Supporting the healthy development of rural children: an ecologically based investigation of barriers and facilitators identified by early years caregivers in the promotion of physical activity and healthy eating

Physical activity and healthy eating are key components of healthy living, and they reduce the risk of developing chronic diseases. Current research indicates that Canadian early years children are not active enough for healthy growth and development. Additionally their diets are high in processed foods and lack fresh and locally grown foods. Parents play a key role in establishing healthy behaviours; however caregivers also have a strong influence, as many early years children spend a large portion on their day in care centres. To date, very little is known about the factors influencing rural caregivers in the provision of healthy opportunities for early years children in their care. Purpose: The purpose of this study was to use an ecological framework to identify facilitators and barriers that rural caregivers face when providing physical activity and healthy eating opportunities in care centres. Methods: Caregivers (N = 8) in rural settings participated in one on one semi-structured interviews. Perceived facilitators and barriers reported by caregivers were categorized using the ecological model as (intrapersonal, interpersonal, institutional, community, and policy). Results: Caregivers identified facilitators and barriers. (i.e., personal health and wellness, caregiver perceptions of lack of parental knowledge, parental support and access to facilities and local foods in the community), that influenced their ability to provide physical activity and healthy eating opportunities for children in their care. Similar barriers and facilitators were clustered together to create themes within each ecological category. A total of 12 key themes emerged from the data. Conclusion: Rural caregivers identified a number of factors that facilitated and inhibited their ability to provide opportunities for engaging in health promoting behaviours. Interestingly caregivers did not identify any intrapersonal barriers. Factors in the interpersonal category were the most commonly reported. Thus behaviours of others were the often indicated as a key factor influencing caregivers in the provision of healthy opportunities. In the institutional and community categories caregivers identified a number of facilitators that supported them in the provision of healthy opportunities. Additionally, some caregivers discussed practices they used to overcome barriers and this in turn, facilitated the promotion of physical activity and healthy eating within the care centres. Research in rural areas is limited and the majority of studies focus the barriers to living in rural areas. This study contributes to the literature because it identified, not only challenges, but also benefits to living in rural areas. Furthermore, the use of an ecological framework allowed barriers and facilitators to be classified into distinct categories. This is important, as classification of specific factors can aid in designing initiatives that target facilitators and alleviate barriers. Such initiatives can then support early years caregivers in the provision of healthy opportunities for children. In turn, this will aid Canadian early years children in establishing lifelong physical activity eating and healthy eating patterns

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

The Saskatchewan/New Brunswick Healthy Start-Départ Santé intervention: implementation cost estimates of a physical activity and healthy eating intervention in early learning centers

Training sessions by year and community size (large, medium, small and rural) in Saskatchewan. Table S2. Training sessions by year and community size (large, medium, small and rural) in New Brunswick. Table S3. Booster Sessions by year and community size (large, medium, small and rural) in Saskatchewan.Table S4. Booster Sessions by year and community size (large, medium, small and rural) in New Brunswick. (PDF 271 kb

A multilevel intervention to increase physical activity and improve healthy eating and physical literacy among young children (ages 3-5) attending early childcare centres: the Healthy Start-Départ Santé cluster randomised controlled trial study protocol

Abstract: Background: Childhood obesity is a growing concern for public health. Given a majority of children in many countries spend approximately 30 h per week in early childcare centers, this environment represents a promising setting for implementing strategies to foster healthy behaviours for preventing and controlling childhood obesity. Healthy Start-Départ Santé was designed to promote physical activity, physical literacy, and healthy eating among preschoolers. The objectives of this study are to assess the effectiveness of the Healthy Start-Départ Santé intervention in improving physical activity levels, physical literacy, and healthy eating among preschoolers attending early childcare centers. Methods/Design: This study follows a cluster randomized controlled trial design in which the childcare centers are randomly assigned to receive the intervention or serve as usual care controls. The Healthy Start-Départ Santé intervention is comprised of interlinked components aiming to enable families and educators to integrate physical activity and healthy eating in the daily lives of young children by influencing factors at the intrapersonal, interpersonal, organizational, community, physical environment and policy levels. The intervention period, spanning 6-8 months, is preceded and followed by data collections. Participants are recruited from 61 childcare centers in two Canadian provinces, New Brunswick and Saskatchewan. Centers eligible for this study have to prepare and provide meals for lunch and have at least 20 children between the ages of 3 and 5. Centers are excluded if they have previously received a physical activity or nutrition promoting intervention. Eligible centers are stratified by province, geographical location (urban or rural) and language (English or French), then recruited and randomized using a one to one protocol for each stratum. Data collection is ongoing. The primary study outcomes are assessed using accelerometers (physical activity levels), the Test of Gross Motor Development-II (physical literacy), and digital photography-assisted weighted plate waste (food intake). Discussion: The multifaceted approach of Healthy Start-Départ Santé positions it well to improve the physical literacy and both dietary and physical activity behaviors of children attending early childcare centers. The results of this study will be of relevance given the overwhelming prevalence of overweight and obesity in children worldwide. Trial registration: NCT02375490 (ClinicalTrials.gov registry)

