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

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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.

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Notes

  1. The investigators had undergone a Train the Trainer workshop prior to running the TOT workshop.

  2. Details regarding the fidelity to intervention has been captured in the process evaluation documentation led by WLC.

  3. For the purpose of documenting the process evaluation of TSM, the second author [WLC] also independently read the FGD records and confirmed the themes that were extracted from the data.

  4. The availability of fruits, vegetables, and water was an improvement of what had been traditionally available at the preschools and was emphasized more during the TSM study. For example, there were disparities in the availability of water at the preschools. Some preschools in Sarawak lacked basic resources such as clean tap water. With the introduction of TSM, these basic resources became more readily available (e.g., after filtered water and water dispensers were distributed to the preschools). Furthermore, the ToyBox module emphasized water drinking instead of sugar-sweetened beverages.

References

  • Ang, Y. N., Wee, B. S., Poh, B. K., & Ismail, M. N. (2013). Multifactorial influences of childhood obesity. Current Obesity Reports, 2(1), 10–22. https://doi.org/10.1007/s13679-012-0042-7

    Article  Google Scholar 

  • Baur, L. A., & Garnett, S. P. (2019). Early childhood — a critical period for obesity prevention. Nature Review on Endocrinology, 15, 5–6. https://doi.org/10.1038/s41574-018-0131-0

    Article  Google Scholar 

  • Beck, A. R. (2016). Psychosocial aspects of obesity. NASN School Nurse, 31(1), 23–27.

    Article  Google Scholar 

  • Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.

    Article  Google Scholar 

  • Braun, V., Clarke, V., & Weate, P. (2016). Using thematic analysis in sport and exercise research. In B. Smith & A. C. Sparkes (Eds.), Routledge handbook of qualitative research in sport and exercise (pp. 191–205). Routledge.

    Google Scholar 

  • Bresee, S., Caruso, B. A., Sales, J., Lupele, J., & Freeman, M. C. (2016). ‘A child is also a teacher’: Exploring the potential for children as change agents in the context of a school-based WASH intervention in rural Eastern Zambia. Health Education Research, 31(4), 521–534. https://doi.org/10.1093/her/cyw022

    Article  Google Scholar 

  • Brouse, C. H., & Chow, T. H. F. (2009). Exploring pre-operational and concrete operational children’s thinking on nutrition: A case study. Health Education Journal, 68(3), 219–231. https://doi.org/10.1177/0017896909346099

    Article  Google Scholar 

  • Brown, T., Moore, T. H., Hooper, L., Gao, Y., Zayegh, A., Ijaz, S., Elwenspoek, M., Foxen, S. C., Magee, L., O’Malley, C., Waters, E., & Summerbell, C. D. (2019). Interventions for preventing obesity in children. The Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001871.pub4

    Article  Google Scholar 

  • Centers for Disease Control and Prevention (2020). Childhood obesity causes and consequences. Retrieved March 25, 2021, from https://www.cdc.gov/obesity/childhood/causes.html

  • Chong, K. H., Wu, S. K., Noor Hafizah, Y., Bragt, M. C., & Poh, B. K. (2016). Eating habits of Malaysian children: Findings of the south east Asian nutrition surveys (SEANUTS). Asia Pacific Journal of Public Health. https://doi.org/10.1177/1010539516654260

    Article  Google Scholar 

  • Clarke, J. L., Griffin, T. L., Lancashire, E. R., Adab, P., Parry, J. M., & Pallan, M. J. (2015). Parent and child perceptions of school-based obesity prevention in England: A qualitative study. BMC Public Health. https://doi.org/10.1186/s12889-015-2567-7

    Article  Google Scholar 

  • Creswell, J. W. (2008). Educational research: Planning, conducting, and evaluating quantitative and qualitative research. Pearson.

    Google Scholar 

  • Darling-Hammond, L., Flook, L., Cook-Harvey, C., Barron, B., & Osher, D. (2020). Implications for educational practice of the science of learning and development. Applied Developmental Science, 24(2), 97–140. https://doi.org/10.1080/10888691.2018.1537791

    Article  Google Scholar 

  • Elliott, R., & Timulak, L. (2021). Essentials of descriptive-interpretive qualitative research: A generic approach. American Psychological Association.

    Book  Google Scholar 

  • Gillespie, A., & Zittoun, T. (2010). Using resources: Conceptualizing the mediation and reflective use of tools and signs. Culture and Psychology, 16(1), 37–62.

