14.12.2018

1

www.salto-salzburg.at susanne.ring@sbg.ac.at

Assoc. Prof. Dr. Dr.

Susanne Ring-Dimitriou Department of Sport Science & Kinesiology

Paris Lodron-University of Salzburg

SALTO SALzburg Together against Obesity

Seinäjoki, Finland ● Healthy Kids of Seinäjoki ● 14.03.2018

Update of an Community Oriented Core Setting Approach of Health Promotion in the Kindergarten

Overview

• Rationale Childhood Obesity in Austria

• Theory Community Orientied Core Setting approach

• Method SALTO and Evaluation

• Results Preliminary Data – up-date

• Implications Challenges and Scaling-up

14.12.2018

2

Quelle: Alberti et al. (2007, p.5), IDF Consensus on MetS-Definition in Children and Adolescents; WHO (2016)

SALTO

Rationale

Source: Ring-Dimitriou (2017)), Government Report, COSI Data (Weghuber, 2017)

6 3

Rationale

Primary School 8 yrs. students COSI-AT (Nov 2017) OW >1-2SD: OB >2 to >3

Boys 32 % Girls 25 %

West

W H O

B 33%

West

W H O

G 21%

4-6 y - Kindergarten SALTO (n=262, 2017)

26/122 Boys 29/140 Girls

21 %

14.12.2018

3

Real World

• 2009, Cumpulsory Kindergarten Year (5-6y) for All, free of charge

Haas et al. (2012), In Salzburg 2010/2011 16h/wk (5y@31.8.)

• 2009, Framework of Education for Austrian Elementary Services

Ministry of Education, Federal State Governments

• 2011, „Kindergesundheit“, Governmental Initiative

Ministry of Health

• 2011, National Action Plan of Nutrition (NAP.e)

Ministry of Health

• 2013, NAP of Physical Activity (NAP.b)

Ministry of Defense and Sports

Starting Point

2nd cumpulsory year is under discussion

No obligate curriculum available

No harmonized standards for catering in schools

Implementation needs time! 2/3 of 79% (WHO, 2017)

No concerted strategy – HiAP! No public health action cycle (action vs. evaluation)

SALTO Model, mod. to:

Loosch & Rosinski (2001, S.81ff), in Scheid & Prohl

(Hrsg.). Bewegungslehre.

Fuchs (2003), Sallis et al. (2006); Newell (1986);

Sozioökologisches Modell (Dahlgren & Whitehead, 1991

Link to Wagner et al. (2016) Environmental Hypothesis

COMMUNITY ENVIORNMENT

Physical and social E. – ADVOCACY

INTERVENTIONS

INTERPERSONAL ENVIRONMENT

MEDIATORS(b), KGTeachers, Parents

SOCIALISATION

PERSONNEL ENVIRONMENT

CHILD

DEVELOPMENT MATURATION

LEARNING

BEHAVIOUR

Behaviour Change in Children

ESI->CB = ESI->M * bM->CB (mod. Fuchs, 2003, p.113)

ESI->BC =

* bM ->BC

ESI->M

Theory – Individual

14.12.2018

4

Kindergarten Teachers

Linkage to Community Level

Professionals Actors of the Community

Moderators of Community Agenda

Children, Peers KG Teachers, Parents, Caregivers External Persons (Farmers….) Institutions (Ski club…)

Kindergarten Setting of the

Interpersonal World

Theory – Interpersonal

Keys of Setting Kindergarten

• Feasability of prevention actions Needs of community has to be recognized Action shall fit to the setting: „SALTO soll sich uns

anpassen“ (SALTO shall fit to our needs)

Theory – COCS Approach

„…CBI reinforces the importance of adapting and localizing an intervention within a community setting!“

Reis et al. (2016), The Lancet

• WHO EOC-Recommendation, Area 4 Provide clear guidance and support to caregivers Ensure food education & PA incorporation

14.12.2018

5

Local Government: Policies, Services -> Support of Actions

Partners - Stakeholders

Actors @ COCS

CHILDREN Overall

Target Group

PARENTS Primary

Target Group

TEACHERS Primary

Target Group

Community Oriented Core Setting

Trainer Sports Club

New Sport Activities

Farmer Food production

Power Company Water and Life

Education School

Teacher

Fam Services Clinic, Civil Society

Peer Group Habts -> Lifestyle …

…

Ring-Dimitriou et al. (2017), Obesity Facts 10:DOI: 10.1159/000481139;

Theory – COCS Approach

2015 – 2018 - …

Method - SALTO

Project Participation via Federal Department & City; The entire Kindergarten team is „on board“ Sample (2017)

Intervention, n=12 Controls, n=8 2016

Children 4-6 y: n=698 (5%) Parents: n=181, Teachers: n=30 3-6y, n=13.700, 119 Muncipalities Lead: SRD, Dep Sport Science & Kinesiology, University of Salzburg

Source: Ring-Dimitriou (2017)), Government Report

14.12.2018

6

Science

Practice

Evaluation Objective

Project & Program

Phase

Preparation 0

Problem Identification Test & Action Development

Formative Evaluation

1

Jun 2013

OAA Experience Therapy Projects InForm Save-OK

Development Evaluation Design & Tests

Obesity 4-6y. -> Prevention

Time to act

Report No Obes. Prev. Proj. @Federal State Level

Analyses Good Practice

Projects

Jan 2014

Pilot- Study

City of Sbg.

