Healthy Start: An Evidence Based Intervention to Increase Physical Activity and Healthy Eating in Rural Childcare Centres

ABSTRACT Research suggests that it is important to establish regular physical activity and healthy eating patterns during the early years (0-5 years). Engaging in healthy behaviours during this stage of life supports growth and development and lays the foundation for a lifetime of health and wellbeing. Despite these benefits, research indicates that children in Canada are not meeting the daily recommended physical activity guidelines for early years. Moreover, their diets are lacking in fruits and vegetables and are high in processed foods. As many early years children spend a large part of their day in childcare centres, educators can have a large influence on their physical activity and healthy eating behaviours. In the Canadian Prairie Provinces many childcare centres are located in rural communities. Previous research suggests that rural educators are influenced by unique factors associated with geographic local (e.g., access to resources to promote physical activity and year round access to variety of healthy foods) when attempting to provide healthy opportunities for children. In order to address the specific factors identified by rural educators and support healthier behaviours among rural early year’s children, a multilevel physical activity and healthy eating intervention (Healthy Start) was developed using McLeroy’s ecological model and a population health approach. Healthy Start was pilot tested in three rural childcare centres. Purpose: The primary purpose of this dissertation study was to evaluate Healthy Start, a multilevel community-based physical activity and healthy eating intervention, in rural childcare centres throughout Saskatchewan. In order to achieve this primary purpose, the specific dissertation objectives were addressed as follows. Paper 1: a) Determine if over the course of the intervention, Healthy Start contributed to increases in physical activity levels and improvements in motor skill development among early years children aged 3 to 5 years; b) Determine if Healthy Start supported educators in providing children with more opportunities for physical activity; c) Describe educators’ experiences and perceptions of Healthy Start and its influence on physical activity within the childcare centre environment. Paper 2: a) Assess to what extent, Healthy Start contributed to healthier eating behaviours among early years children aged 3 to 5 years over the course of the intervention; b) Determine if Healthy Start supported childcare staff (educators and cooks) in providing children with more opportunities for healthy eating; c) Describe educators ‘experiences and perceptions of Healthy Start and its influence on healthy eating within the childcare centre environment. Paper 3: To pilot a pulse crop intervention study in one of the intervention childcare centres in order to: a) Increase knowledge and awareness about the nutritional value and health benefits of pulse crops among childcare staff (educators and cooks); b) Support childcare staff in providing children with more opportunities for pulse crop consumption; c) Expand the variety of healthy foods consumed by early years children by incorporating locally grown pulse crops into the childcare centre meals. Methods: A population health controlled intervention study using a wait-list control design (48 weeks delayed-intervention) was used to evaluate the impact of the intervention. Mixed methods were employed to determine the intervention’s influence on children and educator behaviours and on the childcare centre environment. Results: Overall, increases in children’s physical activity levels and improvements in healthy eating behaviours were observed in the intervention group. Moreover, educators felt the intervention was effective in supporting them to increase physical activity and healthy eating opportunities provided to rural early years children. Lastly, improvements to childcare centre environments were made to promote healthy behaviours among the children. Conclusion: Collectively, the pilot study provided insight into the complexities and feasibility of promoting physical activity and healthy eating among early years children in childcare centres, particularly in rural communities. This was an innovative intervention which addressed critical factors at multiple levels contributing to the development of healthy behaviours among rural early years children. The lessons learned in this dissertation study can be used to improve the Healthy Start intervention so its implementation can be effectively expanded to childcare centres within and outside of Saskatchewan. Additionally, the findings can contribute to the limited body of literature on implementing and evaluating interventions aimed at increasing both physical activity and healthy eating in Canadian childcare centres. In turn, supporting the healthy development of early years children in the province and beyond