000063007 001__ 63007 000063007 005__ 20201105083205.0 000063007 0247_ $$2doi$$a10.1186/s12966-017-0574-z 000063007 0248_ $$2sideral$$a101667 000063007 037__ $$aART-2017-101667 000063007 041__ $$aeng 000063007 100__ $$aDe Craemer, M. 000063007 245__ $$aEffect and process evaluation of a kindergarten-based, family-involved cluster randomised controlled trial in six European countries on four- to six-year-old children's steps per day: The ToyBox-study 000063007 260__ $$c2017 000063007 5060_ $$aAccess copy available to the general public$$fUnrestricted 000063007 5203_ $$aBackground: The ToyBox-intervention is a theory- and evidence-based intervention delivered in kindergartens to improve four- to six-year-old children''s energy balance-related behaviours and prevent obesity. The current study aimed to (1) examine the effect of the ToyBox-intervention on increasing European four- to six-year-old children'' steps per day, and (2) examine if a higher process evaluation score from teachers and parents was related to a more favourable effect on steps per day. Methods: A sample of 2438 four- to six-year-old children (51.9% boys, mean age 4.75±0.43years) from 6 European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain) wore a motion sensor (pedometer or accelerometer) for a minimum of two weekdays and one weekend day both at baseline and follow-up to objectively measure their steps per day. Kindergarten teachers implemented the physical activity component of the ToyBox-intervention for 6 weeks in total, with a focus on (1) environmental changes in the classroom, (2) the child performing the actual behaviour and (3) classroom activities. Children''s parents received newsletters, tip cards and posters. To assess intervention effects, multilevel repeated measures analyses were conducted for the total sample and the six intervention countries separately. In addition, process evaluation questionnaires were used to calculate a total process evaluation score (with implementation and satisfaction as a part of the overall score) for teachers and parents which was then linked with the physical activity outcomes. Results: No significant intervention effects on four- to six-year-old children'' steps per weekday, steps per weekend day and steps per average day were found, both in the total sample and in the country-specific samples (all p>0.05). In general, the intervention effects on steps per day were least favourable in four- to six-year-old children with a low teachers process evaluation score and most favourable in four- to six-year-old children with a high teachers process evaluation score. No differences in intervention effects were found for a low, medium or high parents'' process evaluation score. Conclusion: The physical activity component of the ToyBox-intervention had no overall effect on four- to six-year-old children'' steps per day. However, the process evaluation scores showed that kindergarten teachers that implemented the physical activity component of the ToyBox-intervention as planned and were satisfied with the physical activity component led to favourable effects on children''s steps per day. Strategies to motivate, actively involve and engage the kindergarten teachers and parents/caregivers are needed to induce larger effects. 