Ward Stéphanie, Chow Amanda Froehlich, Humbert M Louise, Bélanger Mathieu, Muhajarine Nazeem, Vatanparast Hassan, Leis Anne
Centre de formation médicale du Nouveau-Brunswick, Pavillon J.-Raymond-Frenette, 100 Des Aboiteaux St. Moncton, New Brunswick, E1A 3E9, Canada.
Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, 104 Clinic Place, P.O. Box 23, Saskatoon, Saskatchewan, S7N 2Z4, Canada.
Eval Program Plann. 2018 Jun;68:90-98. doi: 10.1016/j.evalprogplan.2018.02.005. Epub 2018 Feb 14.
The Healthy Start-Départ Santé intervention was developed to promote physical activity, gross motor skills and healthy eating among preschoolers attending childcare centers. This process evaluation aimed to report the reach, effectiveness, adoption, implementation and maintenance of the Healthy Start-Départ Santé intervention.
The RE-AIM framework was used to guide this process evaluation. Data were collected across 140 childcare centers who received the Healthy Start-Départ Santé intervention in the provinces of Saskatchewan and New Brunswick, Canada. Quantitative data were collected through director questionnaires at 10 months and 2 years after the initial training and analyzed using descriptive statistics. Qualitative data were collected throughout the intervention.
The intervention was successful in reaching a large number of childcare centres and engaging both rural and urban communities across Saskatchewan and New Brunswick. Centres reported increasing opportunities for physical activity and healthy eating, which were generally low-cost, easy and quick to implement. However, these changes were rarely transformed into formal written policies. A total of 87% of centers reported using the physical activity resource and 68% using the nutrition resource on a weekly basis. Implementation fidelity of the initial training was high. Of those centers who received the initial training, 75% participated in the mid-point booster session training. Two year post-implementation questionnaires indicated that 47% of centers were still using the Active Play Equipment kit, while 42% were still using the physical activity resource and 37% were still using the nutrition resource. Key challenges to implementation and sustainability identified during the evaluation were consistent among all of the REAIM elements. These challenges included lack of time, lack of support from childcare staff and low parental engagement.
Findings from this study suggest the implementation of Healthy Start-Départ Santé may be improved further by addressing resistance to change and varied levels of engagement among childcare staff. In addition, further work is needed to provide parents with opportunities to engage in HSDS with their children.
“健康起步 - 健康开端”干预措施旨在促进在儿童保育中心就读的学龄前儿童的体育活动、大肌肉运动技能和健康饮食。本过程评估旨在报告“健康起步 - 健康开端”干预措施的覆盖范围、有效性、采用情况、实施情况和维持情况。
采用RE - AIM框架指导本过程评估。数据收集自加拿大萨斯喀彻温省和新不伦瑞克省接受“健康起步 - 健康开端”干预措施的140个儿童保育中心。定量数据通过在初始培训后10个月和2年时向主任发放问卷收集，并使用描述性统计进行分析。定性数据在整个干预过程中收集。
该干预措施成功覆盖了大量儿童保育中心，并涉及萨斯喀彻温省和新不伦瑞克省的农村和城市社区。各中心报告称，体育活动和健康饮食的机会有所增加，这些活动通常成本低、易于实施且迅速。然而，这些变化很少转化为正式的书面政策。共有87%的中心报告每周使用体育活动资源，68%的中心每周使用营养资源。初始培训的实施保真度很高。在接受初始培训的中心中，75%参加了中期强化培训课程。实施两年后的问卷显示，47%的中心仍在使用主动游戏设备套件，42%仍在使用体育活动资源，37%仍在使用营养资源。评估过程中确定的实施和可持续性方面的关键挑战在所有REAIM要素中都是一致的。这些挑战包括时间不足、儿童保育工作人员缺乏支持以及家长参与度低。
本研究结果表明，通过解决变革阻力和儿童保育工作人员不同程度的参与问题，“健康起步 - 健康开端”的实施可能会得到进一步改善。此外，还需要进一步努力为家长提供与孩子一起参与“健康起步 - 健康开端”的机会。
