# Promoting hEalthy Diet and Active Lifestyle (PEDAL): a protocol for the development and feasibility study of a multicomponent intervention among primary school children in Singapore

## TL;DR

This study outlines a plan to develop and test a school-based program in Singapore to promote healthy eating and active lifestyles among primary school children.

## Contribution

The study introduces a novel multicomponent intervention, PEDAL, tailored for Singaporean primary schools, and evaluates its feasibility.

## Key findings

- PEDAL includes interactive lessons, home activities, parental engagement, and school environment optimization.
- Feasibility of PEDAL components was assessed through mixed methods in two phases.
- Results will guide the refinement of the intervention for a larger trial.

## Abstract

Setting healthy lifestyle habits during the formative years of childhood is critical as habits can track to adulthood and help prevent obesity and chronic disease risks in later life. While multicomponent interventions have been shown to be effective in changing the lifestyle behaviours of children, there is a limited understanding of the feasibility of such interventions in primary schools in Singapore. A multiphase mixed method study was conducted to develop and examine the feasibility of a theory-based multicomponent school-based intervention—Promoting hEatlthy Eating and Active Lifestyle (PEDAL).

Underpinned by Kincaid’s ideation model, the PEDAL intervention was developed to increase fruit and vegetable consumption and decrease sedentary behaviours among children. This study consists of three phases. Phase 1 details the development of PEDAL, which consists of four components: (A) a series of interactive health education lessons, (B) actionable home activities to support habit formation, (C) parental/guardian engagement, and (D) optimising the school environment. In Phase 2, components A and B of PEDAL were implemented in two public, co-educational primary schools among Primary 5 students (aged 10–12 years) in Singapore. Data was collected quantitatively using questionnaires and qualitatively using focus group discussions (FGDs) with students and teachers. The feasibility dimensions of components A and B, including recruitment capability, data collection, social validity, and practicality were examined, and ideation on healthy eating and physical activity was explored. In Phase 3, the full PEDAL intervention was pilot-tested in two other public, co-education primary schools with the same target population, using a concurrent mixed method quasi-experimental study design. Feasibility dimensions and potential effectiveness of the intervention will be assessed.

This study will provide insights into the feasibility of PEDAL and inform its refinement. Findings from the pilot test will guide the planning of a larger-scale definitive trial.

Registered with ISRCTN registry (ISRCTN16114046) on 16 October 2022.

The online version contains supplementary material available at 10.1186/s40814-024-01479-3.