Intervention Mapping

13. Nov 2014

Initiation- Phase

2

SALTO Kick-off

Nov 2018

Implementation- Phase

3

R Reach E Effectiveness A Adoption

Tailoring Actions

& Implementation-> KiGa & Commun.

Salzburger Model Implementation Research

Obesity Prevention

Repeatability Of Effectiveness

Of Selected Actions

Program-Elements SALTO->

in Healthy KiGa &

BAfEP, ZEKIP

SALTO Methode

SALTO Evaluation Model

Quelle: Ring-Dimitriou et al. (2017), Obesity Facts 10:DOI: 10.1159/000481139

Global & Strategic Goals

• Increase of healthy BW in Children @6y

• Child: Improvement of Fundamental Movement Skills

• Child: Improvement of Eating Behavior

• Adults: Teachers and Parents - Empowerment to Implement Health Enhancing Actions

• Adults-Child: Enforcement of Interactions between Teachers – Parents

Quelle: Ring-Dimitriou et al. (2017), Obesity Facts 10:DOI: 10.1159/000481139; Aistleitner et al. (2017), J. Ernährungsmedizin

• Child: Improvement of Physical Activity Behavior

Method - SALTO

14.12.2018

7

Tactical Goals SALTO Actions over 6 months

• Fundamental movement skills & family leisure time activities

• Sitting, standing up & outdoor activities

• Screen time & sports activities

• Portion size & vegetables

• Water consumption & nutrients for children

• Sweets/snacks & special situations

Method - SALTO

„Strengthening competences, Minimizing Barriers“ Modul for KG Teachers

„Parents support Parents“ Modul for Parents/Caregivers

Social Norms Marketing Community Modul

• 4h + 8h Workshops – Social Representations… • Coachings for KG-Teachers – Communication, … • SALTO-Actions in the Curriculum – 6 Mon. Topics • Involvement of community intiatives

• Parent´s Evening and Forum (internet) • Peer Program Workshops • Take-Home-Activities • Newsletter

• Stakeholder Dialog annually and Newsletter • Expert Club • Marketing Mix regarding healthy physical activity and

eating, healthy body weight (homepage, video) • KT meet the Mayor´s

Internal / External Evaluation

• Every year – mixed-longidtudinal seqeuential design • A- Questionnaires: salutogenic/pathogenic eating & PA

behav., PWS-scale • C-Pictorial Tests: Eating & PA preferences • C- Fundamental Movement Skill test battery

Intervention: SALTO Actions 2015-2018

Method - SALTO

14.12.2018

8

1 Intervention Mapping 2 Intro - Workshop Haltungen & Überzeugungen -> Barrieren -> Lösungen

3 Tailored Curriculum

4 Coachings

SALTO Coordinator - Facilitator

5 Austauschtreffen

Method – SALTO: Teachers

3 Peer-Workshop Parents meet Parents

2 Café & Parent-Forum

SALTO meets Parents

1 Parents Evening Kindergarten teacher & Parents & SALTO

4 Take Home Activities Parents with Children

Talent-List Parents with Kindergarten

Kletter Box

Method – SALTO: Parents

14.12.2018

9

R

E

A

I

M

Reach: „No. of children, parents, teachers“

Effectiveness: change in BMI-sds, FMS-Level

Adoption: „No. KiGa (Setting HiAP) “

Implementation: „No. Actions -> Program“

Maintenance: „Certificate Healthy KiGa“

Quelle: mod. to Glasgow et al. (1999) in King, Glasgow, & Leeman-Castillo (2010)

RE-AIM Konzept Evaluation the Success of Health Promoting Interventions/Actions

Method - Evaluation

Participation & Dissemination

Results: Reach – Input/Output

Source: unpublished, SALTO Annual Report (2016)

Input-No.

Output-No.

Reached (2016)

Children 4-6 y: n=698 (5%) Parents: n=181 (Father, Mother) Teachers: n=30 3-6y, n=13.700, 119 muncipalities

14.12.2018

10

Completed Actions – Kindergarten Teachers

Results: Adoption - Input

47x 2016 3,6 x/ Jahr

4/4 12/13 12/13 12/13 12/13

Quelle: eigene Darstellung, Aistleitner & Ring-Dimitriou (2017)

Bahnung – Wie kann es gelingen

14.12.2018

11

Bahnung – Wie kann es gelingen

14.12.2018

12

Bahnung – Wie kann es gelingen

Bahnung – Wie kann es gelingen

14.12.2018

13

Completed Actions – Parents

Steh café

11/13 7/13 2/13 7/13 3/13

Quelle: eigene Darstellung, Aistleitner & Ring-Dimitriou (2017)

