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  1. Social determinants of health and the future well-being of Aboriginal children in Canada
  2. Social determinants of health and the future well-being of Aboriginal children in Canada
  3. Associated Data

For example, parents stated that their job 29 , 34 , 60 , 62 resulted in a lack of time 26 , 29 , 31 , 32 , 34 , 40 , 43 , 52 , 53 , 56 , 57 , 60 and energy 29 , 32 , 40 , 52 , 53 , They also had to make the effort to juggle multiple schedules within the family 40 , 53 , 58 , balancing this with the cost of providing active opportunities 37 , 40 , 44 , 52 , 56 , 57 , which at times limited their young children's physical activity. These barriers also meant that parents tended to use less active modes of transport i. My mom never does anything with me, she just takes me places and leaves me there.

Yeah, okay then between the laundry and the cleaning and everything else, especially at this time of year [December] when there's so much extra stuff to do that I can't even begin to think of doing some organized physical activity with the Kids. I think it gets to a point of how much can you actually do? You know I've got three kids, how many places am I supposed to be after school on one night?

Related to this, a physically active child was often also deemed to have the potential to cause trouble 27 , 29 , 33 , 34 , Yeah, they [the children who are too active] are not controlled by the parents. So, it's not … it becomes a level whereby you start also [to] complain: For example, when asked how bad behaviour influenced physical activity:. Children's wider social networks were also noted to be important: In general, interacting with friends was cited by children 46 , and parents as facilitating physical activity 33 , 34 , 41 , 42 , 52 , 56 , Parents believed that coming together as a family, either at home or on holiday, also positively influenced their young children's activity 29 , 53 , 56 , They [siblings] go out in the garden and she will go and play with them, I suppose so.

She doesn't tend to want to play on her own. In fact, I had to always pull her back because she looks up to her brother who is a very active boy and he has been going to all these things, and she always wanted to be just like him. That is my case. If you live in a neighborhood with children who like to play with you, that is different.


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I have a lot of fun with my friends and I feel better. Well actually all of us together, me my husband and [Participating child] … my husband we always liked kickboxing, never had the chance to do it, so we thought oh we'll ask would you like to go and try. The influence of friends and peers was however limited to developing social interactions with children of the same age, with mixed age groups of children thought to hamper younger children's activity levels 27 , 54 , More broadly, living close to a child's childcare setting and therefore using active transport to get there e.

Parents stated that a sedentary home environment, including a TV being persistently on 52 , 56 , 58 , and small outside spaces inhibited activity 34 , 52 , 53 , 59 , This said, both childcare providers and parents suggested that homes with adequate space and resources i.

One of the priorities for me in terms of where we live will be related to school. I really will like to be close to a school so that we don't have to rely on cars. And we always walk to the local shops and to the hairdressers and things. We have a few parents that walk to school and home and I think that obviously encourages physical activity. My son walks and jumps inside the house. But if you have a small house, the space, the room for him to exercise is limited.

What I am saying is that it depends on the condition of your family. Childcare providers felt that they were able to facilitate and encourage young children to be active 25 , 27 , 38 , 44 , 52 , 64 , which was corroborated by children themselves Childcare providers 25 , 38 , 52 , 64 did however acknowledge that they also may hinder children's activity, with barriers to providing active opportunities including the demands of work, the need to prioritize academic outcomes, wanting to prevent noise and their own reluctance to go outside 38 , You know, It's all the teacher's decision of how much time they're gonna get and how much they're gonna do … Some teachers just aren't into that and some teachers are into that.

Sometimes the children are easier to motivate when I participate myself. When I run around and jump on one leg they have a lot more fun and rather take part than when I just stand there and play with my drum. Our teacher says that, if we run too much, we sweat, and thus we get a cold and we can no longer attend the kindergarten … our teacher says that we can not play outside football or basket, because we are too lively and we are at risk of hurting any other.

I was born in the Dominican Republic. I am not used to the kind of cold weather we get here in [Massachusetts]. I do not think I will ever get used to it … I just try to get through the winter. It can be difficult. Space and resources within the childcare environment were often discussed as helping and hindering children's physical activity. This may be particularly important given childcare was perceived by providers to be the only place children could be active 38 , In general, larger spaces, curriculum materials and play equipment 27 , 47 , 52 were perceived to benefit children's activity levels.

A lack thereof i. So we provide opportunities for the children to get a bit active … I think it is important that we do that especially as the children who are here five days a week. If they don't get stuff like that at the weekend, at least when they come here, they are on the go all the time. We've got more stuff [indoor play equipment] now, so whether it's too hot or too cold or too rainy outside, we take it out, then they can do it [activities] in the classroom. So, yeah, being that we have that stuff now, it does make it easier and they get to do a lot more [physical activity].

