A Good Start Matters Intervention Study

Study Overview
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Brief Summary
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The BC government and partners developed Active Play Standards and a capacity-building strategy to help childcare centers implement the Standards. We have developed an intervention to supplement the governmental capacity-building strategies. The intervention is comprised of implementation support strategies targeted at childcare providers in BC that will aid with the sustainment of Active Play best practices at their facilities. The impact of the intervention will be assessed by measuring its impact on a) change in practices with respect to Active Play; and b) improving child-level outcomes (children's physical activity, sedentary behavior, and motor skill competencies). The findings will inform future policies and enhance our understanding of how policy action supported by communication, capacity-building, and sustainment strategies influence the environment of childcare centres.

Detailed Description
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The Director of Licensing Standard of Practice - Active Play (Active Play Standard), mandates the provision of Active Play opportunities (amount of time spent outdoor, amount of physical activity, provision of fundamental skills) in licensed childcare centers in British Columbia, Canada. To support the implementation of this standard, the province released a capacity-building intervention, called Appetite to Play (ATP). Appetite to Play provides training and support to childcare providers in enhancing physical activity, physical literacy, and healthy eating environments in their facilities. To encourage the sustained use of ATP and aid childcare facilities in maintaining their adherence to the Active Play Standard, we have developed an intervention called, Appetite to Play +, targeted at facility managers and staff. The intervention builds upon ATP and is considered advanced training for childhood educators. The intervention involves the implementation of support strategies focused on integrating Active Play and fundamental movement skills into scheduling, curriculum planning, and creating a supportive environment for Active Play and healthy eating in childcare facilities.

Official Title
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A Good Start Matters: Do Supportive Childcare Centre Environments, Policies and Practices Enhance Physical Activity?

Conditions
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Physical Inactivity, Motor Activity

Intervention / Treatment
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* Behavioral: Appetite to Play +


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria for childcare center: Located in the Metro Vancouver region Provides care to at least 10 children aged 2 1/2 to 5 years Childcare program that is longer than 4 hours each day Inclusion for child outcomes / measurement children must attend a childcare that has volunteered to participate in the study Child must be between 2 1/2 to 5 years of age Inclusion Criteria for managers and staff childcare centers: - Managers at licensed BC childcare facilities, working full time (at least 3 full days per week) in a facility for children aged 2½ to 5 years, defined as an Executive Director, supervisor, or program manager. Aged 19 years or older. OR - Childcare staff at licensed BC childcare facilities, working full time (at least 3 full days per week), defined as Early Childhood Educator, instructor, or staff that cares for 2½ to 5-year-old children. Aged 19 years or older. Exclusion Criteria for childcare center: Located outside Metro Vancouver region Facilities caring only for children under 2 1/2 years old or older than 5 years Family or in-home multi-age childcare Exclusion Criteria for managers and staff childcare centers: Do not care or supervise 2 ½ to 5 years old children Work less than 3 full days per week Administrative assistant/office manager Younger than 19 years of age

Ages Eligible for Study
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Minimum Age: 30 Months

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: To test the efficacy of ATP+, we will conduct a randomized control trial with 52 facilities - where 26 facilities will be randomized to receive the intervention and while the remaining facilities will receive the standard of care as a waitlist control group and will receive the intervention at 3-month post randomization.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention group<br>The experimental group will receive the Appetite to Play + intervention which is a capacity-building intervention that support childcare providers in implementing the best practices for active play. It includes a 3 e-learning online modules and then the are supported with weekly . bi-weekly emails. | Behavioral: Appetite to Play +<br>* In 2017 the province of BC enacted a provincial standard for physical activity, formally titled the Director of Licensing Standard of Practice - Active Play (Active Play Standards) that licensed childcare centers are required to adhere to. Along with this, a provincial capacity-building intervention (Appetite to Play) was released to provide training and education to early years providers working in the province and support the implementation of the Active Play Standards. The intervention, Appetite to Play +, will provide advanced training to early year educators on the Appetite to Play activities and resources. The intervention will include workshops and training on physical literacy, fundamental movement skills, and creating a supportive environment to sustain Active Play practices. As part of the intervention, managers will also be provided with resources to aid them with the integration of Active Play into their curriculums and schedules.<br>|
| Other: Standard of care waitlist control<br>The standard of care waitlist control group will receive the intervention at 3-months post-randomization. The standard of care group has access to the Appetite to Play materials which are available to everyone. The site includes resources that childcare providers can use. | Behavioral: Appetite to Play +<br>* In 2017 the province of BC enacted a provincial standard for physical activity, formally titled the Director of Licensing Standard of Practice - Active Play (Active Play Standards) that licensed childcare centers are required to adhere to. Along with this, a provincial capacity-building intervention (Appetite to Play) was released to provide training and education to early years providers working in the province and support the implementation of the Active Play Standards. The intervention, Appetite to Play +, will provide advanced training to early year educators on the Appetite to Play activities and resources. The intervention will include workshops and training on physical literacy, fundamental movement skills, and creating a supportive environment to sustain Active Play practices. As part of the intervention, managers will also be provided with resources to aid them with the integration of Active Play into their curriculums and schedules.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in practices (Facility level outcomes) | Staff reported assessment of practices based on questions developed by the Early Years Survey and the Environment and Policy Assessment and Observation tool (EPAO-SR). | Two time points -baseline and 3-month post intervention | 
| Time spent in Active Play (Child outcomes) | Field observations using a modified version of the EPAO will be used to observed practices and child engagement in Active Play. The EPAO we used for this study is adapted to specifically assess the practices targeted by the Active Plays Standards (e.g., outdoor time, provision of active play time, provision of fundamental movement skills activity). | Two time points -baseline and 3-month post intervention | 
| Fundamental movement skills (child outcomes) | Children's FMS will be assessed with the validated Test of Gross Motor Development (TGMD-3 a norm-referenced tool for assessing 13 gross motor skills - locomotor (run, gallop, hop, leap, horizontal jump and slide) and object control (strike, dribble, kick, catch, throw, and roll a ball). The measure takes 15-20 min per child to administer and provides standardized and percentile composite scores for the locomotor, object control, and gross motor quotient (GMQ) composites. | Two time points -baseline and 3-month post intervention | 
| Physical activity behaviour (child outcomes) | Measurement of children's physical activity (min/hour) at light, moderate, and vigorous intensity, measured by accelerometry. Children will wear the AX3 accelerometer (Axivity device Actigraph, Pensocola, FL) | Two time points -baseline and 3-month post intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Characteristics of childcare settings | Assessment of structural support and processing supporting implementation of Active Play policies and practices, as measured by the Early Years Survey and the Environment and Policy Assessment and Observation tool (EPAO-SR). | Three time points -baseline and 3-month, and 6-month post intervention | 
| Characteristics of providers | Assessment of staff and manager's knowledge and skills, self-efficacy, and commitment to changes facility practices to implement Active Play standards , as measured by the Early Years Survey. | Three time points -baseline and 3-month, and 6-month post intervention |