Status of Early Childhood Health Promotion Education and Educational Needs Perceived by Primary Caregivers

Article information

J Fundam Nurs Sci. 2025;32(3):376-388

Publication date (electronic) : 2025 August 31

doi : https://doi.org/10.7739/jkafn.2025.32.3.376

Young-Ran Lee¹⁾, Eunjeong Nam²⁾, Sun-Nam Park^1),, Mi-Ran Lee³⁾

¹⁾Professor, Department of Nursing, Seoul Women's College of Nursing, Seoul, Korea

²⁾Assistant Professor, Department of Nursing, Seoul Women's College of Nursing, Seoul, Korea

³⁾Director, Yaedasom Nursery School, Seoul, Korea

Corresponding author: Park, Sun-Nam Seoul Women's College of Nursing 38 Ganhodae-ro, Seodaemoon-gu, Seoul 03617 Korea Tel: +82-2-2287-1738, Fax: +82-2-395-8018, E-mail: nam4868@naver.com

*This study was supported by the innovation support project of the Seoul Women's College of Nursing in 2023.

Received 2025 June 26; Revised 2025 August 5; Accepted 2025 August 18.

Abstract

INTRODUCTION

Regions and countries with low fertility rates and declining economically active populations aim to secure their sustainable potential. To achieve this, they have established legal and institutional frameworks and developed and implemented relevant policies. Since 2002, Korea has been experiencing extremely low fertility rates, and starting in 2020, baby boomers have begun transitioning from being an economically active population to an elderly one [1,2]. This shift indicates that the nation must prepare and respond effectively to ensure its potential for sustainable growth. In this context, Korea has acknowledged the importance of managing population groups based on the characteristics of different life cycles. Social phenomena are demographic phenomena, and they are changes in human culture and behavior. The COVID-19 pandemic, which has persisted since 2020, and the resulting experiences have influenced health attitudes and behaviors, further increasing the need for health promotion efforts among vulnerable populations who are sensitive to environmental changes. Vulnerable populations and their caregivers are open systems subject to internal and external environmental changes, and their health promotion behaviors are influenced by prior experiences and cognitive changes [3].

The preschool age is a critical period for the formation of healthy lifestyles and the establishment of behaviors that promote health. It is essential to emphasize health management and the development of a healthy lifestyle not only to prevent diseases but also to ensure lifelong health. Health promotion is achieved through positive behaviors that incorporate cognition and emotion, reflecting personal characteristics and experiences [4-6]. Health promotion education is an active and positive experience that enhances health intelligence and safeguards health by developing knowledge, attitudes, and habits conducive to health promotion. It is a fundamental and effective strategy for establishing healthy lifestyles, offering high achievability and sustainability [3]. Therefore, it is crucial for the sustainable improvement of health management capabilities and overall health status to identify health-related goals appropriate for the preschool age. This includes determining the needs for health promotion education in terms of content, methods, and staffing [5,6]. Despite this importance, there are very few previous studies on health promotion and education for preschool-age children is very rare [6].

Since preschool children develop judgment, autonomy, and self-control through their experiences, interactions during this period are crucial [4]. Given these factors, the primary caregiver plays a pivotal role [5]. In Korea, the primary caregivers of preschool children have evolved with industrialization. Prior to this shift, family members predominantly provided care. However, post-industrialization, this role has expanded to include not only family members but also childcare facilities and teachers. This change underscores the growing importance of primary caregivers, both at home and in childcare settings, in managing and promoting the health of preschool children [7-9].

Preschool children are a vulnerable group in the life cy-cle, as they struggle to assess their health needs and status and to engage voluntarily in behaviors that benefit their health [6,10,11]. The Constitution of the Republic of Korea guarantees the right to health for all citizens. In particular, the Framework Act on Health and Medical Services, the foundation of public health and medical services, stip-ulates that children are considered vulnerable across the lifespan and that health equity should be ensured [10]. The National Health Promotion Act and the Child Care Act, among others, specify the proactive efforts that the nation, society, and caregivers must make to ensure children's health [11,12].

