Which Meso-Level Characteristics of Early Childhood Education and Care Centers Are Associated with Health, Health Behavior, and Well-Being of Young Children? Findings of a Scoping Review

A new health literacy scale for staff in preschool childcare institution: development and preliminary validation

BACKGROUND

The health literacy of staff in preschool childcare institution is an important issue to consider in providing healthcare for children aged 3-6 years, which could contribute to reducing incidence of diseases and accidental injuries as well as maintaining children's good health. Seldom instruments have been designed to measure health literacy across this group. This research aims to develop a health literacy scale for staff in preschool childcare institutions and validate its psychometric properties.

METHODS

The scale was developed through four phases. In Phase 1, an item pool was developed mainly based on literature review and kindergarten work; In Phase 2, the initial items were reviewed by fifteen experts and content validity analysis was conducted; In Phase 3, a pilot study was conducted involving 30 kindergarten staff, which aimed to further modify the scale; In Phase 4, a psychometric validation study involving 466 kindergarten staff was conducted through a cross-sectional survey in May 2023. Item analysis was performed through critical ration, correlation analysis, and Cronbach's alpha if item deleted. Construct validity was performed through exploratory (n = 190) and confirmatory factor analyses (n = 276). Convergent and discriminant validity were evaluated. Reliability was evaluated through internal consistency, split-half reliability, and test-retest reliability.

RESULTS

The final Health Literacy Scale consisted of 28 items, including dimensions of Basic Health Knowledge (11 items), Functional Health Literacy Skills (3 items), Communicative Health Literacy (5 items), and Critical Health Literacy (9 items). Principal component analysis revealed a four-factor structure that explained 80.092% of the total variance. The goodness-of-fit indices signified an adequate model fit (χ2/df = 2.093, RMSEA = 0.063, RMR = 0.031, GFI = 0.852, CFI = 0.958, NFI = 0.923, IFI = 0.958, TLI = 0.953, PCFI = 0.844). Cronbach's alpha showed a good internal consistency reaching a value of 0.921. The split-half reliability was 0.805, and the test-retest reliability was good with an intraclass correlation coefficient of 0.885 (P < 0.001).

CONCLUSIONS

The Health Literacy Scale developed in this research focuses on health literacy issues related to children aged 3-6 years. The scale is demonstrated to be valid and reliable for assessing the health literacy of staff in preschool childcare institutions. It could potentially be used as an effective instrument for targeted development of health literacy intervention.

The Influence of Educational Determinants on Children's Health: A Scoping Review of Reviews

Objectives: Education is one of the most important social determinants shaping the development and wellbeing of children. The purpose of this review of reviews is to inform policymakers, practitioners and public health stakeholder involved in developing child-friendly policies outside of the healthcare system. Methods: We carried out a scoping review of reviews. It included 32 reviews. Results: We identified four main categories of educational determinants in relation to children's health: 1) the organization and structure of educational activities, 2) the interpersonal relations in the educational facilities and structures, 3) the spatial environment of educational facilities and structures, 4) social inequalities in the educational facilities and structures. This last category highlighted the capacity of education system to act on inequalities derived from the way social structures are organized. Conclusion: We suggest a conceptual framework for action which distinguishes structural determinant (gender, race, social class, etc.) and structuring determinant (public policy, systems of governance, organization of cultures/values consideration). Finally, we discuss on how these social structures and structuring determinants influence the intermediary educational determinants collated in the review.

Socio-economic inequalities in body mass index among preschool children: do sports programs in early childhood education and care centers make a difference?

Background

Overweight in childhood is considered to be one of the most serious public health challenges. Many studies have investigated individual-level determinants of children's body mass index (BMI), yet studies exploring determinants at the meso-level are sparse. The aim of our study was to examine how a sports focus at early childhood education and care (ECEC) centers moderates the effect of parental socio-economic position (SEP) on children's BMI.

Methods

We used data from the German National Educational Panel Study and included 1,891 children (955 boys and 936 girls) from 224 ECEC centers in our analysis. Linear multilevel regressions were used to estimate the main effects of family SEP and the ECEC center sports focus, as well as their interaction, on children's BMI. All analyses were stratified by sex and adjusted for age, migration background, number of siblings, and employment status of parents.

Results

Our analysis confirmed the wellknown health inequalities in childhood overweight with a social gradient toward a higher BMI for children from lower SEP families. An interactive effect between family SEP and ECEC center sports focus was found. Boys with low family SEP not attending a sports-focused ECEC center had the highest BMI among all boys. In contrast, boys with low family SEP attending a sports-focused ECEC center had the lowest BMI. For girls, no association regarding ECEC center focus or interactive effects emerged. Girls with a high SEP had the lowest BMI, independent of the ECEC center focus.

