title: 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
  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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  NCT02375490 (ClinicalTrials.gov registry).
authors.affiliation: Department of family medicine, Université de Sherbrooke, 18 avenue Antonine-Maillet, Moncton, NB, E1A 3E9, Canada.|Centre de formation médicale du Nouveau-Brunswick, 18 avenue Antonine-Maillet, Moncton, NB, E1A 3E9, Canada.|Vitalité Health Network, 330 Université Avenue, Moncton, NB, E1C 2Z3, Canada.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Bélanger
authors.affiliation: College of Kinesiology, University of Saskatchewan, 7 Campus Drive, Saskatoon, SK, S7N 5B2, Canada.
authors.forename: Louise
authors.initials: L
authors.lastname: Humbert
authors.affiliation: College of Pharmacy and Nutrition /School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 0Z2, Canada.
authors.forename: Hassan
authors.initials: H
authors.lastname: Vatanparast
authors.affiliation: Department of family medicine, Université de Sherbrooke, 18 avenue Antonine-Maillet, Moncton, NB, E1A 3E9, Canada.|Centre de formation médicale du Nouveau-Brunswick, 18 avenue Antonine-Maillet, Moncton, NB, E1A 3E9, Canada.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Ward
authors.affiliation: Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan Health Sciences E Wing, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada.
authors.forename: Nazeem
authors.initials: N
authors.lastname: Muhajarine
authors.affiliation: College of Kinesiology, University of Saskatchewan, 7 Campus Drive, Saskatoon, SK, S7N 5B2, Canada.
authors.forename: Amanda Froehlich
authors.initials: AF
authors.lastname: Chow
authors.affiliation: Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan Health Sciences E Wing, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada.
authors.forename: Rachel
authors.initials: R
authors.lastname: Engler-Stringer
authors.affiliation: Centre de formation médicale du Nouveau-Brunswick, 18 avenue Antonine-Maillet, Moncton, NB, E1A 3E9, Canada.
authors.forename: Denise
authors.initials: D
authors.lastname: Donovan
authors.affiliation: École des sciences des aliments, de nutrition et d'études familiales, Faculté des sciences de la santé et des services communautaires, Université de Moncton, 18 avenue Antonine-Maillet, Moncton, NB, E1A 3E9, Canada.
authors.forename: Natalie
authors.initials: N
authors.lastname: Carrier
authors.affiliation: Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan Health Sciences E Wing, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada. Anne.Leis@usask.ca.
authors.forename: Anne
authors.initials: A
authors.lastname: Leis
mesh_terms: D002656:Child Day Care Centers; D002675:Child, Preschool; D000072001:Diet, Healthy; D057220:Health Literacy; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D009043:Motor Activity; D055361:Multilevel Analysis; D009509:New Brunswick; D063766:Pediatric Obesity / Q000517:prevention & control*; D015397:Program Evaluation; D012107:Research Design; D012525:Saskatchewan
keywords: Childhood obesity; eating habits; food intake; physical activity; physical literacy; population health intervention; preschool