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Growing philosophical and empirical evidence shows that physical literacy and risky play enriches movement opportunities, while also fostering increased physical activity, wholistic health, and wellness across the lifespan. However, physical literacy and risky play have typically been theorized and practiced from a western worldview. In response, Nature’s Way-Our Way is an initiative designed to ground physical literacy and risky play in Indigenous games, activities, cultural connections, and traditional teachings, as enacted in Early Childhood Education Centres across Saskatchewan, Canada. This article explores Nature’s Way-Our Way’s theoretical underpinnings of Etuaptmumk (Two-Eyed Seeing), adopted to braid together the strengths of Indigenous Knowledges with western knowledge through practices of Indigenous métissage (land and story-based approaches to curriculum informed by relationality). Providing examples of culturally rooted resources, this article shows how the Nature’ s Way-Our Way initiative supports Indigenous self-determination and sovereignty to foster increased physical activity, wholistic health, and wellness across the lifespan.

The aim of this integrative review was to provide a synthesis of existing evidence on the impact of early childhood educators’ (ECEs) personal health and wellness on their ability to model, engage, and interact with children in developing physical literacy (PL). Electronic databases searched included PubMed, APA PsycInfo, EMBASE, Public Health Database, and Scopus, and a search of grey literature, Google Scholar web browser, and a manual search of study references was also undertaken. The review was guided by the frameworks of Torraco (Resour Dev Rev 4(3):356–367, 2005; Hum Resour Dev Rev 15(4):404–428, 2016) and Whittemore and Knafl (J Adv Nurs 52(5):546–553, 2005) to systematically extract, analyze, and synthesize data from the literature and organize key patterns into new concepts. The three major themes identified as influential elements in engaging children to adopt PL relate to ECEs’ personal physical activity with respect to their confidence, their role modeling capabilities, and their physical ability to engage the children they work with. Despite limited available research on ECEs’ personal health and wellness and their ability to engage children in developing PL, it was determined that ECEs’ interest in physical activity (PA) and level of commitment to their health and wellness contribute to their confidence levels, their role modeling capabilities, and their level of engagement with the children they work with.

Dementia-related continuing education opportunities are important for rural primary health care (PHC) professionals given scarce specialized resources. This report explores the initial perceptions and continuing education needs of rural interprofessional memory clinic team members and other PHC professionals related to a short series of dementia-related education webinars. Three webinars on separate topics were delivered over an 8-month period in 2020 in Saskatchewan, Canada. The research design involved analysis of webinar comments and post-webinar survey data. Sixty-eight individuals participated in at least one webinar, and 46 surveys were completed. Rural memory clinic team members accounted for a minority of webinar participants and a majority of survey respondents. Initial perceptions were positive, with webinar topics and interactivity identified as the most effective aspects. Continuing education needs were mainly aligned with professional roles; however, some overlap of interests occurred. Future webinars will further explore learning needs within an interprofessional environment.

Interventions for caregivers of persons with dementia are well supported, but it remains unclear whether caregivers benefit from early-stage intervention when caring for persons with mild dementia or mild cognitive impairment (MCI). This systematic review and meta-analysis examined whether early-stage interventions for this population positively affect their well-being and ability to provide care and whether effectiveness varies based on intervention or caregiver/recipient characteristics. Searches of four databases (MEDLINE, EMBASE, PSYCINFO, and CINAHL) yielded 20,722 titles and 1,305 full texts were independently screened. Twenty-two reports representing 18 randomized controlled trial (RCT)/controlled early-stage intervention studies were included for meta-analysis, measuring a variety of outcomes for which effect sizes were calculated using standardized mean differences. Findings suggest that early-stage intervention has a small positive effect on both caregiver well-being and ability to provide care, with the largest effects observed for caregiver anxiety and caring-related distress. Moderator analyses showed no statistically significant difference in effectiveness based on type of intervention (counseling/psychotherapy, psychoeducational, or multicomponent) or individual versus group-based interventions. However, interventions that were caregiver only (vs. dyadic) had larger positive effects on caregiver well-being and ability to provide care. None of the caregiver/recipient characteristics examined (sex, type of relationship, and type of dementia) were related to the effectiveness of early-stage interventions. Although published controlled/RCT trials were limited, findings support efforts to offer early-stage interventions to caregivers of persons with mild dementia or MCI. Further research to determine what intervention types or components are most efficacious would aid the provision of optimal support for caregivers early in their caregiving trajectory. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

