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 - Funding Information:
The authors thank the Fundación SHE, intellectual owner of the SI! Program, and its collaborators: the Instituto de Ciencias de la Educacion (Universidad de Barcelona), ALICIA Foundation, and Gasol Foundation. The authors thank the Fundación CardioInfantil-Instituto de Cardiología social program “Comer con alegría” for facilitating Usaquen's community networks and facilities for recruitment and assessment of the study population. We would like to acknowledge Clara Fonseca, Claudia Barrios, Rocío Castellanos, Zoraya Rojas, Yadira Tibavija, and Marlen Laureano for their support in recruitment and communication with study participants and teachers. The authors also thank Rodolfo Dennis, MS (Department of Research, Fundación CardioInfantil-Instituto de Cardiología) for his role as scientific advisor and proofreading; Raquel Diaz-Munoz, RN MS (Icahn School of Medicine at Mount Sinai) for her support with data management; and junior physicians from Rosario University (Bogotá, Colombia) for their support in the assessments and data collection. Special thanks to the children and families participating in the study. Simon Bartlett (Centro Nacional de Investigaciones Cardiovasculares) provided English editing.
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 -