The Appetite Toolbox for Preschools
Condition: Eating Behavior; Self Regulation; Body Weight
MeSH terms: Body Weight
Study type: Interventional

Summary: 
      This study uses a Hybrid research design to assess the effectiveness and implementation of a
      preschool-based programme - the Appetite Toolbox - delivered by Early Childhood Educators to
      promote children's appetite awareness and eating regulation skills. Children, their
      caregivers and classroom teachers will be recruited across 18 classrooms from preschool
      childcare centers. Preschool educators will deliver the Appetite Toolbox over a period of six
      weeks. Using a waitlist-control design we will measure changes in children's appetite
      awareness and eating regulation skills in school and describe implementation outcomes, such
      as fidelity, acceptability, and feasibility of the programme.
    

Detailed description: 
      The Appetite Toolbox is a programme developed for use in preschools and designed to promote
      children's appetite awareness and eating regulation skills through a series of books,
      classroom activities and mealtime routines developed with curriculum specialists and aligned
      to the Centre's core curriculum competencies (e.g. Language and Literacy, and Social and
      Emotional Development).

      Using a Hybrid Type I cluster-controlled pilot design, the Appetite Toolbox for preschools
      study aims to:

      i) Characterise the effectiveness of the Appetite Toolbox delivered over to increase
      children's awareness of appetite and eating regulation skills over a six-week period.

      ii) Assess implementation of the Appetite Toolbox in preschool centers, with a focus on
      acceptability, appropriateness, fidelity, and feasibility of Appetite Toolbox as delivered by
      preschool educators.

      The research team will also explore whether differences in home feeding practices and
      implementation factors moderated the effectiveness of the Appetite Toolbox in preschools.

      Children will be recruited from N2, K1 and K2 classrooms across six preschools from the same
      anchor operator and three locations (18 classrooms in total, three per school). At each
      location, preschools will be randomised to complete the Appetite Toolbox programme over a
      period of six weeks, either immediately (intervention group) or later in the school year
      (waitlist-control group).

      Effectiveness will be characterised by changes in children's ability to communicate
      meaningful changes in appetite, portion selections and tendency to snack in the absence of
      hunger. While implementation measures will assess the utility of training provisions
      alongside fidelity, acceptability, and appropriateness of the Appetite Toolbox programme in
      both the intervention and waitlist schools, captured through a series of questionnaires,
      in-class observations and interviews with teaching staff, central curriculum leaders and
      specialists.

      The research results will provide important evidence for the impact and application of the
      Appetite Toolbox materials as a low-cost means to improve childhood eating behaviours via
      preschools and early years education, and inform the design of a larger-scale definitive
      trial.
    

Intervention name(s): Appetite Toolbox Programme
Intervention type(s): Behavioral
Intervention description(s): Preschool educators are trained to deliver a bio-behavioural classroom-based programme focusing on building skills in i) appetite awareness, ii) attention/attention control and iii) sensing body cues. The programme is delivered using a combination of interactive story books, classroom props and activities, and mealtime transitions/routines.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The effectiveness measures are assessed using a parallel cluster-controlled design. The preschool center is considered a cluster for randomisation to either an Intervention Group or Waitlist Control Group. All preschool centers will deliver the Appetite Toolbox programme by the end of the research and contribute to the implementation outcomes.
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Hybrid Design; Preschool; Eating Behaviour; Appetite; Eating Regulation; Food intake