These strategic health initiatives involve collaborations among the national government, local governments, and the private sector [13]. However, the development, operation, and evaluation of health promotion education programs, as well as the current status of such education, remain poorly understood. Responsibility for this education often falls to the facilities that care for or educate preschool children [4,5]. It is essential to assess the status of health promotion education to effectively develop, operate, and evaluate strategic, proactive, and life cycle-appropriate health promotion education. Childcare teachers and parents, as primary caregivers, are deeply concerned with the development, behavioral characteristics, and health status of preschool children and recognize the need for health promotion education. The experiences and needs of these primary caregivers are crucial in shaping healthy lifestyles and health promotion education for preschool children [3,6,14]. Therefore, it is important to explore the experiences and educational needs related to health promotion among primary caregivers, including parents and childcare teachers, both at home and in childcare facilities.

There are few previous studies that have investigated educational methods that serve as strategic approaches to health promotion education, and the needs survey on educational topics has dealt with safety and infectious disease prevention methods [6,15,16]. Therefore, when researching the needs of child health promotion education, it is necessary to strategically research and analyze educational topics, educators, and methods. Most previous studies have focused on collecting data from childcare teachers to identify needs for infant and toddler health promotion education or to assess the effectiveness of a single topic [15-18].

Since parents' interest in health promotion affects the health level of their children, it is necessary to investigate the needs of parents, and it is meaningful to compare and confirm the needs of childcare teachers and parents.

Therefore, this study aimed to assess the current status and educational needs of health promotion education for preschool children among parents and childcare teachers in daycare centers. This research will provide foundational data for developing health promotion education programs for preschool children in both home and childcare settings and will have utility in a variety of academic fields.

The purpose of this study was to assess the current status and educational needs of health promotion education for children in daycare centers, as perceived by their parents and childcare teachers. This assessment aimed to gather foundational data to aid in the development of health promotion education programs. The specific objectives of the study are outlined below.

METHODS

RESULTS

1. General Characteristics of the Participants

The mean age of parents with children in daycare centers was 39.44±3.75 years, ranging from 31 to 48 years, with mothers comprising 69 (89.6%) of the respondents. A majority of these parents (n=47, 61.0%) held bachelor's de-grees, and over half (n=43, 55.8%) were employed full-time. The families had an average of 1.79±0.69 children, with a distribution of 40 boys (51.9%) and 37 girls (48.1%). The children's mean age was 4.38±0.89 years, spanning from 3 to 6 years. Regarding the children's health, 41 parents (53.2%) described their children as "healthy" and 29(37.7%) as "very healthy." Only eight parents (10.4%) reported health issues in their children, including allergic rhinitis, atopic dermatitis, and asthma (Table 1).

Table 1.

General Characteristics of the Participants (N=154)

The mean age of the childcare teachers was 36.12±8.41 years, ranging from 23 to 55 years. All participants were women, with 40 teachers (52.0%) being single. The majority of the childcare teachers (n=65, 84.4%) worked at national and public daycare centers. Most held associate de-grees (n=39, 50.6%) and grade 1 childcare center teacher certificates (n=53, 45.8%). Over half of the teachers had obtained certificates from colleges or universities (n=57, 74.0%), with the most common position being "teacher" (n=53, 68.8%). Their average career span was 9.14±4.70 years, with a range of 1 to 23 years. The mean age of the children under their care was 3.02±1.27 years, spanning from newborns to 6 years old. On average, each teacher was responsible for 13.04±4.64 children, with individual loads ranging from 3 to 26 children (Table 1).

