TY - JOUR
T1 - Sustainability of and Adherence to Preschool Health Promotion Among Children 9 to 13 Years Old
AU - Fernández-Jiménez, Rodrigo
AU - Briceño, German
AU - Céspedes, Jaime
AU - Vargas, Sarha
AU - Guijarro, Jennifer
AU - Baxter, Jorge
AU - Hunn, Marilyn
AU - Santos-Beneit, Gloria
AU - Rodríguez, Carla
AU - Céspedes, Maria Paula
AU - Bagiella, Emilia
AU - Moreno, Zorayda
AU - Carvajal, Isabel
AU - Fuster, Valentin
N1 - Publisher Copyright:
© 2020
PY - 2020/4/7
Y1 - 2020/4/7
N2 - Background: Long-term evaluations of child health promotion programs are required to assess their sustainability and the need for reintervention. Objectives: This study sought to explore the long-term impact of a preschool health promotion intervention delivered in an urban low-income area of Colombia (phase 1) and to assess the effect of a new community-based intervention (phase 2). Methods: In phase 1, a cross-sectional analysis of knowledge, attitudes, and habits (KAH) toward a healthy lifestyle and ideal cardiovascular health (ICH) scores of 1,216 children 9 to 13 years old was performed. Of the total, 596 had previously received a preschool health promotion intervention at 3 to 5 years old, whereas the remaining 620 were not previously intervened (intervention-naive group). In phase 2, all children were cluster randomized 1:1 to receive either a 4-month educational intervention (the SI! Program) to instill healthy behaviors in community centers (24 clusters, 616 children) or to control (24 clusters, 600 children). Previously intervened and intervention-naive children were not mixed in the same cluster. The primary outcomes were the change from baseline in KAH and ICH scores. Intervention effects were tested for with linear mixed-effects models. Results: In phase 1, ∼85% of children had nonideal cardiovascular health, and those who previously received a preschool intervention showed a negligible residual effect compared with intervention-naive children. In phase 2, the between-group (control vs. intervention) differences in the change of the overall KAH and ICH scores were 0.92 points (95% confidence interval [CI]: −0.28 to 2.13; p = 0.133) and −0.20 points (95% CI: −0.43 to 0.03; p = 0.089), respectively. No booster effect was detected. However, a dose-response effect was observed, with maximal benefit in children attending >75% of the scheduled intervention; the difference in the change of KAH between the high- and low-adherence groups was 3.72 points (95% CI: 1.71 to 5.73; p < 0.001). Conclusions: Although overall significant differences between the intervention and control groups were not observed, high adherence rates to health promotion interventions may improve effectiveness and outcomes in children.
AB - Background: Long-term evaluations of child health promotion programs are required to assess their sustainability and the need for reintervention. Objectives: This study sought to explore the long-term impact of a preschool health promotion intervention delivered in an urban low-income area of Colombia (phase 1) and to assess the effect of a new community-based intervention (phase 2). Methods: In phase 1, a cross-sectional analysis of knowledge, attitudes, and habits (KAH) toward a healthy lifestyle and ideal cardiovascular health (ICH) scores of 1,216 children 9 to 13 years old was performed. Of the total, 596 had previously received a preschool health promotion intervention at 3 to 5 years old, whereas the remaining 620 were not previously intervened (intervention-naive group). In phase 2, all children were cluster randomized 1:1 to receive either a 4-month educational intervention (the SI! Program) to instill healthy behaviors in community centers (24 clusters, 616 children) or to control (24 clusters, 600 children). Previously intervened and intervention-naive children were not mixed in the same cluster. The primary outcomes were the change from baseline in KAH and ICH scores. Intervention effects were tested for with linear mixed-effects models. Results: In phase 1, ∼85% of children had nonideal cardiovascular health, and those who previously received a preschool intervention showed a negligible residual effect compared with intervention-naive children. In phase 2, the between-group (control vs. intervention) differences in the change of the overall KAH and ICH scores were 0.92 points (95% confidence interval [CI]: −0.28 to 2.13; p = 0.133) and −0.20 points (95% CI: −0.43 to 0.03; p = 0.089), respectively. No booster effect was detected. However, a dose-response effect was observed, with maximal benefit in children attending >75% of the scheduled intervention; the difference in the change of KAH between the high- and low-adherence groups was 3.72 points (95% CI: 1.71 to 5.73; p < 0.001). Conclusions: Although overall significant differences between the intervention and control groups were not observed, high adherence rates to health promotion interventions may improve effectiveness and outcomes in children.
KW - child
KW - health promotion
KW - healthy lifestyle
KW - preschool
KW - prevention
UR - http://www.scopus.com/inward/record.url?scp=85081994207&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2020.01.051
DO - 10.1016/j.jacc.2020.01.051
M3 - Article
C2 - 32241373
AN - SCOPUS:85081994207
SN - 0735-1097
VL - 75
SP - 1565
EP - 1578
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 13
ER -