The BRA-study (completed)
Early promotion of healthy dietary habits: Targeting kindergarten and home environments in a group-randomized controlled trial.
About the project
Early childhood is important for establishing healthy dietary habits. The importance of early prevention of social inequalities in health and promotion of a healthy diet early in life is highlighted in strategic document from health authorities at all levels. Despite the recognition of early prevention as important, reviews show that there so far has been much more studies targeting school-aged children than pre-school children. The reason may be that schools until now have been the best place to reach all children, but in Norway the attendance in kindergartens is now 90% of the age group 1-5 years, making it a highly relevant setting for interventions. Moreover, national dietary surveys among Norwegian pre-schoolers have identified several dietary challenges which may be important to target in an intervention.
The overall objective was to develop, implement and evaluate a theory and evidence-based intervention targeting healthy eating of 3-5 year olds through environmental changes in the kindergarten and the home in a group-randomized controlled study evaluation design.
Specific objectives were:
1) Develop kindergarten intervention components and home intervention components based on theory and evidence and in collaboration with kindergarten personnel and parents.
2) Develop evaluation instruments to measure changes in the children’s vegetable intake, wholegrain bread and changes in the kindergarten and the home environment.
3) Investigate which factors are important for effective implementation of the intervention in the kindergarten and the homes, and develop tools and measure these in the process evaluation.
4) Evaluate the effect and cost-effectiveness of the interventions and the degree of implementation in relation to the factors important for implementation.
Factors in kindergarten and home which are associated with vegetable availability and children’s vegetable intake.
The primary outcome of the BRA-study was the children’s vegetable intake measured in frequency, variation and amount, whereas the secondary ouctomes were availability of vegetable and food practices related to vegetables in the kindergartens and at home. Associations between the primary and secondary outcomes have been explored using the data collected prior to the intervention (73 kindergartens and 633 children). In the home there were positive associations between the childrens’ vegetable intake and availability of vegetables, involvement of the children, practical role modelling and demand to eat, while there were negative associations with barriers to serving vegetables, negative parental attitudes and use of rewards (Kristiansen et al 2017a and b). Results from the kindergarten showed that initial encouragement was positive associated, while reactive encouragement was negatively associated with the childrens’ vegetable intake. Similarly to the home environment, role modelling and demand to eat were positively associated with the childrens’ vegetable intake (Vellinga, 2016). In the kindergartens several economic factors were found to be associated with the vegetable availability, while there were few or no associations with political, physical or socio-cultural factors (Himberg-Sundet et al 2018). These findings indicate that a complex interaction between economic factors, physical availability and food practices in the eating situation can influence childrens’ vegetable intake.
The project was conducted by researchers at the Department of Nutrition, University of Oslo in collaboration with national partners and international experts. The dietary habit chosen was vegetable consumption and the study was named BRA from the Norwegian words for kindergarten, vegetables and family (Barnehage, gRønnsaker and fAmilie).
The study was conducted in 73 public and private kindergartens in the counties of Vestfold and Buskerud in the Eastern part of Norway, starting in the spring of 2015 with 3-5 year olds, parents and kindergartens participating for the next two years. Kindergartens were randomly assigned to intervention or control and the intervention was implemented in the 2015/2016 kindergarten year.
The study was presented to the Norwegian Social Science Data Service AS.
The study was funded by the Research Council of Norway; BEDRE HELSE, 2013-2017(18) and Direktør Throne Holsts Stiftelse for Ernæringsforskning for supplementary grants.
- Professor Thomas Moser, University of South-Eastern Norway
- Associate professor Asle Holthe, Western Norway University of Applied Sciences
- Professor Gerjo Kok, Dep. of Experimental Psychology, Maastricht University, The Netherlands
- Professor Stef Kremers, Dep. of Health Promotion, Maastricht University, The Netherlands Professor Dianne S. Ward, Dep. of Nutrition, University of North Carolina, USA
- Professor David R. Jacobs, School of Public Health, University of Minnesota, USA
- Professor Jørgen Dejgård Jensen, Department of Food and Resource Economics, University of Copenhagen, Denmark.
- Clinical nutritionist Vigdis-Brit Skulberg, Oslo municipality
- Clinical nutritionist Kari-Hege Mortensen, Nordland County
- Norwegian Information Bureau for Fruit and Vegetables
- Geitmyra Culinary Center for Children