2. Status of Health Promotion Education for Pre-School Children

1) Parents' and childcare teachers' participation in health promotion education

The participation of parents and childcare teachers in health promotion education for preschool children over the past year was assessed. There was a significant difference in participation rates between parents (n=13, 16.9%) and childcare teachers (n=57, 74.0%) (x²=50.70, p <.001) (Table 2). Additionally, the involvement of children in structured health promotion education programs was examined. Forty-two parents (54.5%) and 68 childcare teachers (88.3%) reported that the children in their care had received such education, indicating a significant disparity between the two groups (x²=21.51, p<.001) (Table 3).

Table 2.

Participation Status in Health Promotion Education for Preschool Children (N=154)

Table 3.

Operational Status of Health Promotion Education Programs for Preschool Children (N=154)

2) Operational status of health promotion education for preschool children

Table 3 presents the operational status of health promotion education received by children. The primary educators were childcare teachers, with 31 parents (73.8%) and 46 childcare teachers (67.7%) involved, showing no significant difference between the two groups. The education predominantly occurred during the semester and within regular classes, as reported by 38 parents (92.8%) and 68 childcare teachers (89.5%), and 32 parents (76.2%) and 41 childcare teachers (60.3%), respectively, with no significant difference noted between the groups. Education was mainly conducted inside the daycare centers, with 39 parents (95.1%) and 65 childcare teachers (95.6%) participating, and again, no significant difference was observed between the groups. However, the number of educational sessions per year differed significantly, with parents reporting an average of 4.83±4.21 sessions and childcare teachers reporting 12.72±12.87 sessions (t=3.84, p<.001). Satisfaction with the education was rated on a 5-point scale, revealing a significant difference between parents (4.17±0.58) and childcare teachers (3.87±0.66) (t=2.25, p=.022)(Table 3).

3. Needs for Health Promotion Education for Pre-School Children

1) Needs for educational strategies and methods

Table 4 describes the need for strategies and methods in health promotion education for children in daycare centers. The majority of both parents and childcare teachers agreed that disease prevention is the most cost-effective approach, with no significant difference in their responses. Similarly, both groups viewed healthy lifestyle habits as the most influential determinant of child health, again with no significant difference noted. A substantial majority, 79.2% of childcare teachers and 55.8% of parents, believed that health promotion education for children is "very necessary," with a significantly higher proportion among childcare teachers than among parents (x²=14.05, p=.003). Both groups overwhelmingly supported public backing for health promotion education and educational manuals for children, citing the recognition of health importance as the primary educational goal. No significant differences were found between the groups in these respects. Both groups also agreed that health educators should deliver this education directly at childcare centers, with no significant differences in their responses. Regarding the preferred educational support organization, 35.0% of parents and 33.8% of childcare teachers favored daycare centers, while 32.5% of parents and 44.1% of childcare teachers preferred responsible public health centers; how-ever, these differences were not statistically significant. Role play emerged as the favored teaching method among both groups, with no significant difference observed. In terms of educational media, parents and childcare teachers showed different preferences: parents favor real objects (28.5%), followed by photos and pictures (26.0%), models (20.8%), story books (13.0%), and animated films (10.4%). Childcare teachers, on the other hand, preferred real objects (50.6%), followed by models (16.9%), photos and pictures (13.0%), story books (10.4%), and animated films (3.9%), with these differences reaching statistical significance (x²=12.68, p=.027). Both groups agreed that regular class times are the most appropriate for delivering education, with no significant differences between their responses.

Table 4.

Needs for Educational Strategies and Methods (N=154)

2) Needs for educational topics

In the health lifestyle domain, parents prioritized oral health care, scoring it 4.78±0.48 points, followed by life safety and traffic safety in the safety and accident prevention domain. Conversely, childcare teachers in the safety and accident prevention domain rated traffic safety highest at 4.88±0.32 points, followed by life safety, and then smartphones and health. Regarding educational needs, parents expressed the least interest in learning about health promotion facilities, followed by the role and function of healthcare professionals, the types and functions of hospitals, and drinking and health. Childcare teachers, in contrast, showed the least interest in education about drinking and health, followed by smoking and health, and health promotion facilities.