RÉSUMÉL’application d’approches d’équipes en soins de santé de première ligne (SPL) pour le diagnostic et le traitement de la démence est considérée comme une pratique exemplaire. Malheureusement, il arrive fréquemment que les personnes vivant dans les régions rurales et éloignées aient peu d’accès à des services de SPL spécialisés pour la démence. Le but de cet examen de la portée était d’identifier et de comprendre les approches d’équipes en SPL pour les soins en milieu rural visant les cas de démence. La stratégie de recherche utilisée a uniquement inclus des articles de revues à comité de lecture publiés entre 1997 et 2017. Quatre bases de données (Embase, Medline PsycInfo et CINAHL) ont été consultées de mars 2017 à mai 2017. Les dix études retenues montraient des degrés de collaboration et des interactions variables dans les équipes de soins. Peu d’informations étaient rapportées sur les stratégies de collaboration de ces équipes. Une adaptation du modèle socioécologique a été utilisée pour catégoriser les facteurs clés influençant les approches collaboratives. Ces résultats rassemblés pourraient être utilisés pour guider la recherche future et l’élaboration d’un modèle de soins de santé de première ligne pour la démence dans les milieux ruraux.

Background and objectives People living with dementia deserve to experience the benefits of receiving palliative care and end-of-life services and supports, yet they often do not receive this care compared to those with other terminal diseases. People living with dementia in rural areas often face additional challenges to accessing such care. The purpose of this scoping review was to systematically review and synthesize the literature on palliative and end-of-life care for people with dementia living in rural areas, and to identify and describe key findings and gaps in the literature. Methods A collaborative research team approach was used in an iterative process across all stages of this review. Systematic, comprehensive searches were conducted across ten databases and eight targeted websites for relevant peer-reviewed, original research and other less formal literature, published in English, which yielded a total of 4476 results. After duplicate removal, screening, and review, 24 items were included for synthesis. Results All items were described and illustrated by frequency distribution, findings were grouped thematically, and five key themes emerged, including: 1) Knowledge about dementia, 2) Availability, accessibility, and utilization of palliative and end-of-life care services and supports, 3) Decision-making about care, the value of a person-centered approach and collaborative support, 4) Perspectives on artificial nutrition, hydration, and comfort care, and 5) Quality of life and death. The main gap identified was literature pertaining to rural populations, especially from locations other than the United States. The influence of rurality on relevant findings was mixed across rural-urban comparison studies, as was the effect of sex and gender across the literature. Conclusions Several areas were highlighted including the importance of increasing knowledge about dementia, having early conversations about advanced care and treatment options, providing a person-centered approach, and the potential for using technology to address rural access issues. These findings can be used to inform future research and policy and the development of services, supports, and strategies for rural people living with dementia. Further research is recommended.

BACKGROUND Plant-based foods, including pulses (dry beans, lentils, chickpeas, and peas), have gained worldwide attention owing to their health and environmental benefits. Despite high production, the consumption of pulses is low in Canada. Behavior change interventions systematically designed to promote the consumption of pulse-based foods are scarce. OBJECTIVE We describe the utilization of intervention mapping (IM) in the development of a multicomponent nutrition intervention aimed at promoting consumption of pulse-based foods among preschool children in childcare centers in Saskatchewan, Canada. METHODS The Pulse Discovery Toolkit intervention was developed following the six steps of the IM protocol. Decisions at each step were either based upon literature review, expert consultation, pretesting, or a combination of these. Following the initial phase of the study, which focused on intervention development, phases II and III of the study were concerned with pilot testing and roll-out of the intervention, respectively. In total, one, two, and four childcare centers participated in phases I, II, and III, respectively. A multimethod approach was designed to evaluate the intervention during pilot testing and roll-out. RESULTS The application of IM steps 1 to 3 in phase I resulted in the creation of performance objectives at different levels, including at the individual level (preschool children), and the social and environmental levels (parents, early childhood educators, and cooks). These objectives were then used to create a matrix of objectives matching the constructs of the social cognitive theory while taking Piaget cognitive development into consideration. This step was followed by defining program components, implementation, adoption, and evaluation strategies, which were utilized in phases II and III. Data have been collected from 2015 to 2018 and analyzed. The results will be reported elsewhere. CONCLUSIONS The IM protocol provided a rigorous framework for the development of a multicomponent evidence-based intervention to promote pulse-based foods in childcare centers. INTERNATIONAL REGISTERED REPORT RR1-10.2196/22775