Conclusion

We provided evidence for the gender-specific relevance of sports-focused ECEC centers for the prevention of overweight. Especially boys from low SEP families benefited from a sports focus, whereas for girls the family's SEP was more relevant. As a consequence, gender differences in determinants for BMI at different levels and their interaction should be considered in further research and preventive measures. Our research indicates that ECEC centers may decrease health inequalities by providing opportunities for physical activity.

Physical activity promotion in daycare centres in Germany: study protocol for a cross-sectional survey within the BeweKi study

INTRODUCTION

In Germany, a total of 92.2% of children between the age of 3 and school entry age attend daycare centres. Therefore, daycare centres are a suitable setting to promote physical activity among children. Yet, there is a lack of knowledge on the promotion of physical activity in daycare centres with regards to different structures and concepts, culture/policies/practices and the characteristics of directors and pedagogical staff of daycare centres in Germany. The aim of this study is to investigate (a) the status quo, as well as (b) the fostering and hindering conditions (barriers and facilitators) of physical activity promotion in daycare centres in Germany.

METHODS AND ANALYSIS

The cross-sectional study will collect data from November 2022 to February 2023. For the sample, about 5500 daycare centres will be drawn from an address database available through the German Youth Institute (DJI) and invited to the survey. From each daycare centre a director and a pedagogical staff member will be asked to fill in a standardised self-administered questionnaire. The survey explores characteristics of the daycare centre and the implementation of physical activity promotion, for example, the extent and form of physical activity promotion, the use and size of indoor and outdoor area, structural conditions such as personal and financial resources, personal attitudes towards physical activity promotion, demographic characteristics of pedagogical staff, structural daycare centre's characteristics such as proportion of children from socioeconomic disadvantaged groups. In addition, micro-geographical data on socioeconomic and infrastructural environment of the daycare centres will be included in the data set.

ETHICS AND DISSEMINATION

The study has been received and approved by the Commissioner for Data Protection of the Robert Koch Institute and by the Ethics Committee of Alice Salomon Hochschule Berlin, University of Applied Sciences. Results will be disseminated through publications and presentations to scientific community and stakeholders.

Kindergarten Affordances for Physical Activity and Preschoolers' Motor and Social-Emotional Competence

This study examined the relationship between the quality of the kindergarten physical and social environment to promote physical activity (PA) and preschoolers' motor and social-emotional competence. Two Portuguese kindergartens (Gondomar city) were selected from a pool of seventeen with an assessment of kindergarten PA best practices (one with high PA practices, the other with low). Thirty-six children (M = 4.42; SD = 1.00 years) without neuromotor disorders participated in this study. Motor and social-emotional competence were assessed with standardized motor skills tasks and parent report of child behaviors. Children from the kindergarten with higher compliance with PA best practices showed significantly better motor competence. No statistically significant differences were found for social-emotional competence scores. These findings emphasize the critical importance of kindergarten in promoting preschoolers' motor competence by assuring a physical and social environment that enhances their PA practice. This is a particularly relevant concern for directors and teachers during the post-pandemic period, given the developmental delays and decreases in physical activity preschool children experienced across the pandemic period.

Factors Associated with Motor Competence in Preschoolers from a Brazilian Urban Area

Background

Preschool is a crucial period for developing motor skills.

Objective

This study evaluated factors associated with motor competence in preschoolers from a Brazilian urban area.

Methods

A total of 211 preschoolers (51.2% girls and 48.8% boys) were evaluated. Body mass index was calculated; the Brazilian Economic Research Criterion, the Mini-Mental Scale (MMC) and the Early Childhood Environment Rating Scale®, Revised (ECERS-R™) were applied; the Habitual Physical Activity time was recorded; the Test of Gross Motor Development (TGMD-2) was performed. Univariate analysis was performed using simple linear regression for the independent variables, considering the motor test subscales as dependent variables. Variables with p < 0.20 in the univariate analysis were considered for the multiple linear regression model and were entered into the stepwise method.

Results

The independent variables remaining in the Standard Score Locomotor model were BMI, presence of park at school, and MMC (R2 = 0.16). The independent variables remaining in the Standard Object Control score were MMC and gender (R2 = 0.03). The variables associated with the highest scores of Gross Motor Quotient were MMC, body mass index, and presence of a park at school, respectively (R2 = 0.11).

Conclusion

Male eutrophic preschoolers who are physically active and attend schools with parks or courtyards in a Brazilian urban area have the highest scores for global cognitive function and motor competence.