In the domain of health and growth understanding, the importance of health exhibited the highest level of educational need, scoring 4.58±0.59 points. There was no significant difference between parents and childcare teachers in this regard.

In the domain of health and lifestyle, childcare teachers demonstrated a higher educational need for nutrition and diet (4.78±0.42 points) compared to parents (4.58±0.59 points), with this difference being statistically significant (t=2.41, p=.017). Conversely, in oral health care, parents showed a slightly higher educational need (4.78±0.48 points) than childcare teachers (4.73±0.45 points); how-ever, this difference was not significant.

In the domain of disease prevention and management, childcare teachers demonstrated a significantly higher level of educational needs regarding vaccination (4.65±0.56 points) compared to parents (4.38±0.74 points) (t=2.58, p=.011).

In the domain of safety and accident prevention, childcare teachers exhibited higher educational needs across all topics compared to parents. However, significant differences between the two groups were noted in all areas ex-cept for life safety and traffic safety. These areas include fire prevention (t=2.19, p=.030), proper medication use (t=2.96, p=.004), child abuse (t=2.89, p=.004), sexual assault prevention (t=2.40, p=.018), and disaster response (t=2.61, p=.010). Notably, the topic of proper medication use registered the lowest educational needs among both parents (4.44±0.75 points) and childcare teachers (4.74± 0.47 points).

In the domain of mental health, both parents and childcare teachers identified the greatest educational needs in the areas of smartphones and health, followed by TV watching and internet gaming. Notably, childcare teachers exhibited a significantly higher level of educational needs compared to parents. Specifically, in the category of smartphones and health, childcare teachers scored higher (4.86±0.39 points) than parents (4.66±0.58 points), with a statistically significant difference between the two groups (t=2.51, p =.013). Similarly, TV watching also demonstrated a significant difference, with childcare teachers scoring 4.83±0.44 points and parents scoring 4.58±0.61 points (t=2.82, p =.005). In the area of internet gaming, there was again a notable difference, with scores of 4.71 ±0.56 points for childcare teachers and 4.49±0.68 points for parents (t=2.15, p=.033).

Among the six domains, the health care resources domain exhibited the lowest level of educational needs both in parents and childcare teachers. In particular, health promotion facilities showed the lowest level of educational needs in parents (3.83±0.80 points) and childcare teachers (4.09±0.76 points), and there was no significant difference between the two groups (t=2.07, p=.040) (Table 5).

Table 5.

Needs for Educational Topics (N=154)

DISCUSSION

Childcare teachers showed higher participation in health promotion education for children in daycare centers than parents (70.4% vs. 16.9%). Additionally, a greater proportion of childcare teachers (88.3%) reported that the children in their care had received health promotion education in the past year, in contrast to parents (54.5%). These findings suggest that childcare teachers not only participate more in health promotion education for children but are also more likely to be aware of the children's participation in such programs than parents. Compared to the findings of Lee, Park, & Lee [5], both parents and childcare teachers have shown improvements in participation rates and awareness of health promotion education for children. However, parents still lag behind childcare teachers in both participation and awareness. These results underscore the need to enhance parental involvement in health promotion education for children in daycare centers and to raise parents' awareness of such educational initiatives. To boost parental participation and awareness, and to strengthen the connection between health promotion education in daycare centers and healthcare at home, it is essential to develop promotional materials. These could include letters to parents or the use of social network services, coupled with efforts to actively disseminate information [18,22].

Both parents and childcare teachers agreed that health promotion education for children was conducted by childcare teachers during regular classes at daycare centers, with no significant difference in perception between the two groups. However, while childcare teachers reported conducting more educational sessions, parents expressed significantly higher satisfaction with the education provided. Previous studies have identified childcare teachers and health educators as the primary educators, with education often delivered upon request [5,14]. Recently, how-ever, there has been a notable improvement in the involvement of childcare teachers and the integration of health promotion education into the regular curriculum at daycare centers. These findings underscore the national policy and direction toward actively ensuring child health and highlight the need for the ongoing inclusion of health promotion education in the regular curriculum [13].

