Teachers’ and Parents’ Perspectives on the Feasibility of a Preschool-Based Behavioral Intervention to Prevent Obesity: An Embedded Qualitative Study within ToyBox Study Malaysia

Abstract

The aim of this qualitative study, an embedded component of ToyBox Study Malaysia (TSM), was to elicit the perspectives of teachers and parents regarding the implementation of TSM. TSM is a preschool-based behavioral intervention program aimed at improving healthy energy balance-related behaviors among young children attending preschools. The qualitative study adopted a descriptive-interpretive methodology, and triangulated data collected through semi-structured focus groups with artifacts collected. The setting involved rural and metropolitan preschools in Sarawak and Peninsular Malaysia, respectively. In Sarawak, 11 teachers and 20 parents from six intervention preschools participated in this study. In Peninsular Malaysia, 14 preschool teachers and seven assistant teachers representing all 15 intervention preschools participated in the study. Data were analyzed thematically and four overarching themes were identified: impact of TSM on the children's knowledge and practices of healthy energy balance-related behaviors; spheres of influence upon the children's energy balance-related behaviors; constraints and affordances related to the implementation of TSM; and prospective sustainability of TSM. The triangulation of data from teachers, parents, and the artifacts related to TSM enabled the corroboration of evidence to support the themes identified. This study provides evidence on the reciprocal interactions between the teachers and parents who played key roles in facilitating behavioral change in the children, and the children who, in turn, served as change agents beyond the preschool. Furthermore, the mediational tools such as the TSM crockery and availability of healthy food and water led to the reported behavioral changes at both rural and metropolitan settings.

Process evaluation of a kindergarten-based intervention for obesity prevention in early childhood: the Toybox study Malaysia

“…The findings are briefly discussed in this paper. A more detailed report of the themes has been published previously by Lee et al [ 14 ].…”

“…The sessions were facilitated by two trained research personnel and audio-recorded. Only a summary of the major themes will be presented in this paper as the detailed findings have been published by Lee et al [ 14 ].…”

Barriers, enablers and motivators of the “I’m an active Hero” physical activity intervention for preschool children: a qualitative study

“…However, the generalisability of these findings might be constrained, given that they pertain to a singular programme within a distinct context ( 27 ). While the value of engaging key stakeholders such as parents and teachers in designing and implementing PA programmes is recognised by ( 28 ), research indicates limited capture of their perspectives regarding PA interventions specifically ( 29 ). Understanding these stakeholders’ viewpoints, experiences, and perceptions is essential for the effective design and implementation of PA interventions in preschool settings ( 30 ).…”

“…Moreover, they can offer strategies and actions, including suggested modifications, to ensure the adaptability and sustainability of proposed programmes in real-world contexts ( 32 ). Unfortunately, researchers often overlook this phase, resulting in limited evidence reflecting stakeholder viewpoints to inform the expansion and implementation of preschool-based or home-based PA initiatives, especially those promoting activity in young children ( 29 ). Researchers have highlighted the need to ensure interventions meet the target population's needs and capitalise on their strengths, involving strategies to help parents modify children's behaviours ( 33 ).…”

Dietary Energy and Nutrient Intake of Healthy Pre-School Children in Hungary

“…As a response to the increasing trend in the prevalence of childhood obesity worldwide, governments initiated intervention programs to change this trend. The urgent need for new dietary, physical activity, behavioral, environmental and pharmacological approaches for the prevention and treatment of obesity, as well as for effective family-based and school-based programs, was emphasized [11][12][13]. Hungary implemented an extra tax on unhealthy food-called the "junk food tax" [14]-in 2011, mandatory physical education five times in a week for schoolchildren [15] in 2012, and the inclusion of less salt and more healthy food into the menus provided in schools in 2014 [16].…”