Effect Of Intervention On Eating Behavior Problems Among Preschool Children In Shandong Province

BackgroundNowadays, Malnutrition, including both under-nutrition (underweight and stunting) and over-nutrition (overweight and obesity), is an important public health challenge as it causes mortality and morbidities among children. With the economic development and increasing household income in our country, children don’t only have the problems of under-nutrition and growth, but also the incidence of overweight and obesity caused by over-nutrition was increasing. Preschool children’s improper eating behaviors affect dietary intake, resulting in hindering the growth and development of children, especially the excessive intake of high-calorie, high-sugar foods will lead to children’s overweight and obesity. Children’s eating problems were popular in our rural areas, which were associate with caregivers’knowledge, attitudes and behaviors of nutrition.ObjectivesIn this study, we implement the family-school-community comprehensive intervention to caregivers for one year. By improving caregivers’ nutrition knowledge’s level and motivation of attitudes and behaviors, we correct the eating problems of children and improve the growth and development of children ultimately.Materials and MethodsOur study is the first cluster-randomized trial combined with an additional qualitative approach aiming to improve the dietary behaviors among rural preschool children, with an assumption that the living environment in which they grow up has an influence to their physical and psychological development.Quantitative data collection and analysis:We implemented a community-based cluster randomized trial in Gaotang County of Shandong Province with 6 villages were selected. The 6 villages were randomly allocated into either the intervention group or the control group. Children in small and intermediate classes were recruited to our survey. Data was input in Epidata 3.0 and analyzed by using SPSS 19.0. Chi-squared test or t-test was used to examine the difference between the intervention and the control group. Difference in difference analysis was used to estimate the intervention effects over time on caregivers’nutrition knowledge, attitudes and behaviors and over time on children’s eating behaviors.Qualitative data collection and analysis:The participants were recruited by convenient sampling from those enrolled in the intervention. We made a deep interview with 20 caregivers and 5 teachers. Data acquiring from notes and audio recordings were analyzed manually by using content analysis techniques.Main ResultsQuantitative research results:1) Before intervention, there were no difference in eating behaviors among children between intervention and control group. The children in intervention group have eating behaviors such as eating in front of TV, playing while eating, often eating before sleeping and often eating snacks were lower than control group after intervention. (51.7% vs 65.3%; 50.3% vs 64.0%; 41.5% vs 54.2%; 31.1% vs 59.4%), often eating breakfast were higher than control group (96.6% vs 90.7%). They were significantly different.2) Before intervention, there was no difference in nutrition knowledge among caregivers between intervention and control group. The caregivers knowledge score in intervention was higher than control group after intervention (8.565±0.876 vs 8.398±0.924). It had no difference.3) Before intervention, there were no differences in attitudes and behaviors of nutrition among caregivers between intervention and control group. After intervention, the prevalence of caregivers who knew children’s dietary in kindergartens regularly, thought it was necessary to implement seminar of nutrition in kindergarten and pay attention to children’s dietary in intervention group was more than control group(74.8% vs 62.8%; 100.0% vs 97.0%; 91.8% vs 82,2%), caregivers who gave children ate health products were less than control group (17.7% vs 25.8%).They had significantly differences.4) Difference in difference analysis revealed that the intervention had significant effect on reducing children in eating watch TV, playing while eating, eating before sleeping and often eating snacks, and on improving children in eating breakfast. What’s more, the intervention had significant effect on improving caregivers’nutrition knowledge level and promoting caregivers knew children dietary regularly and reducing taking health products.Qualitative research results:Through interviews with caregivers, we have learned that caregivers’lack nutrition knowledge and spoiling children lead to children’s bad eating behaviors. Through the intervention, caregivers’nutrition knowledge and children’s eating behaviors have changed, kindergartens’ teachers’ knowledge and behaviors have changed.Conclusions and SuggestionsConclusions:The family-school-community comprehensive intervention can improve caregivers’ nutrition knowledge, promoting caregivers nutrition attitudes and behaviors, thereby correcting children’s eating behaviors.Suggestion:The intervention should be vigorously promoted in Chinese rural areas to improve the growth of children.