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Teachers’ and Parents’ Perspectives on the Feasibility of a Preschool-Based Behavioral Intervention to Prevent Obesity: An Embedded Qualitative Study within ToyBox Study Malaysia


The aim of this qualitative study, an embedded component of ToyBox Study Malaysia (TSM), was to elicit the perspectives of teachers and parents regarding the implementation of TSM. TSM is a preschool-based behavioral intervention program aimed at improving healthy energy balance-related behaviors among young children attending preschools. The qualitative study adopted a descriptive-interpretive methodology, and triangulated data collected through semi-structured focus groups with artifacts collected. The setting involved rural and metropolitan preschools in Sarawak and Peninsular Malaysia, respectively. In Sarawak, 11 teachers and 20 parents from six intervention preschools participated in this study. In Peninsular Malaysia, 14 preschool teachers and seven assistant teachers representing all 15 intervention preschools participated in the study. Data were analyzed thematically and four overarching themes were identified: impact of TSM on the children’s knowledge and practices of healthy energy balance-related behaviors; spheres of influence upon the children’s energy balance-related behaviors; constraints and affordances related to the implementation of TSM; and prospective sustainability of TSM. The triangulation of data from teachers, parents, and the artifacts related to TSM enabled the corroboration of evidence to support the themes identified. This study provides evidence on the reciprocal interactions between the teachers and parents who played key roles in facilitating behavioral change in the children, and the children who, in turn, served as change agents beyond the preschool. Furthermore, the mediational tools such as the TSM crockery and availability of healthy food and water led to the reported behavioral changes at both rural and metropolitan settings.

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  1. The investigators had undergone a Train the Trainer workshop prior to running the TOT workshop.

  2. Details regarding the fidelity to intervention has been captured in the process evaluation documentation led by WLC.

  3. For the purpose of documenting the process evaluation of TSM, the second author [WLC] also independently read the FGD records and confirmed the themes that were extracted from the data.

  4. The availability of fruits, vegetables, and water was an improvement of what had been traditionally available at the preschools and was emphasized more during the TSM study. For example, there were disparities in the availability of water at the preschools. Some preschools in Sarawak lacked basic resources such as clean tap water. With the introduction of TSM, these basic resources became more readily available (e.g., after filtered water and water dispensers were distributed to the preschools). Furthermore, the ToyBox module emphasized water drinking instead of sugar-sweetened beverages.


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We thank the Department of Community Development (KEMAS) under the Ministry of Rural Development (Malaysia), the teachers, parents, and children for participating in this project.


The ToyBox Study Malaysia feasibility project was funded by the United Kingdom Medical Research Council (MRC) Grant under the Newton-Ungku Omar Fund (MR/PO13805/1). We thank Universiti Malaysia Sarawak for the financial support of this publication.

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Conceptualization and contribution to the article: all authors. Material preparation and data collection: GA, MA, RAT, and NHY. Writing—original draft preparation and revision: JACL. Writing – review: all authors. Writing—editing: LG, BKP, SR, CS, DK, and CE. Approval of the submitted version: all authors.

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Correspondence to J. A. C. Lee.

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Lee, J.A.C., Cheah, W.L., Anchang, G.N.J. et al. Teachers’ and Parents’ Perspectives on the Feasibility of a Preschool-Based Behavioral Intervention to Prevent Obesity: An Embedded Qualitative Study within ToyBox Study Malaysia. Early Childhood Educ J (2022).

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  • Preschool
  • Obesity
  • Healthy eating
  • Physical activity
  • Early care and education prevention
  • Public health