Results: Adoption - Input

53,8

46,2

46,2

38,5

38,5

33,3

30,8

15,4

8,3

38,5

53,8

38,5

61,5

38,5

66,7

46,2

69,2

50

53,8

27,3

7,7

15,4

23,1

23,1

15,4

41,7

30,8

36,4

15,4

36,4

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Erweiterung des fachlichen Wissens

neue Ideen für die alltägliche Arbeit

Persönliche Weiterbildung

Möglichkeit zur Integration von SALTO in den Arbeitsalltag

Erfahrungsaustausch mit anderen PädagogInnen

spürbare Einstellungsänderung im Team

spürbare Einstellungsänderung bei den Kindern

Förderung des Gesundheitsbewusstsein der Eltern

bereits erkennbare Effekte durch die Maßnahmen

spürbare Einstellungsänderung bei den Eltern

Vernetzung mit relevanten Einrichtungen in der Gemeinde

Erfüllung der Erwartungen an SALTO (Angaben in Prozent; N = 13)

zur Gänze eher eher nicht gar nicht

Interview with the Head of Elementary Service (n=13) External Evaluation - Maislinger-Parzer et al. (2017)

Quelle: Maislinger-Parzer et al. (2017)

Results: Adoption - Output

KT: Expectations to SALTO

Increase in knowledge of health promotion

Kind of further education

New ideas for daily work

Possibility of integrating SALTO into Work

Significant changes of attitudes in the team

Exchange of experiences with other KiGa-T.

Significant changes of behavior in kids

Promotion of health literacy in parents

Experiences effects of actions

Significant changes of attitudes in parents

Networking with community services

14.12.2018

14

Interview with Parents (n=56-65) External Evaluation, Maislinger-Parzer et al. (2016)

Quelle: Maislinger-Parzer et al. (2016)

Results: Adoption - Output

How often have you been informed about SALTO actions by the KiGa (n=56 to 65, %)

SALTO Leaflets, 6 Topics

On-site Talks KT with P

Parents Evening

Black Board

Events

Parents Peers

My child told me

Other parents told me

Longitudinal Data Motor Tests (2015-2016, n=60) Freudenthaler (2017, unpubl.) – t1=4+5 J., t2=5+6 J. – Outcomes

Locomotion Coordination

Postural Control Balance

Locomotion Endurance

Locomotion Leg Strength

2015 2016 2015 2016 2015 2016 2015 2016

Quelle: unpublished, Freudenthaler (2017) , in Ring-Dimitriou für BMLVS (2017)

Results: Effectiveness - Outcome

14.12.2018

15

Input 3,6 x /Year Contacts; 11/13 Parents Café

Output + Didactic material, Knowledge about…, Attitudes in the team

- Reflecting daily work, Networking with the community

Outcome Fundamental Movement Skill Level Cross sectional – process / qualitative - Loc, Obj Manipulation OW/OB = NW, Postural C. OW/OB < NW - B >> G Catch, Throw, Kick; B > G Run, Jump; G > B one-leg stand, Balance Longitudinal – result / quantitative - Loc: 4- / 5-y. > as norm values; strength, endurance decrease, coordination increases - Postural contorl: 4- / 5-y. = Norm, no change MVPA -> „silent vs. active paedagogic input“ In 2h -> 48 min (14–50 min) -> ca. 1/3 of PA-recommendations

Impact OW+OB Children: 21 % 4-6 y., 16 % to high WC OW+OB Parents: 19 % Mothers, 51 % Fathers

Quelle: eigene Darstellung, Ring-Dimitriou (2017)

Results: Summary

Quelle: EU Action Plan (2014, p.11)

Implications

14.12.2018

16

From evidence-to-practice practice-to-evidence concepts

Research

Scientific evidence – theory based interventions on obesity prevention via concepts of PA- and eating behaviour and preferences, fundamental movement skills Policies: Reviewing & collaboration Evaluation & Testing – internal & external Identifying indicators (input, output, outcome, impact) and proof of effects

Actions

Initiation Phase: - SALTO large -> Purzelbaum initiation phase + SALTO - Capacity Building: Education sector, Sports Sector - Dissemination to Education Sector & Stakeholder Program Implementation: - Actions that work (2018)

ECHO-zone: Scaling up needs Time, e.g. 20yrs in CATCH, 7yrs Munch&Move Extending the reach of intervention / actions

Implications

14.12.2018

17

Assoc.-Prof. Dr. Dr. Susanne Ring-Dimitriou Sport Scientist, Physical Activity & Health,

Head of SALTO

Mag. Thomas Freudenthaler Sport Scientist, Fundamental Movement Skills

Testing Coordination

Mag. Gertrude Horvath Dietician & Sport Scientist, Nutrition

Coordination Kindergarten

BSc. Julia Stallinger Sport Scientist & Kindergarten Teacher

Assistent

Mag. Verena Aistleitner Sociologist, Health Promotion

Project Management

PD Dr. med. Daniel Weghuber Pediatrician & Gastroenterologist

Vice President European Childhood Obesity Group

Head of Medical Issues

Facilitated with support of:

Ernährungs- Kommunikation GmbH

www.essenziell.at