-appropriate movement activities, preference for real-time recording over recall). Practical recommendations for the use of the tools to measure movement behaviours of pre-school children are provided.
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Affiliation(s)
- Sophie M. Phillips
- Department of Sport and Exercise Sciences, Durham University, Durham DH1 3HN, UK;
- The Centre for Translational Research in Public Health (Fuse), Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Durham DH1 3HN, UK;
- The Centre for Translational Research in Public Health (Fuse), Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| | - Kathryn R. Hesketh
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, UK;
- Population Policy & Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Sonia Saxena
- School of Public Health, Imperial College London, London W6 8RP, UK;
| | - Frances C. Hillier-Brown
- The Centre for Translational Research in Public Health (Fuse), Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Newcastle University Centre of Research Excellence in Healthier Lives, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
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Luecking CT, Neshteruk CD, Mazzucca S, Ward DS. Efficacy of an Enhanced Implementation Strategy to Increase Parent Engagement with a Health Promotion Program in Childcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:106. [PMID: 35010364 PMCID: PMC8750233 DOI: 10.3390/ijerph19010106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 06/14/2023]
Abstract
Previous efforts to involve parents in implementation of childcare-based health promotion interventions have yielded limited success, suggesting a need for different implementation strategies. This study evaluated the efficacy of an enhanced implementation strategy to increase parent engagement with Healthy Me, Healthy We. This quasi-experimental study included childcare centers from the second of two waves of a cluster-randomized trial. The standard approach (giving parents intervention materials, prompting participation at home, inviting participation with classroom events) was delivered in 2016-2017 (29 centers, 116 providers, and 199 parents). The enhanced approach (standard plus seeking feedback, identifying and addressing barriers to parent participation) was delivered in 2017-2018 (13 centers, 57 providers, and 114 parents). Parent engagement was evaluated at two levels. For the center-level, structured interview questions with providers throughout the intervention were systematically scored. For the parent-level, parents completed surveys following the intervention. Differences in parent engagement were evaluated using linear regression (center-level) and mixed effects (parent-level) models. Statistical significance was set at p < 0.025 for two primary outcomes. There was no difference in parent engagement between approaches at the center-level, β = -1.45 (95% confidence interval, -4.76 to 1.87), p = 0.38l. However, the enhanced approach had higher parent-level scores, β = 3.60, (95% confidence interval, 1.49 to 5.75), p < 0.001. In the enhanced approach group, providers consistently reported greater satisfaction with the intervention than parents (p < 0.001), yet their fidelity of implementing the enhanced approach was low (less than 20%). Results show promise that parent engagement with childcare-based health promotion innovations can positively respond to appropriately designed and executed implementation strategies, but strategies need to be feasible and acceptable for all stakeholders.
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Affiliation(s)
- Courtney T. Luecking
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY 40506, USA
| | - Cody D. Neshteruk
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, USA;
| | - Stephanie Mazzucca
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA;
| | - Dianne S. Ward
- Center for Health Promotion and Disease Prevention, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
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Clemes SA, Bingham DD, Pearson N, Chen YL, Edwardson C, McEachan R, Tolfrey K, Cale L, Richardson G, Fray M, Altunkaya J, Bandelow S, Jaicim NB, Barber SE. Sit–stand desks to reduce sedentary behaviour in 9- to 10-year-olds: the Stand Out in Class pilot cluster RCT. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background
Sedentary behaviour (sitting) is a highly prevalent negative health behaviour, with individuals of all ages exposed to environments that promote prolonged sitting. The school classroom represents an ideal setting for environmental change through the provision of sit–stand desks.
Objectives
The aim of this study was to undertake a pilot cluster randomised controlled trial of the introduction of sit–stand desks in primary school classrooms, to inform a definitive trial. Objectives included providing information on school and participant recruitment and retention, acceptability of the intervention, and outcome measures. A preliminary estimate of the intervention’s effectiveness on the proposed primary outcome (change in weekday sitting time) for inclusion in a definitive trial was calculated, along with a preliminary assessment of potential cost-effectiveness. A full process evaluation was also undertaken.
Design
A two-armed pilot cluster randomised controlled trial with economic and qualitative evaluations. Schools were randomised on a 1 : 1 basis to the intervention (n = 4) or control (n = 4) trial arms.
Setting
Primary schools in Bradford, West Yorkshire, UK.
Participants
Children in Year 5 (i.e. aged 9–10 years).
Intervention
Six sit–stand desks replaced three standard desks (sitting six children) in the intervention classrooms for 4.5 months. Teachers were encouraged to ensure that all pupils were exposed to the sit–stand desks for at least 1 hour per day, on average, using a rotation system. Schools assigned to the control arm continued with their usual practice.
Main outcome measures
Trial feasibility outcomes included school and participant recruitment and attrition, acceptability of the intervention, and acceptability of and compliance with the proposed outcome measures [including weekday sitting measured using activPAL™ (PAL Technologies Ltd, Glasgow, UK) accelerometers, physical activity, adiposity, blood pressure, cognitive function, musculoskeletal comfort, academic progress, engagement and behaviour].
