MULTIMEDIA-BASED ADDED-SUGAR AWARENESS EDUCATION FOR KINDERGARTEN CHILDREN: A QUASI EXPERIMENTAL STUDY

Abstract

Background: Early nutrition education may support children’s understanding of added-sugar-related health risks; however, evidence regarding developmentally appropriate multimedia interventions during kindergarten remains limited. Objective: This study evaluated changes in added-sugar awareness associated with participation in a 16-week multimedia-based nutrition-awareness program among children aged 5–6 years and examined the association between baseline parental awareness and post-test child awareness. BMI categories were described as contextual weight-status indicators, and two children with autism spectrum disorder (ASD) were followed as descriptive embedded cases. Methods: A quasi-experimental pre-test–post-test control-group design was implemented at one kindergarten center in Makkah, Saudi Arabia. The inferential sample comprised 110 typically developing children allocated to an experimental group (n = 55) or a control group (n = 55). Two additional children with ASD participated in the intervention and were analysed descriptively.Child awareness was assessed using a 10-item Pictorial Child Awareness Scale. Baseline parental awareness was assessed using a Parental Awareness Questionnaire, and age- and sex-adjusted BMI category was recorded descriptively. Results: Experimental-group awareness scores increased from 6.07 ± 1.51 at pre-test to 17.53 ± 1.26 at post-test, t(54) = 39.04, p < .001. At post-test, the experimental group scored higher than the control group (17.53 ± 1.26 vs. 6.87 ± 1.32, respectively). Because post-test scores demonstrated a pronounced ceiling pattern, the very large observed effect estimates should be interpreted cautiously. Baseline parental awareness and post-test child awareness were moderately correlated (r = .34, 95% CI [.16, .50], p < .001). Parental awareness also differed significantly between groups at baseline; however, an ANCOVA adjusting for baseline child awareness and parental awareness showed that the adjusted group difference (B = 10.82, 95% CI [10.29, 11.36], p < .001) remained very similar to the unadjusted estimate, and neither covariate was significant. Forty-three children were classified as obese; no biochemical measures were collected, and BMI findings should not be interpreted as evidence of prediabetes or metabolic disease. The two ASD cases demonstrated individual improvement, but no population-level conclusions can be drawn. Conclusions: Participation in the multimedia-based nutrition program was associated with substantial short-term improvement in study-specific added-sugar-awareness scores among kindergarten children. However, the single-center non-randomised design, pronounced post-test ceiling effect, study-specific outcome measure, absence of behavioral and biochemical outcomes, and descriptive nature of the two ASD cases limit causal and clinical interpretation. Multi-center studies using independently validated measures and longer-term behavioral outcomes are warranted.