Effect and process evaluation of a kindergarten-based, family-involved intervention with a randomized cluster design on sedentary behaviour in 4- to 6- year old European preschool children: The ToyBox-study

Abstract

BackgroundThe aim of the present study evaluated the effect and process of the ToyBox-intervention on proxy-reported sedentary behaviours in 4- to 6-year-old preschoolers from six European countries.MethodsIn total, 2434 preschoolers’ parents/primary caregivers (mean age: 4.7±0.4 years, 52.2% boys) filled out a questionnaire, assessing preschoolers’ sedentary behaviours (TV/DVD/video viewing, computer/video games use and quiet play) on weekdays and weekend days. Multilevel repeated measures analyses were conducted to measure the intervention effects. Additionally, process evaluation data were included to better understand the intervention effects.ResultsPositive intervention effects were found for computer/video games use. In the total sample, the intervention group showed a smaller increase in computer/video games use on weekdays (ß = -3.40, p = 0.06; intervention: +5.48 min/day, control: +8.89 min/day) and on weekend days (ß = -5.97, p = 0.05; intervention: +9.46 min/day, control: +15.43 min/day) from baseline to follow-up, compared to the control group. Country-specific analyses showed similar effects in Belgium and Bulgaria, while no significant intervention effects were found in the other countries. Process evaluation data showed relatively low teachers’ and low parents’ process evaluation scores for the sedentary behaviour component of the intervention (mean: 15.6/24, range: 2.5–23.5 and mean: 8.7/17, range: 0–17, respectively). Higher parents’ process evaluation scores were related to a larger intervention effect, but higher teachers’ process evaluation scores were not.ConclusionsThe ToyBox-intervention had a small, positive effect on European preschoolers’ computer/video games use on both weekdays and weekend days, but not on TV/DVD/video viewing or quiet play. The lack of larger effects can possibly be due to the fact that parents were only passively involved in the intervention and to the fact that the intervention was too demanding for the teachers. Future interventions targeting preschoolers' behaviours should involve parents more actively in both the development and the implementation of the intervention and, when involving schools, less demanding activities for teachers should be developed.Trial registrationclinicaltrials.gov NCT02116296

Combining Effect and Process Evaluation on European Preschool Children’s Snacking Behavior in a Kindergarten-Based, Family-Involved Cluster Randomized Controlled Trial: The ToyBox Study

“…Within the ToyBox study, no effects of a higher process evaluation score in teachers were found for snacking behavior. This means that the results that were found for physical activity, sedentary behavior, and beverage consumption [ 17 , 18 , 19 ] were unfortunately not replicated for snacking behavior. In general, also no different effects on preschoolers’ snacking behavior were found according to parents’/caregivers’ process evaluation score.…”

“…The ToyBox study was a large European project, from which partial results already have been published previously for physical activity [ 17 ], sedentary behavior [ 18 ], and beverage consumption [ 19 ]. Six European countries (i.e., Belgium, Bulgaria, Germany, Greece, Poland, and Spain) conducted a kindergarten-based, family-involved intervention with a cluster randomized controlled design targeting preschool children between four and six years old.…”

“…Another study, although in adolescents, showed positive effects on the intake of fruit and vegetables when a higher process evaluation score was found [ 13 ]. Within the ToyBox study, the combination of process and effect evaluation has already been investigated for physical activity, sedentary behavior, and beverage consumption [ 17 , 18 , 19 ], but the results for snacking behavior have remained unstudied until now.…”

Effect and process evaluation of a kindergarten-based, family-involved cluster randomised controlled trial in six European countries on four- to six-year-old children’s steps per day: the ToyBox-study

“…Finally, it should be acknowledged that there is no standardised way to calculate process evaluation scores. Although it was based on a method used in previous studies [ 37 , 49 , 50 ], there are still some limitations linked to the method used to calculate the process evaluation scores as not all components of Saunders et al (2005) were used to calculate the score, and equal weights for each component were used. In addition, there is not yet a consensus on how to operationalise the different process evaluation components [ 37 , 51 ].…”

Assessing the acceptability of an adapted preschool obesity prevention programme: ToyBox‐Scotland

“…One such intervention, Toybox, has recently been tested in six countries in Europe (Manios, ) and involved classroom and home‐based activities, which targeted physical activity (PA), sedentary behaviour (SB), eating/snacking, and water consumption. The results show that Toybox has a positive impact on some energy balance‐related behaviours and, importantly, does not lead to intervention‐generated inequalities (De Craemer et al, ; De Craemer et al, ; Latomme et al, ; Pinket et al, ). The authors of the present paper, some of whom were also involved with the original Toybox study, have adapted the intervention for Scotland (Malden et al, ) and have conducted a feasibility cluster randomized controlled trial (cRCT) of Toybox‐Scotland in Glasgow.…”