Identifying and understanding the health and social care needs of Indigenous older adults with multiple chronic conditions and their caregivers: a scoping review

Abstract Background Indigenous people continue to experience high rates of multiple chronic conditions (MCC) at younger ages than other populations, resulting in an increase in health and social care needs. Those who provide services designed to address MCC for Indigenous communities require synthesized information to develop interventions that meet the needs of their older adult population. This review seeks to answer the research question: What are the health and social care needs, priorities and preferences of Indigenous older adults (living outside of long-term care settings) with MCC and their caregivers? Methods A scoping review, guided by a refinement of the Arksey & O’Malley framework, was conducted. Articles were included if the authors reported on health and social care needs and priorities of older Indigenous adults. We also included articles that focused on Indigenous conceptions of wellness, resilience, well-being, and/or balance within the context of aging, and articles where authors drew from Indigenous specific worldviews, ways of knowing, cultural safety, cultural competence, cultural appropriateness, cultural relevance and community needs. Results This scoping review included 9 articles that were examined using an Indigenous determinants of health (IDH) theoretical framework to analyze the needs of older adults and CGs. Five areas of needs were identified: accessible health services; building community capacity; improved social support networks; preservation of cultural values in health care; and wellness-based approaches. Conclusion The review highlights key determinants of health that influenced older adults’ needs: education and literacy, ethnicity, and social support/network (proximal); health promotion and health care (intermediate); and a combination of historical and contemporary structures (distal). The findings highlight the importance of local Indigenous knowledge and perspectives to improve accessibility of culturally relevant health and social services

Palliative and end-of-life care for people living with dementia in rural areas: A scoping review.

Background and objectivesPeople living with dementia deserve to experience the benefits of receiving palliative care and end-of-life services and supports, yet they often do not receive this care compared to those with other terminal diseases. People living with dementia in rural areas often face additional challenges to accessing such care. The purpose of this scoping review was to systematically review and synthesize the literature on palliative and end-of-life care for people with dementia living in rural areas, and to identify and describe key findings and gaps in the literature.MethodsA collaborative research team approach was used in an iterative process across all stages of this review. Systematic, comprehensive searches were conducted across ten databases and eight targeted websites for relevant peer-reviewed, original research and other less formal literature, published in English, which yielded a total of 4476 results. After duplicate removal, screening, and review, 24 items were included for synthesis.ResultsAll items were described and illustrated by frequency distribution, findings were grouped thematically, and five key themes emerged, including: 1) Knowledge about dementia, 2) Availability, accessibility, and utilization of palliative and end-of-life care services and supports, 3) Decision-making about care, the value of a person-centered approach and collaborative support, 4) Perspectives on artificial nutrition, hydration, and comfort care, and 5) Quality of life and death. The main gap identified was literature pertaining to rural populations, especially from locations other than the United States. The influence of rurality on relevant findings was mixed across rural-urban comparison studies, as was the effect of sex and gender across the literature.ConclusionsSeveral areas were highlighted including the importance of increasing knowledge about dementia, having early conversations about advanced care and treatment options, providing a person-centered approach, and the potential for using technology to address rural access issues. These findings can be used to inform future research and policy and the development of services, supports, and strategies for rural people living with dementia. Further research is recommended