This scoping review mapped and synthesized published literature related to education and support services for individuals with dementia and their caregivers living rurally. Specifically, we investigated education and support service needs, availability and use of services, barriers to service access and use, and solutions to these barriers. Empirical, English-language articles (2,381) were identified within MEDLINE, CINAHL, PSYCINFO, and EMBASE. Articles were screened according to Arksey and O’Malley’s (2005) five-stage scoping review methodology and the recommendations of Levac et al. (2010). Findings suggest limited availability of rural dementia-related support and education services, particularly respite care and day programs. Service use varied across studies, with barriers including low knowledge regarding services, practicality, and resource issues (e.g., transportation, financial), values and beliefs, stigma, and negative perceptions of services. Solutions included tailored and person-centred services, technological service provision, accessibility assistance, inter-organization collaboration, education regarding services, and having a “point of entry” to service use.

Background The Healthy Start-Depart Sante intervention was developed to promote physical activity, gross motor skills and healthy eating among preschoolers attending childcare centers. This process evaluation aimed to report the reach, effectiveness, adoption, implementation and maintenance of the Healthy Start-Depart Sante intervention. Methods The RE-AIM framework was used to guide this process evaluation. Data were collected across 140 childcare centers who received the Healthy Start-Depart Sante intervention in the provinces of Saskatchewan and New Brunswick, Canada. Quantitative data were collected through director questionnaires at 10 months and 2 years after the initial training and analyzed using descriptive statistics. Qualitative data were collected throughout the intervention. Results The intervention was successful in reaching a large number of childcare centres and engaging both rural and urban communities across Saskatchewan and New Brunswick. Centres reported increasing opportunities for physical activity and healthy eating, which were generally low-cost, easy and quick to implement. However, these changes were rarely transformed into formal written policies. A total of 87% of centers reported using the physical activity resource and 68% using the nutrition resource on a weekly basis. Implementation fidelity of the initial training was high. Of those centers who received the initial training, 75% participated in the mid-point booster session training. Two year post-implementation questionnaires indicated that 47% of centers were still using the Active Play Equipment kit, while 42% were still using the physical activity resource and 37% were still using the nutrition resource. Key challenges to implementation and sustainability identified during the evaluation were consistent among all of the REAIM elements. These challenges included lack of time, lack of support from childcare staff and low parental engagement. Conclusions Findings from this study suggest the implementation of Healthy Start-Depart Sante may be improved further by addressing resistance to change and varied levels of engagement among childcare staff. In addition, further work is needed to provide parents with opportunities to engage in HSDS with their children.

BackgroundSince young children spend approximately 30 h per week in early childcare centres (ECC), this setting is ideal to foster healthy behaviours. This study aimed to assess the effectiveness of the Healthy Start-Départ Santé (HSDS) randomized controlled trial in increasing physical activity (PA) levels and improving healthy eating and fundamental movement skills in preschoolers attending ECC.MethodsSixty-one ECC were randomly selected and allocated to either the usual practice (n = 30;n = 433 children) or intervention group (n = 31;n = 464 children). The HSDS intervention group was provided a 3-h on-site training for childcare educators which aimed to increase their knowledge and self-efficacy in promoting healthy eating, PA and development of fundamental movement skills in preschoolers. PA was measured during childcare hours for five consecutive days using the Actical accelerometer. Preschoolers’ fundamental movement skills were assessed using the standard TGMD-II protocol and POMP scores. Food intake was evaluated using digital photography-assisted weighted plate waste at lunch, over two consecutive days. All data were collected prior to the HSDS intervention and again 9 months later. Mixed-effect models were used to analyse the effectiveness of the HSDS intervention on all outcome measures.ResultsTotal number of children who provided valid data at baseline and endpoint for PA, food intake and fundamental movement skills were 259, 670 and 492, respectively. Children in the HSDS intervention group had, on average, a 3.33 greater point increase in their locomotor motor skills scores than children in the control group (β = 3.33,p = 0.009). No significant differences in effects were observed for object control, PA and food intake. However, results demonstrated a marginal increase in portions of fruits and vegetables served in the intervention group compared to control group (β = 0.06,p = 0.05).ConclusionOf the 12 outcome variables investigated in this study, 10 were not different between the study groups and two of them (locomotor skills and vegetables and fruits servings) showed a significant improvement. This suggests that HSDS is an effective intervention for the promotion of some healthy behaviours among preschoolers attending ECC.Trial registrationClinical TrialsNCT02375490. Registered on February 24, 2015; 77 retrospectively registered.