    Article  Google Scholar 

  • Griffin, T. L., Clarke, J. L., Lancashire, E. R., Pallan, M. J., Passmore, S., & Adab, P. (2014). Teacher experiences of delivering an obesity prevention programme (The WAVES study intervention) in a primary school setting. Health Education Journal, 74(6), 655–667. https://doi.org/10.1177/0017896914556907

    Article  Google Scholar 

  • Herlitz, L., MacIntyre, H., Osborn, T., & Bonell, C. (2020). The sustainability of public health interventions in schools: A systematic review. Implementation Science. https://doi.org/10.1186/s13012-019-0961-8

    Article  Google Scholar 

  • Institute for Public Health. (2016). National health and morbidity survey 2016 – Maternal and child health findings (Vol. 2). Institute for Public Health, Ministry of Health, Kuala Lumpur, Malaysia. Retrieved March 25, 2021, from http://www.iku.gov.my/images/IKU/Document/REPORT/2016/NHMS2016ReportVolumeII-MaternalChildHealthFindingsv2.pdf

  • Institute for Public Health. (2019). Fact sheet: National health and morbidity survey 2019 – Non-communicable diseases, healthcare demand, and health literacy. Retrieved March 25, 2021, from http://iku.moh.gov.my/images/IKU/Document/REPORT/NHMS2019/FactSheet_BI_AUG2020.pdf

  • Ishak, S. I. Z. S., Chin, Y. S., Taib, M. N. M., Chan, Y. M., & Shariff, Z. M. (2020). Effectiveness of a school-based intervention on knowledge, attitude and practice on healthy lifestyle and body composition in Malaysian adolescents. BMC Pediatrics, 20(1), 1–12.

    Google Scholar 

  • Jakobovich, R., Shoval, E., Berry, E. M., & Shulruf, B. (2019). Supporting children to act as change agents for parents in preparing their lunch box. Australasian Journal of Early Childhood, 44(2), 153–165. https://doi.org/10.1177/1836939119831887

    Article  Google Scholar 

  • John-Steiner, V., & Mahn, H. (1996). Sociocultural approaches to learning and development: A Vygotskian framework. Educational Psychologist, 31(3–4), 191–206. https://doi.org/10.1080/00461520.1996.9653266

    Article  Google Scholar 

  • Knol, L. L., Myers, H. H., Black, S., Robinson, D., Awololo, Y., Clark, D., Parker, C. L., Douglas, J. W., & Higginbotham, J. C. (2016). Development and feasibility of a childhood obesity prevention program for rural families: Application of the social cognitive theory. American Journal of Health Education, 47(4), 204–214. https://doi.org/10.1080/19325037.2016.1179607

    Article  Google Scholar 

  • Koo, H. C., Poh, B. K., & Talib, R. A. (2020). The GReat-child TrialTM: A quasi-experimental dietary intervention among overweight and obese children. Nutrients, 12(10), 2972. https://doi.org/10.3390/nu12102972

    Article  Google Scholar 

  • Lee, S. T., Wong, J. E., Chan, G. K., & Poh, B. K. (2021). Association between compliance with movement behavior guidelines and obesity among Malaysian preschoolers. International Journal of Environmental Research and Public Health, 18(9), 4611. https://doi.org/10.3390/ijerph18094611

    Article  Google Scholar 

  • Manios, Y., Grammatikaki, E., Androutsos, O., Chinapaw, M. J., Gibson, E. L., Buijs, G., Iotova, V., Socha, P., Annemans, L., Wildgruber, A., Mouratidou, T., Yngve, A., Duvinage, K., de Bourdeaudhuij, I., & ToyBox-study group (2012). A systematic approach for the development of a kindergarten-based intervention for the prevention of obesity in preschool age children: The ToyBox-study. Obesity Reviews, 13, 3–12. https://doi.org/10.1111/j.1467-789X.2011.00974.x

  • Manios, Y., Androutsos, O., Katsarou, C., Iotova, V., Socha, P., Geyer, C., Moreno, L., Koletzko, B., De Bourdeaudhuij, I., & ToyBox-study group. (2014). Designing and implementing a kindergarten-based, family-involved intervention to prevent obesity in early childhood: The ToyBox-study. Obesity Reviews, 15, 5–13

  • Milakovich, J., Simonds, V. W., Held, S., Picket, V., LaVeaux, D., Cummins, J., Martin, C., & Kelting-Gibson, L. (2018). Children as agents of change: Parent perceptions of child-driven environmental health communication in the crow community. Journal of Health Disparities Research and Practice, 11(3), 115–127.

