In the cross-sectional study a baseline survey of preschool education policies was conducted to identify and assess the type and extent of preschool PAPs and opportunities. Prior ethical approval was obtained from the Ethics Committee of the Hannover Medical School (Approval No. 6004).
The baseline survey (February to April 2011) consisted of a comprehensive online and postal survey of programmes and opportunities at all preschools (N = 4114) in Lower Saxony, the second largest and the fourth most populous state in Germany. Data on structural factors (size, ownership, day-care hours, etc.), socio-demographic factors (e.g. location, migration background and socioeconomic status (SES) of the children attending preschool), education policy, health education policy, PA measures and opportunities, social interactions, prevention and health promotion, and quality assurance were collected by questionnaire.
The five-page preschool survey was to be conducted mainly online. As it was known from our previous studies that some of the preschools had no access to the Internet and/or had technical difficulties answering online questionnaires, preschools that did not respond to the survey online were sent the questionnaire by regular mail.
Our goal was to make the survey as quick and easy to complete as possible in order to achieve the highest possible response rate. Pre-testing at 20 preschools showed that it takes about five to ten minutes to complete the questionnaire. The instrument was designed to allow the child care centre directors to answer the questions with assistance from key staff members.
The baseline survey provided a base of data for the identification of preschools with systematic PAPs (type 1) and no PAPs (type 2). Systematic PAPs were defined as integrated, comprehensive and targeted PA promotion programmes. An assessment instrument was developed to identify preschools with systematic PAPs based on the following five quality criteria, comprising a total of 22 items:
A) Written PA policy (two items): written educational concept and/or programme including the topic of PA promotion and describing the preschool’s policies and practices regarding PA;
B) Structured weekly PA offerings for all children (three items): at least 120 minutes of structured physical activities per week, with at least 75% of children participating;
C) At least one trained physical education (PE) teacher (two items): at least one teacher with additional qualifications in PE (e.g. coach) who regularly participates in continuing education courses (at least once every two years);
D) PA-friendly indoor and outdoor facilities (14 items): exercise room, situational PA opportunities, freely designed outdoor areas, play equipment, etc.;
E) Structured PA promotion in place for at least two years (one item).
The selection criteria were based on evidence-based German guidelines for preschool certification in the field of PA in three German states (Lower Saxony, North Rhine-Westphalia and Rhineland-Palatinate) . As all three guidelines specify four quality areas (PA policy, individual structured PA offerings, teacher qualification, and structural conditions/facilities), these areas were included in our assessment instrument. They also had to be amenable to questionnaire measurement.
All items of each criterion had to be met to get one point for each criterion, corresponding to a maximum score of five. Preschools with systematic PAPs had to score at least four out of five points. All item requirements for Criteria A, C and E and ten of 14 for Criterion D had to be met. Regarding Criterion B, it must be noted that some preschools were also classified as having systematic PAPs if they implemented structured physical activities for only 90 to under 120 minutes per week. In this case, 0.3 points were deducted from the score for this criterion.
Criterion E involved the question: For how many years has structured PA promotion been implemented at your facility? In order to receive one point for this item, structured PA promotion had to have been implemented at the facility for an extended period (at least two years).
By definition, preschools with no PAPs (type 2) had a) no structured PA offerings and b) no trained PE teachers, so they could only receive a maximum of two points for the criteria A) written PA policy and D) PA-friendly indoor and outdoor facilities. Preschools reaching a score of 2 to 4 points were classified as preschools with limited PAPs. These preschools promote PA in children to some extent, i.e., they meet the criteria partially but not completely.
In addition to the items of the assessment instrument, we surveyed the frequency of PA promotion measures in ongoing educational work. In the end, this item was not included in the assessment instrument because specific types of structured or unstructured activities were not specified.
The preschools were asked to report the rate of specific promotion of social interaction in daily preschool routine. Social interaction was defined as “action and communication among preschool children”. Two examples of specific measures to promote social interaction were “conflict management/prevention of violence” and “promotion of socio-emotional development”.
The presence of cooperation with a professional provider of PA promotion measures (e.g. sport club) was also determined.
The preschools were also asked to provide information on the socio-demographic characteristics of their area, that is, to indicate whether they are located in a deprived area and how many of their children have a low socioeconomic status (SES) and/or migration background. The proportion of children with a low SES was determined based on the question: How many children at your facility are exempt from paying preschool fees? In Germany, parents exempt from paying preschool fees, receive social welfare benefits. Children with a migration background were defined as those in which both parents have a migration background.
Respondents were also asked to identify their function at the preschool (director, assistant director, teacher or member of the board).
Data analysis was performed using SPSS 20.0 for Windows. The quantitative data analysis was performed using primarily descriptive statistics. Differences in preschool characteristics (size, day care hours, socio-demographic background, etc.) were tested using chi-square statistics. An alpha level of 0.05 was used to judge statistical significance.