My preschooler actually is in a [private preschool] program and they don't have the room to have the physical activity part of it every day or even once a week, so they get it once a month. Of particular interest was the persistent push—pull between parents and childcare providers regarding children's physical activity.

As mentioned previously, care providers believed parents to be important role models for their children's physical activity, and responsible for inhibiting their child's active opportunities by, e. Conversely, parents saw childcare centres as a crucial initiator of physical activity for their in children 26 , 33 , 41 , 43 , 49 , 52 ; the active opportunities provided by childcare centres were mentioned as being central to children's daily needs 56 , So that's I guess a pet peeve of mine … They're going outside. They are going to play. They are going to be on the floor.

They are going to be, you know, children. I have a hard time when parents don't respect the rules that I have around children bringing and using electronics such as DS. I don't really like to have to keep reminding them that those devices are not allowed … Communication with parents is … very important because it gives us a chance to learn about the child's home environment, the family's routines and rules. Working together, with improved communication between parents and care providers, was often cited by childcare providers as how this might be achieved 27 , 36 , 47 , We need to work together with them.

It's very important …. Information that will help would be like to have more communication [with parents about the importance of physical activity] now that winter's coming. Communication with parents is also very important because it gives us a chance to learn about the child's home environment, the family's routines and rules, which is really important information to have to understand and care for the child in our FCCHs. Resources within the community, including parks and playgrounds, presented both barriers 34 , 37 , 41 , 60 and opportunities for activity 44 , Children spending increased time spent outside 27 , 32 , 49 and having community support for activity 41 available were perceived to be universally positive influences.

Because there is a lot of fear around with drug users and a lot of crime and that, people don't let their kids out. Our town is a pretty secluded area and that helps because parents feel comfortable sending their kids outside, and you know they can do whatever they [parents] want in the house and they know that their kid will be ok. In order to prevent obesity in childhood, it is necessary to build inspiring playgrounds and green areas where children can play …. Interestingly, although the majority of parents living in rural locations thought this benefited their children's physical activity 41 , 49 , 52 , rural locations may also prove to be barrier owing to their isolation and a lack of resources There's nothing really like that indoors around here.

Like, a play place for kids, you know? I feel like there are a lot of open places in [rural town] that you could fit something like that in. I haven't seen a park around here. Well, there is one in Wilmington, but it's too far to take them in the afternoon. It takes about an hour to go and come back. A common theme mentioned by parents, care providers and even the children themselves was safety. Many parents worried that a physically active child could and would hurt themselves and may therefore be likely to limit their child's activity 29 , 37 , 41 , 49 , 53 , 56 , 58 , Children also mentioned that adults' fears in relation to their safety and their health limited their activity levels Mom says that I can play with the ball with my sister, but not with all my friends at the kindergarten, because she is afraid I can get hurt … once a friend of mine pushed me and I was hurt and my mom told my teacher that I had not to play running.

I think that the most important barrier to physical activity in children is safety concerns re: The way I see it, I prefer that they watch television rather than being endangered outside. This preoccupation with safety was also widespread in childcare providers 27 , 39 , 44 , 54 , 64 , particularly in relation to restrictive preschool policies preventing children from being active 39 , 52 , I don't think they really get their heart rate up much from climbing because with all the new licensing regulations [in childcare centres], our climbing equipment isn't that hard anymore ….

We can go on walks except it's got to be a field trip so it's a little more difficult in the sense that we can't go for a neighborhood walk. It has to have a specific purpose, and then we have to get permission. In order to offer moving opportunities, more staff is necessary. For instance, a climbing landscape requires more supervisory staff. The children are not allowed to do it by themselves. Importantly, perceptions about changing societal norms and children no longer being allowed to or wanting to go out to play were cited by parents to be major barriers to their children's activity 26 , 34 , 41 , 49 , 57 , I grew up in a country town where you could just go off and play.

There were gangs of kids running around the street playing cricket and stuff. You're not living in the city and your kids are just free. This appeared to relate to both their local environment and parents' and children's circumstances: Because, sometimes, they fall or they can run away and get run over by a car.

