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Community intervention improves physical activity in family child care homes
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Educating staff members of family child care homes on physical activity in children and promoting activity increased the number of structured activities and promoted physical activity, according to research published in the American Journal of Preventive Medicine.
According to Janice Kao, MPH, from the Nutrition Policy Institute at the University of California Agriculture and National Resources, and colleagues, nearly 1 million children receive care in family child care homes (FCCs). These settings typically provide care to children in a private home of an individual unrelated to the family.
“In the United States, nearly one-third of children under 5 years and not yet in kindergarten participate in non-relative care arrangements at least once a week, for an average of 33 hours a week,” Kao and colleagues wrote. “Efforts have been called to prevent and reduce rates of childhood obesity by targeting the environments and conditions that support healthy behaviors. Policy and practice changes in child care settings where young children are frequently exposed can be effective and sustainable,”
To examine the effects of a multifaceted approach to obesity prevention, which includes community-based policy and environmental changes, known as the Healthy Eating and Active Living project, on FCCs, the researchers evaluated these settings before and after the implementation of this project. The FCCs were located within areas serviced by the Kaiser Permanente Health System.
During the study period, which fell between 2012 and 2014, 17 FCC staff in Northern California received a physical activity workshop that included technical assistance to promote policy development for physical activity and other healthy behaviors in children. Before and after the intervention, the researchers collected data from observations, questionnaires and physical activity logs. Additionally, Kao and colleagues assessed screen time provided, the type and amount of physical activity completed and the application of best practices.
The researchers observed that FCCs improved in providing parents a written policy upon enrollment, providing screen time for only educational reasons and training staff on physical activity practices for children. According to Kao and colleagues, all FCCs in this study offered indoor and outdoor activity every day, and all activity and equipment used was deemed developmentally appropriate at baseline. These outcomes were maintained at follow-up.
Furthermore, no decreases were observed in any of the best practices by the researchers, nor were any significant changes in the frequency of physical activity reported. FCC staff reported minimal barriers to offering additional physical activity before and after the intervention. This availability did not change over time.
Of the FCCs that participated in the study, 77% had adequate outdoor space for all forms of physical activity, although indoor space was restricted to either limited movement (53%) or active play (35%). After the intervention, FCCs significantly increased the amount of fixed and portable play equipment. A significant increase in promotional materials related to physical activity were displayed after the intervention despite the number of materials still considered low with a mean total of one item per FCC. Television use was limited at all sites during the entirety of the study period.
When the types of activities provided were assessed, Kao and colleagues observed that the average number of adult-led activities significantly increased in type and in time spent performing these activities; however, an insignificant reduction in unstructured activity was observed. Upon assessing all forms of activity, the researchers observed that an insignificant increase was observed in time spent performing the activity and types of activities offered.
Participation was strong before and after the intervention, with more than 90% of children partaking in all activities on average. No changes were observed regarding the amount of time spent participating in an activity.
Before the intervention, Kao and colleagues observed that the most frequently reported activities included free play, dancing and toy or prop play. A change was made in the top activities after the intervention, with the three most frequent activities including free play, dancing and ball play (catching, throwing, kicking) and mat activities.
Unstructured play was observed for free play before and after the intervention, whereas dancing was frequently structured before and after the intervention. A variety of structured and unstructured toy and prop play was observed before the implementation of the intervention. By follow-up, this form of play was mostly unstructured and decreased overall. The researchers also observed that ball and mat activities were fully structured in addition to other exercise and game activities.
“Especially meaningful is the increase in adult-led, or structured, physical activity,” Kao and colleagues wrote. “Research indicates that structured, compared with unstructured, physical activity increases the amount of moderate to vigorous physical activity. On average, the FCCs in this study increased the amount of structured activity provided by 69%, such that for the children participating, the average endpoint exceeds the daily recommendation for 60 minutes of structured physical activity per day.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
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