Results
Thirty-three per cent of schools approached and 75% (n = 176) of eligible children took part. At the 7-month follow-up, retention rates were 100% for schools and 97% for children. Outcome measure completion rates ranged from 63% to 97%. A preliminary estimate of intervention effectiveness, from a weighted linear regression model (adjusting for baseline sitting time and wear time) revealed a mean difference in change in sitting of –30.6 minutes per day (95% confidence interval –56.42 to –4.84 minutes per day) between the intervention and control trial arms. The process evaluation revealed that the intervention, recruitment and evaluation procedures were acceptable to teachers and children, with the exception of minor issues around activPAL attachment. A preliminary within-trial economic analysis revealed no difference between intervention and control trial arms in health and education resource use or outcomes. Long-term modelling estimated an unadjusted incremental cost-effectiveness ratio of Stand Out in Class of £78,986 per quality-adjusted life-year gained.
Conclusion
This study has provided evidence of the acceptability and feasibility of the Stand Out in Class intervention and evaluation methods. Preliminary evidence suggests that the intervention may have a positive direction of effect on weekday sitting time, which warrants testing in a full cluster randomised controlled trial. Lessons learnt from this trial will inform the planning of a definitive trial.
Trial registration
Current Controlled Trials ISRCTN12915848.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Stacy A Clemes
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
| | - Daniel D Bingham
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Natalie Pearson
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Yu-Ling Chen
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Charlotte Edwardson
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Rosemary McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Keith Tolfrey
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
| | - Lorraine Cale
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Mike Fray
- Loughborough Design School, Loughborough University, Loughborough, UK
| | | | - Stephan Bandelow
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Sally E Barber
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Tucker P, Vanderloo LM, Johnson AM, Burke SM, Irwin JD, Gaston A, Driediger M, Timmons BW. Impact of the Supporting Physical Activity in the Childcare Environment (SPACE) intervention on preschoolers' physical activity levels and sedentary time: a single-blind cluster randomized controlled trial. Int J Behav Nutr Phys Act 2017; 14:120. [PMID: 28882152 PMCID: PMC5590124 DOI: 10.1186/s12966-017-0579-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/29/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Physical activity levels among preschoolers in childcare are low and sedentary time high. The Supporting Physical Activity in the Childcare Environment (SPACE) intervention had three components: 1. portable play equipment; 2. staff training; and, 3. modified outdoor playtime (i.e., shorter, more frequent periods). This study aimed to examine the effectiveness of the SPACE intervention on preschoolers' physical activity levels and sedentary time during childcare hours (compared to standard care). METHODS Via a single-blind cluster randomized controlled trial, 338 preschoolers (39.86 ± 7.33 months; 52% boys) from 22 centre-based childcare facilities (11 experimental, 11 control) were enrolled. Preschoolers wore an Actical™ accelerometer for 5 days during childcare hours at baseline, post-intervention, and 6- and 12-month follow-up, and were included in the analyses if they had a minimum of two valid days (5 h each day) at baseline and one additional time point. Intervention effectiveness was tested using a linear mixed effects model for each of the four outcome variables (i.e., sedentary time, light physical activity [LPA], moderate-to-vigorous physical activity [MVPA], and total physical activity [TPA]). Fixed effects were further evaluated with t-tests, for which degrees of freedom were estimated using a Satterthwaite approximation. RESULTS One hundred and ninety-five preschoolers were retained for analyses. The intervention did not significantly impact LPA. MVPA was significantly greater among children in the experimental group when comparing post-intervention to pre-intervention, t(318) = 3.50, p = .0005, but no intervention effects were evident at 6- or 12-month follow-up. TPA was significantly greater for children in the intervention group at post-intervention when compared to pre-intervention, t(321) = 2.70, p = .007, with no intervention effects evident at later time periods. Finally, sedentary time was significantly lower among preschoolers in the experimental group when comparing post-intervention to pre-intervention, t(322) = 2.63, p = .009, with no significant effects at follow-up. CONCLUSIONS The SPACE intervention was effective at increasing MVPA and TPA among preschoolers, while simultaneously decreasing sedentary time. The ability of the SPACE intervention to target higher intensity activity is promising, as MVPA levels have been documented to be low in centre-based childcare. The changes in physical activity were not sustained long term (6- or 12-month follow-up). TRIAL REGISTRATION ISRCTN70604107 (October 8, 2014).