So, it's better inside because I can keep an eye on him, here in the room or in the hall: If they go out, they have to go out with us …. They told us that if they saw them playing by themselves there, they were going to be taken by social services. Finally, and often mentioned in combination with safety, the weather was cited as both a facilitator parents 34 , 49 , 57 , 60 and childcare providers 38 , 52 and more often as a barrier by children 67 , by parents 31 , 40 , 49 , 57 , 59 and childcare providers 27 , 36 , 38 , 54 , 64 to young children's physical activity.

During the summer their activity behaviors are great. I love how active they are and how they want to be outside doing things. Sometimes, I see on the news that children in the sun can pass out. I worry when the sun is very strong because if it's very hot, her heart can beat faster and she could pass out or something. I think the cool air. I think a lot of people have the misconception that you are going to get sick if you go outside in cold weather. Really, it's better for you. No, my mom does not want me to play outside at the kindergarten, because otherwise I get sick.

When it is raining outside or it is very cold, then the children are inside the school building because we [the preschool] do not have a covered playground. And then we [teachers] put on a movie. Barriers and facilitators were classified into seven broad themes: Parents, care providers and the children themselves most commonly cited influences at the interpersonal and organizational levels as barriers and facilitators.

A large number of factors remain unexplored in the qualitative literature in the community and policy domains. Moreover, targeting factors that those caring for young children, and the children themselves, believe to be important may enhance intervention tailoring, ultimately effecting both greater increases in young children's physical activity and decreases in sedentary behaviours. Whilst researchers often differentiate between these behaviours for research purposes, many of the participants in studies included here failed to make any distinction: This was true of both parents and care providers, suggesting that those looking after young children perceive these behaviours to be equal and opposite.

Moreover, guidelines for young children recommend specific amounts of physical activity, whilst limiting sedentary time e. Therefore activity behaviour can be thought of as occurring on a spectrum, where sedentary behaviour and very vigorous physical activity lie at opposite ends.

This evidence synthesis is therefore beneficial to researchers working in the fields of both sedentary and physical activity behaviour, providing novel information about what those who are most influential to young children's activity behaviours perceive to be important. As noted earlier, a wide range of facilitators and barriers to activity behaviour were identified in the qualitative literature that have yet to be explored quantitatively Interestingly, parents and care providers frequently expressed the belief that children require a certain amount of daily downtime and should not be constantly active.

Moreover, not all sedentary time was perceived to be equal, with more academic or developmental activities e. Studies suggest that children may meet these guidelines 72 , 73 , in part owing to a large proportion of time spent in light intensity activity Nevertheless, it is important to distinguish between developmentally beneficial i.

TV viewing , as recently acknowledged by the American Association of Pediatrics. Skype and FaceTime is permitted. However, parents frequently acknowledged that media use was a major barrier to their children's physical activity 28 , 29 , 30 , 31 , 52 , 56 , 58 , 59 , Although it is not possible to, e. Use of wider environmental resources, such as parks and community space, which were deemed to positively influence children's physical activity behaviours, may also help parents and children to actively interact.

This may be particularly beneficial to boost activity within families In addition, practical advice would be helpful given the concerns parents expressed about child safety when being active and young children's reliance on parents to take them to these places. The qualitative literature here suggests that within the childcare centre, care providers perceive themselves to be important for children's physical activity. Quantitative literature suggests that providing training for childcare providers may influence change in children's MVPA, but the precise mechanism for this is not clear given the wide variation in training across interventions and countries As no quantitative studies to date have specifically focused on care provider physical activity behaviour as a potential determinant of children's activity behaviour 11 , it is difficult to determine the direct role childcare providers play in influencing preschoolers' physical activity.

Consequently, childcare providers' own behaviour, e. Future work should therefore focus on providers' own behaviour in relation to the children in their care. Such work would be timely in light of provider perceptions about their ability to encourage children to be active, and given the current growing interest in this sphere of research for children later in childhood Childcare providers frequently stated that available resources and space within the childcare environment were both positive and negative influences on preschoolers' activity in the qualitative literature 39 , 44 , 52 , However as yet, no clear association between the childcare environment and change in physical activity has been found in interventions In order to show exactly what influences children's physical activity in this setting, it may therefore be beneficial to assess the way children interact with the staff themselves and the environment, rather than focusing on the role of specific elements within the environment.

The perceived influence of parent—childcare provider interactions on children's activity behaviours was a novel and potentially important finding to emerge here. However, few to date have incorporated or assess interactions between these elements. Moreover, given the opinions expressed here, that each of the other party i.