Dietary patterns are closely linked to healthy child development, which in turn is a powerful determinant of lifelong health and well-being. As many early years children spend a large part of their day in childcare centers, educators can have a large influence on their healthy eating behaviors. In Saskatchewan, a number of childcare centers are located in rural communities and research suggests that rural educators are influenced by unique factors when providing healthy eating opportunities for children. In order to diversify and improve the diets of rural early years children, a pulse crop intervention was piloted tested in one rural childcare center. A pre and post 28-week intervention design was used to evaluate the pulse crop intervention on increasing educators' knowledge and awareness about pulse crops and supporting educators in incorporating pulse crops into centers' menus. Overall, the intervention was effective in increasing rural educators' knowledge and use of pulse crops. Additionally, educators were able to diversify and increase the number of healthy meals offered in the childcare center. The lessons learned can be used to improve and expand the intervention to other childcare centers in Saskatchewan and beyond, in turn supporting the healthy development of early years children.

IntroductionCaregivers of persons with dementia and mild cognitive impairment (MCI) are at risk of decreased well-being. While many interventions for caregivers exist, evidence is sparse regarding intervention timing and effectiveness at an early stage of cognitive decline. Our systematic review aims to answer the following questions: (1) Do interventions for caregivers of persons with early stage dementia or MCI affect their well-being and ability to provide care? (2) Are particular types of caregiver interventions most effective during early stage cognitive decline? (3) How does effectiveness differ when early and later interventions are directly compared? (4) Do effects of early stage caregiver intervention vary based on care recipient and caregiver characteristics (eg, sex, type of dementia)?Methods and analysisThe databases MEDLINE, EMBASE, PSYCINFO and CINAHL, as well as grey literature databases, will be searched for English language studies using search terms related to caregiver interventions and dementia/MCI. Abstracts and full texts will be screened by two independent reviewers; included studies must assess the effects of an intervention for caregivers of persons with early stage dementia or MCI on caregiver well-being or ability to provide care. Intervention, study and participant characteristics will be extracted by two independent reviewers, along with outcome data. Risk of bias will be assessed using the Cochrane risk of bias tool (for controlled trials with and without randomisation). Interventions will be grouped by type (eg, psychoeducational) and a narrative synthesis is planned due to expected heterogeneity, but a meta-analysis will be performed where possible. The Grading of Recommendations, Assessment, Development and Evaluations approach will be used to inform conclusions regarding the quality of evidence for each type of intervention.Ethics and disseminationFindings from this review will be disseminated via conferences and peer-reviewed publication, and a summary will be provided to the Alzheimer Society.PROSPERO registration numberCRD42018114960.

Physical activity is a key component of health living and it reduces the risk of developing chronic disease. Current research indicates that Canadian early years children are not active enough for healthy growth and development. Parents play a key role in establishing healthy behaviours; however caregivers also have a strong influence, as many early years children spend a large portion in their day in care centres. To date, very little is known about the physical activity practises in rural care centres. The purpose of this study is to use an ecological framework to identify specific factors (facilitators and barriers) that rural caregivers face when providing physical activity opportunities in care centres. Caregivers in rural settings participated in one on one semi-structured interviews. Reported facilitators and barriers perceived by caregivers were categorized using the ecological model as individual level (i.e., intrapersonal) or social environmental (interpersonal, institutional, community, and policy). Caregivers identified individual facilitators and barriers. (i.e., personal health and wellness) and several social environmental facilitators and barriers (i.e., lack of knowledge; parental support), that influence their ability to provide physical activity opportunities for children in their care.