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Affiliation(s)
- Patricia Tucker
- School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Road, Elborn College, Room 2547, London, ON N6G 1H1 Canada
| | - Leigh M. Vanderloo
- Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, ON Canada
| | - Andrew M. Johnson
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON Canada
| | - Shauna M. Burke
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON Canada
| | - Jennifer D. Irwin
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON Canada
| | - Anca Gaston
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, ON Canada
| | - Molly Driediger
- School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Road, Elborn College, Room 2547, London, ON N6G 1H1 Canada
| | - Brian W. Timmons
- Child Health & Exercise Medicine Program, McMaster University, Hamilton, Canada
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Barber SE, Jackson C, Hewitt C, Ainsworth HR, Buckley H, Akhtar S, Bingham DD, Routen AC, Summerbell C, Richardson G, Moore HJ, Pickett KE, O'Malley C, Brierley S, Wright J. Assessing the feasibility of evaluating and delivering a physical activity intervention for pre-school children: a pilot randomised controlled trial. Pilot Feasibility Stud 2016; 2:12. [PMID: 27965832 PMCID: PMC5154100 DOI: 10.1186/s40814-016-0052-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 02/10/2016] [Indexed: 12/03/2022] Open
Abstract
Background Few evidence-based physical activity interventions for pre-school children are available. This two-armed pilot cluster randomised controlled trial aimed to evaluate the feasibility of conducting a full-scale trial and of delivering an outdoor physical activity intervention for pre-school children. Methods School was the unit of randomisation, and follow-up occurred at 10 and 52 weeks. Trial feasibility was assessed by recruitment, retention and completion rates of primary (daily moderate-to-vigorous physical activity (MVPA)) and secondary (anthropometric, quality of life, self-efficacy) outcomes. Potential effectiveness was assessed for the primary outcome using a linear regression model comparing MVPA between trial arms adjusting for clustering by school. Feasibility of delivering the intervention was assessed by intervention fidelity and attendance. Semi-structured interviews with parents, intervention facilitators, and head teachers explored acceptability and capability to deliver the intervention as well as acceptability of the study design. Results Recruitment rates were 37 % of schools (n = 10 schools) and 48 % of pre-school children (n = 164 children). Retention of children to the trial at 52 weeks was 83.5 %. Thirty-nine percent of children had valid primary outcome accelerometer data at baseline and 52 weeks. Response rates for secondary outcome measures ranged from 52 to 88 % at 10 weeks and 59 to 80 % at 52 weeks. The mean difference in daily MVPA between trial arms at 52 weeks was 0.4, 95 % CI 16.3 to 17.0; p = 0.96. Fidelity of intervention implementation was 81 %. Intervention attendance was higher (82 %) during the summer initiation phase compared to autumn/spring initiation (50 %). Parents, facilitators and head teachers found the intervention acceptable and beneficial. Conclusions Recruitment and retention rates suggest a trial in this outdoor setting with this population was feasible but is weather sensitive. However, strategies to increase accelerometer wear-time would need to be implemented for reliable primary outcome data to be obtained. There was high implementation fidelity by facilitators, and the intervention was seen as acceptable and deliverable. However, attendance was low and preliminary data showed no evidence of intervention effectiveness. A revised intervention, building on the successful elements of this pilot alongside adapting implementation strategies to improve attendance, should therefore be considered. Trial registration Trial registry name and number: Current Controlled Trials, ISRCTN54165860. Date of registration: 4 September 2012.
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Affiliation(s)
- Sally E Barber
- Born in Bradford Cohort Study, BiB Project Office, Temple Bank House, Bradford Royal Infirmary, Bradford Institute for Health Research, Duckworth Lane, Bradford, BD9 6RJ UK
| | - Cath Jackson
- Department of Health Sciences, University of York, York, UK
| | | | | | - Hannah Buckley
- Department of Health Sciences, University of York, York, UK
| | - Shaheen Akhtar
- Born in Bradford Cohort Study, BiB Project Office, Temple Bank House, Bradford Royal Infirmary, Bradford Institute for Health Research, Duckworth Lane, Bradford, BD9 6RJ UK
| | - Daniel D Bingham
- Born in Bradford Cohort Study, BiB Project Office, Temple Bank House, Bradford Royal Infirmary, Bradford Institute for Health Research, Duckworth Lane, Bradford, BD9 6RJ UK.,National Centre for Sport and Exercise Medicine (NCSEM), School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Ash C Routen
- National Centre for Sport and Exercise Medicine (NCSEM), School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Carolyn Summerbell
- School of Medicine, Pharmacy and Health, Durham University Queens Campus, Stockton-on-Tees, Durham UK
| | | | - Helen J Moore
- School of Medicine, Pharmacy and Health, Durham University Queens Campus, Stockton-on-Tees, Durham UK
| | - Kate E Pickett
- Department of Health Sciences, University of York, York, UK
| | - Claire O'Malley
- School of Medicine, Pharmacy and Health, Durham University Queens Campus, Stockton-on-Tees, Durham UK
| | - Shirley Brierley
- Public Health, City of Bradford Metropolitan District Council, Bradford, UK
| | - John Wright
- Born in Bradford Cohort Study, BiB Project Office, Temple Bank House, Bradford Royal Infirmary, Bradford Institute for Health Research, Duckworth Lane, Bradford, BD9 6RJ UK
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