WHO guidelines on physical activity, sedentary behaviour, and sleep for children under 5: a qualitative study of Mongolian stakeholder perceptions.

Abstract

WHO's '24-hour movement guidelines' provide integrated recommendations for physical activity, sedentary behaviour, and sleep to improve health outcomes in children aged 0-5. This study aimed to examine stakeholders' perceptions about these guidelines to inform its future adoption, adaptation, and implementation decisions in Mongolia. Key stakeholders involved in young children's health and development were recruited through purposive sampling and snowball methods. Semi-structured interviews spanning 30-50 minutes were conducted with 38 participants using an interview guide in Mongolian language: caregivers (n = 19), kindergarten teachers (n = 14), health and policy professionals (n = 5). Audio-recorded data were transcribed, translated to English, and thematically analysed using deductive thematic analysis. Four main themes were identified: (i) awareness and appropriateness, (ii) understanding of the guidelines, (iii) perceived factors influencing adoption and implementation, and (iv) dissemination and implementation strategies. Stakeholders were mostly unaware of the WHO guidelines but perceived them as useful, feasible and culturally appropriate. Stakeholders identified barriers including competing priorities (e.g. work/family obligations), environmental challenges (lack of child-friendly spaces, cold weather, air pollution), and knowledge and capacity gaps. Stakeholder-recommended strategies for effective dissemination and implementation were kindergarten-based integration, training for caregivers and teachers, and adequate resource provision. Dissemination should use multichannel communication approaches emphasizing benefits, potential consequences of non-adherence, and provide specific, culturally relevant examples. This study provides first examination of stakeholder perspectives on WHO 24-hour movement guidelines in Central Asia. These preliminary findings suggest that successful adoption may require cultural adaptation, stakeholder education, and leveraging existing infrastructure and policy frameworks, though education sector consultation would be needed for comprehensive feasibility assessment.