Effects of the Preschool-Based Family-Involving DAGIS Intervention Program on Children’s Energy Balance-Related Behaviors and Self-Regulation Skills: A Clustered Randomized Controlled Trial

Abstract

The study examines the effects of a preschool-based family-involving multicomponent intervention on children’s energy balance-related behaviors (EBRBs) such as food consumption, screen time and physical activity (PA), and self-regulation (SR) skills, and whether the intervention effects differed among children with low or high parental educational level (PEL) backgrounds. The Increased Health and Wellbeing in Preschools (DAGIS) intervention was conducted as a clustered randomized controlled trial, clustered at preschool level, over five months in 2017–2018. Altogether, 802 children aged 3–6 years in age participated. Parents reported children’s consumption of sugary everyday foods and beverages, sugary treats, fruits, and vegetables by a food frequency questionnaire, and screen time by a 7-day diary. Physical activity was assessed by a hip-worn accelerometer. Cognitive and emotional SR was reported in a questionnaire by parents. General linear mixed models with and without repeated measures were used as statistical methods. At follow-up, no differences were detected in EBRBs or SR skills between the intervention and control group, nor did differences emerge in children’s EBRBs between the intervention and the control groups when stratified by PEL. The improvement in cognitive SR skills among low PEL intervention children differed from low PEL control children, the significance being borderline. The DAGIS multicomponent intervention did not significantly affect children’s EBRBs or SR. Further sub-analyses and a comprehensive process evaluation may shed light on the non-significant findings.

Effects of the Preschool-Based Family-Involving DAGIS Intervention on Family Environment: A Cluster Randomised Trial

“…The presumed pathways to children's food consumption in the DAGIS intervention study should therefore be tested further by mediation analyses, as previously discussed [19,20], even though the main effects on children's food consumption in the DAGIS study showed no statistically significant results. Still, the study of intervention effects on children's EBRBs in the DAGIS study showed a tendency towards increasing fruit and vegetable consumption among children in the intervention group [29].…”

“…The DAGIS intervention study was conducted in Southern Finland during the school year 2017-2018 [29] as a cluster randomised trial at the preschool level. The aim was to promote 3-6-year old children's healthy EBRBs and self-regulation skills through activities in both preschools and at home.…”

“…The recruitment process for the DAGIS intervention study started at the municipality level, inviting municipalities one by one [29]. The invited municipalities had a high number of preschools and a large variety in educational and income levels among their inhabitants.…”

“…The invited municipalities had a high number of preschools and a large variety in educational and income levels among their inhabitants. Finally, the DAGIS study included preschools from two municipalities in Southern Finland, both located about 100 km from Helsinki, and both consisting of an urban city center, surrounded by a wide rural area [29]. In the municipality of Salo, all public preschools participated (n = 29), and in Riihimäki there were three public preschools which registered their participation as soon as we had informed the preschool headmasters about the study [29].…”

“…The 32 participating preschools were, using an online programme, randomized into 13 intervention and 19 control preschools [29]. The DAGIS intervention lasted five months from November 2017 to April 2018.…”