Health Literacy in Early Childhood: A Systematic Review of Empirical Studies

Early childhood plays a key role in the formation of healthy habits and the establishment of health literacy. Nonetheless, there are only a few research studies focusing on the health literacy level of children under the age of eight. The aim of our systematic review is to explore empirical research on health literacy related to early childhood. The research was conducted in accordance with the PRISMA protocol. This systematic review examines 12 studies published between 2013–2022. Results show that research focuses on different domains of health literacy for children. In relation to children’s food literacy, children understand the relationship between health and nutrition and they realize the health impact of obesity. The habits connected to oral health are strongly associated with parents’ knowledge of and behaviours around oral health. Results related to health care situations show that children are able to be actively involved in decision-making processes in connection with their health. Exploring young children’s health literacy is essential in order to be able to plan health promotion interventions, embedded into early childhood education. Picture-based messages or story-based messages supported by illustrations can help measure health literacy in early childhood and can support the formation of health literacy.

Associations of individual factors and early childhood education and care (ECEC) centres characteristics with preschoolers' BMI in Germany

BACKGROUND

The number of obese children is rising worldwide. Many studies have investigated single determinants of children's body mass index (BMI), yet studies measuring determinants at different potential levels of influence are sparse. The aim of this study is to investigate the independent role of parental socioeconomic position (SEP), additional family factors at the micro level, as well as early childhood education and care (ECEC) centre characteristics at the meso level regarding BMI.

METHODS

Analyses used the baseline data of the PReschool INtervention Study (PRINS) including up to 1,151 children from 53 ECEC centres. Multi-level models first estimated the associations of parental SEP indicators (parental school education, vocational training, and household income) with the children's standard deviation scores for BMI (SDS BMI, standardised for age and gender). Second, structural (number of siblings), psychosocial (strained family relationships), and nutrition behavioural (soft-drink consumption, frequency of fast-food restaurant visits) family factors at the micro level were included. Third, characteristics of the ECEC centre at the meso level in terms of average group size, the ratio of overweight children in the group, ECEC centre type (all-day care), and the location of the ECEC centre (rural vs urban) were included. All analyses were stratified by gender and adjusted for age, migration background, and parental employment status.

RESULTS

Estimates for boys and girls appeared to differ. In the full model, for boys the parental SEP indicators were not related to SDS BMI. Factors related to SDS BMI in boys were: two or more siblings; B = -.55; p = 0.045 [ref.: no sibling]), the characteristics of the ECEC centre in terms of average group size (20 - 25 children; B = -.54; p = 0.022 [ref.: < 20 children]), and the ratio of overweight children (more overweight children B = -1.39; p < 0.001 [ref.: few overweight children]). For girls the number of siblings (two and more siblings; B = .67; p = 0.027 [ref.: no sibling]) and average group size (> 25 children; B = -.52; p = 0.037 [ref.: < 20 children]) were related to SDS BMI.

CONCLUSIONS

The BMI of preschool children appears to be associated with determinants at the micro and meso level, however with some gender differences. The identified factors at the micro and meso level appear largely modifiable and can inform about possible interventions to reduce obesity in preschool children.

Moderating or mediating effects of family characteristics on socioeconomic inequalities in child health in high-income countries - a scoping review

BACKGROUND

By explaining the development of health inequalities, eco-social theories highlight the importance of social environments that children are embedded in. The most important environment during early childhood is the family, as it profoundly influences children's health through various characteristics. These include family processes, family structure/size, and living conditions, and are closely linked to the socioeconomic position (SEP) of the family. Although it is known that the SEP contributes to health inequalities in early childhood, the effects of family characteristics on health inequalities remain unclear. The objective of this scoping review is to synthesise existing research on the mediating and moderating effects of family characteristics on socioeconomic health inequalities (HI) during early childhood in high-income countries.

METHODS

This review followed the methodology of "Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews". To identify German and English scientific peer-reviewed literature published from January 1^st, 2000, to December 19^th, 2019, the following search term blocks were linked with the logical operator "AND": (1) family structure/size, processes, living conditions, (2) inequalities, disparities, diversities, (3) income, education, occupation, (4) health and (5) young children. The search covered the electronic databases PubMed, PsycINFO, and Scopus.

RESULTS

The search yielded 7,089 records. After title/abstract and full-text screening, only ten peer-reviewed articles were included in the synthesis, which analysed the effects of family characteristics on HI in early childhood. Family processes (i.e., rules /descriptive norms, stress, parental screen time, parent-child conflicts) are identified to have mediating or moderating effects. While families' living conditions (i.e., TVs in children's bedrooms) are suggested as mediating factors, family structure/size (i.e., single parenthood, number of children in the household) appear to moderate health inequalities.

CONCLUSION

Family characteristics contribute to health inequalities in early childhood. The results provide overall support of models of family stress and family investment. However, knowledge gaps remain regarding the role of family health literacy, regarding a wide range of children's health outcomes (e.g., oral health, inflammation parameters, weight, and height), and the development of health inequalities over the life course starting at birth.