The findings of this study highlight that preschool teachers perceived themselves and the preschool environment as important facilitators for promoting physical activity in the early years. Teacher involvement emerged as a key factor in motivating children to engage in physical activity, particularly in children who do not naturally enjoy it. Dialogue and collaboration between parents and preschool teachers was also important for fostering healthy lifestyle behaviour among children. Moreover, face-to-face support such as inspirational lectures or education days, which also could be complemented by a digital support tool, were seen as valuable for increasing awareness and motivation among educators to promote healthy lifestyle behaviours. Furthermore, such a combined approach was highlighted as particularly beneficial for supporting educators with lower engagement or interest in physical activity. Finally, participants perceived the sections on physical activity in the preschool curriculum as vague and difficult to interpret and expressed a need for a revision to better support the promotion of physical activity.
The results of this study are in line with a systematic review of qualitative literature by Hesketh et al., exploring barriers and facilitators for physical activity in children aged 0–6 years [23]. Similar to the current study, Hesketh et al. [23] found that childcare providers in preschool settings are essential for promoting physical activity in children. Not only the providers’ skills in engaging the children were highlighted as important, but also the providers’ own physical activity behaviours [23]. Interestingly, the role of teachers for preschool-aged children’s physical activity levels was also confirmed in a systematic review including objectively measured physical activity [24]. Tonge et al. found correlations between children’s physical activity and the presence and skills of educators, suggesting that active involvement and engagement may be important aspects, but found no studies investigating this [24].
Additionally, in a qualitative study by Ek et al. [25], Swedish preschool teachers underscored the impact of their own attitudes, interest and engagement in physical activity on children’s level and intensity of physical activity. Furthermore, the impact of the outdoor and indoor preschool environment on children’s physical activity has been addressed by previous research [23, 24, 26], emphasizing the importance of space as well as portable and fixed equipment for promoting physical activity, which is in line with the current study.
One perceived barrier for increasing children’s physical activity was the preschool curriculum and daily scheduling, which were described by the participants as more focused on school preparatory subjects rather than on physical activity. This aligns with Mak et al. [27] who reviewed strategies for promoting physical activity in the preschool setting and suggested that such prioritization may be explained by limited knowledge among decision makers about the importance of physical activity in young children. Indeed, the Swedish government recently called for the need to strengthen and clarify the guidance on physical activity in the preschool curriculum in order to emphasize the importance of integrating movement into daily routines [28, 29] and a new curriculum is planned to be published in 2025 [29]. Participants in the current study voiced that revising the sections on physical activity in the curriculum could be a way to motivate teachers to engage children in more physical activity, especially teachers with low interest in this area. Also, some respondents believed that moderate-to-vigorous physical activity is obtained when children play spontaneously, while others thought structured, teacher-led exercise is required. This highlights the importance of providing training and guidance for educators on what moderate-to-vigorous physical activity is and how it can be effectively integrated into everyday preschool routines. Furthermore, there was a lack of clear policies for physical activity among the participating preschools. This is noteworthy, as formal physical activity policies in Swedish preschools have been found to be associated with more active children, compared to preschools without policies [30]. Hence, a clear preschool curriculum as well as having local physical activity policies in place are essential to ensure an effective approach to promote healthy movement behaviours in young children. It is important to note that preschool systems across countries may differ and that the generalizability of the results regarding the Swedish curriculum and policies may be limited to countries with similar preschool systems as Sweden. However, having clear policies or guidelines for the preschool staff may contribute to healthier lifestyle behaviours in preschoolers, regardless of country, and we can also learn from each other’s systems.
With regards to screen time in the preschool setting, Ek et al. [25] found that teachers expressed concerns about the requirement to integrate screens into the daily routine, even before the publication of the WHO movement guidelines for young children [2]. Thus, although integrating screens into preschool routines was in accordance with the preschool curriculum at that time, teachers questioned the use of screens as they saw no educational benefit or believed it would be challenging for young children to learn how to use them [25]. Notably, this requirement has now been removed from the preschool curriculum, suggesting that these concerns were well-founded. Furthermore, participants in the present study emphasized that teaching children how to use screens is not the responsibility of preschools. It is also relevant to note that the planned update to the preschool curriculum will emphasize that preschools should be free from screen time [29].
In terms of sleep, participants highlighted that it is common for parents to stop allowing their child to nap at preschool, which was reported a barrier for supporting and promoting healthy sleep routines. This parental preference aligns with findings from a questionnaire-based study in Australian parents, which found that parents favoured putting their child to bed early over ensuring that their child naps at preschool [31]. Interestingly, teachers and principals in the current study believed that downtime is crucial for children’s recovery and described it as a natural part of the preschool schedule. Similarly, Hesketh et al. [23] found that childcare providers repeatedly stressed the importance of children having downtime. While other sedentary activities during downtime, such as reading, are known as being important for children’s development, both studies highlighted the significance of downtime itself. Currently, the WHO guidelines [2] include napping as part of the 10–13 h of daily sleep recommended; however, the benefits of downtime in the preschool setting are not clearly supported by current evidence. Therefore, more research is needed on possible advantages of downtime for recovery in the preschool setting.