Across the quantitative literature, factors such child and parental knowledge have frequently been targeted as potential determinants of physical activity but are rarely associated with positive change in young children In contrast, the two final themes identified in this review, safety and weather, were largely cited as barriers to children's physical activity. Yet despite both being plausible and potentially influential determinants of young children's activity behaviours, they have rarely been explored in the quantitative literature 11 , 16 , Extreme weather was frequently mentioned in the context of child safety, but a general preoccupation with ensuring children were protected, usually at the expense of being physically active, was pervasive.

Indeed, children themselves perceived their play was restricted because physical activity could result in them hurting themselves It can occur in each of four domains i. Children accumulate their physical activity in each of these domains, and largely in an informal manner during the preschool years Modification of adult risk perceptions may therefore be one way to positively influence young children's activity behaviours, risk awareness and wider development.

Doing so, either by intervention or in natural experiments, e. Moderate weather, either hot or cold, was perceived to facilitate children's activity behaviours 34 , 38 , 49 , 52 , 57 , 60 ; hot and cold extremes were perceived here to result in less physical activity and more sedentary time in preschoolers. This fits with quantitative research assessing weather as a correlate of physical activity.

For example, in locations with more temperate weather year round 84 , 85 , samples of US preschoolers tended not to show variation in physical activity. In contrast, in studies conducted in regions where clear seasonal variation in weather exists, there are comparable fluctuations in physical activity e. Where possible, learning to adapt to weather conditions that may provide fun opportunities for physical activity i. This could prevent such marked seasonal variation in young children's physical activity and lead to consistently higher levels of physical activity in this age group year round.

In general these groups are less likely to participate in quantitative both prospective and intervention studies. It is therefore beneficial to ascertain the perceived barriers and facilitators to activity behaviours across strata qualitatively. Moreover, parenting during the early years is time intensive regardless of resources. Therefore, that consensus as to the barriers and facilitators to young children's activity behaviours emerged across several themes here hints to a number of determinants of children's activity behaviour being viable future intervention targets.

Finally, this review highlights were gaps in the current qualitative literature exist. Interestingly as in the quantitative literature 11 , there was a paucity of research with fathers and male care providers, and in developing countries; greater engagement with these populations is required as perceptions and influences on young children's physical activity may differ by carer sex and cultural practices.

Further, in an era after the epidemiological transition 89 , it is more challenging to determine why some children are more or less active than others as we often lack the heterogeneity in exposures and outcomes to explore associations quantitatively. Developing countries are currently undergoing similar transitions towards lower physical activity and higher sedentary time as those seen previously in higher income countries, perhaps at a fast rate. By conducting both qualitative and quantitative research in developing countries, where greater heterogeneity may still exist, we can ascertain potential influences on young children's activity behaviours.

From this, we can learn how best to reverse negative trends towards inactivity in the future. Lastly factors in the environmental community resources, rural locations and changing society and policy domains of the SEM were rarely studied in the quantitative literature, but were suggested by parents and care providers in the qualitative literature as having a significant impact on young children's activity behaviour. These factors therefore represent key future avenues for quantitative activity promotion research in the preschool years. This review is the first to specifically explore and systematically synthesize the qualitative barriers and facilitators to activity behaviours in children aged 6 and under.

We applied rigorous review methods and did not exclude papers based on time of publication or language although no foreign language papers were identified. In addition to a systematic literature search, we used a parallel reference examination to yield an additional two studies for inclusion. As this review was restricted to published studies, publication bias cannot be discounted.

However, that we included a range of international studies, which used differing methods of qualitative data collection and analysis, is another strength of this review. Qualitative studies were predominantly published from onwards, with a large increase in studies after These studies, conducted across differing continents, provide only a snapshot in time of parental, childcare provider and, to a lesser extent, children's activity behaviour perceptions.

This said, included studies tended to draw conclusions that were not always supported by sufficient evidence i. This review draws upon author findings and also uses primary evidence from each paper i. Whilst it is not possible to determine the extent of confirmability 90 for each individual study, every effort was made to ensure our findings were not influenced by researcher bias, motivation or interest.

Moreover, similar themes, barriers and facilitators were identified across the wide range of included studies. This implies that the perceptions around activity behaviours of those women caring for young children are relatively dependable i.

Social determinants of health and the future well-being of Aboriginal children in Canada

Similarities were apparent between previously explored determinants from quantitative studies, and the barriers and facilitators to activity behaviours identified here, particularly at the interpersonal and organizational levels. Thoughts and beliefs of men caring for young children, those from developing countries and about barriers and facilitators in the environmental and policy domains are currently lacking. The authors extend their sincere thanks to the following project collaborators: Obesity Reviews , National Center for Biotechnology Information , U.

