The voices of children on movement behaviours: implications for promoting international guidelines to support obesity-prevention efforts

BACKGROUND: As a key factor for the prevention of childhood obesity, WHO recommends a specific balance of movement behaviours (ie, physical activity, sedentary behaviour, and sleep) across the 24-h day for children younger than 5 years. Substantial evidence underpins our understanding of the benefits for healthy growth and development; however, little is known about young children's experiences and perceptions, and whether context-specific factors that might influence movement behaviours differ across the globe. METHODS: Acknowledging children's agency as knowledgeable informants on matters affecting their lives, children aged 3-5 years from communities and preschools in urban and rural Australia, Chile, China, India, Morocco, and South Africa, were interviewed. Discussions were based on a socioecological framework of the multifactorial, complex influences on young children's movement behaviours. Prompts were adapted to ensure relevance across diverse study sites. Ethics approval and guardian consent were obtained, and the Framework Method used for analysis. FINDINGS: 156 children (101 [65%] from urban areas, 55 [45%] from rural areas; 73 [47%] female, 83 [53%] male) shared their experiences, perceptions, and preferences related to movement behaviours and the barriers and enablers of outdoor play. Physical activity, sedentary behaviour, and to a lesser degree screen time occurred predominantly through play. Barriers to outdoor play included weather, air quality, and safety concerns. Sleep routines varied considerably and were influenced by room or bed sharing. Screen use was ubiquitous, presenting a challenge to meeting recommendations. The effect of daily structure, degree of autonomy, and interactions were consistent themes, and differences in how these factors influenced movement behaviours across study sites were evident. INTERPRETATION: The findings highlight that although movement behaviour guidelines are universal, contextual realities need to be considered in how socialisation and promotion of the guidelines are enacted. How young children's sociocultural and physical environments are constructed and influenced can foster or disrupt healthy movement behaviours, which might have implications for childhood obesity. FUNDING: Beijing High Level Talents Cultivation Project for Public Health Academic Leader; Beijing Medical Research Institute (Public service development and reform pilot project); British Academy for the Humanities and Social Sciences; KEM Hospital Research Centre; Ministry of Education and Universidad de La Frontera (Innovation in Higher Education Program); and National Health and Medical Research Council (Investigator Grant Leadership Fellow, Level 2).

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