Playtime, healthy feeding and nature experiences in Hong Kong pre-schoolers. Evaluation of pilot study 'PLAY & GROW'

Abstract

INTRODUCTION: Most health promoting programs for pre-schoolers focus on diet and physical activity, and although some health promoting programs worldwide have started to include gardening and connections to farms, none in Hong Kong to the best of our knowledge has taken into consideration a family’s interactions with nature. PURPOSE: This pilot project aimed to develop, implement and evaluate “Play&Grow”, a novel program designed to promote age-appropriate healthy routines concerning playtime, eating/feeding habits and “connectedness to nature” habits in families with young children. METHODS: The pilot project included 39 pre-schoolers (aged 2.2 ± 0.9), mothers and their foreign domestic workers. The program was delivered in clusters of 4-5 families in in Hong Kong, with participants attending one workshop per week for a 4-month period. The activities aimed at enhancing family communication and co-operation were related to playtime and eating habits. Each session consisted of four main parts: 1) short discussions on selected health topics; 2) games with food; 3) nature related activities (e.g. growing plants, healthy cooking and creative activities around vegetables and nature). Pre-/post-test questionnaires assessed caregiver’s feeding behaviour and practices, physical activity patterns of caregivers and children, and intervention adherence. Due to the small sample size, non-parametric tests were employed to compare pre- and post-intervention differences. The r code determined the effect size. Correlation analysis was performed between family-related factors and the effectiveness of the intervention, and variables selected from these were included in a multiple regression model. RESULTS: Overall, some of the caregivers’ feeding practices, particularly Instrumental Feeding (IF) and Promoting and Encouraging Eating (PE) improved after the intervention (p=.013 and .015). Weekday vigorous and moderate physical activity levels of domestic helpers and weekend sedentary levels of mothers improved after the intervention (p =.025, .025 and .045), but no differences were detected on children’s playtime. Interestingly, the families with a domestic helper as a primary caretaker had better improvement in the IF behaviours (p = .046). Child’s birth weight and mothers BMI (p = .004, and .048 respectively) were found to have a bearing on the improvement of PE habits as one of a programs outcome. CONCLUSIONS: The “Play&Grow” pilot confirmed the design, adapted for 2-4 year olds protocols, evaluation instruments and logistics of the study. Modified “Play&Grow” intervention will be conducted in a larger, more rigorous study (RCT) to determine the long-term impact of this intervention on disease risk reduction and obesity prevention in Hong Kong.