Published online Jun 6. Hesketh , 1 , 2 R. Lakshman , 1 , 3 and E. Author information Article notes Copyright and License information Disclaimer. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC. Quality assessment criteria and operationalisation. Summary Positive activity behaviours i. Physical activity, preschool, qualitative, review. Study selection After an initial fidelity check between reviewers 11 , three reviewers leading reviews on the included behaviours K.

Quality assessment A standard tool, specific to qualitative study designs, was used to assess the quality of included studies Data extraction and synthesis All full texts identified for inclusion were read by K.

Social determinants of health and the future well-being of Aboriginal children in Canada

Results A total of 37, and 2, references were retrieved in and , respectively, of which were read in full and 43 qualitative papers describing 35 study samples relating to children's physical activity and sedentary behaviour were identified for inclusion Fig. Open in a separate window. Table 1 Qualitative study characteristics. Table 2 Summary of included studies. Parents lacked interest in having their children play during preschool time, whilst care providers perceived adults were a major factor in limiting children's play 4 Goodway Midwest, USA 55 59 30F preschoolers Mean age 4.

Parents registered with the researchers to participate in the group 7 FGs: Prevention efforts need to acknowledge the issues faced and provide support: Staff sent letter translated into 6 languages to all families receiving Child Care Assistance. Clear and specific policies for required clothing required so that children's active play opportunities are not curtailed.

The sampling strategy was purposive rather than random mixed purposeful sampling vs. Parents were subsequently approached through schools Parents: When a pattern emerged, the new theme was integrated into the coding system Children demonstrated better understanding of the benefits of healthy eating compared with PA. Obesity prevention efforts targeting young children need to use consistent messaging across all contexts. Key gaps in young children's understanding include: Method piloted in 1 KG Interviews, drawings, observation; FGs for adults — The new methodology of videotaping gives the researcher the chance to interpret a wider range of responses.

Only one parent per child invited those with disabled children excluded. Parents desired professional support from preschool, Child Health Care and a collective responsibility from society with uniform guidelines. Specific recruitment strategies through community centres for low SES citizens or through charity institutions e. Providing parents the guidelines early with resources for minimizing SB should be considered.

Highlights important considerations for efforts to promote healthy weight environments in the early care setting 11 Bentley South West England, UK sample as Bentley 32 24 parents Mean age of parents not stated but their children were 2 [ Information about accurately assessing PA and SB should be provided with guidelines. Interventions should be tailored to community stage of readiness.

Thematic analysis Family care providers are aware of the importance of healthy eating and PA: Data will inform development of a culturally relevant, multicomponent intervention for ethnically diverse family care providers 9 Woo Baidal MA, USA 35 49 parents Mean age of 17 pregnant parents: Improving child PA may benefit from developing interventions that target both children and fathers 10 Bentley South West England, UK sample as Bentley 28 26 parents Age of parents not given but their children were 2 [ More research is needed to determine the impact of this; how much time preschool children spend using mobile devices; and which activities their use may be replacing 11 Grzywacz NC, USA 34 33 parents Age not stated; Latino; SES information not provided Purposive sample of mothers of children in farmworker households balanced by farmworker status i.

Children also perceived to be sufficiently active, and sedentary forms of play benefit children's brains Barriers and facilitators to physical activity The derived theoretical framework is shown in Fig. Table 3 Summary of factors influencing young children's activity behaviours. Parent [P] 53 It's absolutely important. P 68 A child's own preferences for more sedentary behaviours were cited as largely negative influences by parents 26 , 56 , 57 and care providers 27 , P 31 I rather think that I have to slow down my child at that age.

Development Parents mentioned the importance of positive early habit formation 37 , 53 , 57 , and a higher skill level i. P 57 We have to go out of our way to teach them sports because we have found if you don't … you get to a certain age where they just won't do it. P 62 [Children's physical activity] is a necessary element as far as what we were saying earlier, their muscle development and their balance and I think there is a lot of social development that goes along with it too. CP 39 I wish he'd sit down and write his name and all that because that would make him learn more things, because doing physical activity makes them develop physically, but they should also develop their ability to pay attention.

Health and lifestyle Children with a healthier lifestyle 33 , 56 i. P 40 I think one important barrier to physical activity in obese children is that it is more difficult to participate in activities because of the obesity itself … I think that exercising and sports are very important to a child's health status.


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  • The home The role of parents By far, the most commonly cited influences, both positive and negative, were at the interpersonal level. P 26 I feel that adults play a crucial role in the physical activity of children. P 42 If you're going to the convenience store, walk to the store … instead of taking the elevator, taking the stairs. P 58 They did however acknowledge that they themselves may also be a barrier to children's activity 25 , 38 , 40 , 42 , 52 , 53 , 57 , P 57 I think it gets to a point of how much can you actually do?