    Google Scholar 

  • Natale, R. A., Messiah, S. E., Asfour, L., Uhlhorn, S. B., Delamater, A., & Arheart, K. L. (2014). Role modeling as an early childhood obesity prevention strategy: Effect of parents and teachers on preschool children’s healthy lifestyle habits. Journal of Developmental and Behavioral Pediatrics, 35(6), 378–387. https://doi.org/10.1097/DBP.0000000000000074

    Article  Google Scholar 

  • Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16, 1–13. https://doi.org/10.1177/1609406917733847

    Article  Google Scholar 

  • OECD. (2019). The heavy burden of obesity: The economics of prevention. OECD Health Policy Studies, OECD Publishing. https://doi.org/10.1787/67450d67-en

  • Poh, B. K., Ng, B. K., Haslinda, M. D. S., Shanita, S. N., Wong, J. E., Budin, S. B., Ruzita, A. T., Ng, L. O., Khouw, I., & Norimah, A. K. (2013). Nutritional status and dietary intakes of children aged 6 months to 12 years: Findings of the nutrition survey of Malaysian children (SEANUTS Malaysia). British Journal of Nutrition, 110(S3), S21–S35. https://doi.org/10.1017/S0007114513002092

    Article  Google Scholar 

  • Ramos, M. F., Weber, J., Thompson, J. A., Werk, L., Shuell, J., Woods, K., & Bamdad, T. (2020). Evaluation of “Healthy Way to Grow”: An obesity prevention program in early care and education centers. Early Childhood Education Journal. https://doi.org/10.1007/s10643-020-01102-z

    Article  Google Scholar 

  • Reeves, S., Poh, B. K., Essau, C., Summerbell, C., Cheah, W. L., Koh, D., Lee, J. A. C., Abdul Talib, R., & Gibson E. L. (2018). ToyBox Study Malaysia: Improving healthy energy balance and obesity-related behaviours among pre-schoolers in Malaysia. Nutrition Bulletin, 43(3), 290–295.

    Article  Google Scholar 

  • Silventoinen, K., Jelenkovic, A., Sund, R., Hur, Y. M., Yokoyama, Y., Honda, C., Hjelmborg, J. V., Möller, S., Ooki, S., Aaltonen, S., Ji, F., Ning, F., Pang, Z., Rebato, E., Busjahn, A., Kandler, C., Saudino, K. J., Jang, K. L., Cozen, W., … Kaprio, J. (2016). Genetic and environmental effects on body mass index from infancy to the onset of adulthood: An individual-based pooled analysis of 45 twin cohorts participating in the COllaborative project of development of anthropometrical measures in twins (CODATwins) study. The American Journal of Clinical Nutrition, 104(2), 371–379. https://doi.org/10.3945/ajcn.116.130252

    Article  Google Scholar 

  • Smith, A. D., Herle, M., Fildes, A., Cooke, L., Steinsbekk, S., & Llewellyn, C. H. (2016). Food fussiness and food neophobia share a common etiology in early childhood. Journal of Child Psychology and Psychiatry, 58(2), 189–196. https://doi.org/10.1111/jcpp.12647

    Article  Google Scholar 

  • Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Harvard University Press.

    Google Scholar 

  • World Health Organization. (2016). Report on the commission on ending childhood obesity. Retrieved March 25, 2021, from http://apps.who.int/iris/bitstream/handle/10665/204176/9789241510066_eng.pdf?sequence=1

  • World Health Organization. (2020). Nutrition action in schools: A review of evidence related to the Nutrition-Friendly Schools Initiative. https://www.who.int/publications/i/item/9789241516969

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Acknowledgements

We thank the Department of Community Development (KEMAS) under the Ministry of Rural Development (Malaysia), the teachers, parents, and children for participating in this project.

Funding

The ToyBox Study Malaysia feasibility project was funded by the United Kingdom Medical Research Council (MRC) Grant under the Newton-Ungku Omar Fund (MR/PO13805/1). We thank Universiti Malaysia Sarawak for the financial support of this publication.

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Authors and Affiliations

  1. Universiti Malaysia Sarawak, Kota Samarahan, Malaysia

    J. A. C. Lee, W. L. Cheah, G. N. J. Anchang & M. Abim

  2. Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia

    Y. Noor Hafizah, A. T. Ruzita & B. K. Poh

  3. Universiti Kebangsaan Malaysia, Bangi, Malaysia

    D. Koh

  4. University of Roehampton, London, UK

    S. Reeves, C. A. Essau & E. L. Gibson

  5. Durham University, Durham, UK

    C. Summerbell

  6. Fuse, NIHR Centre for Translational Research in Public Health, Newcastle upon Tyne, UK

    C. Summerbell

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Contributions

Conceptualization and contribution to the article: all authors. Material preparation and data collection: GA, MA, RAT, and NHY. Writing—original draft preparation and revision: JACL. Writing – review: all authors. Writing—editing: LG, BKP, SR, CS, DK, and CE. Approval of the submitted version: all authors.

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Correspondence to J. A. C. Lee.

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Lee, J.A.C., Cheah, W.L., Anchang, G.N.J. et al. Teachers’ and Parents’ Perspectives on the Feasibility of a Preschool-Based Behavioral Intervention to Prevent Obesity: An Embedded Qualitative Study within ToyBox Study Malaysia. Early Childhood Educ J 51, 149–164 (2023). https://doi.org/10.1007/s10643-021-01290-2

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