Play&Grow: Randomised Controlled Trial

Dr Sobko, Tanja   (Principal Investigator (PI))

Professor Kaplan Matt   (Co-Investigator)

Professor Brown Gavin   (Co-Investigator)

Dr Tse Michael Andrew   (Co-Investigator)

Dr Chan Ruth Suk-mei   (Co-Investigator)

36

2017-06-01

2020-05-31

44320

Play&Grow: Randomised Controlled Trial

Dietary habits, Early in life intervention, Environmental behaviour, Healthy lifestyle, Physical activity, Preschool children

Environmental ResearchPaediatrics

Physical Sciences (P)

201611159063

Seed Fund for PI Research – Basic Research

2016

Completed

Lifestyles are becoming unhealthier worldwide, and Hong Kong is no exception. The urban environment is criticised for being ‘toxic’, promoting the ‘nature-deficit’ phenomenon, and for stimulating a sedentary lifestyle in young children. In Hong Kong, the majority of people live in densely populated areas and have little exposure to nature. Moreover, Hong Kong’s unique environment (small spaces, limited areas for play), coupled with Hong Kong parents’ greater emphasis on academic rather than physical extra-curricular pursuits for their children, may result in delayed or even impaired motor development. Obesity among children has become an increasingly prominent public health concern in Hong Kong. A recent study of the population reported that children as young as 6 months are overweight/obese and, by the age of 24 months, as many as 4.7% of the territory’s children are overweight/obese. Habits established early in life continue into adolescence and adulthood, making it clear that lifestyle interventions should start as early as possible. The tools, taught in the interventions, often required by the caregivers to manage some problematic behaviour of children (e.g., food fussiness) can enhance general parenting and parenting practices in specific situations. A recent Cochrane review reported only a marginally significant reduction of body weight after some interventions and little to no effect on dietary, physical activity behaviours. Hence, searching for new approaches may be the answer: to develop novel intervention programmes for preschool children and test these becomes highly relevant. For these reasons, we have chosen to target families with younger children, aged 2 to 4, in our proposed research. The family setting is the most powerful influence upon preschool children; consequently, many of the risk factors for obesity in the preschool years are rooted in the family context. Parents have the capacity to impact their children’s emerging food choices with their knowledge of nutrition, parenting style, and modelling8. In Hong Kong, parents often adopt inappropriate strategies in managing the physical activities and dietary habits of their children, such as force-feeding and watching TV while each eating. In our family intervention, we will therefore target children’s primary caregivers by educating them about the benefits of active play, as it seems clear that it is they who influence the habits and establish the routines of young children. Conceptual influences One of the most effective lifestyle parenting programmes is InFANT (Infant Feeding Activity and Nutrition Trial), which focuses on parenting skills to support the development of healthy lifestyle behaviours in infancy and employs an anticipatory guidance framework (AGF). This framework helps parents to manage certain behaviours in advance, not after they have materialised. The intervention P&G proposed here will use the same AGF in addressing the eating and sedentary lifestyle habits of children aged 2 to 4. As a result, it is hoped that specific parenting practices (e.g., eating, active play, and CN routines) will be modified and, in turn, result in improved family quality of life and child health. Connectedness to nature is a relatively new concept that, to date, has been investigated primarily in adults. It suggests, that engaging in activities in a natural environment can induce a feeling of connectedness to nature. Exposing preschool children to nature and to thinking about nature in different ways could stimulate nature relatedness as a measurable construct. When children are placed in a natural setting, they are more likely to be physically active. In addition, the products of nature, such as fruits and vegetables are widely acknowledged to improve health9. Many habits and attitudes are developed early in life, and those related to the natural world are no exception. In fact, children are inherently interested in their environment and in nature in general. We hypothesize that outdoor nature-related activities may induce connectedness to nature and bring about positive changes in both eating and activity habits (short-term outcomes) in preschool children, in turn leading to a higher quality of life (a long-term outcome) (Fig 1). The completed pilot programme Play & Grow (P&G) Play & Grow (P&G) is a 10-session family-based, multi-component healthy lifestyle programme for families with preschool children aged 2 to 4. It was developed and tested in a pilot study (n=38, retention rate of 93%) by the PI and her team. The aim of P&G was to encourage healthy eating habits and active play in children from an early age, and to bring about healthy behavioural changes in families. The programme also included a CN element designed to equip caregivers with environmental knowledge and skills. Briefly, feeding practices, particularly Promoting and Encouragement to eat (PE) and Instrumental Feeding (IF) improved after the intervention (p =.008 and .016, respectively). Physical activity of caregivers improved after the intervention. The pilot study therefore confirmed the design, protocols, evaluation instruments and logistics of the study. A detailed manual and full resource kit was created, and each session consisted of: (i) a theoretical education component (food, activity, CN), and (ii) a component on nature-related activities, such as searching for and playing with natural objects (Table 1). Some nature activities were food-related (e.g. growing plants, creating miniature indoor gardens, and healthy cooking). The outcome data was collected using a number of scales and questionnaires addressed eating, active play and nature-related habits before and after the programme, and focus group discussions were held at the beginning and end of the programme. The programme proved popular amongst participants and the results demonstrated significant positive changes on a number of health-related outcomes, such as food habits and caregiver’s physical activity levels. The objectives of current proposal are: 1. To measure the effectiveness of the healthy lifestyle intervention programme Play & Grow (P&G), which includes a novel connectedness to nature (CN) element, by conducting a randomised controlled trial (RCT). 2. To evaluate the post-intervention improvement of both primary and secondary outcomes, including child active play/sedentary behaviours, BMI z-score, eating habits and CN, as well as caregiver’s eating habits and physical activity levels.