    P 53 usually just to get anywhere, popping out [for] groceries … heading to the park … basically anytime we need to get somewhere with a fairly tight timeline [we use the stroller]. P 30 Related to this, a physically active child was often also deemed to have the potential to cause trouble 27 , 29 , 33 , 34 , P 33 For example, when asked how bad behaviour influenced physical activity: Siblings and peers Children's wider social networks were also noted to be important: P 42 I have a lot of fun with my friends and I feel better.

    C 46 Well actually all of us together, me my husband and [Participating child] … my husband we always liked kickboxing, never had the chance to do it, so we thought oh we'll ask would you like to go and try. P 62 The influence of friends and peers was however limited to developing social interactions with children of the same age, with mixed age groups of children thought to hamper younger children's activity levels 27 , 54 , The home environment More broadly, living close to a child's childcare setting and therefore using active transport to get there e. P 53 We have a few parents that walk to school and home and I think that obviously encourages physical activity.

    CP 65 My son walks and jumps inside the house. P 42 [We] live [in an] upstairs [apartment], so it's hard to have indoor playtime that won't bother the neighbors downstairs … it is very easy for things to get broken inside the house. CP 38 Sometimes the children are easier to motivate when I participate myself. CP 52 Our teacher says that, if we run too much, we sweat, and thus we get a cold and we can no longer attend the kindergarten … our teacher says that we can not play outside football or basket, because we are too lively and we are at risk of hurting any other.

    C 46 I was born in the Dominican Republic. The childcare environment Space and resources within the childcare environment were often discussed as helping and hindering children's physical activity. CP 44 We've got more stuff [indoor play equipment] now, so whether it's too hot or too cold or too rainy outside, we take it out, then they can do it [activities] in the classroom. CP 47 My preschooler actually is in a [private preschool] program and they don't have the room to have the physical activity part of it every day or even once a week, so they get it once a month.

    Parent and childcare provider interactions Of particular interest was the persistent push—pull between parents and childcare providers regarding children's physical activity. CP 48 I have a hard time when parents don't respect the rules that I have around children bringing and using electronics such as DS.

    CP 43 [j]ust like what you do with us as educators, like professional development for us … it's kind of like for the families; if you could help to promote it or inform them [parents] then maybe they might go [to neighbourhood activities and programs] …. CP 65 Information that will help would be like to have more communication [with parents about the importance of physical activity] now that winter's coming.

    CP 27 Communication with parents is also very important because it gives us a chance to learn about the child's home environment, the family's routines and rules, which is really important information to have to understand and care for the child in our FCCHs. Environment Resources within the community, including parks and playgrounds, presented both barriers 34 , 37 , 41 , 60 and opportunities for activity 44 , P 37 Our town is a pretty secluded area and that helps because parents feel comfortable sending their kids outside, and you know they can do whatever they [parents] want in the house and they know that their kid will be ok.

    P 41 In order to prevent obesity in childhood, it is necessary to build inspiring playgrounds and green areas where children can play …. P 26 Interestingly, although the majority of parents living in rural locations thought this benefited their children's physical activity 41 , 49 , 52 , rural locations may also prove to be barrier owing to their isolation and a lack of resources P 49 I haven't seen a park around here.

    Safety A common theme mentioned by parents, care providers and even the children themselves was safety. C 46 I think that the most important barrier to physical activity in children is safety concerns re: P 61 The way I see it, I prefer that they watch television rather than being endangered outside. P 56 This preoccupation with safety was also widespread in childcare providers 27 , 39 , 44 , 54 , 64 , particularly in relation to restrictive preschool policies preventing children from being active 39 , 52 , CP 39 We can go on walks except it's got to be a field trip so it's a little more difficult in the sense that we can't go for a neighborhood walk.

    CP 64 In order to offer moving opportunities, more staff is necessary. CP 52 Importantly, perceptions about changing societal norms and children no longer being allowed to or wanting to go out to play were cited by parents to be major barriers to their children's activity 26 , 34 , 41 , 49 , 57 , P 53 This appeared to relate to both their local environment and parents' and children's circumstances: Weather Finally, and often mentioned in combination with safety, the weather was cited as both a facilitator parents 34 , 49 , 57 , 60 and childcare providers 38 , 52 and more often as a barrier by children 67 , by parents 31 , 40 , 49 , 57 , 59 and childcare providers 27 , 36 , 38 , 54 , 64 to young children's physical activity.

