Discussion
obesity
OBESITY, CHILDHOOD OBESITY, SECONDARY
Based on the findings from this study, the results of the process evaluation provided detailed information on the implementation of the ToyBox Study Malaysia intervention. The areas for improvement serve as an important basis for the enhancement of future obesity intervention programs that target children in the kindergarten setting, especially those from low-income families. Overall, the findings indicated that the intervention was delivered as intended to all participants. More importantly, it was well-received by both the teachers and parents.The retention rate for this study was 85.3%, close to other studies as reported in a systematic review of obesity prevention trials targeting children [In terms of the completeness of the dose delivered, 91–99% of the implementation/retention of environmental changes and children’s lifestyle behavior in the kindergarten were carried out. Teachers and their assistants reported in the FGD that the training modules prepared by the ToyBox team enabled them to complete all the necessary components. In fact, they were very satisfied with the clear instructions in the training manuals that helped them to blend ToyBox materials into their current kindergarten syllabus. This was consistent with the findings from ToyBox Europe teams [Furthermore, previous studies highlighted the parental influence on the prevention and management of childhood obesity [In addition, the teachers and assistants were happy and satisfied with the training materials. Their attendance at the training session was high. Like primary and secondary schools, kindergartens have also been recognized as an appropriate setting for health promotion activities, especially obesity prevention strategies as these educational institutions represent continual and concentrated access to a group of individuals at a developmentally appropriate age [Based on the encouraging feedback from the teachers, assistants, and parents, the ToyBox Study Malaysia intervention program can be viewed as successful. However, the sustainability of the program requires support from all parties. The kindergarten teachers have expressed their interest in continuing the intervention program with the necessary support in terms of knowledge transfer and financial assistance. Without external support, it is difficult to sustain ongoing ToyBox activities, especially in the current kindergartens that are supported by the Ministry of Rural and Regional Development and meant for children aged 4–6 years from very low-income groups.