000063007 536__ $$9info:eu-repo/grantAgreement/EC/FP7/245200/EU/Multifactorial evidence based approach using behavioural models in understanding and promoting fun, healthy food, play and policy for the prevention of obesity in early childhood: ToyBox/TOYBOX 000063007 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/ 000063007 590__ $$a5.548$$b2017 000063007 591__ $$aPHYSIOLOGY$$b7 / 83 = 0.084$$c2017$$dQ1$$eT1 000063007 591__ $$aNUTRITION & DIETETICS$$b7 / 81 = 0.086$$c2017$$dQ1$$eT1 000063007 592__ $$a2.626$$b2017 000063007 593__ $$aMedicine (miscellaneous)$$c2017$$dQ1 000063007 593__ $$aPhysical Therapy, Sports Therapy and Rehabilitation$$c2017$$dQ1 000063007 593__ $$aNutrition and Dietetics$$c2017$$dQ1 000063007 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion 000063007 700__ $$aVerloigne, M. 000063007 700__ $$aDe Bourdeaudhuij, I. 000063007 700__ $$aAndroutsos, O. 000063007 700__ $$aIotova, V. 000063007 700__ $$0(orcid)0000-0003-0454-653X$$aMoreno, L.$$uUniversidad de Zaragoza 000063007 700__ $$aKoletzko, B. 000063007 700__ $$aSocha, P. 000063007 700__ $$aManios, Y. 000063007 700__ $$aCardon, G. 000063007 700__ $$aSummerbell, C. 000063007 700__ $$aLobstein, T. 000063007 700__ $$aAnnemans, L. 000063007 700__ $$aReilly, G.B.J. 000063007 700__ $$aSwinburn, B. 000063007 700__ $$aWard, D. 000063007 700__ $$aGrammatikaki, E. 000063007 700__ $$aKatsarou, C. 000063007 700__ $$aApostolidou, E. 000063007 700__ $$aEfstathopoulou, E. 000063007 700__ $$aDe Decker, E. 000063007 700__ $$aDuvinage, K. 000063007 700__ $$aIbrügger, S. 000063007 700__ $$aStraub, A. 000063007 700__ $$aHerbert, B. 000063007 700__ $$aBirnbaum, J. 000063007 700__ $$aPayr, A. 000063007 700__ $$aChristine, Geyer 000063007 700__ $$aDe Henauw, S. 000063007 700__ $$aMaes, L. 000063007 700__ $$aVereecken, C. 000063007 700__ $$aVan Assche, J. 000063007 700__ $$aPil, L. 000063007 700__ $$aPaw, M.C.A. 000063007 700__ $$ate Velde, S. 000063007 700__ $$aMouratidou, T. 000063007 700__ $$aFernandez, J. 000063007 700__ $$aMesana, M. 000063007 700__ $$aDe Miguel-Etayo, P. 000063007 700__ $$aGonzález, E. 000063007 700__ $$aGracia-Marco, L. 000063007 700__ $$aOves, B. 000063007 700__ $$aYngve, A. 000063007 700__ $$aKugelberg, S. 000063007 700__ $$aLynch, C. 000063007 700__ $$aMosdøl, A. 000063007 700__ $$aMoore, H. 000063007 700__ $$aDouthwaite, W. 000063007 700__ $$aNixon, C. 000063007 700__ $$aKreichauf, S. 000063007 700__ $$aWildgruber, A. 000063007 700__ $$aKulaga, Z. 000063007 700__ $$aZych, K. 000063007 700__ $$aMagdalena, Gózdz 000063007 700__ $$aGurzkowska, B. 000063007 700__ $$aSzott, K. 000063007 700__ $$aLateva, M. 000063007 700__ $$aUsheva, N. 000063007 700__ $$aGalcheva, S. 000063007 700__ $$aMarinova, V. 000063007 700__ $$aRadkova, Z. 000063007 700__ $$aFeschieva, N. 000063007 700__ $$aAikenhead, A. 000063007 700__ $$aBuijs, G. 000063007 700__ $$aDorgelo, A. 000063007 700__ $$aNethe, A. 000063007 700__ $$aJansen, J. 000063007 700__ $$aGmeiner, O. 000063007 700__ $$aRetterath, J. 000063007 700__ $$aWildeis, J. 000063007 700__ $$aGünthersberger, A. 000063007 700__ $$aGibson, L. 000063007 700__ $$aVoegele, C. 000063007 7102_ $$11006$$2255$$aUniversidad de Zaragoza$$bDpto. Fisiatría y Enfermería$$cÁrea Enfermería 000063007 773__ $$g14, 1 (2017), [16 pp]$$pInternational Journal of Behavioral Nutrition and Physical Activity$$tInternational Journal of Behavioral Nutrition and Physical Activity$$x1479-5868 000063007 8564_ $$s1253595$$uhttps://zaguan.unizar.es/record/63007/files/texto_completo.pdf$$yVersión publicada 000063007 8564_ $$s88832$$uhttps://zaguan.unizar.es/record/63007/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada 000063007 909CO $$ooai:zaguan.unizar.es:63007$$particulos$$pdriver 000063007 951__ $$a2020-11-05-08:18:30 000063007 980__ $$aARTICLE