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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.

Latomme, J. and Cardon, G. and De Bourdeaudhuij, I. and Iotova, V. and Koletzko, B. and Socha, P. and Moreno, L. and Androutsos, O. and Manios, Y. and De Craemer, M. and Paw, M.C.A. and Summerbell, C. and Lobstein, T. and Annemans, L. and Buijs, G. and Reilly, J. and Swinburn, B. and Ward, D. and Grammatikaki, E. and Katsarou, C. and Apostolidou, E. and Efstathopoulou, E. and Duvinage, K. and Ibrügger, S. and Strauß, A. and Herbert, B. and Birnbaum, J. and Payr, A. and Geyer, C. and De Decker, E. and De Henauw, S. and Maes, L. and Vereecken, C. and Van Assche, J. and Pil, L. and Te Velde, S. and Mouratidou, T. and Fernandez, J. and Mesana, M. and De Miguel-Etayo, P. and González, E. and Gracia-Marco, L. and Oves, B. and Yngve, A. and Kugelberg, S. and Lynch, C. and Mosdøl, A. and Nilsen, B.B. and Moore, H. and Douthwaite, W. and Nixon, C. and Kreichauf, S. and Wildgruber, A. and Kulaga, Z. and Zych, K. and Góźdź, M. and Gurzkowska, B. and Szott, K. and Lateva, M. and Usheva, N. and Galcheva, S. and Marinova, V. and Radkova, Z. and Feschieva, N. and Aikenhead, A. and Dorgelo, A. and Nethe, A. and Jansen, J. and Gmeiner, O. and Retterath, J. and Wildeis, J. and Günthersberger, A. and Gibson, L. and Voegele, C. (2017) '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.', PLoS ONE., 12 (4). e0172730.


Background The 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. Methods In 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. Results Positive 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. Conclusions The 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 registration NCT02116296

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Publisher statement:© 2017 Latomme et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Date accepted:07 February 2017
Date deposited:28 July 2017
Date of first online publication:05 April 2017
Date first made open access:28 July 2017

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