    P 57 Sometimes, I see on the news that children in the sun can pass out. P 34 I think the cool air. CP 38 No, my mom does not want me to play outside at the kindergarten, because otherwise I get sick. C 67 When it is raining outside or it is very cold, then the children are inside the school building because we [the preschool] do not have a covered playground. Barriers and facilitators to young children's activity behaviours As noted earlier, a wide range of facilitators and barriers to activity behaviour were identified in the qualitative literature that have yet to be explored quantitatively Emerging themes for use in intervention development The perceived influence of parent—childcare provider interactions on children's activity behaviours was a novel and potentially important finding to emerge here.

    Strengths and limitations This review is the first to specifically explore and systematically synthesize the qualitative barriers and facilitators to activity behaviours in children aged 6 and under. Conflict of interest statement No conflict of interest was declared.

    Supporting information Table S1. Quality assessment criteria and operationalisation Click here for additional data file. Acknowledgements The authors extend their sincere thanks to the following project collaborators: Department of Health and Human Services. Start Active, Stay Active: Systematic review of physical activity and health in the early years aged 0—4 years. Appl Physiol Nutr Metab ; Sedentary Behaviour Research Network.

    Letter to the Editor: Systematic review of sedentary behaviour and health indicators in the early years aged 0—4 years. Low levels of objectively measured physical activity in preschoolers in child care. Med Sci Sports Exerc ; J Sci Med Sport ; Prevalence of sedentary behavior in children under 2 years: Prev Med Baltim ; Obes Rev ; Childhood obesity prevention interventions in childcare settings: Am J Health Promot ; Determinants of change in physical activity in children 0—6 years of age: Interventions to prevent obesity in 0—5 year olds: Health Psychol ; Ann Behav Med ; Preschool children and physical activity: Am J Prev Med ; Physical activity in young children: Early Child Dev Care ; Physical activity during the early years.

    Correlates of sedentary behaviours in preschool children: BMC Syst Rev ; 2: Children and Healthy Eating: A Systematic Review of Barriers and Facilitators. Children and Physical Activity: Sansolios S, Mikkelsen BE. Views of parents, teachers and children on health promotion in kindergarten — first results from formative focus groups.

    Int J Pediatr Obes ; 6: Acta Paediatr ; Child Obes ; BMC Public Health ; These data, however, are weak because they often do not account for the social determinants of health. Social determinants of health increasingly explain the most pressing global inequities. These determinants, among others, include peace, income, shelter, education, food, a stable ecosystem, sustainable resources, and social justice and equity 3.

    Essentially, a social determinant of health lens considers both the causes of the causes of disparities 5 and the causes that underlie the causes of the causes 6. Such a framework is imperative to understanding the enduring health inequities between Indigenous and non-Indigenous peoples. In Canada, Aboriginal children experience higher rates of infant mortality 8 , tuberculosis 9 , injuries and deaths 10 , youth suicide 11 , middle ear infections 12 — 14 , childhood obesity and diabetes 15 , dental caries 16 and increased exposure to environmental contaminants including tobacco smoke 12 , 14 , Immunization rates for Aboriginal children are lower than those of non-Aboriginal children 18 , 19 , as are rates of accessing a doctor These health inequities can only be understood and intervened upon if understood as holistic challenges.

    Such an understanding requires moving beyond the physical realm, or the absence of disease, to include the social, spiritual and emotional realms. Aboriginal children are born into a colonial legacy that results in low socioeconomic status 21 , high rates of substance abuse 22 and increased incidents of interaction with the criminal justice system These are linked with intergenerational trauma associated with residential schooling 24 and the extensive loss of language and culture The basis of adult health and health inequity begin in early childhood First, there are proximal determinants of health.

    These have a direct impact on the physical, emotional, mental and or spiritual health of an individual, and include employment, income and education. Second are intermediate determinants, the origin of proximal determinants, inclusive of community infrastructure, cultural continuity and health care systems. Third are the distal determinants, which include colonialism, racism, social exclusion and self-determination; these comprise the context in which intermediate and proximal determinants are constructed and are the most difficult to change.

    However, if transformed, distal determinants may yield the greatest health impacts and, thus, long-term change to Aboriginal child health inequities Figure 1. Adapted from reference Colonial legislation and policies continue to influence the health of Aboriginal children and their families, explicit, for instance, in Indian reserves that have unique jurisdictional complexities that result in disparities of service access and ongoing dislocation of people from traditional lands, fishing and hunting sites, and water rights.