Background Participation in daily physical activity and consuming a balanced diet high in fruits and vegetables and low in processed foods are behaviours associated with positive health outcomes during all stages of life. Previous literature suggests that the earlier these behaviours are established the greater the health benefits. As such, early learning settings have been shown to provide an effective avenue for exploring and influencing the physical activity and healthy eating behaviours of children before school entry. However, in addition to improving individual level health of children, such interventions may also result in a number of social benefits for the society. In fact, research among adult populations has shown that sufficient participation in physical activity can significantly lower hospital stays and physician visits, in turn leading to positive economic outcomes. To our knowledge there is very limited literature about economic evaluations of interventions implemented in early learning centers to increase physical activity and healthy eating behaviours among children. The primary purpose of this paper is to identify inputs and costs needed to implement a physical activity and healthy eating intervention (Healthy Start-Départ Santé (HS-DS)) in early learning centres throughout Saskatchewan and New Brunswick over the course of three years. In doing so, implementation cost is estimated to complete the first phase of a social return on investment analysis of this intervention. Methods In order to carry out this evaluation the first step was to identify the inputs and costs needed to implement the intervention, along with the corresponding outputs. With stakeholder interviews and using existing database, we estimated the implementation cost by measuring, valuing and monetizing each individual input. Results Our results show that the total annual cost of implementing HS-DS was $378,753 in the first year, this total cost decreased slightly in the second year ($356,861) and again in the third year ($312,179). On average, the total annual cost is about $350,000 which implies an annual cost of $285 per child. Among all inputs, time–cost accounted for the larger share of total resources need to implement the intervention. Overall, administration and support services accounted for the largest portion of the total implementation cost each year: 74% (year 1), 79% (year 2), and 75% (year 3). Conclusions The results from this study shed lights for future implementation of similar interventions in this context. It also helps to assess the cost effectiveness of future interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-1978-9) contains supplementary material, which is available to authorized users.

OBJECTIVES: In order to improve healthy behaviours among rural children in their early years, a physical activity and healthy eating intervention (Healthy Start – Depart Sante) was implemented in rural childcare centres throughout Saskatchewan. The objective of the current study was to evaluate the impact of a multimodal physical activity and healthy eating intervention on educators’ provision of opportunities for children to improve their physical activity levels, fundamental movement skills and healthy eating behaviours. SETTINGS: Six childcare centres (three Francophone and three Anglophone) located in five different rural and semi-rural communities in Saskatchewan participated in this intervention. PARTICIPANTS: A total of 69 children with a mean age of 4 years 9 months, and 19 female early childhood educators. INTERVENTION: Guided by an ecological framework, we implemented a population health controlled intervention, using a wait list control design (48 weeks delayed intervention), and evaluated its impact in rural childcare centres. Mixed methods were employed to determine the effectiveness of the intervention. OUTCOMES: Overall, educators felt that the intervention supported the provision of physical activity and healthy eating opportunities for children. Increases in children’s physical activity levels were reported following the intervention. CONCLUSION: The lessons learned in this study can be used to improve the Healthy Start – Depart Sante intervention so that its implementation can be effectively expanded to childcare centres within and outside Saskatchewan, in turn, supporting the healthy development of early years (0–5) children in the province and beyond.

Introduction Increasingly, physical activity (PA) and sedentary behaviour (SED) are independently being associated with physical, mental and emotional well-being. The heightened research interest in this area has resulted in an upsurge of accelerometer usage to objectively quantify PA and SED. However, these epidemiological investigations consistently ignore systematic variation in the number of hours participants wear accelerometers each day (i.e., systematic accelerometer wear-time variation), and this has a direct impact on measured activity. Objectives Using three different cohorts (3–5 years ─ N=83; 10-14years ─ N=455; and 18 years and older ─ N=21), this study aims to validate a standardization methodology to minimize measurement bias due to accelerometer wear-time variation. Methods In epidemiological studies, accelerometry is generally conducted over seven consecutive days, and participants9 data are considered 9valid9 only if wear-time is at least 10 hours/day. However, there could be systematic wear-time variation even within 9valid9 data. To explore this variation, accelerometer data from two studies set in Saskatoon, Saskatchewan were analyzed: Smart Cities, Healthy Kids (smartcitieshealthykids.com) and Healthy Start (http://www.canadainmotion.ca/healthy_start/). Subsequently, a standardization method was developed where case-specific observed wear-time was controlled for using an ‘analyst specified’ time period. Next, case-specific accelerometer data were interpolated to this controlled wear-time to produce standardized variables. To understand discrepancies owing to wear-time variation, identical analyses were conducted with data from all three cohorts both pre- and post-standardization. The results of these identical analyses were compared to objectively validate the standardization methodology. Results In all three cohorts, descriptive analyses revealed systematic wear-time variation between participants. Again, in all three cohorts, pre- and post-standardized analyses of the three outcome variables (SED, light physical activity and moderate vigorous physical activity) that cover the whole range of human activities revealed an identical and often significant trend of wear-time9s influence on activity. For instance, SED which was consistently higher during weekdays pre-standardization, proved to be higher during weekends post-standardization. Conclusions Analyzing accelerometer data without standardizing wear-time will cause biased results and erroneous conclusions. Standardizing accelerometer data using the above mentioned methodology produces stable variables and a uniform platform to compare results between studies, irrespective of the studies9 sample size or age characteristics.