title: Effect and Process Evaluation of a Cluster Randomized Control Trial on Water Intake and Beverage Consumption in Preschoolers from Six European Countries: The ToyBox-Study.
abstract: BACKGROUND
  Within the ToyBox-study, a kindergarten-based, family-involved intervention was developed to prevent overweight and obesity in European preschoolers, targeting four key behaviours related to early childhood obesity, including water consumption. The present study aimed to examine the effect of the ToyBox-intervention (cluster randomized controlled trial) on water intake and beverage consumption in European preschoolers and to investigate if the intervention effects differed by implementation score of kindergartens and parents/caregivers.
  
  
  METHODS
  A sample of 4964 preschoolers (4.7 ± 0.4 years; 51.5% boys) from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, Spain) was included in the data analyses. A standardized protocol was used and parents/caregivers filled in socio-demographic data and a food-frequency questionnaire. To assess intervention effects, multilevel repeated measures analyses were conducted for the total sample and for the six country-specific samples. Based on the process evaluation questionnaire of teachers and parents/caregivers, an implementation score was constructed. To assess differences in water intake and beverage consumption by implementation score in the total sample, multilevel repeated measures analyses were performed.
  
  
  RESULTS
  Limited intervention effects on water intake from beverages and overall beverage consumption were found. However, important results were found on prepacked fruit juice consumption, with a larger decrease in the intervention group compared to the control group. However, also a decline in plain milk consumption was found. Implementation scores were rather low in both kindergartens and parents/caregivers. Nevertheless, more favorable effects on beverage choices were found in preschoolers whose parents/caregivers and kindergarten teachers had higher implementation scores compared to those with lower implementation scores.
  
  
  CONCLUSIONS
  The ToyBox-intervention can provide the basis for the development of more tailor-made interventions. However, new strategies to improve implementation of interventions should be created.
authors.affiliation: Department of Public Health, Ghent University, Ghent, Belgium.
authors.forename: An-Sofie
authors.initials: AS
authors.lastname: Pinket
authors.affiliation: Department of Public Health, Ghent University, Ghent, Belgium.
authors.forename: Wendy
authors.initials: W
authors.lastname: Van Lippevelde
authors.affiliation: Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
authors.forename: Ilse
authors.initials: I
authors.lastname: De Bourdeaudhuij
authors.affiliation: Department of Public Health, Ghent University, Ghent, Belgium.|Department of Human Biometry and Biomechanics, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Benedicte
authors.initials: B
authors.lastname: Deforche
authors.affiliation: Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
authors.forename: Greet
authors.initials: G
authors.lastname: Cardon
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: Odysseas
authors.initials: O
authors.lastname: Androutsos
authors.affiliation: Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, München, Germany.
authors.forename: Berthold
authors.initials: B
authors.lastname: Koletzko
authors.affiliation: GENUD (Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Moreno
authors.affiliation: The Children's Memorial Health Institute, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Socha
authors.affiliation: Dept. of pediatrics and medical Genetics, Medical University of Varna, Varna, Bulgaria.
authors.forename: Violeta
authors.initials: V
authors.lastname: Iotova
authors.affiliation: Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
authors.forename: Yannis
authors.initials: Y
authors.lastname: Manios
authors.affiliation: Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.
authors.forename: Marieke
authors.initials: M
authors.lastname: De Craemer
mesh_terms: D001628:Beverages / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004326:Drinking; D005060:Europe; D005178:Faculty; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010290:Parents / Q000193:education*; D063766:Pediatric Obesity / Q000517:prevention & control; D015397:Program Evaluation; D012574:Schools; D057185:Sedentary Behavior; D011795:Surveys and Questionnaires