Although it was emphasized that selective eating occurs to a small extent and that it is important to encourage all children to try new vegetables and foods, eating behaviours in the preschool setting were not considered challenging. Similar to our findings, qualitative data from early childhood teachers in Portugal, where preschool meals are also provided, highlighted that teachers are important role models for healthy eating behaviours in children [32]. They also expressed that the healthy meals provided at preschools may compensate for poor eating habits at home [32]. Together, this suggests that when healthy meals are provided within the preschool setting, teachers are not concerned about children’s eating behaviours in the preschool environment.
Participants in the current study expressed interest in being supported in promoting healthy movement and eating behaviours through inspirational lectures. Also, having a library of activities easily accessible, for instance in an app, was desired, especially to facilitate physical activity promotion for teachers with a low interest in physical activity. In the study by Ek et al. [25], teachers were also interested in an app to promote physical activity; however, they emphasized the particular need for it in situations where spontaneous activity is restricted, such as on days spent mostly indoors or when space is limited. Taken together, this highlights the need for a support that offers concrete, practical guidance tailored to the preschool setting.
Strengths and limitations
This study has several strengths. First, performing the interviews using video calls enabled participation from multiple regions in Sweden, increasing the geographic range of the sample. Additionally, conducting the interviews in a familiar setting may have encouraged participants to speak more openly about their experiences and perspectives [33]. The study was further strengthened by the inclusion of participants from a wide range of preschool contexts across Sweden, capturing experiences from different settings. Furthermore, participants’ levels of education and years of work experience varied, contributing to a broad range of perspectives. A potential limitation is related to sample characteristics, as it is possible that the teachers and principals agreeing to participate had a specific interest in healthy lifestyle behaviours. Hence, perspectives from teachers and principals that are less engaged in this topic may be underrepresented. However, as most of those invited chose to participate (15 out of 18), the risk of selection bias appears small. Nevertheless, this study provides valuable insights and perspectives of preschool teachers and principals on promoting healthy lifestyle behaviours, and findings contribute to the evidence on how to best support preschools in fostering healthy lifestyle behaviours.
To ensure the trustworthiness of this study, established criteria for qualitative research were followed, including credibility, dependability, and transferability [21]. Credibility was strengthened through data triangulation using purposive sampling, ensuring that participants represented diverse perspectives (e.g. various regions, urban and rural locations, and women and men). Additionally, a wide age range (31–64 years), and participant triangulation via including two levels of respondents (principals and teachers) provided nuanced experiences. The semi-structured interview guide ensured consistency across interviews while also leaving room for individualized questions. Additionally, credibility was strengthened by investigator triangulation, as researchers with different expertise (nutrition and physiotherapy) developed the interview guide and analysed the data. Dependability was accomplished by having the same researcher conduct all interviews, ensuring consistency. The interviews were audio-recorded to assure no details were lost. Transferability of the findings was supported through a detailed study description of participants and the preschool settings. Finally, to further increase trustworthiness, COREQ [20] was used to confirm that all necessary aspects of the study were reported.
Implications
The findings of this study indicate the need for a clearer curriculum and preschool policies to better support physical activity in the preschool setting. Notably, the Swedish government has announced that an updated preschool curriculum will be published in 2025, with a strengthened emphasis on increasing physical activity and reducing screen time. Our results support this direction, as participants expressed a need for more concrete and practical guidance to promote healthy movement behaviours. The results also indicate a need for evidence-based support tailored to the preschool setting as the level of encouragement is highly dependent on individual knowledge and interests among preschool teachers. Decision makers should include clear guidance on supporting healthy movement behaviours in the preschool curriculum and local policies to ensure consistency across preschools. In addition, we suggest that the curriculum highlight the importance of physical activity in early childhood for long-term health. Strengthening this may help boost teachers’ motivation and the prioritization of physical activity in the preschool setting.
Strategies for effectively integrating physical activity into daily routines are also warranted. Workshops, lectures, and providing teachers with concrete approaches to encourage physical activity should be prioritized in such strategies. Furthermore, a digital tool for promoting healthy lifestyle behaviours, combined with face-to-face support, align with needs and preferences of preschool teachers and principals, proposing a broad support to fit all preschool settings. Preferably, such a tool should be developed through a co-design process [34] together with teachers, principals and parents. In addition, encouraging collaboration between preschools and parents is essential in shaping healthy lifestyle behaviours and future initiatives should aim to strengthen the communication between them to ensure a unified approach towards healthy lifestyle behaviours. Taken together, addressing these gaps is crucial to ensure that all children, receive the best possible opportunities for healthy movement behaviours throughout childhood.