Educational needs for health promotion strategies and methods in daycare centers were found to be similar among parents and childcare teachers. Both groups agreed that disease prevention is the most cost-effective approach and that healthy lifestyle habits are key determinants of child health. This consensus highlights the value placed on disease prevention as a primary-level health promotion concept. Compared to secondary and tertiary prevention, disease prevention not only proves more cost-effective but also plays a crucial role in promoting and securing children's growth and development. Furthermore, fostering healthy lifestyle habits is a critical component of Health 2030 and is significant in influencing child health [23].

Both groups recognized the need for public support and educational manuals, and they emphasized the importance of health as an educational objective. They identified health educators as key instructors, child care centers as educational venues, and public health centers and child care centers as supportive educational organizations. They also favored role play as a teaching method and regular classes as the appropriate timing for education. These findings align with those of previous studies [5,14]. In this study, both parents and childcare teachers agreed on the importance of having health educators as promoters of children's health education. However, the actual education was primarily conducted by childcare teachers. It is necessary to further revitalize the health education project for nurses visiting daycare centers, which has recently been implemented as part of the Seoul public health center project. At the same time, there is a need to enhance the role of nurses as health promotion educators for children within the community. This can be achieved by developing nurses, who are healthcare professionals, into specialists in health promotion education for children in daycare settings. Additionally, the perception of public health centers as educational support organizations must evolve to reflect a central and essential role in community healthcare [2]. Future efforts and research are necessary to de-termine the value and requirements for human, administrative, and economic support to implement health promotion education for children in daycare centers within actual community healthcare plans.

Parents and childcare teachers exhibited differing views on the need for health promotion education and the preferred teaching media. Childcare teachers demonstrated a greater awareness of the importance of health promotion education compared to parents. This perception is crucial as it influences behaviors, alongside knowledge and attitudes, and plays a significant role in health promotion education for children [4]. While over half of the childcare teachers (50.6%) favored using real objects as teaching media, parents preferred a variety of methods including real objects, photos, pictures, models, storybooks, and animated films. This marks an increase in the preference for storybooks and animated films compared to findings from a previous study [5]. In the context of daycare centers, when employing role play as an educational method suit-able for children, it is essential to incorporate a diverse range of the latest educational media. These should include real objects, photos, pictures, models, storybooks, animated films, and board games to enhance children's learning motivation [18,24,25].

Childcare teachers exhibited a higher demand for educational topics such as traffic safety, life safety, and the impact of smartphones on health. In contrast, parents showed a preference for topics like oral healthcare, life safety, and traffic safety. Topics that were less in demand included drinking and health, smoking and health, and health promotion facilities among childcare teachers, and health promotion facilities, the role and function of healthcare professionals, types and functions of hospitals, and drinking and health among parents. These findings align with previous studies indicating that accident prevention, first aid, and safety education are of utmost importance in the health education of preschool-aged children [4,5,14]. Additionally, studies on safety education for preschool children have shown a higher proportion of educational content dedicated to life safety and traffic safety [17]. However, achieving consistent results has been challenging. For instance, one study highlighted a high demand for education on infectious disease prevention and management [15], while another indicated low demand [4]. Before the COVID-19 pandemic, a study reported educational needs scores of 4.67 among childcare teachers and 4.62 among parents for infectious disease prevention and management [5]. Post-pandemic, this study found no significant difference, with scores of 4.69 among childcare teachers and 4.52 among parents. Child deaths are used as indi-cators representing the level of health care in a region or country, and infectious diseases are particularly closely related to the health level and death of children. Considering the developmental stage and characteristics, children have low self-health management ability and are vulnerable to infectious disease prevention, so in Korea, the national mandatory vaccination program for children is actively being carried out and infectious disease prevention education for children is emphasized [2]. Due to this social back-ground, even before the COVID-19 pandemic, there was a high demand for infectious disease prevention education in children's educational institutions [26]. The results of this study, which showed that the demand for infectious disease prevention education was not higher than in previous studies despite the COVID-19 pandemic in 2020, confirm that the importance of infectious disease prevention and management in children was recognized and the demand for education was high even before.