Preventing type 2 diabetes among Indigenous youth: A systematic review of community-based interventions

ABSTRACTA systematic review was conducted to assess evidence on effectiveness of community-based interventions promoting wellbeing and prevention of type 2 diabetes (T2D) among Indigenous youth. A convergent, segregated, mixed methods approach was used, with six databases and four grey literature sites searched from inception to May 2022. Articles selected for inclusion were about community-based interventions related to T2D prevention with Indigenous youth that evaluated effectiveness or youth experience published in English. Reference lists were also searched for relevant sources. Seven quantitative research articles met the inclusion and quality assessment criteria. No qualitative articles were identified. The results were synthesised through narrative analysis, while meta-analysis was not possible due to heterogenous study designs. Common foci across interventions included promoting physical wellness, improving physical activity and healthy eating patterns, enhancing knowledge, and psychosocial wellness. Interventions deemed effective addressed multiple areas, were school-based, and operated for at least a year. Findings support multi-strategy, community-based interventions implemented over longer periods of time. However, gaps in research and reporting included the extent to which interventions are culturally informed and based on community-driven priorities. Future research should include Indigenous, mixed and qualitative methods and Indigenous-driven measures of success to better understand effectiveness in alignment with Indigenous worldviews

Parents, Teachers, and Community: A Team Approach to Developing Physical Competence in Children

Increasing children’s physical activity engagement has short- and long-term health benefits. Developing physical competence is a key component of children’s engagement in physical activity. The purpose of our study was to assess if a 12-week home, school, and community-based physical literacy intervention improved the physical competence of children in kindergarten and grade one. Four schools were either assigned to receive the intervention (n = 2 schools) or continue with their usual practice (control sites) (n = 2 schools). Physical competence was evaluated pre- and post-intervention in 103 intervention (41 female) and 83 usual practice (36 female) children using PLAY Fun. PLAY Parent and PLAY Coach tools measured parent and teacher perspectives of children’s physical competence, respectively. The intervention effect was assessed with repeated measures MANOVA to evaluate change in physical competence, with alpha set at p p p p > 0.05). However, teachers perceived improved physical competence for children in the intervention. Our physical literacy intervention improved the physical competence of children in kindergarten and grade one

Barriers and facilitators to development and implementation of a rural primary health care intervention for dementia: a process evaluation

Abstract Background With rural population aging there are growing numbers of people with dementia in rural and remote settings. The role of primary health care (PHC) is critical in rural locations, yet there is a lack of rural-specific PHC models for dementia, and little is known about factors influencing the development, implementation, and sustainability of rural PHC interventions. Using a community-based participatory research approach, researchers collaborated with a rural PHC team to co-design and implement an evidence-based interdisciplinary rural PHC memory clinic in the Canadian province of Saskatchewan. This paper reports barriers and facilitators to developing, implementing, and sustaining the intervention. Methods A qualitative longitudinal process evaluation was conducted over two and half years, from pre- to post-implementation. Data collection and analyses were guided by the Consolidated Framework for Implementation Research (CFIR) which consists of 38 constructs within five domains: innovation characteristics, outer setting, inner setting, individual characteristics, and process. Data were collected via focus groups with the PHC team and stakeholders, smaller team workgroup meetings, and team member interviews. Analysis was conducted using a deductive approach to apply CFIR codes to the data and an inductive analysis to identify barriers and facilitators. Results Across all domains, 14 constructs influenced development and implementation. Three domains (innovation characteristics, inner setting, process) were most important. Facilitators were the relative advantage of the intervention, ability to trial on a small scale, tension for change, leadership engagement, availability of resources, education and support from researchers, increased self-efficacy, and engagement of champions. Barriers included the complexity of multiple intervention components, required practice changes, lack of formal incentive programs, time intensiveness of modifying the EMR during iterative development, lack of EMR access by all team members, lack of co-location of team members, workload and busy clinical schedules, inability to justify a designated dementia care manager role, and turnover of PHC team members. Conclusions The study identified key factors that supported and hindered the development and implementation of a rural-specific strategy for dementia assessment and management in PHC. Despite challenges related to the rural context, the researcher-academic partnership was successful in developing and implementing the intervention