A multi-component tailored intervention in family childcare homes improves diet quality and sedentary behavior of preschool children compared to an attention control: results from the Healthy Start-Comienzos Sanos cluster randomized trial

Abstract

Background Childcare settings are important environments for influencing child eating and physical activity (PA). Family childcare homes (FCCH) care for many children of low-income and diverse racial/ethnic backgrounds who are at greater risk for poor diet quality, low PA, and obesity, but few interventions have targeted this setting. The aim of this study was to assess the efficacy of a multicomponent intervention conducted in FCCH on the diet quality and PA of 2–5 year old children in their care. Trial design Cluster randomized trial. Methods The cluster-randomized trial, Healthy Start/Comienzos Sanos (2015–2019) evaluated an 8-month nutrition and PA intervention that included four components: (1) monthly telephone calls from a support coach using brief motivational interviewing, (2) tailored reports, newsletters and videos, (3) group support meetings, and (4) active play toys. After completing baseline measurement, FCCH were randomized into intervention or comparison groups in matched pairs. Both groups received the same intervention components but on different topics (intervention: nutrition/PA vs. comparison: reading readiness/literacy). Evaluation staff were blinded to group assignment. Child primary outcome measures collected at baseline and 8-months included: 1) Healthy Eating Index (HEI-2015) scores calculated from diet observation, and 2) accelerometer measurement of PA. Process measures were collected from field data and provider surveys. Generalized Estimating Equation Models assessed changes in HEI-2015 scores and PA over time by experimental condition. Results Ethnically diverse FCCH providers (n = 119) and 2-to-5-year-old children in their care (n = 377) were included in the final analysis. Process evaluation showed high participation in all intervention components except for group meetings. Compared to children in comparison group FCCH, children in intervention FCCH increased total HEI-2015 scores by 7.2 points (p < .001) including improvement in component scores for vegetables (0.84 points, p = .025) and added sugar (0.94 points, p = .025). For PA, compared to children in the comparison group, children in intervention FCCH decreased sedentary time by 5.7% (p = .021). Conclusions The multicomponent Healthy Start intervention was effective in improving diet quality and sedentary behavior of children in FCCH, which demonstrates the promise of obesity prevention interventions in this setting. Future research could include enhancing the Healthy Start intervention to strengthen the PA component, considering virtual peer support, and determining how to best translate and disseminate the intervention into FCCH nationally. Trial registration National Institutes of Health, NCT02452645. Registered 5 May 2015.

Assessing the scalability of healthy eating interventions within the early childhood education and care setting: secondary analysis of a Cochrane systematic review

“…Three ISAT domains (political and strategic context, fidelity and adaptation and reach and acceptability) contained two criteria, and therefore could receive a ‘Partial’ rating. Seventeen (45 %) studies fully reported on the political and strategic context domain of the ISAT (31,35,36,40,41,45,50,51,53,54,56,59–64) , eighteen (47 %) studies reported partial data (32–34,38,39,42–44,46–48,52,55,58,65–68) and three (8 %) studies did not report this domain at all (57,69,70) . For those studies partially reporting data, this included one study only reporting context and seventeen studies only reporting on funding sources.…”

“…Fidelity and adaptation were reported in full by 34 % of studies ( n 13) (31,32,34,37,41,42,51,53–55,58) , partially reported by 32 % of ( n 12) studies (33,35,36,40,44,46,48,50,56,59,61,64,68,70) and not at all by 34 % ( n 13) of studies (38,39,43,45,47,52,57,60,63,65–67,69) . For those studies partially reporting data, this included eleven studies only reporting fidelity, and one study only reporting adaptations.…”

Variabilidad dietética e intervención educomunicacional en escolares con obesidad y sobrepeso: un estudio no aleatorizado

“…Se ha demostrado que entre los factores asociados con el sobrepeso y la obesidad se citan, entre otros, una dieta rica en grasas, el comportamiento sedentario, los marcadores fisiológicos, los factores familiares y la actividad física medioambiental de la comunidad en general (17) . Dado que el aumento de la obesidad es una carga importante para la salud pública en países en desarrollo, en diferentes estudios se menciona la necesidad de mayores esfuerzos de intervención en la familia en países de bajos y medianos ingresos, dado que los padres son importantes agentes de cambio en esta pandemia (18) .…”

Feeding and Activity Environments for Infants and Toddlers in Childcare Centers and Family Childcare Homes in Southeastern New England

“…Recruitment for this study occurred in cities and towns in the Providence, Rhode Island (RI) area that have lower income levels and higher ethnic/racial diversity. Recruitment of FCCH included providers enrolled in the control group for the Healthy Start study [ 13 , 14 ], a randomized controlled trial of an intervention for FCCP caring for 2–5-year-old children in RI and Massachusetts (MA). In that study, FCCPs were recruited using direct mailings, phone calls to licensed FCCHs available in state databases and through state organizations overseeing Child and Adult Care Food Program (CACFP) trainings.…”

“…Childcare attendance is significantly associated with an increased risk of obesity in cross-sectional research [ 4 ], as well as longitudinal studies showing higher later child obesity risk after exposure to childcare in the first year of life [ 5 , 6 , 7 , 8 ]. However, few studies have examined how the childcare environment impacts feeding behaviors and PA in children under age 2 [ 4 , 5 , 6 , 7 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ].…”