The educational topics that showed a difference between childcare teachers and parents included nutrition and diet, vaccination, fire prevention, proper medication use, child abuse, sexual assault prevention, disaster response, smartphones and health, TV watching, internet gaming, and health promotion facilities. Childcare teachers demonstrated a higher need for these topics than parents.

Childcare teachers must periodically complete mandatory education in order to enhance their professionalism in performing their duties and to cultivate their qualifications as teachers [27]. Among the mandatory education contents of childcare teachers, it includes child health and nutrition management, safety accident coping, first aid, media overdependence, child abuse prevention education, and child sexual violence prevention education [27,28]. In addition, there are studies showing that kindergarten teachers experience positive changes and developments such as professional development or knowledge acquisition through participation in education [29]. In this study, health promotion education topics that showed differences in educational needs between parents and childcare teachers were included in the mandatory education contents of childcare teachers, childcare teachers had a higher participation rate in health promotion education for children than parents, and childcare teachers were the most common health promotion education providers, which is considered to have influenced childcare teachers' interest in educational topics and recognizing the importance and necessity of various educational topics.

The increasing risk of smartphone overdependence among children aged 3 to 9 years, exacerbated by earlier exposure to smartphones, underscores the growing need for education in this area [30]. Based on these findings, it is recommended that education on smartphones and health, TV watching, and internet gaming be introduced from preschool age, particularly within the mental health domain.

In determining health promotion education topics for children, especially those with high educational needs or differing needs between parents and childcare teachers, it is crucial to consider the perspectives of both groups when developing educational programs. This approach ensures that the selected topics adequately reflect the needs of both childcare teachers and parents.

Based on the findings of this study, we recommend the development and implementation of educational programs tailored to the needs of childcare teachers and parents. These programs should focus on strategies, methods, and topics relevant to health promotion education for children in daycare centers. However, it is important to note a limitation of this study: the findings may not be gen-eralizable, as the research was conducted with childcare teachers and parents from select daycare centers in Seoul.

CONCLUSION

This study aimed to examine the current state and needs of health promotion education for children in daycare centers, focusing on childcare teachers and parents. The findings revealed that childcare teachers were more engaged in the educational activities than parents and had a higher awareness of the children's participation in health promotion education. Typically, health promotion education was delivered by childcare teachers during regular class sessions, with no significant differences in the roles between parents and teachers. However, parents expressed greater satisfaction with the education provided compared to childcare teachers.

The needs for strategies, methods, and topics of health promotion education for children showed differences between parents and childcare teachers regarding the perceived necessity for health promotion education and the preferred teaching media. Both groups identified high educational needs in areas such as nutrition and diet, vaccination, fire prevention, proper medication use, child abuse, sexual assault prevention, disaster response, smartphone use, television viewing, internet gaming, and health promotion facilities.

The findings in this study indicate that it is necessary to establish educational objectives that emphasize the importance of health in developing healthy lifestyle habits among children as a preventive measure against diseases. Health educators should deliver this education using standardized manuals during regular class sessions at daycare centers. The instructional approach should predominantly involve role-playing and incorporate a variety of teaching media such as real objects, models, photographs, storybooks, and animated films. Additionally, the curriculum should cover topics of high educational need, including life safety, traffic safety, oral health care, and the impact of smartphones on health.

Based on the results of this study, we suggest the following.

The significance of this study is that this study investigated children's health promotion education needs for both parents and childcare teachers, who are the main caregivers of children, by differentiating them from previous studies that investigated children's health promotion education needs only for childcare teachers. Finally, this study makes a significant contribution by providing foundational data for developing health promotion education programs for children in daycare centers. Additionally, it supplies essential information needed to establish health promotion education initiatives within the community.

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