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    The reserve system precipitated great and sudden changes in lifestyle and patterns of settlement The Indian Act also governed the Indian Residential Schools, institutions that operated for more than years, with the last school in Canada closing in This experience resulted in collective trauma, consisting of… the structural effects of disrupting families and communities; the loss of parenting skills as a result of institutionalization; patterns of emotional response resulting from the absence of warmth and intimacy in childhood; the carryover of physical and sexual abuse; the loss of Indigenous knowledges, languages, and traditions; and the systematic devaluing of Indigenous identity Child welfare systems continue to intervene in the lives of Aboriginal families in Canada at a rate greater than any other population in the country 33 , and currently more Aboriginal children live as governmental wards than were ever in residential schools.

    Both colonization and colonialism are more than economic or material structures. Colonialism results in multiple forms of discrimination. Stemming from racism are microaggressions, which are often very subtle. Racism, along with these microaggressions, is evidence of advanced colonization 39 and has become entrenched in society. Taken together, these realities can be considered Aboriginal-specific determinants of health in that they result in a disproportionate experience with socioeconomic inequities that are rooted in a particular socio-historical context.

    A sense of cultural continuity for First Nations individuals and communities, and likely for Indigenous peoples more broadly, builds resiliency and reduces negative health outcomes, particularly youth suicide For Aboriginal people, the right to identify as an Indigenous person, the right to practice Indigenous ceremonies, and the right to speak an Indigenous language, are all crucial to identity and health, both of which are also especially linked to spirituality Language and cultural revitalization are viewed as health promotion strategies If Aboriginal children are provided opportunity for growth and development that fosters and promotes cultural strengths and citizenship, health disparities resulting from the impacts of colonialism may be lessened.

    Interventions and practices designed to foster and enhance the health and well-being of Aboriginal children require holistic concepts of health that move beyond biomedical realms and, instead, address and focus upon social determinants. Approaches must be flexible, while also addressing historical and contemporary determinants and should include decolonizing strategies.

    Interventions should not target individual behavioural change or focus solely on proximal determinants of child health. Instead, interventions should account for broader contexts and distal determinants that continue to influence the context and, thus, the health of the child. These broad contexts require collaborations across and between sectors and disciplines; medical or even health sectors alone cannot address or influence these determinants of health and must work in concert with other sectors such as education, child welfare, housing and justice, among others.

    A critical starting point is to create awareness of the social and historical context in which Aboriginal peoples find themselves. This begins with the education and training of professionals that interact with Aboriginal people on a daily basis. Students in the health professions who are not trained to understand socioeconomic and historical contexts may be vulnerable to adopting common, social stereotypes about Indigenous peoples Concentrated effort is required to include the knowledge and strengths held by Aboriginal peoples into the curriculum.

    Elliott and de Leeuw 44 write that:. This type of education opens opportunities for transmission of knowledge to other disciplines and even broader society. These individuals provide relational bridges of understanding between the health care system and the Aboriginal children and their families interfacing with it. While much baseline data about Indigenous peoples are needed, intervention research aimed at improving the lives of Aboriginal children is also necessary. This type of research demands collaborative partnerships with Aboriginal communities based on respectful, equitable relationships.

    Recognizing multiple ways of knowing and being in the world is fundamental to effective research and effective health care practice, with and for Aboriginal peoples. Understanding that this knowledge exists within Aboriginal communities, and engaging with the community from the onset of research and practice processes will be the basis for understanding and ensuring relevant, meaningful work.

    Principles of ownership, control, access and possession are also necessary to research endeavours involving Aboriginal peoples Effective programs are characterized by vision and leadership, holism, active community participation, strengths-based orientation, and reinvigoration and revitalization of Aboriginal cultures aimed at realizing self-determination. Little doubt exists that Aboriginal children experience a greater burden of ill health compared with other children in Canada. It is time for a change — a change that will impact individuals, families, communities and, ultimately, future nations.

    This change must last beyond seven generations.

    Funding provided by the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada. National Center for Biotechnology Information , U. Journal List Paediatr Child Health v. Author information Article notes Copyright and License information Disclaimer. Accepted Jun See " Healing winds: This article has been cited by other articles in PMC. Aboriginal health area of specialization , Children and youth, Health inequities, Social determinants.

    Open in a separate window. Achieving strength through numbers: Commission on Social Determinants of Health Closing the gap in a generation: Health equity through action on the social determinants of health Final report of the Commission on Social Determinants of Health. World Health Organization; The Ottawa Charter for Health Promotion.